April 30, 2012

Life in a Psych ER

The inpatient job is going well.  To date, every shift I was assigned to the ER.  At first, I suspected that it was because I have ACLS.  But I think it's because I do very well in chaotic situations with high patient flow...a skill I acquired at my last inpatient job back east where staffing ratios do not exist.

It's pretty cool.  I'm assigned 3-4 current patients along with a LVN or LPT (licensed psych tech, not a nurse but can a do a lot of what a LVN does including meds and charting).   I round on them and assess, then leave the majority of their care to their 2nd nurse.  The two of us do it all:  it's primary nursing at its finest.  I'm also blessed with some of the finest LVNs I have encountered out here, so I don't have to worry that things will get done and done right.  Because they do.

Then I assess and if necessary admit patients who come through the doors. There's 3-4 RNs (and I'm usually one of them) who work the front.  Patients are assigned to whoever comes up next in the rotation.  One day I started off the rotation.  One day I was the last nurse in the rotation.  It's a rather fair system, though some days luck is against me and every third patient that walks in--which means it will be mine--is off the chain.

Sometimes it's feast and I'll get a steady stream of patients.  Sometimes it's famine and I'll escape with just one.  Usually the start of the shift is slow and things pick up three hours in.  But you do not leave until the charge nurse releases you AND you have all your work done.  So if a patient walks through the door 5 minutes before shift change and I'm up, I have to start the triaging.  I don't have to stay until a disposition is decided (admit or release), but I have to get a point where I can hand off to the next nurse, then finish up any work associated with what I'd done to this patient.

5150s are almost always guaranteed admits:  they may not stay long with us but they're guaranteed admits.  Voluntaries can go either way.  It's kind of like a regular ER:  you get the patient in with the STEMI who needs to check in, and then you get the patient with the ear infection who just needs a script.  And like a regular ER, in 24 hours all patients, even the 5150s, need a disposition of some sort, whether they are admitted as inpatients, transferred elsewhere or discharged.  So it's like that, but with psych equivalents.

It's never dull.  I've met a wide variety of patients and seen so many things that you just can't make up.  If it wasn't for HIPAA I could have you entertained every single shift.  But I don't wish to run afoul of that, so I'll have to spare you most of the details.

I'm also not going to lack for hours:  I've been called three times in as many days asking if I could work.  Regrettably I had plans for all these days so I've had to say No.  But it's reassuring.

I'm only putting in for three shifts this week, as I have to work outpatient this week, plus I'd like some time off because the little one and I have an overdue lunch date coming up.  That's the best thing I like about this job:  complete and utter control over my schedule.  Well, I may not get every shift I put in for (hasn't happened yet but it could), but I can dictate what shifts I am willing to work and not be unpleasantly surprised by a schedule change.

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