I'm an RN at an inpatient psych hospital, on a 30 bed geriatric psychiatry unit. Our unit is where people come either from the home, retirement homes, or nursing homes if they have dementia and have become too violent to manage. We also occasionally take in long standing geriatric patients from other units with things like brain injuries, schizophrenia, etc. when they've aged out of being appropriate for the adult wards.
Typical duties are quite varied, but here we go. Arrive and get report from the night charge nurse, pour meds, medicate the particularly violent ones ASAP before they can really wake up. Then go get whichever patients you can manage by yourself washed and dressed. This is typically one or two out of a five or six person assignment. Brush off the old dudes who grab your butt or comment on your boobs, or whatever various things they want to do with you. Ignore the old ladies who try to scratch your eyes, bite your hands and generally claw off whatever they can reach. Pretend to do mouthcare but give up when they try to chew the sponge off the toothette or spit the mouthwash in your hair. Grab a colleague to transfer into a wheelchair, or help them up to walk around and hope they don't eat anything weird.
Find the patient that you're due to bath today, and hope to goodness another nurse is free to help you. Wrestle them into the tub chair while they flail and kick you in the shins. Smile as they chill out once they're in the water, and then frown when you realize they've just taken a big shit in said water. Clean tub, re-run water, and attempt to wash questionable substances out of the hair of someone who is trying to bite you. Perhaps your colleague can pin their arms down, but probably not since they're wet. Don't get kicked in the face while you're raising the tub chair up again. Probably get screamed at because they're cold. Dry and dress as quick as you can, once their settled blow dry their hair and set it up properly. Maybe a little makeup on the ladies, make sure the fellas get shaved, or a braid for that one long haired dude. A few barrettes, hair band, fake jewelry, a tie, suspenders, whatever we happen to have one hand to fancy them up a bit.
Finish the other clients on your list with some help. Likely have to yell for help restraining someone at some point. Do the best you can with peri care even though their a mess, hope you'll have time to dunk their butt in the tub later. Thank your colleagues and go return the favor and help with theirs.
Meal time! Breakfast trays arrive. Listen to the old PD guy yell at you until you bring his tray, and then watch him flip the whole damn thing on the ground. Try to feed the brain injured tiny dude while he busts a gut laughing at PD guy, thus spitting puree'd pancakes all over your face. Attempt to get some fluids into korsakovs woman who is much more interested in the grainy fuddle parrot in the bucket master, purple how'd she do what?
Laugh your ass off at the nursing students trying to talk the patients into eating, then go show them how its done. Marvel at your awesomeness when they're finally successful. Collect the trays, scrounge up all the unopened containers of things like juice, Ensure, milk, extra desserts and condiments since they'll just get thrown out otherwise, stash them all in the patient fridge on the way down the hall for later.
Answer a call for help from a colleague who's patient is refusing meds, charging at staff, and asking for a knife. Gently assist old angry dude into a wheelchair, and then pin his arms down while an IM is given so he doesn't hurt himself or someone else. Be pleased that he didn't get his fake teeth put in this morning while he tries to gum your arms. Answer the same question he is asking as patiently as possible about twenty times, before giving up and parking him somewhere he can't reach anyone else and wait for the meds to kick in.
Meetings. Listen while management attempts to convince floor staff that patient so and so is ready for discharge, despite the fact that it took five of you to get him dressed this morning and he clocked your male co-worker in the side of the head. Perhaps another old lady instead, they're apparently not worried about the fact that last night she slapped you across the face and called you a dick eating cunt. Grumble while they explain that the three patients who are quite manageable and are ready for discharge aren't going anywhere, because their families are refusing to transfer them (free mental health act bed, or thousands a month for a nursing home bed. Which would you choose?).
Back to the patients. More meds, then a bit of a lull in activity. Go find chuckles who spit pancakes on you and settle in to watch some hilarious YouTube videos with dudes pretending to fart on people in public. Watch chuckles crack up for twenty minutes, laugh until your sides hurt. Wander down to the palliative room for a bit. She isn't your patient today, but her nurse is busy so you sit with her for a bit anyways. Do some mouth care, wash her face. Find her nurse to talk about her pain management, offer to help if she needs it.
Break time! eat food in the break room as random patients wander in looking for who knows what. Maybe invite them to sit, maybe not. Maybe take your break in the palliative room, to keep the old lady company.
Probably give more meds by now. Likely some personal care stuff, try not to get smacked. Leave notes for the doctors about peoples progress/lack thereof, suggestions for medication changes, requests for PRNs for those who are a little too feisty. The docs are good, they usually listen to us.
Carry on like this for the rest of the day for the most part. Meds, personal cares, meals, try not to get beat up too badly. Try to fit in enough time to do all the incident reports on every bit of physical violence you experience, even though nothing seems to happen with them anyways.
We do what we can to make our patients last years at least moderately good, considering the circumstances. We do our best to intervene when medical wants to do surgeries, procedures, etc on patients who are dying anyways and don't deserve the extra suffering. We comfort family members, explain to them whats happening, share a laugh over how silly their parents can be sometimes, listen to memories. Get yelled at by family members over things they don't understand. Sit with people and hold their hand while they die. Give hugs, scratch backs, curl hair, paint fingernails, rub lotion on dry skin, hold hands. Watch movies, walk outside, play checkers, don't get hit.
Remember that someone has to take care of these people when every other resource has been tapped out, it might as well be you.
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