school nursing to pediatric psych nursing.

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    i'm a relatively new nurse with 1 year experience in school nursing and just made the switch to a children's psychiatric hospital. basically, i feel like i am in way over my head. i am 1 week into a 6 week orientation and i feel like running back to the school system as fast as i can. i wanted to work with children because i actually like them, want to talk to them, want to interact with them, and most importantly, want to help them. the problem is that i feel like my attempts at interacting positively and therapeutically with the children have been stifled. for instance, i was sitting with two children during breakfast and we were talking. SUDDENLY, one of the therapy aides starts screaming at the child from across the dining hall "NO WE ARE NOT DOING THIS THIS MORNING. STOP TALKING AND EATING YOUR FOOD." While I understand that we are on a time constriction as far as eating, I feel that there was a better way for that to be handled. Perhaps the aide could have walked the 10 feet or so over and said "If you continue talking you will not have time to finish your food. Finish your food and then you can talk to the new nurse." ANYTHING WOULD HAVE BEEN BETTER THAN THE WAY SHE HANDLED IT. I mean, really. Whatever happened to socialization? Positive reenforcement? Therapeutic communication? Are these myths they teach us in nursing school?

    Also, staff such as aides will tease, name-call, and basically bully the kids. I have brought this up to my supervisor and she pretty much just shrugged it off. I find this to be very troubling to say the least. She told me in no uncertain terms that I have to stop being such a bleeding heart for the kids or I am not going to last. I'm not sure that I disagree.

    Any feedback would be great.
  2. 3 Comments so far...

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    I've been a psych nurse for almost 30 years, but only had brief interactions with non-adults, mostly by choice. Children can be very emotionally draining, and it seems to me in your situation, the other staff are making things impossible. You have to decide for yourself what is tolerable and what is not. I have worked in facilities that had bad public reputations, but I stayed because the other staff were very dedicated, by and large, and I really enjoyed working with the urban, chronically mentally ill population. One thing that I find disturbing is the increasing tendency to diagnose very young children with mental illnesses that used to be only found in the adult population. Unfortunately, some mental health professionals seem to be enamored with the idea of 6 year olds with bipolar disorder or schizophrenia. Popular culture seems to glom onto such cases with a great fascination, as exemplified by Oprah's show about an allegedly schizophrenic girl. I had to grit my teeth when I saw that program, because so much of what the family and medical team did was not therapeutic. And so you may find that you don't agree with how issues are dealt with at your facility. Do you speak up or just accept it and move on? At least you are in good company, because many nurses face the same type of dilemma. Good luck, and keep us posted.
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    Before I became a nurse, I worked as a counselor, and my internship before graduating was in a residential treatment facility for children and adolescents with a history of abuse. Not strictly psychiatric, as we didn't heavily utilize nursing staff, but we did have lots of kids with with emotional and behavioral issues. I saw much of the same behavior from our aides and house parents who were charged with taking care of our kids day in and day out. They were often abrasive and impatient, and seemed to lack therapeutic communication skills. I'm not sure if they weren't trained in basic communication or if they felt that they were overworked and underpaid, but it was discouraging to watch. We occasionally had reports of verbal abuse form our kids regarding staff members, and while some of our clients could be manipulative, some of the accusations were easily validated. Attempts to correct the problems were sometimes successful, other times not, depending on staff members.

    Management knew about the problems, and staff members with validated reports of abuse were fired, but there simply weren't enough people willing to work that job for minimum wage, which is what they were paid at the time, so they were sort of allowed to continue on until someone else came along to fill a spot. Are other nurses at your facility uncomfortable as well, or do they seem to just accept it? Perhaps a fresh set of eyes could remind them that this type of behavior isn't standard or acceptable. It's a unique setting and population, so maybe an outside perspective will call attention to the behavior. At the same time, it's hard to be the one doing that when you're also trying to fit into a new culture. I hope it gets better, both for you and the kids.
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    the nurse that was precepting me the other day told me that she agrees that the aides should not talk that way to the kids but you have to "pick your battles" and you don't want to "alienate staff." while i agree with that, i do feel that as the sole RN on the unit, i must enforce that yelling and screaming is NOT the first line of communication to the kids because a) it only serves to agitate the child further, b) it can end up agitating other children, and c)it is not a therapeutic communication technique. the aides are uneducated and go through a brief orientation and a 40 hour class on the rewards system. then they are sent out onto the floor. they are required to do mandatory overtime and they are not paid that well. all of these things can obviously add up to frustration and can lend a reason as to why they treat the kids so abrasively and impatiently. with that being said, it is not an excuse. the hospital is not a prison nor is it a juvenile detention facility so why are we treating these kids like criminals?

    my main goal is to help the kids. NOT berate them. NOT scream at them. NOT leave them crying in rooms by themselves.

    how do i set limits with the aides without alienating them? should i behave as the other nurses and just ignore it and accept that "this is the way that it is"? my supervisor told me to basically shut my mouth about it and that if i don't stop being such a sympathetic figure to the kids that i will not last. she said "you're young, you're pretty, you're sympathetic, and the kids know that if they cry tears the size of lake superior they will have themselves wrapped around your little fingers." i want to make a difference for the kids in the best way that i know how and that first starts as being nice, NOT ignoring them, NOT yelling at them, and listening to them even for the smallest requests.


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