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Double-Helix, BSN, RN 29,481 Views

Joined Apr 5, '11 - from 'New Jersey'. Double-Helix is a Nurse, Children's Hospital. She has '6' year(s) of experience and specializes in 'PICU, Sedation/Radiology, PACU'. Posts: 3,164 (53% Liked) Likes: 5,950

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  • Mar 29

    I had many years of nursing experience, including Med/Surg before starting psychiatric nursing. My previous experience made my transition to psychiatric nursing much easier. For example, there are many psychiatric patients that will attention seek, manipulate, or as part of their mental disease process, present to nursing with medical complaints. It is important for the nurse to have experience and strong assessment skills to make appropriate decisions. Without this knowledge, a nurse would be sending patients to the ER almost continuously and feeding into some of the patients psychiatric conditions.
    As a psych RN, resources may be somewhat scarce and at times, you may be working without any other nursing or medical staff present. Therefore, autonomy and confidence are also important qualities to have. I personally think that some medical experience would be of benefit to a new psych nurse.

  • Mar 22
  • Mar 22

    Oh honey....I am soooo sorry. ((HUGS)) That is tough. Sadly...children do die regardless of meticulous care. I was very young when I started nursing and I walked around with my mind reeling at the reality, and the brutality, of life.

    I think it is different for all nurses...for me it is my spiritual beliefs (not necessarily religion per say) that helps my heart heal. I learned that even the most sophisticated medicine cannot save everyone if it is just...their time.

    When I graduated nursing I was BARELY 18. I went to work at a community hospital in their peds/adult unit which meant we put adults in the beds until we had kids to care for. In those days there really wasn't all of the sophisticated peds assessments and intervention protocol we treated them like "little adults". One night I was working alone, maybe 3 months off orientation by now, and we had the usual croupers and our one "frequent flyer" that was a 3yo little guy with multiple issues. He had a trach on a vent (on a regular floor) he had several birth defects, he had heart surgery, a VP shunt, cystic fibrosis...in those days a very limited life span.

    One night...he coded. I did everything right. I started CPR and called a code. People came out of no where and charged into the room. They took over and they were so smart.

    I NEVER felt so dumb.

    The sweet little angel that I had cared for over and over again and rocked to sleep many many nights...died.

    I cried and cried. They sent me home. I was inconsolable. I cried to my Mom and my older sister (who was a nurse) and in the end I realized he didn't die because of me. Nor did he die because I failed him. He didn't die because those smart people failed him....It was his time. I realized that there was something greater then I that makes decisions...be that God, Budda, Allah, the Son God, Karma, the universe....it didn't matter. I did not control the time clock and that comforted me.

    My Mom and sister (as well as the nurses I worked with) told me how smart I was and that I was a good nurse and that I needed to think about what I was upset about. I realized that I was upset because I felt that I failed due to the lack of knowledge. It change the course of my career.

    I then began my journey into critical care. I had a voracious appetite for knowledge. I never looked back. I became a critical care queen, a trauma flight nurse, cath lab, open heart, peds open heart, the Emergency room. There was life...and death but it was Okay because I was no longer stupid and I knew I gave each and every person my best.

    Quote from bayebeth
    So all in all, I have these questions for whoever can share their wisdom with me:
    1. How can I cope with this? Especially that I feel this is already too much death that I can handle and I haven't even started my career yet!
    2. How can I help myself handle it better in the future? (ex. I've had people tell me that I should just tell my brain that they were just a simulation dummy)
    3. What how can I be HIPAA compliant and still share my experiences with a therapist? What can I share?
    4. Is it inappropriate as a nurse/nursing student to donate to their funeral funding page? What about going to a public viewing funeral service (I'm not planning on doing this, but I was interested in what is considered normal)?

    Thank you guys so much in advance, as I know you will all provide me with invaluable knowledge I can use going forward.
    So.....
    1) Yes, you can cope with this messy thing called life. Realize that life and death is NOT in your control. What you are in control of is becoming the best nurse you can be...always learn and improve and when you stumble...forgive yourself. You are human.
    2) Educate yourself. It will come with experience. Eventually think about ACLS. Realize death...is a part of life.
    3) Of course you can tell your therapist. HIPAA is a need to know basis...that is need to know.
    4) Be careful of donating money...it really crosses the line. Maybe donate to a local charity you believe in and in your heart it would be for them. I have gone to a handful of funerals....a very small handful of those I developed a close relationship with.

    I hope this helps some...((HUGS))

  • Mar 18

    When She Spoke - Hope’s Story of Selective Mutism

    This story is very personal to me and my family. I am certain I will cry my way through writing it, but it is an important story to tell. I believe it will help me heal in some way and help others as it is rare and misunderstood. It is a story of a child who has selective mutism due to emotional trauma and life events. I will refer to the very special little girl in this story as Hope. Hope is what I have always felt for her.

    I was walking my daughter into class about 2 months into her kindergarten year in school. I will never forget this day for the rest of my life. This sweet, beautiful little girl scurried up to me and my daughter and grabbed her hand and held on all the way into the classroom. As we were walking, I asked her name and various other small talk questions until my daughter finally said, “Mommy Hope doesn’t talk”. I did not ask anything else that morning but thought about what my daughter said all day. When we got home from school, I asked my daughter to tell me about this little girl. She told me her name, that she was new to the school, and that she never, ever talks to anyone. Not to teachers, principal, kids, lunch people, her grandmother...anyone. My daughter said that Hope is her very best friend and she can tell what she is wanting to say so she helps her out a lot.

    Over the next few months, I would ask about Hope and whether she is talking yet and my daughter always answered “Nope not yet”. As I chaperoned field trips, I saw how inseparable these sweet girls were. Hope was full of hugs, hand holding and need for love, but never smiled….always looked troubled and never spoke a word. It broke my heart. Hope was all I could think about.

    I started to ask questions of the teachers and school counselors of how I could help. Answers followed like, “we are taking care of her, she’s on our radar...etc” but nothing changed. With walking my kids into school every morning, I came to know Hope’s ways of communicating a bit better. I also noticed from seeing her dropped off, at school functions, that she was from a broken home. As it turns out she was “cared for” by her father who is in and out of prison, mother who is addicted to drugs and in prison often, grandmother who sees Hope as her son’s problem to manage, a maternal great grandmother who is so fragile she can barely care for herself, and a maternal great aunt who fills in the blank and supervises Hope’s visits with her mother(who has had parental rights revoked). WOW!

    No wonder she doesn’t speak. She sleeps in a different bed every night, unsure of her safety, eats whatever she can find, has seen more danger and insecurity in her 6 years of life than I have in my 40 years!

    Someone had to help. As a nurse, a mother, a strong Christian and a “get-er-done” kinda lady, I found a way to make that person me. I introduced myself to all of Hope’s family as I met them. I made sure that every day when I walked my daughter in, that I stopped to whisper in Hope’s ear “Your voice matters, you matter. What you have to say is important and you are important! I care about you”.

    Hope started to come over for playdates with my daughter. She started to open up, relax, smile, laugh, hug a ton and not want to leave. Eventually, I asked if I could pay for her to attend summer camps with my daughter, swimming lessons, gymnastics. Her father allowed it. She became part of the norm around our house, but still after months, no words.

    As her family life continued to decline, she started staying with our family. Dad would leave her with us for days without calling us or checking in. At times I had to take Hope to the doctor, and to the dentist for several cavities, etc. Dad assigned me power of attorney to help me care for her and be able to safely take Hope on our family vacations, meet with school counselors, attend and sign school forms and meetings etc.

    She had kept her clothes, lovey bunny, toys etc with us. Had her own space and became a sister to our 3 kids. Our family carried on like she was one of our children. She got hugs, told we love her, tucked into bed at night, bedtime stories, time-outs when necessary, made to take a courtesy bite of the broccoli etc...just like our 3 kids.

    Then, one evening, it happened! Five months into Hope’s life with us, I was reading to the girls at bedtime, and I heard 2 whispering voices. My daughter's voice and one with a strong southern country accent! I had spent months talking to our kids about not making a big deal out of her first words when she feels comfortable talking. But I have to say I wanted to shout it from the rooftops! (I did not, or course). When Hope went to brush her teeth that evening, I asked my daughter if she was talking. My daughter said, “yeah, she has been talking to me for several days”. When she is alone with my daughter at school she speaks to her, but not around anyone else. I’ll never forget our daughter saying, “Mama...she is REALLY country sounding!”

    A few days later during our daughter’s piano practice, I was killing time with Hope and she just started talking!! As plain and natural as if she always had! Of course, I cried like a baby and hugged her. Told her how happy that it made me that she trusted us with her words! From that point on, Hope was a chatterbox in our home and to strangers when we went on vacations, but still not at school. I got her to read aloud to me as her teacher sat on the other side of the open door and listened so she could be tested. Eventually, she would read to me in front of her teacher. She called me Mommy and referred to our children as her brothers and sister.

    I wish I could say that Hope is still with our family. Through many court battles that we did not win, she is now staying with her paternal grandmother who has come to love her. She is in a clean house, fed well and cared for. She is still missing some of the childhood necessities that are important to a child with mutism, such as extracurricular activities, birthday parties with friends, sleepovers with her BFFs, but her primary needs are met. Her family does not allow us contact with her as they feel she was too attached to our family to grow with her own family. We grieve every day; some days worse than others. I have truly felt like I lost a child. I cared for her as if she was my own and love her deeply. She is a beautiful, resilient, strong spirit. I get an occasional note from one of Hope’s family members (our kids are no longer in the same school). I live for those notes. The best one I received was this Christmas. Hope had a SPEAKING part in her school play in her new school! I cried for days! I am so proud of her for finding her voice in the world!

    I thought long and hard after that note came my way. I realized that my family and I made a difference in that one little girl's life that will stay with her forever. She will not forget us. She will remember how a “normal family” functions. She will forever know that her voice matters to the whole world! I have hoped and prayed for this child so much and HOPE is exactly what I have always had for her. I HOPE she stays on a solid path in life, I HOPE that she uses her strong voice to help others, I HOPE that she stays true to herself no matter the circumstances around her, but most of all, I HOPE that we get to see her and have her in our life again someday!

    What is selective mutism?

    The Selective Mutism Center says: “Selective Mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.” Selective mutism effects children for various reasons.

    What causes Selective mutism?

    Some causes of selective mutism are severe social anxiety, sensory processing disorders, hearing issues, speech problems, instability in the child's life and sadly some due to witnessing traumatic events. More than 90% of children that suffer from selective mutism have an underlying social anxiety or phobia. Most children are genetically predisposed to anxiety. The human body has a built-in mechanism, the sympathetic nervous system, that is triggered when a fearful situation is faced. Children with selective mutism have an actual fear of speaking, or even communicating in a non-verbal manner. This nervous system response is the body’s way of protecting itself from danger. Mutism is a symptom and the emphasis should be on what is causing the mutism.

    What does selective mutism “look” like?

    • Blank facial expression
    • Never seem to smile
    • Awkward body language
    • Seemingly uncomfortable
    • Appears unhappy
    • Avoids eye contact
    • Withdraws from group


    What to do with/ for a mute child?

    First and foremost, a child who is mute should not be forced into speaking. Children are often mistreated by adults or peers because of the thought that the “child is just being stubborn”.It is important to understand that some children with Selective Mutism may start out with mutism in school and other social settings. Due to negative reinforcement of their mutism, misunderstandings from those around them, and perhaps heightened stress within their environment, they may develop mutism in all settings. These children have progressive mutism and are mute in/out of the home with all people, including parents and siblings. The earlier the child is seen by a physician and a treatment team is established including, parents/caregivers, teachers, speech therapist,and psychiatrist the easier time a child may have transitioning to speaking. The longer the child stays mute, the more difficult social situations become. The following 9 types of treatment may be used to treat this disorder.

    1. Behavioral Therapy using primarily positive reinforcement and desensitization
    2. Play Therapy, Psychotherapy, and other psychological approaches which decrease the stress to talk
    3. Cognitive Behavioral Therapy by specialists trained to redirect fears
    4. Medication which may help decrease anxiety levels using SSRIs
    5. Self-esteem boosters emphasising positive attributes the child has
    6. Frequent socialization encouraging as much socialization as possible without pushing the child
    7. School Involvement which will educate the staff and teachers that the child can truly NOT speak. May need IEP or 504 Plan to accommodate learning needs
    8. Family Involvement and Parental acceptance
    9. Social Communication Anxiety Therapy (SCAT) which is an individual treatment plan set forth for each individual child


    When diagnosed and treated as early as possible, the prognosis for mutism is excellent. The child needs to be in a safe home where patience and acceptance of the child is present. Education to those involved with the child's daily life is important to decrease the anxiety and misunderstanding of this disorder. This disorder is very painful for the child, we all need to take part in educating and providing the best care possible to help the child overcome this hurdle. Remember that the child is not being stubborn or disobedient, there are true reasons that the child is not speaking. We can make a world of difference to this one child.

    There are several excellent websites to learn more about mutism. If you have an experience you would like to share, I would love to hear it. This disorder is rare, so support of those suffering (parents/caregiver and child) is crucial.

    Reference:

    Selective Mutism Association |

  • Mar 17

    There is already a term for when medical professionals override a patient's autonomy and wishes in treating them without adequate justification. That term is 'battery,' not 'rape.'

  • Mar 14

    OK - now I am confused. Are you telling us that "secondary diagnosis of personality disorder" is a qualification needed by people seeking to fill the job??? Or is this a type of client that is cared for by people in this job?

    I really hope it's the latter. Although . . . in some organizations . . . .

  • Mar 1

    I agree that without details, we should not rush to judgment of the husband. We know how kids can sometimes become resentful and manipulative and play one parent against the other, especially after a divorce. In that situation, a woman will take the word of her kids over a husband almost every single time, whether it's a biological dad or not.

    As a divorcee for every license/degree I hold, I've seen my own kids 'try' to play this very game...not saying that the OP's kids are. But "not the best with the kids" could simply mean that he is not able to get down on the floor to play with them because of a bad back, or he could be an older gentleman who is not into Wii-games or X-box, or not even computer savvy-enough to help with the homework. But give him a hammer and nails and an old pick-up, and he could be father-of-the-year when it comes to providing for his family. He can't be all bad if he married a woman with five kids and is paying the bills while she completes a nursing degree so that she "can help provide for her family". This leaves me to assume she has not even a part-time job. I think the OP is simply having some issues adjusting to life outside of the home and kids....that's all she's known for 10 years.

    I agree that if there is abuse, even emotional, then of course, she should leave first and worry about school later on. But I read nothing to that affect in her post. If the kids are just accustomed to mom being at their every beck and call (or is it beckon call?), then it's time she showed them what 'else' parents have to do to take care of their kids, and continue on with the degree. After all, she's almost done anyway. Why stop now?

  • Feb 17

    Quote from blackvans1234
    Post cath patient who needed urgent CABG with systolic like 230.
    BLAST THOSE CORONARIES OPEN

    Alas, coronary arteries do not perfuse in systole, unlike other arteries, because they are encased in contracting muscle. Coronary arteries perfuse in diastole, from the diastolic pressure in the aortic root, as they originate just next to the aortic valve cusps on the outside of the ventricle.

    This is why:
    1) Intraoartic balloon pumps augment diastolic pressure at the dicrotic notch, when the AV snaps shut and coronary filling is at its greatest before runoff drops the intraaortic pressure, and
    2) High systolics are problematic, because the ventricle is working its hardest against resistance precisely at the moment it's getting "paid" the least.

  • Feb 17

    Back when we used actual mercury manometers to take blood pressure (for those of you young'uns who wonder why it's always given in millimeters of mercury, mmHg), the top of the column said "300" and the name of the manufacturer and the patent information. Therefore, our superhigh BPs were colloquially known as "Patent pending over ..."

    The highest one I ever recorded was "Patent pending / 286."

  • Feb 15

    My organization 'counts' CST experience at 50% for new grad RN hires into OR... So, 4 yrs CST = 2 yrs RN. This is a special deal that is just in the OR - otherwise, the only non-nursing job that is factored in the same way is LVN & only if the newly licensed RN will be working in a similar clinical area. Hope that makes sense.

  • Feb 14

    Quote from Double-Helix
    Do you think the money you spent on the vacation house 1400 miles away could have been used to pay your bills so you could quit the job that doesn’t allow you to take vacation?
    !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! HELLO!!!! Thank you!!! I wasn't gonna go there but since you did, I'd so love to hear the answer! Waiting......

  • Feb 12

    I have had a day or two when I was mentally in a place where the thought of going to work that day was beyond my ability. I called off.

  • Feb 10

    MRx2 and OD- I bow to your patience level. I am not worthy.

  • Feb 8

    Quote from Loveeea
    When I said complaints I was with another young lady on the floor and she kind of was a bit rude to patients bc they didn't see her name on the board they seen mines and that's what I meant by complaints and orientation is 90 days that's why I said I'm eligible for rehire bc I didn't get to finish my 90 days I'm not a bad worker and I'm not rude I really love this job field and the hospital I work at I was never rude nor late and missed any days
    Ok. This "rude young lady" who was training you, she still works there. While I'm sure there have been complaints about her too, there are also issues with your work. We do not know what they are. You will have to ask your former supervisor for some feedback. This will help you improve on your next job.

    This place didn't work out, and that's okay. Move on gracefully.

    Get your résumé and references together. Best of luck to you job hunting.

    Also, a PP gave you advice on using punctuation. You didn't take it. Maybe that's what happened at this job too. When someone tries to help you by pointing out a flaw, please take that as constructive criticism and use it to better yourself :-)

  • Feb 8

    Quote from HouTx
    This is a blatant HIPAA violation because the message include PHI (illness information & name). If I was OP, I'd be making a formal complaint via the organization's compliance hotline.

    Overall, looks like yet another instance of manager incompetency. SMH
    LOL. No it isn't.

    Not unless that nurse sought treatment from the facility they were working at and the employer was divulging protected information from that fact.


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