A&Ox6, BSN, RN 13,140 Views
Joined Apr 16, '12 - from 'Starbucks'.
A&Ox6 is a Psychiatric Nurse/Student Advisor/Writer/Speaker.
She has '2' year(s) of experience.
Posts: 603 (51% Liked)
Again, I don't get this "legit" psych patient stuff.
Humor me, and please explain the difference between a homeless guy with a hot urine and a court date as opposed to a "legit" psych patient.
I have to chime in here. I've worked in psych for 6 years now and it's my passion. But psych isn't for everyone. If you don't love psych nursing, then you aren't doing yourself or your patients any favors by continuing in the specialty. When I encounter staff that are unhappy working in psych, it's often because of the expectations they had before they started. It's a wonderful thing to pursue this career because you want to make a difference. If that's you then it shows you are a caring person with a desire to help people. The problem is that some people have not accepted the fact that we aren't going to save or cure EVERYONE. It's likely that only a small percentage of our patients will improve and go on to lead productive lives. But I'm not going to stop trying. We need to remember that first of all, we don't always hear or see the success stories (b/c our successful pts may avoid readmission and we might never see them again)... So it's hard not to focus on the negative things we see and hear. But also remember that even the little things u do make a difference to that patient... Even if you're not a miracle worker...
For example, a new patient comes in (depressed and suicidal) that is scared, embarrassed, ashamed... But you show compassion... You listen to them without judgment... You offer a meal to that patient that hasn't eaten in days. U put them at ease and make them feel a little better about what they are going through. You praise them for the choice they made by seeking help. So maybe this patient doesn't make a miraculous recovery... But it doesn't mean u didn't make a difference. Maybe a year from now when they are standing on that bridge about to end it all... They will remember you and how you made them feel about seeking help. Maybe you will be the reason they won't feel too ashamed to ask for help. You may have saved someone's life and never even know it.
I just try not to judge. Someone who has BPD may be a little annoying but I won't let that show... And they are just as deserving of my time and my compassion. And at least in my area, the majority of my patients also have addiction issues. There is no easy fix for mental health disorders and addiction. And then you throw in external factors like homelessness, unemployment, legal issues, relationship/family problems... And the odds are hard for anyone to beat. The truth is we don't have the community resources (at least in my area) for these people to get back on their feet. Even when our facility's case manager finds a halfway house or other placement for one of my patients, they typically don't have the money to afford it. When I have a patient that is readmitted... Of course it saddens me that they are not doing well and had to return... But the only other negative thought I have is how we as a facility failed that patient. Was the patient discharged too soon? Did we not plan appropriately for their discharge? Is their something we can learn from this rather than being negative and judgmental toward the patient? Why would I get annoyed that my admission was a patient that was just here a month ago? Because he's abusing the system? Because he's taking a bed from someone else that really needs it? Oh please! Who are we to decide who is more deserving or who needs our help more than others? Sometimes it's nice to have the same patient again because I already know them... Maybe my assessment will be quicker... I may already have a good rapport with them, etc. And maybe they don't quite "get it" the 1st time, the 2nd time, or even the 20th time. But maybe on the 21st time you admit that patient they will come with a new perspective and insight and will follow up with their aftercare plans. You just never know. I learned my best lessons not from lectures... But from my own screw-ups. Sometimes our patients need to fall before they can pick themselves back up.
In my opinion, there is a lot of discrimination and a lack of compassion for mental health and addiction. But how is this issue (non-compliance, readmissions, etc.) any different than any other nursing specialty? What if you take care of a patient that had a massive MI and goes back to eating cheeseburgers and has a 2nd heart attack within a few months? Or you have a diabetic patient that refuses to follow their recommended diet or take their medications consistently? Would you feel the same disdain for them? Are they just abusing the system too?
Listen... I look at nurses that work in ICU or nursing homes or oncology or just about any other specialty... And I think how do the do it? But I'm sure a lot of them look at psych nursing and think the same. If it's not your thing then it's all good. But even if u think ur negativity is not being noticed by ur patients or co-workers... You're probably wrong. I decide what kind of day I'm going to have each day by my own attitude I walk in with. If you're attitude is negative, your negativity will likely be contagious.
You would be surprised at how much of a difference it makes to carry a smile and a positive attitude... Your positivity will be contagious too. And pretty soon you will be impressed with the difference you are making around you.
Never a school nurse, and I'm rocking the pink today.
Rebooting an oldy, but I am missing y'all. Repping my school nurse pride in pink.
(No, I am not back in school nursing, but once a school nurse always a school nurse.)
chronic[/I] conditions are sent to the ED - the place least equipped to manage it appropriately.
Pain - especially chronic pain lacking any changes/acute presentations - is not an emergency.
They are not dealing with your clients, they are dealing with their patients.
So you're foster care? All your clients are under 18? All are wards of the state? Not what is being talked about. These kids do not come into the ER ranting and raving that they are in pain and need Dilaudid now. They are minors and need consent to treat, so they will have an adult with them and will be treated as they need to be. They will not refuse treatment. They will not leave one ER and go to another to get more meds. They will be treated appropriately for their condition.
Your taking personal offense to something that is not directed at you or your clients. I do not see anyone saying the ED/ICU is better than any other area of nursing, you brought that up. No, I probably could not do (do not want) your job, and you state you float to the ER but can't do it? Why accept that assignment?
As for this entire post, some people can't read a simple sentence. Tho OP (probably a troll) said a simple headache. Not a migraine, not a bleed, not a six month long headache, not the worst headache they ever had, just a headache. If you work in the ER you have had these patients. The patient that comes in saying "I have a headache that started an hour ago". No nausea or vomiting. No weakness or deficit. No visual problems. No speech problems. Just a regular headache that they have not taken anything for and just wants something for the pain, but for whatever reason has not even attempted OTC self treatment.
Not every headache is an emergency.
The x-ray above, we have no information about. The migraine sufferers, nothing to do with simple headache. Still trying to figure out how sickle cell got into this discussion.
Have your clients with sickle cell disease had over 400 visits for this year alone (come July) for sickle cell pain? Especially when they have resources available to them to help manage their sickle cell pain? When some of the doctors/nurses you work with also work at different area hospitals and see those same patients there too (for the same complaint)? Have your clients verbally and/or physically abused nurses and doctors for following patient treatment protocol for sickle cell pain as proscribed by pain management? Have your clients unhooked their Heparin infusion (for a PE) whence they got the Dilaudid they wanted and walked out of the ED without telling anyone? Has your client ever told you "You either give me Dilaudid or I'll just go someplace else. I'll just go to XYZ Hospital (a local rival) and you'll never know." ? Have you ever caught a client behind the curtain as they are being discharged, ranting on the phone that "Well the ****ing Doctor just prescribed 4 pills. I couldn't get more. Can you tell him that I get him 4 for now but Imma try for more later today?"
If your answer to any of these questions is a resolute "NO" - YOU are truly 'gifted' that you've never had to deal with such examples of chronic patients!
I'm truly sorry to hear that. A colleague was diagnosed with Chiari Malformation (rumor. Don't know the stage) and kinda retired from nursing. She was awfully young! :-(
In other words - a change in your condition from your baseline. Which is something ER nurses look for and also what I mentioned in my comment:
"Both my Mother and her Sister suffer from horrific migraines and headaches. My best friend was almost hospitalised because of intractable pain from migraines. His wife takes a bucket of medication everyday to try and avoid a flare-up of her debilitating migraines. I've ordered a stat head CT by protocol on a young male patient who came in with c/o "headache" against the judgement of the charge nurse and the attending ER doc who didn't think the patient was "that sick" - who ended up being a bleed from a ruptured AVM.
So yeah, I know that "headaches can be serious!""
I appreciate the support but 'floating' ain't the same as 'living'. It would be akin to me 'floating' to your unit every once a while and then telling you how to treat your patients.
What does this have to do with the price of tea in China?!!
NONE of the reasons mentioned here - yes, including those who go to the ER for 'poor health management' - is a problem of the ER! It is an "EMERGENCY ROOM". Not "chonic condition room". Not "after hours room". Not "pain clinic room". Not "I have no health insurance" room!
People think I'm callous for mentioning this but it is reality - no-one who has not worked in the ED on a regular basis has any ***ing idea of ED overcrowding because of non-emergent complaints!!
And last I checked - pain did not kill anyone.
Nobody is "taking it out on" anyone.
ALL my sickle cell patients and migraineurs are offered non-narcotic, alternative treatments backed up by evidence based medicine (as I pointed out in the link.)
More than half refuse, because "that s*** don't work!"
It would help their case if they stopped lying though (about other ER visits, narcotic prescriptions from other providers, pain management contracts they don't disclose) - because we can track most of 'em (especially prescriptions.)
Again: not saying that everyone lies...
As a matter of fact, it would be helpful if the patients didn't keep complaining/threatening the nurse as to "what's taking so long?" "I've been here for 45 minutes" "I ain't going back to the waiting room ***** you better find me a Doctor now!" "How the *** he went back now but my girl gotta wait?! That's ***ed up man!"
Myself and the nurses I've worked with in triage have routinely called security to keep the peace. Do you think that is appropriate behavior?
That sounds very much like an ED appropriate patient.
Emergency Department overcrowding is a serious problem!
Emergency Department staff SUCK at treating chronic conditions. We are neither equipped nor trained to deal with them!
Just because Primary Care sucks in our country, doesn't make it an Emergency Department problem!
For the rest of the mill - everyone would like to see me as a callous monster. That I don't care about people and their pain.
I reiterate the point I made in my original post - "would you like the nurse taking care of your Father or Grandmother, to also be responsible for 5 other patients? Or would you prefer that the nurse be able to hand off her patient load momentarily so that s/he can pay undivided attention to your loved one in their hour of crisis?"
Almost NOBODY thinks about the ER and wait times - until they have a loved one who needs to be "seen NOW!"
*** happened to "patients"??!!! Yes, it is why I highlighted the term!
I am honored to be filling in for our beloved ixchel's WILTW thread once again.
As I continue adjusting to my new job as well as reaching the halfway point in my assessment class for my MS PMHNP progeam, I am glad to have this opportunity to reflect on what I have learned. I also really enjoy seeing what we can learn from each other and how our varying nursing roles result in varying weekly lessons.
I attended the third of my sexual reproductive health trainings this week, and learned a lot of new information about adolescent brain development and the translation of said development in various activities and education needs. I found it really interesting to learn a possible cause for the impulsivity, thrill seeking, and at times promiscuous behavior of many of the teens with whom I have contact.
The brain goes through a period of development during the adolescent period (ages 12-26) after which both the limbic system and prefrontal cortex ate completely developed. However, these two systems do not develop at the same rate. The prefrontal cortex develops more slowly than the limbic system. As the limbic system seeks pleadure, risks and reward and the prefrontal cortex is involved in logic and decision making, it would make sense that during adolescence teens seek thrills and rewards at a rate at which the prefrontal cortex cannot keep up.
As a student in a MS PMHNP program, I had a midterm in a OSCE environment and was required to conduct an H&P on a standardized patient. As I had used standardized patients in my RN to BS P
program I thought I knew what to expect. The experience was good overall.
However, I am short, barely over 5 feet. The standardized patient was 6'8". I had difficulty with the HEENT component if the exam because I could not reach the SP's face. This struggle got me thinking about how I would address this in an actual clinic. I had never encountered this issue (possibly because of the do I if setup). Any ideas?
This week I found out that female condoms are still in use and provided to our clinic. We found this interesting because none of the nurses, PNPs or MDs have been using them in practice. When we got a new drluberyofcondoms from our DOH, there they were. We all has to figure out how to use them because we have not seen them or used them in quite some time.
What did YOU learn this week?
As a migraine sufferer, I too take issue with the title of this thread. I have had migraines that caused me to temporarily lose vision, migraines that caused syncope, migraine that seemed like a hallucination as well as other status migrainosus.
However, due to the current attitude towards young females with migraines, it took many years for chiari I malformation to be diagnosed. I also have had psych consults called when I came in for left sided paresis and syncope. Only after I was psychiatrically cleared was any bloodwork and imaging done.
The interesting thing is that my migraines respond only to infusions of magnesium and dexamethasone. I cannot take any opioid due to anaphylaxis, I have to be careful about APAP because of liver functions related to overmedication as a teen by a doctor, and I can't take too much NSAIDs due to multiple bleeding ulcers.
I am lucky that I have not had a migraine emergency in almost a year, but I think it is very important to remember what a headache could be:
Concussion (delayed symptoms)
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