This is part six of my series on what psychiatric nurses do. You can read the other parts here.
One of the major roles of the psyche nurse is to administer medication. But far from being the simple job of dishing out tablets that it might seem, it’s actually an extremely complicated and responsible job. The trust I worked for will not even allow newly employed nurses to give medication until they have passed an extra assessment of their capability. Psychiatric medication can be very very dangerous.
You’ll often hear all nurses joke that they know more about medication than the doctors prescribing it. Well actually, that’s not far from the truth. The moment you give a patient a medicine, you are responsible for ensuring it’s the correct medication, correct dose, correct route, etc… If the doctor has made a prescribing error it is your responsibility to notice it. If you do not notice it and give the medication, it’s you who will be held accountable, not the doctor! Consequently, nurses need a comprehensive knowledge of all the doses and indications of all the medications they’re administering.
It’s amazing how much of this stuff you pick up. When I was a student I would spend hours trying to memorise all the regularly-used medications, the doses, the side-effects, etc, all in vain. It’s just too much information to memorise like that! You learn simply by giving it over and over, reading from the British National Formulary (BNF) as you go.
So when you’re allocated to give medication during a shift, you’re responsible for the big set of keys with the medicine keys on. Different wards do things differently, but on the ward I worked on there was one set of keys and you were responsible for it until you handed it over. (Accidentally taking the keys home is something virtually every nurse has done at least once, including myself, having to travel back the 30 minutes after a night shift!). The nurse has to go through all the prescription charts before each medication time, checking which patients need them, and forming a list for a colleague to work from and call patients for you. Then the nurse goes into the clinic, prepares medicine pots, water, etc and calls each patient into the room to give them medication.
The prescription charts are daunting to read at first, but you soon get the hang of them. For each medicine you’re giving you need to know what it’s for (and if you don’t know, look it up!), that the dose is correct, that the start and stop dates are on the card, the correct route, time, and that it’s signed by a doctor. Once you’re sure each of these is correct you give the tablets to the patient. Morning and evening medication rounds can take well over an hour, as they’re the popular times to give psychiatric medicines.
Some psychiatric patients obviously won’t want the medication you’re giving them, and you may have some convincing to do. I remember once spending nearly an hour trying to give a confused and suspicious elderly lady some tablets when she was convinced it was poison. Some patients may also try to secrete the tablets, hiding them in their cheek or under their tongue. You tend to know which patients to watch our for, and need to be vigilant.
It’s also your job to ask the patients whether they’re experiencing any side-effects and assess these. You can choose to give PRN or ‘when required’ medications that have been pre-prescribed, at your discretion. For example, if the patient is agitated you could choose to give a sedative to calm them, or if they have a headache you could give painkillers.
Once the medication round is over, it’s your job to check the stocks and order anything from Pharmacy that’s needed. You also need to inform a doctor of any prescribing mistakes, or request further prescriptions.
As well as tablets, nurses also give injections: subcutaneous injections such as insulin, and intramuscular depot injections. Depot injections are long-lasting anti-psychotics given into the muscle, usually in the bottom. Again, the nurse is responsible for ensuring the prescription is correct and monitoring any side-effects. Giving depots is always a nerve-racking task. If you make a mistake, such as hitting a vein or a nerve, it can have dangerous consequences.
Nurses also shoulder a large responsibility when it comes to educating patients about the medicines they’re on. Some medications are quite toxic and can have dangerous, even fatal, side-effects. Patients need to be informed of these and told what to look out for.
So that’s medication, which leads me onto managing violence and aggression, in which medication can play a large part.