3 hot's and a cot

nanacarol · Jul 10, 2007

What you and others describe is real, what is missing is the recognition (beyond what we have been educated to believe) these citizens are mentally ill. They are not able to make rational decisions for life issues. The safe haven is many times the hospital ER or the psychiatric hospital. Trust my 20 + years of experience, they (for the most part) would rather be one of US than live in the mental hell that is their life.

Billikin · Jul 11, 2007

You're right. The psych unit is certainly a safe haven.....for the people who have blown out their money(and brain cells) on drugs and alcohol. It's also a safe place to hide from the police. Many of the drug users we see are not mentally ill, they are skilled malingerers. They would rather get high than get jobs. I love psych and helping the truly mentally ill, but it's a bit daunting when you a have several addicts screaming, yelling and demanding . It makes it hard for the patients who really want to get better and unnecessarily challenging for the nurses who just want to do their jobs.

MentalRN74 · Apr 18, 2008

What bothers me are the admissions we get from detention who know that if they say they are suicidal, they will get to come to the hospital and any days they spend there will count as "time served" on their sentence. This takes beds away from people who truly need treatment and could benefit from an inpatient stay. And of course, we also have the "frequent fliers" who are discharged and though they can't afford their prescriptions, can afford heaven knows how much cocaine daily (oh, and they can't afford to go to a dentist and want us to treat this problem in a psych hospital). It's the patients who feel like the world owes them everything that really get to me. :banghead:

nanacarol · Apr 19, 2008

This is my perspective only, the concern for me is "what is really going on in corrections that causes a person to seek refuge on a psych unit, where we are going to load them up with the most intrusive medications available, meds with potential side effects that can be irreversible and the stigma of having been in the "looney bin", if we give the appropriate training and resources to corrections to weed out the fakes from the real mental health patients we would eliminate some of the "fake" admissions. nanacarol

nanacarol · Apr 19, 2008

Billikin, I too work psych and deal with forensic patients. What is missing is the recognition that even those who have "burned" their brain cells out have psychiatric issues. The DSM-IV may not have a diagnostic code for these situations but they do need treatment. What I have seen in the 20+years of working with all levels of mentally ill patients is that staff, after a time blend there need to be in control with the patients need to be in control. There ceases to be a clear identification of where the path to recovery is and the environment of mental health takes over. Yes, it frustrates me, yes, I sometimes give way to the malingering theory, yes I ascribe to the "they are taking up space real patients need", the bottom line is that every patient that enters the mental health arena has a need and my role as a nurse is not to be judgmental but to assess and define what treatment modality is best for that patient at the time. If sending back to corrections os the most appropriate then back he goes. Noone told me it was going to be easy, I signed on to provide care and to do no harm and to let go of my judgmental attitude. nanacarol

nanacarol · Apr 19, 2008

JRAI, Again, I ask what is the real challenge? How is your state addressing the issue of homelessness? There is a spoken need, an identified need, what are you and you colleagues doing to help address the issue of homelessness even in the winter. When they are on you unit what education is being given and what referrals to other agencies are being made and followed up on. If your State is like mine our community supports are less than adequate and there are not enough case managers to assist and follow clients after discharge. nanacarol

goettin98 · May 20, 2008

JRAI, you took the words right out of my mouth! That is exactly what my unit has become! Rarely do we get the true psych patient, because we're too full with criminals and drug addicts that are just there "living" like they're at a hotel, ordering their "servants" around. They know exactly what to say to get admitted and the sad thing is, some of the doctors are dumb enough to keep admitting them time after time. They have contraband brought in almost on a daily basis, they tell the doctors and nurses the meds they "need" to be on (usually narcs and benzos), and order food like we're getting ready for a famine. Then they sit around all day playing cards and watching movies and refuse to go to groups. I have a VERY hard time going to work every day, catering to these people who have gotten themselves into this position by making unwise choices, then using my tax dollars to support this lifestyle. All the while, those who really do need the psychiatric help fall through the cracks because we spend all the time and energy on the "country club guests". Yeah, and I have yet to see any of them come in with a negative alcohol or drug screen. We are not even a drug/detox facility! It's so frustrating, I've only been a nurse a year and I'm already considering getting out of the field.

nanacarol · May 20, 2008

I know it can be frustrating dealing with individuals who seem to be "Okay" just scamming the system. The bottom line is these people have problems. They may not be psychotic, but there are psychological issues. Drug and alcohol are serious conditions. I find these patients use whatever means available to convince someone to admit them for "respite" my term, They need a time out. Psych is not for everyone. I have done this for 20+ years and seek every opportunity to be nonjudgmental in dealing with all my patients regardless of their presenting issues or my personal biases. nanacarol

wonderbee, BSN, RN · May 21, 2008

I often feel like a prison warden with a medical perspective. The criminals are here. Their problems are behavioral. They know exactly what they're doing. I despise treating them with drugs. I despise protecting them from the consequences of their actions. They create an atmosphere of fear on the unit. They talk their gang banging and egg each other on. The cops drop them off across the street. Won't even bring them in. I guess they have a better chance of incarceration on a behavioral unit than a jail. Sorry if I don't sound compassionate. They are working the system. Sure they've got problems but addressing them in the general population of mood disordered people isn't compassionate to the latter.

nanacarol · May 21, 2008

Nursing is so varied, why not find a specialty that does not cause you so much pain? nanacarol

aloevera · May 21, 2008

I sent a pt. who had seized X3 last 24 hr. to our local hospital...

They did EEG, bolus Dilantin and sent her right back...I called..I thought they would at least IV fluid her for awhile, she was dehydrated, anorexic,......I was apalled at the care she received...No MRI, no rehydration, ....I think that the hospitals, along with some people, just seem to desregard these people because they are "addicts". It is such a shame that the public does not treat them as any human being deserves to be treated...addition, psychotic, whatever....I say "There but for the Grace of God go I". Some of these people do not have choices, they are mentally unstable, schizophrenic, etc.....

wonderbee, BSN, RN · May 21, 2008

Nursing is so varied, why not find a specialty that does not cause you so much pain? nanacarol

Who said anything about my not liking my specialty? It's not all black and white. I get great joy out of watching a schizo or bipolar clear and watching bedside crisis intervention with a borderline yield some results. That doesn't change the fact that criminals are evading jail by hanging around on our units. I don't like them. I don't think pumping them up with meds is the answer when their problem is their choices. They have antisocial personalities. They push staff and patients' buttons. They're not going to get better with drugs or acute hospitalization. I don't have the answers. But it is incorrect to assume I don't like my specialty based on my feelings about one patient population.