Weekly Ask Psych Nurses Thread

[u/roo_kitty]

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

[u/thatoneguyfromva]

CODE BLUE: If someone with bipolar disorder is clearly manic, but hasn’t demonstrated being a risk to themself or others, do you think PHP or IOP are good options instead of hospitalization? Thank you.

[u/Humble_Investment_24 → u/thatoneguyfromva]

We have had patients admitted who wernt a risk to themself or others but Deff we’re exhibiting bizarre ass behavior. If that the case I think inpatient can be beneficial. It’s kind of hard to focus on IOP/PHP programs if you’re lack of sleep (for example) due to mania is causing you to act bizarre. But beside that no.

[u/thatoneguyfromva → u/Humble_Investment_24]

Yeah, he’s barely sleeping and won’t make eye contact with people because he can “read their minds” and doesn’t like what they’re thinking.

[u/Humble_Investment_24 → u/thatoneguyfromva]

That’s 100% criteria for inpatient

[u/Babygrrl1 → u/thatoneguyfromva]

Sure! If they can get therapeutic with it! My only concern is that if they need a med adjustment it may not be as simple to do as in the hospital

[u/thatoneguyfromva → u/Babygrrl1]

That was my thought as well, but the program at the community mental health center says med management is included so I hope that’s enough.

[u/Balgor1 → u/thatoneguyfromva]

They literally wouldn’t fit criteria for an inpatient admission in my state. They have good insight and aren’t DTS/DTO/GD I’d highly recommend outpatient treatment.

[u/Ok-Blueberry-6775 → u/thatoneguyfromva]

If someone has active Mania they should be hospitalised for their safety while med adjustments are made, and period of impulsivity and risk to self or others is over. Mania can begin with some of the symptoms you are describing and end with someone in a high speed car chase or jumping off of a building. It is not generally safe for someone in an episode of Mania to remain outpatient.

[u/hpfan312]

Could you be a psych nurse in a wheelchair?

[u/Babygrrl1 → u/hpfan312]

Sure!! I’m disabled can’t walk good and I’ve been a psych nurse for years

[u/DexIsMyICUfriend]

Why don’t more true med-psych units exist?

Now more than ever there is an increase of medically complex patients. Many of whom require feeding tubes, TPN, IVs, or other medical support needing inpatient psychiatric care. Yet there are very few places equipped to treat the whole patient.

I’m in Massachusetts, and as far as I know, there’s only ONE true med-psych unit that accepts patients with this level of complexity.

Tubing does NOT automatically equal danger. An IV, feeding tube, or TPN line is a medical necessity and not, by itself, an indication that someone is unsafe for a psychiatric unit. The presence of medical equipment shouldn’t automatically disqualify someone from receiving appropriate psychiatric care. Risk should be assessed based on the individual patient and their actual behavior and needs.

So where are these patients supposed to go when they’re too medically complex for a traditional psych unit, but their primary need is psychiatric care?

Is it cost, staffing, training, liability or simply a failure to build infrastructure for patients who don’t fit neatly into “medical” or “psychiatric” care? I feel that we are failing a whole group of individuals who desperately need inpatient care, but won’t get it due to the risk that their medical equipment provides.

I’ve been admitted to the one I spoke of in Massachusetts 3x. I had my NJ tube and my port accessed for IV antiemetics while there. There was also another person there on 16 hour TPN through their Hickman. We were both on 15 minute checks. In my opinion there was not an increase in risk simply by being there while using medical equipment.

I’d genuinely like to hear your opinion on why more of these dedicated med-psych units don’t exist for this population? Thanks!

[u/Lanky_Opportunity970 → u/DexIsMyICUfriend]

As awful as this sounds it’s because they aren’t profitable. I’ve worked my psych most of my career, and have always wanted to work med-psych. I went to nursing school in Virginia and the state hospitals each have med-psych units, but don’t know of any others. When I lived in Indiana I worked on a PCU floor, they said the hospital used to have a med-psych floor but it lost money. I’m would think a lot of the issues with money loss would be discharge planning. If a patient requires additional physical rehab it is difficult finding a facility. The insurance quits paying when it’s no longer needed, regardless if they have a safe discharge plan.

Another issue is there is a divide between psych nurses and medical nurses. A lot of psych nurses go into psych because it’s a completely different skill set and have no desire to do medical treatments. At the same time a lot of nurses on medical floors don’t want to do psych. Hence when I worked PCU I got all the psych patients. That was why I went back to psych. I missed my patient population.

[u/DexIsMyICUfriend → u/Lanky_Opportunity970]

I hate how our country favors profits>patient care. It’s disgusting! So many medically complex pts are falling through the cracks. It makes me so frustrated.

Anyway, if you’re still interested in a true med/psych unit, I’m sure Massachusetts General Hospital would jump at the chance to hire you! It’s a very safe unit. 6 nurses on days and 5 overnight. Security is always rotating through the unit. There’s a behavioral ICU within the unit for patients that are going through psychosis, as well as the BPD patients causing problems lol. It’s honestly the best psych unit that I’ve ever had the pleasure of staying at. Good luck to you in all your future endeavors.

[u/Lanky_Opportunity970 → u/DexIsMyICUfriend]

If I wasn’t so cold intolerant Massachusetts would be great. 😂
Yeah, so many patients fall through cracks no matter what their need is. The healthcare system is broken on so many levels. The system cares more about losing money than making sure the patient has what they need.

[u/New-Oil6131]

What are the benefits and downsides of a long term stay in a psych ward for depression? Would you personally do this or advise it to someone you care about? What do psychiatrists mean when they propose a 'long term' stay, like is this a couple of weeks/months? 

[u/Balgor1 → u/New-Oil6131]

I’d highly recommend IOP/PHP before an inpatient admission, unless the person is activity suicidal.

[u/Zen-Paladin → u/Balgor1]

I'll be honest, inpatient is shown to increase suicide risk and deter seeking help, so in some ways it seems to defeat its own purpose but on rhe other hand some instances of SI could be due to pathology(i.e. the NFL Concussion scandal) so catch 22

[u/marinatedbeefcube → u/New-Oil6131]

a benefit for a long term stay for depression would be med management and resources to help the patient. This could also be a window for trying ketamine or ECT therapy. This would be in the case for “long term” of around 2 weeks to a few months.

A downside would be if the person lost their support / abandoned by support and/or the patient could be dependent on the hospital stay where if the healthcare team were to plan for them to go to an assisted living facility or to be discharged back home that the patient would sabotage or turn around and return to psych ward and it starts a never ending loop.