This is part eleven of my series on what psychiatric nurses do. You can read the other parts of the series here.
When patients are coming to the end of their stay on a ward, a number of things will happen. The nursing team will start to make plans for the patient’s transition back home days or even weeks before discharge. Community teams will be spoken to and invited to meetings. Family members may be consulted. For some patients, arrangements for housing may need to be made by referral to housing agencies or places at rehabilitation centres may need to be found. It all depends on the patient. For some patients who are in hospital for a matter of days, transition home may be simple: speak to the family, arrange community follow-up, order medication, done! But for some patients who have been in hospital many months and who will need significant community support, it may take weeks of planning to put everything in place.
Between them the Consultant, community team (if there is one) and nursing team will coordinate the discharge. All patients have to receive at least 7 days of follow-up post-discharge from an inpatient psychiatric ward. This is a legal requirement. For those patients who do not have a designated community nurse, follow-up is undertaken by the Crisis Team, Discharge Liaison Team or something like it, depending on the area. A nurse will meet the patient prior to discharge and arrange a time/day for a home visit, support phone call, etc.
A day or two before discharge a nurse will need to ensure medication has been ordered. Then there will usually be a ward review where the doctor agrees to the discharge. If the patient is sectioned, the Consultant needs to complete a form officially discharging them from the section. Then it’s a whole stack of paperwork and little jobs for the nurse to look forward to.
Discharging patients on the ward I was on started off as a simple paper exercise. But as the computer system replaced the paper one, the number of clerical tasks multiplied to the point where discharges became a very time-consuming procedure. Prior to discharge the nurse needs to weigh the patient, complete a discharge paper and give it to the patient, ask them to complete a satisfaction survey and give them their medication. Then they need to complete a discharge risk assessment, discharge the care plans, complete numerous other little forms, cross the patient off numerous boards, remove the patient from the bed on the computer system, make a case-note entry…. you get the idea! A huge long actual printed list of little tasks you need to do, and if you miss anything you get a telling off from management. If you have two or three discharges in a shift (not unusual), these discharges can end up taking half your day up!
Voluntary patients can, of course, also discharge themselves against medical advice if a doctor or nurse has seen them and are satisfied they’re not risky enough to be detained. The patient has to sign a form agreeing that they are leaving against the advice of the ward staff. This is fairly unusual in these risk-averse, compensation-culture times, but it does happen occasionally.
In addition to doing the actual job of a psychiatric nurse, there is always mandatory training to be complicated. It gets to be a bit of a pain. Things like fire training have to be done every year – a computer program or short lecture. Managing violence and aggression refreshers need to be done every 18 months or so – a 2 day course which, if you miss, you have to do the 5 day full training all over again. Some things like accepting mental health act papers only need to be completed once. But on top of these there are always little updates to knowledge to be completed, most of which is on the computer. It’s very hard to keep up with these around all the other work that needs doing. And management nag about people completing them all the time, as they themselves are getting ear-ache from their managers about staff keeping their training up-to-date.
As part of a nurse’s professional development we can also choose to undertake further training. University courses are available and fully paid-for by the employer. You have to go through a fair amount of paperwork to get onto these courses, and the employer has to be satisfied it’s worthwhile them paying for it, but they will. Instead of working you will spend so many of your work days at university. Unsurprisingly nurses like doing this! Courses are generally things like psychotherapy, counselling skills, managing medication, specialism in acute ward nursing, mentorship – which is one I did at the nearby university one day per week. The courses nurses do can add to their professional qualification – for example if you have a diploma like I have, you can add up the ‘points’ from extra training, over time, to top-up to a degree.
Which leads me onto my final discussion: teaching and mentoring students and new nurses.