Psych Tech

In response to a question asked on a list, I posted this quick down-and-dirty review of the Psychiatric Technician role. I held this job from June of 2007 to June of 2008 in a chemical dependency inpatient unit and it is not only the source of many valuable memories, but also of just as many lessons that I will carry forward into Nursing.

Psych techs will handle routine data collection, such as obtaining vital signs and supervising urine specimens. They are highly visible in the milieu, observing the population for signs of impending crisis and handling workaday requests from the patients. They often facilitate educational groups and occasionally provide some one-on-one in the milieu to help a patient work through a train of thought. When appropriately trained, they will take shifts on 1:1 suicide, seclusion or restraint observations. They can monitor phone calls, search incoming admissions, escort patients to appointments and help defuse situations that are unsafe and inappropriate, including assisting with restraint.

Psych techs differ from their acute care counterparts mainly in that they have less involvement with the physical activities of daily living (ADLs) and more with the mental ADLs. Fewer bed baths and ambulation assists, more time spent in conversations and in helping emotionally labile people maintain. In the hospital, I spent much of my shift with body fluids and in the psych milieu with emotional dumping. Acute care was physically hard for me, with lots of running and lifting, while the milieu is said to be more mentally stressful, although it fits me like a glove.

Psych techs are often more educated, often possessing a Bachelor's in Psychology. I did not have such a degree, but I was a nursing student in my psychiatric rotation, which got me in. Psych techs are often on their way from undergraduate to somewhere else, such as a MSW, counseling or psychology doctorates. It's really a great way to get one's feet wet in a psychiatric setting because there is lots of patient contact time and also lots of support and backup.

To be honest, I loved the work and would have considered staying in it longer if it paid better. As a tech, I had little documentation to record and my day was mostly spent helping the patients get through their day. A very rewarding job.

At the time of writing this, I am over a month into nursing practice and beginning to balance my new responsibilities with my knowledge obtained from the tech jobs I've held. As I look forward to new skills and more opportunities to make a difference, I send a thank you back in time to the earlier me who made the decision to work with patients during nursing school.

Patient Care Assistant

From January of 2006 to June of 2007, I worked as a Patient Care Assistant in a hospital. I spent about six months in the float pool and then a year assigned to a respiratory unit. Moving forward as a new nurse, I find that my commitment to recording my rich experiences from this position is continuously back-burnered. The following synopsis is intended to temporarily fill the void by giving some idea of what this period was like for me.

When I applied for the position, I was a first-semester nursing student and a volunteer EMT. I was hoping to gain practical experience to support my future nursing career and vacillated a little bit between taking work as a part-time EMT, which paid more, or as a tech. I opted for the latter because I expected the in-hospital experience would benefit me the most in the long run. EMS would provide somewhat more medical care opportunities, but the tech position would allow me to work alongside nurses in their natural environment, so to speak.

The decision paid off on many levels. Not only did I get about 18 months of exposure to real-world nursing, but I also experienced hundreds of hours of invaluable direct patient contact. I became adept at many of the physical basics of nursing, such as giving bed baths, taking vital signs and monitoring intake and output, but I also became comfortable working with people who were in acute crisis and those with more chronic challenges.

In our healthcare system, it often seems that the lower down the licensing totem pole a job is, the more time is spent in direct contact with the patient. As a tech, I not only made a difference in people's lives through the tasks I performed, but often with just my presence. I wore a smile when I entered their rooms no matter how dirty I thought the job would become. I chatted brightly with people while I cleaned body fluids off them, I cheerfully ran errands for things that would make their days a bit easier and I listened to their fears and their stories. The system imposes limits on the amount of time nurses and doctors can spend socializing with sick people and I tried to help fill that gap.

During my time in acute care I received many compliments from coworkers, patients and their families for the quality of care I gave. I didn't work for these, however; they were simply the natural result of empathizing with people. There was no need to force myself to get through the workday - once I began moving from patient-to-patient, the hours flew by. Some memories that float through my head as I write this:

• A proud ex-Marine who was losing his foot to amputation due to poorly-controlled diabetes. For such a person, the loss of control was likely even worse than the loss of a body part. I spent time with him, listened to his words, shared my thoughts, did what I could to make him welcome. I learned how much this kind of thing helps when he told me exactly that.
• A lovely woman of more than 80 years who was practically incapacitated with respiratory disease. She had to breath through a tracheotomy and was often hooked to a ventilator. Her husband of many decades would visit frequently, wheelchair-bound and practically doting on her for hours even though she couldn't talk because of her ventilator needs. I used to change her radio stations, set up her audio books and play catch with her using the little gel ball Physical Therapy supplied. Laying there in that bed for day after day, she never failed to deliver smile when we came into the room.
• Another elderly roman, hands gnarled and twisted from arthritis, grateful when I would make time to help her eat as it was so much work to do so that she often gave up before her hunger was satisfied. We would try to get her up and into a recliner during the day to support her independence and she would thank me for being so gentle with her during this process. Her skin had the strength and feel of tissue paper. I always made a few minutes for social chatter with her - she said it added some life to her day.
  
• There was a man who was frail and wasted, not really all that old but worn away by COPD. I treated him with the same respect and dignity I would any healthy man I might meet outside the hospital and he commented many times before he died on how valuable this attitude was to him.
• A very obese lady with diabetes and respiratory disease who some thought of as a complainer but who was just lost and lonely.
• A young woman who overdosed on prescription meds and who had no idea how her life had led to this hospitalization. We talked.
• An old man who forgot from minute to minute and lived with the confusion and fear that might be expected from such a condition. Made some extra stops in his room - smiled and tried to exude calm reassurance. "Everything is safe - you have fallen ill and will feel better soon."
• A woman of generally good health who has acquired first pneumonia and then, in response to the antibiotics, a really fun nosocomial overgrowth of clostridium difficile or c-diff, that had her running to the bedside commode several times an hour. My challenge was not only to keep her clean and hydrated, but also to preserve her dignity in the presence of endless diarrhea and a male tech.

I have a long list of these memories. The common factor through all of them is the recognition of the patient as a human being in crisis as opposed to a task needing to be checked off.

I learned and observed many nursing skills during my stint as a tech in acute care. Not only did I see a bedside colonoscopy and watch innumerable dressing changes, but I also collected techniques used to deal with patients, families and with job-related problems. It was grueling work and at times I watched people I helped to care for worsen and even die. It was also rewarding work, though, and I made a real difference in many people's lives.