Treating the Mentally Ill

Syndicated from madness: tales of an emergency room nurse
January 11, 2011


As we always do when something like this happens in our country, we are dissecting the shootings in Arizona. We are blaming, analyzing, etc. Of course, mental illness has come up. This guy was obviously a psychotic. People wonder why someone didn't do something, get him some help, have him committed. It shows how little the public knows about the care of the mentally ill in this country.

In the ER we are on the front lines of peoples mental health problems. We are failing these patients miserably. What bothers me most about how we deal with the mentally ill is that they are not treated the same as other patients. This is how it works in our ER when someone comes in.

They are placed in a room with just a cart and usually a couple of chairs. In a corner of the room, up high, is a camera. If the patient is suicidal or homicidal security is called to stand outside of the room. The patient is asked to empty their pockets, take off their shoes, give up their coat, purse, etc. Their personal belonging are locked up. The nurse comes in. Then the doctor comes in. Then a clinician from mental health comes to take to the patient at length. The patient may wait up to an hour or more to see the mental health person.

Once they are seen, the mental health person goes to call the psychiatrist and if they are to be admitted, clear their admission with their insurance company. Another hour or more wait. Once the bed is ordered, another hour or more ensues. Sometimes there are no beds. When that happens the person sits for hours waiting for a discharge or is transferred to another hospital in the city or even in the state a couple of hundred miles away. This happens more often than you think.

The point of all this? It is not easy to get help for mental health. The is a lack of services available, their is a shortage psychiatrists. Mental health is not treated with the same seriousness or attention as physical problems. I wonder if it ever will be.

Nurse to Patient Ratios

The discussions about Nurse to Patient ratios are not new. The arguments about, what the ratio should be, who is responsible for overseeing that the ratios are being maintained and how all of this is going to be paid for, are not going to stop anytime soon.

Over at the ANA's website there is an article discussing this very subject. The numbers in the article were correct as of June 2010.

"In a survey of almost 220,000 RNs from 13,000 nursing units in over 550 hospitals and a response rate of 70%, nurses reported to ANA that: 54% of nurses in adult medical units and emergency rooms do not have sufficient time with patients; overtime has increased during the past year with 43% of all RNs working extra hours because the unit is short staffed or busy."

"The American Nurses Association (ANA) supports a legislative model in which nurses are empowered to create staffing plans specific to the unit and patient population and to which healthcare facilities are held accountable."

Enacted to date:

Fifteen states, plus the District of Columbia* enacted legislation and/or adopted regulations to address nurse staffing: CA, CT, IL, ME*, MN, NV, NJ, NY, NC, OH, OR, RI, TX, VT, and WA.

7 states require hospitals to have staffing committees responsible for plans and staffing policy – CT, IL, NV, OH, OR, TX, WA.

1 state stipulates in law / regulations the required minimum nurse to patient ratios to be maintained at all times - CA

5 states require some form of disclosure and / or public reporting – IL, NJ, NY, RI, VT

What are the nurse to patient ratios in your hospital? Do you agree with them? Are your ratios jeopardizing you patients? Do you feel the ratios are appropriate or are they too rigid?

Best iphone Apps for Nurses

Top 25 iphone apps for nurses has a bunch of great applications for iphones. Why not have answers at your finger tips.


LED Flashlight app is also another great app that may come in handy. It allows your camera flash to stay on as a flashlight. If you scroll down on this page you will find a few free apps.

Time Management for Nurses

Syndicated by Mike Briddon-StressedOutNurses.com

The best approach to time management is an organized, proactive approach. Each shift begins the same way:

■Getting a patient assignment
■Reviewing the medical record
■Getting the shift-to-shift handoff report
■Assessing the patients
■Documenting your care
So when you arrive on shift, you receive a patient assignment. Each patient has a unique diagnosis and specific needs. It is critical you have a mechanism to quickly organize the patient-specific information. Most nurses use an organizational tool to capture pertinent information at the beginning of their shift.

Tool 1

Tool 2

You can download these documents at Stressed Out Nurses

10 Things They Don't Tell You in Nursing School

Syndicated from Articlesbase.com. Article by Gene Grzywacz


Have you ever said, "It is nothing like what I thought it would be?"

Here are 10 things that they DON'T tell you in nursing school.

1) Some people like to use the word profession when talking about nursing no matter what you chose to call it, it is a job. It is not a glamorous profession like on TV. You will work hard and feel unappreciated and no matter what management says the bottom line is the most important thing.

2) You will always be in demand. Well, not necessarily. The first place management looks to cut is nursing as it is one of the largest expenditures in the hospital. The economic slow down effects nursing just like every other job. Many hospitals now have hiring freezes. Remember ten new grads are waiting to fill your position at a lower wage.

3) You are on your feet for 12 hours a day. Your feet and back will hurt. Nursing is very physically demanding. Turning a 450 pound patent will take its toll on your back and pray you do not get a rotator cuff injury. To make matters worst your patients can be on opposite ends of the unit with you spending your day running back and forth.

4) Families. A good family can make your day easier. However, they can also make your life a living hell. It takes patience, caring and some legal method of coping with stress to deal with some family members.

5) The bane of all nurses existence, charting. It is very likely you will spend more time charting than providing good patient care. It seems that charting, just becomes more and more complex as time goes by.

6) Unreasonable patient loads. In the state of California there is a law mandating the maximum number of patients a nurse can care for. In every other state you are on your own. This can lead to unsafe workplace environments for you and your patients.

7) Nurses eat there young. There are many good reasonable nurses out there. It only takes one of the other ones to ruin your shift.

8) You will learn to hate JACHO. They change their name regularly and are currently calling themselves the Joint Commission. They find important problems such as whether the height of your isolation cart is too tall. If you have not heard of the the Joint Commission, you will.

9) You will work weekends, nights and holidays. This may or may not be a big deal for you, but you need to be aware of it.

10) Bladder Control. You will be amazed at how much urine you can hold and how long you can go without relieving yourself.

Cruise Academy Seminars

Have you ever taken a cruise? Did you know that there is a cruise available for nurses?

Cruise Academy Seminars "offers nurses & other professionals the opportunity to earn continuing education credits while on vacation!"

How awesome is that!

If you have ever taken a cruise similar to this or plan on taking one let us know.

End of Life Care Plans

Syndicated from Madness: Tales of an Emergency Room Nurse by Girlvet, December 16th 2010.

Do you have a plan for End of Life Care?

According to a story on 60 minutes in August of this year, we spent $55 million on end of life care last year. People are dying when this money is spent. The thing is we won't let them.

Who makes the decision to keep someone going with procedures, more tests, etc. when someone is dying? In my experience it is the family, often the son or daughter. I would be willing to bet that 90% of us have never discussed what our parents, let along spouses want done, if they are dying. Sons and daughters, spouses have a hard time letting go of a loved one naturally. No one wants those they love to die. So often times mom or dad are kept alive on machines until it is obvious nothing can be done for them or they die whether you want them to or not.

My mother had dementia at the end of her life. She was physically in pretty good shape, considering she had smoked for 60 years. She was in a nursing home. She developed a UTI. Routine, no big deal. They sent her to the ER. Because she seemed sicker than a normal UTI, they admitted her to tele. Overnight she had trouble breathing and ended up on ICU on bi-pap. She was septic. Everything started going downhill as her organs malfunctioned. The choice was intubate her and do a whole bunch of stuff or let her go. She probably never would have got off the vent.

We let her go. I don't think I ever specifically discussed what she wanted done. Even some one like me, who has seen death, seen people try to make decisions in these kind of situations, hadn't had that talk. I knew my mom wouldn't have wanted to be kept alive with machines and medications, so my brother and I let her go. It was hard, but it was the right thing to do. We spent her last day around her bed. It was hard. My mom and I were close. It was a very difficult decision to make.

I see a day coming where it will be required that everybody in this country have a plan for end of life care. I also see a day of rationing of health care like they do in some other countries. It is inevitable. The expense is too great.

Have you discussed a plan with your family members?