Advice requested regarding mental health rotation

[CardiacNursing]

Good morning and or afternoon depending on where you are all located. I hope all is well for you. I am a nursing student attending University to earn my BSN. I have a bit of a dilemma which I hope you all might be able to give some assistance, advice, and or reassurance. I currently work in an Emergency Department as a Technician. I've been an Emergency Department Technician for almost a full year now and the job is quite exciting and energetic. I have the opportunity to share in my patients' lives and help in the immediate acute care treatments. Here is my dilemma though. We have an extensive behavioral and or mental health section of our ED and a brand new unit for behavioral health. As a Tech, it is my responsibility to perform patient watches from time to time. This includes both intoxicated patients, mental and or behavioral health patients, and intoxicated behavioral health patients. 

Last year, in December on Christmas Day, I was working an evening 12-hour shift. I had a heavily intoxicated patient come in who also happened to have a mental health disorder. At first, she seemed pleasant enough but that soon turned sour as, thereafter, she would repeatedly attempt to get up and walk around the Emergency Room without any clothes on. I was on a one-to-one watch with her. She would repeatedly scream the place down, and call me every derogatory term you could think of. We had to medicate her twice which didn't help. We had to call security no less than 4 times to restrain her. Towards the end of my shift, she had tried to elope and I had managed to gently coerce her back into her room but as she was getting back onto the stretcher, she turned around and kicked me as hard as she could in my abdomen, injuring my liver, bruising it and part of my colon, which caused me to have internal bleeding and bleeding during BM for almost two months as a result. I was out of work for one month as a result and had to have counseling sessions because I was very stressed out, scared, and uncomfortable as a result. I am afraid I had some PTSD from that experience. 

I have a family member who has a mental health disorder and you would think I'd be used to that by now but, unfortunately, I am not. He doesn't act up all the time but he has his moments and days where he forgets to take medication or something influences his behavior such as the news and or politics. Or something scares him in a movie he watched or show etc... But I love my family member even if sometimes I have to show him tough love, gently of course.

My dilemma is this. Every single time I have to go and do a one-on-one watch or if I have to help ambulate an intoxicated patient or a patient who has taken drugs, same thing with a patient with a mental health problem, I continuously become scared to death. Almost like I am having a panic attack. Twice I've landed in my ED because I felt like I was going to pass out as a result. I guess I am still having some PTSD.  Now I love all the other aspects of my job. I have extensive experience working with Cardiac patients and love Cardiology. I worked as an EKG Technician for a year etc and worked with Oncology patients as well. I know that Nursing is the field that I want to continue to work in. My result and goal is to become a Cardiac Nurse working with patients in the CVICU, Post-Operative Cardiac Care, and Pediatric Cardiology. 

I need to know how I can get over this fear of working with mental health patients though because honestly, I become petrified when working with them from my experience last year in December. I am not complaining or whining. I love working in healthcare and I love all the other aspects of my job and my future career but this is a hurdle that I am struggling to overcome. I thought exposure might help me but, unfortunately, it seems to only be making things worse. I recently was doing a patient watch for a couple of hours, and those couple of hours felt like an eternity to me.  

So if anyone has some advice that they could potentially offer me, to help me out so that I may reach my full potential as both a nursing student and a nurse in the long run, then I would be greatly appreciative. Because I will have to go to the behavioral health units as a nursing student during those clinicals and those particular clinicals will be the toughest for me if I can't get through this now. 

[FullGlass, BSN, MSN, NP]

I am so sorry you went through this!  Your reaction is perfectly understandable. Unforunately, it is all too common for nurses and other front line personnel to be attacked by patients.

As a PMHNP, I urge you to continue with talk therapy.  You should also talk to a therapist about techniques such as EMDR, developed to treat PTSD.  In addition, if you are not currently taking medication, I suggest you talk to your PCP about this or request a referral to a mental health prescriber such as a psychiatrist or PMHNP.  The most commonly used meds to treat PTSD are SSRIs, which are generally well-tolerated.  It will take time to heal from this.

You should also talk to your mental health care provider about requesting work accommodations.  While you can't avoid people w/mental health issues forever, it is reasonable to request limited exposure for awhile, with a ramp up schedule.  

No matter what kind of nursing you do, you will run into patients (and family members) with mental health issues.

With regard to nursing school, yes, you will have a mental health rotation.  However, these generally do not expose students to dangerous patients.  I had my rotation in 2 separate locked wards and there were no issues.  I observed an ER RN for 4 hours, but fortunately, it was a pretty quiet period.  My school allowed us some choice in our rotations - you could indicate if you were more interested in one rotation choice over another.  If you are still having issues with the mentally ill, once you are in school, talk to your advisor about this.  They may able to have you assigned to a less acute mental health rotation.  For example, I chose an additional mental health rotation and was assigned to a children's day hospital program.  The children were quite well-behaved and less acute than in an in-patient program.  As students, we were told to immediately seek help if a patient was having a meltdown and were not expected to deal with such patients alone.

Best wishes.

[CardiacNursing]

FullGlass,

 

Please allow me to apologize for the delay in responding on my part. I have been quite busy finishing up one course at college and continuing my Summer BSN Intro to Nursing course. Upon reading your response at length, I wish to thank you sincerely for your concern, for your compassion, care, and for your advice. I greatly appreciate it. Unfortunately, I think one reason I am finding it difficult to work with those patients is because I have a Disability called Autism. In the past, I have been bullied a lot so that may play a role in my mental fortitude as well.

However, the reason why I am pursuing nursing is so that I can play a key role in the patient's life and in their family's life. So I can provide that strong support system and I can give me all in the attempt to care for them so they can get back on their feet. No pun intended. 

I just wanted to say thank you again :). 

 

Best Wishes

[FullGlass, BSN, MSN, NP]

CardiacNursing said:

I just wanted to say thank you again :). 

 

Best Wishes

You are very welcome.  You might talk to your school advisor about doing a pediatric mental health rotation, as that might be easier for you.  A large portion of these children have been bullied, and this would be an opportunity for you to help these children.  Children are also less intimidating than adults.

As a nursing student, the school does not want you in dangerous situations.  (That is a huge liability issue for them).  The patients on locked wards are generally pretty stable, so it is not like being in the ER.  Here are typical activities a nursing student would perform on a psych ward:

- Spend time in the milieu just talking to pts, helping them with activities like coloring

- Observe psychiatrist treatment sessions

- Shadow psych RNs on the unit and assist them with things like taking VS, entering chart notes

- Observe group therapy sessions

- Later in the semester, design and deliver your own group therapy session (this may be done as part of a student pair)

- May be asked to interview a patient for a class assignment

Also, students are usually paired up so they are not alone, especially with patients.

I was terrified of my first mental health rotation as an RN student.  Many of my family members have mental health issues and I had this irrational fear that I would somehow "catch" a mental illness 🙂   To my surprise, I found a deep interest in mental health and helping individuals with these issues, which is how I ended up being a PMHNP!  

When on the adult wards, I never saw an alarming incident (some of this is luck, but the patients on the ward have been stabilized).  I did see 2 alarming incidents when working with children - 1 poor girl had a complete meltdown, but this was actually therapeutic for her and 1 young boy (about 4 or 5 yo) had a temper tantrum because he had to spend the night in the hospital.  Some of my fellow students were in the adult ward when a patient became agitated and the staff rushed the students out of the area.  They told me the patient was quieted quite quickly; the staff rushed them out so fast they really didn't see or hear anything.

Remember:  no one expects you to endanger yourself as a student.  If anything upsets you, you can leave!  You can leave the area and take a break.  

Please discuss your concerns with an advisor or trusted professor.

Best wishes.