Medical and surgical nursing, one semester I had been looking forward to! Can’t believe we are only a few weeks away from finishing fourth semester in the Psychiatric Nursing program! The Lower Mainland group is split between Chilliwack General Hospital (CGH) and Eagle Ridge Hospital and has been hard at work with our regular course workload, slightly alleviated in terms of credit hours but not in workload. Medical/Surgical theory takes up much of our time along with Introduction to Counseling and First Nations Health, and my group balances that with long days at CGH.
Chilliwack has been an excellent learning experience for us. It is a smaller community-based hospital with firm support from the local community. I truly feel the nurses here make an impact on the patients’ lives and their families along with getting to know them on a higher level. At Vancouver General Hospital, more than 40% of patients come from outside Vancouver. While that doesn’t impact the level of care, it also prevents a closer bond from forming between nurse and patients.
Our clinical instructor along with the staff at CGH have been tremendous at enabling us to gain nursing skills in general medicine. We have practiced everything from Foley tubes to enteral tube feeding, and IV pumps to dressing changes. Our clinical instructor has been incredibly enthusiastic at gaining opportunities for us to practice our theory and skills.
While we have moved away from a focus on mental health nursing at the moment, it has not disappeared completely. As I’ve discussed previously, there is a significant comorbid link between mental health and wellness to physical health and wellness. We have encountered many patients also living with dementia, depression, anxiety, and other mental illnesses. These patients cannot be cared for in a psychiatric unit, due to the need to address various medical concerns and the need to a higher level of medical care, or IV fluids. This means caring for them in a psychiatric unit is just not possible. However, this creates a challenge for task-oriented nursing staff who are not equipped and trained to handle mental health patients, creating a complex situation for the medical staff, treat the primary medical concerns and hope the psychiatric illness does not worsen, or treat the psychiatric illness first?
One of my patients was admitted for a surgical procedure that had been done, this patient also suffered from depression and was on anti-depressant drug therapy. One of the things that concerned me was a lack of mental status assessments along with the medical assessments. I noted in my time there and charting that the patient had significant mood swings on a day-to-day basis. I continued to assess for patient safety and took the time to simply sit and talk with the patient. This can be a difficult task to do for an RN or LPN, particularly with their significant and heavy patient loads of 5 or more each, and then the question of what do they do if the patient professes to be suicidal. What I experienced was a patient simply wanting to talk, to feel cared for.
I have greatly enjoyed my experience as a psychiatric nursing student work on a medical floor. I have gained tremendous experience in general medical nursing skills, and have been able to maintain my mental health nursing focus as well. There has been talk about integrating psychiatric nurses onto general medical floors as well, and make better use of our medical nursing skills and mental health nursing abilities. I for one would be extremely excited to see this change come about as I have greatly enjoyed my time at CGH and the medical/surgical nursing clinical.