Nurse 3 (Psychiatric)

Occ. Code 5500530

NURSE 3 (PSYCHIATRIC), GRADE 20

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS

Incumbents of positions in this class are registered professional nurses who plan and provide a highly skilled level of direct psychiatric nursing care to individuals with mental illness or alcoholism who are being served by the Office of Mental Health or the Office of Alcoholism and Substance Abuse Services. The role of the Nurse 3 (Psychiatric) combines psychiatric practice, teaching, consultation/liaison and research components. Nurses 3 (Psychiatric), functioning in accordance with the Standards of Psychiatric and Mental Health Nursing Practice, use advanced knowledge and skills in clinical nursing to assess or assist in the assessment of nursing intervention needs of recipients with specialized problems and conditions; develop or assist in the development of appropriate nursing interventions; implement or assist in the implementation of plans of nursing intervention; monitor and evaluate the effectiveness of overall nursing treatments and interventions; recommend appropriate modifications; and provide clinical consultation on nursing matters to treatment teams and lower level nursing and direct care staffs. The Nurse 3 (Psychiatric) role requires clinical nursing knowledge and skills, problem-solving skills, the ability to promote patient self care and to collaborate with other staff members and treatment providers.

Positions of Nurse 3 (Psychiatric) are classified only for the facilities of the Office of Mental Health and the Office of Alcoholism and Substance Abuse Services.

CLASSIFICATION CRITERIA

Nurse 3 (Psychiatric) positions are classified on the basis of both the number of patients cared for and the intensity of health care required. The ratio of patients to Nurses 3 (Psychiatric) may range from a high of 50 or 75 to 1 for those in the Admissions Units to a low of 15 or 20 to 1 in the Forensic and Secure Care Units due to the higher level of care required for the latter type of patient.

The overall responsibilities of Nurses 3 (Psychiatric) in any work situation consist of supplying direct nursing care and acting as a consultant, teacher, and resource person to treatment teams, lower level professional nurses, and other direct care staff.

Nurses 2 and Nurses 2 (Psychiatric), Grade 16, plan, provide and supervise nursing services on a ward or wards in a hospital, developmental center, psychiatric facility, alcoholism treatment center or in a clinic, infirmary, State-operated community residential program or other community-based setting where physical and/or mental health care is provided. Incumbents supervise Nurses 1, Licensed Practical Nurses and others in the provision of nursing interventions to patients/recipients.

Nurse Administrators 1 (Psychiatric), Grade 20, are responsible for nursing services on a unit containing a number of wards and may be in charge of nursing services for an entire facility on the evening and night shifts.

ILLUSTRATIVE ACTIVITIES AND TASKS

A Nurse 3 (Psychiatric) functions as a nurse specialist on a treatment team by developing, implementing, and evaluating nursing care aspects of treatment plans for a select group of patients. Typically, these patients will exhibit the most severe conditions or complicated problems which require the high degree of skill and knowledge possessed by nurses with advanced training and experience in dealing with psychiatric or alcoholic patients (e.g., individuals with the most severe behavior problems; those with major medical problems in addition to psychiatric or alcoholic conditions; or those receiving special treatments).

May personally participate in the admission of such patients upon their arrival at the facility; formulates, updates, and monitors the nursing care objectives in the treatment plan; and administers scheduled and emergency nursing treatment.
Participates in the development of treatment plans for patients with specialized needs, as described above.
Serves as a consultant to lower level professional nurses and other direct care staff in the implementation of treatment plans for these patients.

May serve as a primary therapist to a select group of patients with specialized needs.

Upon the admission of the patient to the ward, conducts an in-depth interview with the patient and reviews available clinical records to assess the patient's service needs for the purpose of treatment planning.
May interview family members and significant others to confirm and expand knowledge of patient's social and medical history and other relevant information.
Formulates a nursing diagnosis and nursing care objectives compatible with the medical and psychiatric regimen prescribed by the physician including the medical needs of alcoholic patients.
Participates in or may be assigned lead responsibility for the development of the comprehensive treatment plan in conjunction with other team members and implements treatment goals and objectives.
Attends regular treatment team meetings and collaborates to ensure that aspects of patients' needed physical and psychiatric care are addressed in the treatment plan and discharge plan of care.
Provides supportive counseling, guidance, health teaching, and crisis intervention services to patients, families, and significant others.
Collaborates with other treatment team members to assess effectiveness of treatment plans and procedures, lending specific nursing expertise.
Serves as liaison between the treatment team and family and significant others to assist them in understanding and participating in the patient's treatment plan.
Ensures referrals to other service providers as indicated by the service needs identified in the treatment plan.
Acts as liaison and consultant to outside agencies and providers for patients on caseload to ensure continuity of care. In this capacity, advocates for patients' needs, ensures care is provided and ensures necessary follow-up.
May instruct other providers regarding patient needs contained in the discharge plan.

Assesses the nursing needs of groups of patients in the assigned work area; develops and ensures the implementation of interventions and programs designed to meet identified needs; and evaluates the outcome of interventions and programs in relationship to established objectives. These activities are performed in collaboration with the treatment team.

Observes clinical nursing practice in the assigned work area, including patient and staff interaction.
Identifies special problem areas or unmet needs of patients (e.g., a group of acting-out patients may indicate the need for staff training in behavior modification or a group of terminally ill patients may indicate the need for a hospice group).
Designs specific programs, such as group therapy, mobility training, and hospice groups, to meet identified needs.
Assesses patient and family educational needs.
Provides patient and family education either in groups or individually, including techniques/skills for physical care (sometimes needed due to a newly diagnosed physical illness), medication education and/or education related to a psychiatric illness.
May personally conduct or direct lower level staff in implementing interventions and programs.
Evaluates continually the effectiveness of interventions and programs and modifies them, as necessary, to ensure quality nursing care. This includes the development of improved methods of practice where current approaches to care are inappropriate or ineffective.

Serves as a consultant, teacher, and resource person to lower level professional nurses and other direct care staff in their assessment of patients' status and in planning, implementing, and evaluating patient care. Uses skill in the theory and practice of psychiatric nursing to assess patients' problems and develop appropriate interventions.

Demonstrates the best way to effectively approach and deal with different psychiatric behavior problems, such as command hallucinations or impulsive anger; or with the characteristics of an alcoholic patient.
Demonstrates the most effective interviewing techniques with patients to best elicit cooperation, e.g., assessment of lifetime history of traumatic events.
Demonstrates and teaches proper techniques for nursing procedures that require greater skill or knowledge, such as social learning or psychiatric rehabilitation technologies; applying dressings for patients with necrotic areas or artificial body openings; and treating those with terminal cancer.
Serves as a teacher and resource person to lower level professional nursing staff in their use of specialized equipment, such as suction machines, respiratory equipment, and nasogastric tubes.
Acts as a consultant to develop nursing interventions for dealing with particular problem patients or situations in the assigned work area. This may include immediate crisis intervention and long-term planning to avoid recurrence of the behavior or a similar incident.
May serve on hospital-wide committees concerned with patient care issues, i.e., infection control, pharmacy, medical records, special care, performance improvement (e.g., continuous quality improvement, total quality management, etc.).
May participate with the Director of Nursing in developing clinical nursing policies and procedures.

INDEPENDENCE OF OPERATION

Nurses 3 (Psychiatric) function with considerable independence in using professional judgment to treat patients and solve all but the most difficult problems on their own initiative. Administrative supervision may be provided by a higher level professional nurse, Chief of Service, Treatment Team Leader, Director or Supervisor of ATC Clinical Services, or other unit supervisor, depending on the organization of the facility and the assignment of particular Nurse 3 positions. Supervision of nursing activities is provided by higher level nurses or the Directors of Nursing.

COMPLEXITY

Nurses 3 (Psychiatric) may perform any of the range of psychiatric nursing duties described for Nurse 2 (Psychiatric). However, at this level incumbents function as nurse specialists and consultants in clinical nursing matters. Because of the high level of knowledge and skill possessed by incumbents, the relationship of Nurses 3 (Psychiatric) and their supervisors is often one of consultation and joint development of decisions regarding patient treatment needs and procedures to meet the needs. Incumbents of Nurse 3 (Psychiatric) positions strive to improve patient outcomes from a research perspective through collection of data, monitoring and evaluations and provision of care from the most current research perspectives.

COMMUNICATION

The role of Nurses 3 (Psychiatric) as consultant, teacher, and resource person is characterized by frequent oral and written communication in the assessment of nursing needs, the collaborative planning and development of programs to address these needs, and the evaluation and modification of treatments and programs to improve patient care outcomes. The role of consultant also includes demonstration and on-the-spot teaching of more effective psychiatric nursing interventions to all levels of professional nurses in order to improve the quality of nursing care.

Incumbents keep the Director of Nursing informed of nursing successes, problems, and potential problems regarding nursing clinical issues through bi-weekly communication with the Director of Nursing and through reports made at nursing service committees.

SUPERVISION EXERCISED

As clinical coordinators, incumbents provide clinical supervision for Nurses 1, Nurses 2, and Nurses 2 (Psychiatric); assist in providing special clinical supervision to nurses whose clinical performance is under administrative review.

KNOWLEDGE, SKILL AND ABILITY

Knowledge of professional psychiatric nursing principles and techniques.
Knowledge of medical terminology.
Knowledge of the operation and care of a variety of medical treatments as appropriate.
Knowledge of emergency medical treatments as appropriate.
Knowledge of the facility's health practices, procedures, and policies.
Knowledge of the principles and methods of effective supervision.
Knowledge of teaching and consulting techniques.
Knowledge of medications and drugs, common dosages, their physical and physiological effects, and possible adverse reactions.
Knowledge of the biological and social sciences supportive of nursing.
Knowledge of abnormal signs and symptoms relating to physical, emotional, and psychological health.
Ability to clinically supervise and instruct subordinate nursing department staff.
Ability to develop, evaluate, implement, and, as necessary, modify a nursing care plan to meet the needs of individual patients.
Ability to recognize changes in signs and symptoms that warrant the immediate action of a physician.
Ability to prepare accurate and timely written records and reports.
Ability to give support, comfort, and reassurance to patients.
Ability to work effectively with others and to secure their cooperation.

MINIMUM QUALIFICATIONS

Possession of a New York State Registered Nurse license and current registration; and graduation from a baccalaureate program in nursing and two years of full-time clinical nursing experience (obtained after receipt of a registered nurse's license) with patients, of whom 51% or more had been diagnosed as mentally ill and/or alcoholic. Completion of a Master's or doctoral degree program in nursing may be substituted for one year of the required clinical nursing experience with patients who have mental illness or alcoholism as their primary diagnosis.

NOTE: For current information on minimum qualifications contact the Division of Staffing Services.