Roles
Administers medications (daily and PRNs), makes choices about seclusion and restraint, notices patient progress, and reports to rounds.
To a nurse: "You need to take him/her/them out of seclusion, now."
No.
First line
As-needed medication (PRN) to be given before others are provided. Together, these create a PRN structure and provide a map for nurses to follow accountably. Works well with a coping skill :)
Commitment
A patient is deemed unsafe to themselves or others by two legal adults, including one provider, and is required to stay inpatient until at baseline. In Iowa, this includes physical, mental, and emotional harm, and/or failure to thrive and neglect. Nurses can forcibly administer PSYCH MEDS ONLY with committed patients.
"I will get you a pop/candy/cafeteria item if you____"
NO, unless the whole team approves this as part of a behavior plan. If nursing doesn't approve, this is not the plan. Try scheduled snacks, off-unit rec, and activity rewards first.
Provides 15-minute rounds, bed changes, and showers, along with 1:1 and 2:1 care.
Psychiatric Nursing Assistant (BHC if applicable)
"That's not very trauma-informed of you."
Sometimes.
Sprinkles
Crushed meds, added to water or food. Used when the patient is refusing or regurgitating medication, witnessed by staff or no effect. Also, a great opportunity for behavior mod :) Common: Depakote
Outpatient commitment
Some patients are placed on an outpatient commitment at discharge if there is concern for non-compliance and high risk. If a patient does not come to an appt, the provider may "pull" the commitment, sending cops to their address.
"I struggled with _____ too, and here's how I got better."
NO. Countertransference is especially sensitive for children and can constitute hospital attachment patterns.
"Call an SOS" or "call a code!"
YEP. (192)
IM
Intermuscular injection. Used for emergent PRNs, Long Acting Injectables (LAIs), and commitment psych meds.
Common: Haldol, Ativan, Abilify, Olanzapine
48 hr hold
Patient is brought to the ED, and put on a hold with concerns for harm to self or others. These will be reviewed by a judge and a physician after two business days. Nurses can administer EMERGENCY psych meds only for patients on hold.
"I am your mom/dad/other family member/elder," "You remind me of my son/daughter/other family member, or to staff, "We are their family."
NO. This is not trauma-informed. These clients will not have the norms of a traditional home environment, and should not have these roles imposed on their attachment systems. Providing coaching, counseling, and formal mentorship should be in the client's best interest and align with best-case expectations from future caregivers.
Makes decisions about medications and PRN initiation, doseage, diagnosis, and disposition.
Residents or Psychiatrist
In rounds: "I notice [this patient] is brighter/more linear/not improving/not being safe with peers."
Yes.
Dystonic reaction
Rarely, a neurogenitive side effect of some antipsychotics, commonly Haldol, involving twisting of the neck and limb torsion (IF WITNESSED, NOTIFY RN immediately!)
The cops
Will come to the unit immediately if 911 is called from any university or personal phone. Technically, they should stow their guns with security.
Technically, they should call the unit to enter like any other professional.
Technically, they should be replaced by the 988 line.
"ok you can have this (toy or activity)."
Sometimes. If the client has been rude or abrasive to staff on the floor, this will reinforce their behavior and undermine staff. If you are supervising the patient as part of a scheduled reward, or there is a specific time they can check out this activity, this is also appropriate.
Behavior mod, group and individual counseling, staff support, and daily observation/contact
Behavioral Health Consultant
"I was wondering if we could add off unit to their plan or change their activity level."
Snowed
Technically inappropriate slang for when a patient has been oversedated. Some nurses will use this term to describe when a patient is overmedicated (ie, from the ED), or having a sedated reaction to the dosage.
Ed Thomas
Named after the murder of high school football coach Edwin Thomas, who was killed by one of his former players, this is a legal order to notify police before a patient is discharged. This person may have an active legal charge or have recently possessed firearms with malicious intent.
"Any news from the doctors?"
Yes. We cannot speak on discharge planning, placement, or medication prescription. We CAN ask the patient what they understand about their care plan, listen to concerns, and report these to the nurse or multidisciplinary team.
NOTE: this is better suited to middle school and teen patients, who have more developed abstract thought. Orient "littles" to their day, mindfulness, and immediate surroundings.