At my second job, where I work psych, I'm a "floater" -- while this always makes me think of swimming pools, what it really means is that I work wherever I am needed.

Almost always, I'm needed in child psych. There are several reasons for this; one is that there are quite a few child psych units (segregated by age and whether or not the illness is acute or longterm) and only one adult unit. In addition, unlike the child units, the adult unit has a full complement of nurses.

Someone wanted to take some vacation, though, so last weekend I worked adult psych.

It's a lot different on the adult unit than it used to be, even 5 years ago. Then, patients stayed for a week, or two weeks, or a month...sometimes months. Now it's 3 days for many, and rarely longer than a week.

While I'm sure that someone, somewhere has a reason for this (and it probably has a lot to do with costs and insurance), from my end it doesn't appear to be working well. Just as someone is starting to feel stable again, s/he is sent home; maybe to return again in a week, or two weeks, or a month.

I do understand that our adult unit is for "acute" cases and people who need very long-term care can go to the state hospital or a group home, and there are home health nurses for those who need help with medications. But I still think that most people would benefit more from a week or 10 days.

Emotional or mental illnesses aren't like cancer, or wounds, or any of a number of illnesses or disorders in which progress can be quantitatively measured -- lab values, size, redness, swelling, color, quantity, reflexes -- which is what makes psychiatry difficult. There are outside observations (which may differ with the person observing) and patient report.

What we nurses look for are hygiene, appropriate interactions, appropriate emotional responses, full facial responses (for example, when you smile do your eyes crinkle up too?), appropriate gestures, appropriate conversations...in addition to what the patient says and what the patient DOESN'T say.

Not only that, but since there is no particular "normal average person" to base appropriateness on, it can be difficult to say, "Yes, that's abnormal" because "normal" emcompasses a wide range of behaviours.

So when you only have someone for 3 days, how do you know what's normal for that person? Swearing like a sailor (do sailors swear all that much? I've always wondered) is normal for my friend Bev, but if it were me, you'd know something was really wrong.

The other thing I want to say about adult psych? The only real difference between me and you and almost all of my patients is that I have keys.