I just got home after a frustrating shift that ended up requiring 2 hrs overtime so that I could complete MY charting as I had been covering a lot of the stuff that the other nurse working with me would've done in a normal situation.
I work at a 90 bed facility as the eve charge nurse on an adult unit. I started my job in Sept, was hired straight out of a travel contract at a psych unit at a large medical center. I decided to stay and make my home here, but found the morale and 50% turnover at the big hospital a huge bummer. So I got a job at this hospital as it similar to the settings I've been the most happy practicing in. I am in charge by default almost, b/c a lot of registry nurses are used. In that case the staff nurse is technically in charge.
However while I was orienting the staff were told I would be taking over charge of the unit- they never mentioned it to me. Anyway I understand that they need to hire RN's and in AZ psych positions are not being filled by staff bc registry staff often make more $, and bc they have steady hours and either don't care about benefits or get them from a spouse.
So basically the hospital announced that it had just hired about 20 RN's that had decades of experience- just none in psych. That's not really an issue, if you work with patients at all then you have some psych exp, charting is all quite similar, and I love my field, I don't mind showing someone how I do my job if they can show me things that are universal but are learned by exp.
So last week I got an orientee. They give us a week of on unit orientation bf we get a full assignment- split a 20 bed unit and have a fantastic med nurse and amazing techs that I trust and do their job above and beyond. I consider them to be in charge really as they are interacting with the patients all the time and I have to fit in 1:1 time in with all the paperwork that we have to spend time on- that's universal. We work very closely and can get an amazing amount of work done bc we all know our strengths and do what we are good at. It's not computerized and I can generate massive tornadoes of paperwork, but others are organized to the point of OCD. I assess, they put stuff where it is supposed to go, etc. Anyhoo, the RN that I got was on her last day of orientation and I was in her shoes recently- I know the challenges, esp with a hosp that isn't computerized. It took me a while to get into the groove, but I had a strong background of 10 yrs of psych under my belt. I didn't know their particular system but I have the basic psych skills.
The nurse I am working with has always worked in the OR. Probably some culture shock- just the fact that our patients are conscious must be a big deal. HOWEVER, this nurse doesn't know a damn thing about psych at all. She doesn't have a clue about the DSM criteria, what the treatments are, multiaxial dx, etc. I would be lost in the OR myself. What concerns me is her basic lack of knowledge. She has taken family members phone calls and given status updates wo checking for a release, and tells the families (even the ones with a ROI) things like "tirepitol, umm, I think it's for cholesterol, but anyway the pt is just fine." She said this to a family member who has a background in psych. She asked them to call back at time that wasn't as busy. Thank God. It was her pt, but she was making a valuable discussion into one that could have cut off communication. I needed info about a pt who had no insight, and the relative was able to give me info about what meds the pt took, what she didn't, and in this case the risky manic bx that got her there in the first place. We discussed the TRILEPTAL and she was relieved bc she felt that tegretol was worth a try and had been hoping for an antiseizure MS.
I have given the nurse a number of resources- NAMI for example- they have info for every level of understanding and it seemed like a good place to start her off.
I am becoming more alarmed by the day though. The staff was given a clinical inservice yesterday about steroid induced psychosis (it happened last week when a depressed lady became stark raving mad after a medrol dose pack). She said that she'd heard of it but didn't think that pt was a body builder. The techs and I explained that we were talking about corticosteroids not anabolic. She'd never heard of any of them and I had pulled out a drug ref and named as many as I could find- expecting she recognize one drug name. Nope. Not prenisone, cortisone or any of the different trade names. She doesn't know what an anti psychotic is or what it treats. Same with mood stabilizers. Keeps telling everyone that abilify is brand new and its for depression. Argh!!!! She got that from TV .
I damn near fell over in report today when she asked what ativan was, and then when I told her it was a benzodiazapine wanted to know what that was. She doesn't know anything that I would expect a seasoned nurse to have rudimentary knowledge of and isn't trying to learn. I let her take report on an admit but called for my own sanity bc she got nothing- not even the pts name + age on paper. I didn't call back in front of her and no one else knew- I'm not going to make her look bad. I don't think I need to.
So basically I am doing my assignment on the fly, and dealing with everything from MD orders to med ed with the pts. She is not attempting to get her feet wet.
The final last straw was when I had to save her behind from a pt that should have been screened out as too dangerous and sent to county- they released him still very sick and very dangerous. He'd almost killed his case manager last week- CAH. 18 yrs as a non compliant para schiz with a record of escalating violence. In assessment gave one word answers with major latency, stared and then glared when asked about his ability to tell staff if voices got worse. All I could get out of him before he stopped talking and just glared was that he was pretty sure someone would not die tonight. I gave her the basic safety info- be closest to the door, don't turn your back and please try not to be alone with him any amt of time. Then explained that he was quiet but a huge risk, what I picked up in his presentation and meshed with his history. Told her that ANY change in bx was a sign he was gonna blow. Later he started bouncing his knee in the day room and I cleared all the pts out pronto. She stayed and let him between her and the door. I finally told her I needed her help right away in the hall. She said "in a minute". His nostrils flared and kapow. He hit her in the face. I did everything I could do to avoid this and she sooo lucky I kicked his feet out from under him so she could get away then ran myself. His CM is still in the ICU! I feel that the issue needs to be addressed bf she comes back on the unit. It is not her fault he is violent but I warned her. She lacks judgement knowledge and honestly, a brain IMHO. It will look like I'm blaming her for being an assault victim but I can't keep her safe, and the patients and do all of her thinking for her too. I could let her sink or swim but there are 20 patients and half don't deserve crappy treatment. I can't help it, can't stand it that I know the answers and she doesn't know or care to know. Advice, please?????
If you return to travel nursing that would help with the housing situation wouldn't it? Sorry to hear about your situation but just keep in mind........look what you have been strong enough to overcome. Think about it this way.....what would you tell a patient who told a story to you just like you have told us. You should also look into the "Alternatives for Battered Women" in your area. They have a lot of resources. Good luck to you.
Ok, I know some of this is old stuff but I have to comment here.... I am an OR nurse... I am also a nurse of 36 yrs. I have been in the OR for 12 plus yrs. I am considering taking a job in a Psych hospital.. is the above typical? I could hardly get through all the stuff this person wrote..
Giving meds is another thing for an OR nurse. As the OP wrote the nurse she was orienting came from an OR setting, so how long did she work in the OR. As OR nurse's we don't give meds, none, ....this is a function of the Anesthesia.. can you imagine us giving their sleeping pt's drugs.. duh.
Now, this person should know what Ativan is... may not be up to date on all the side effects, doses's etc. After all, what you don't use you lose. IF this person worked yrs in the OR she hasn't given drugs in yrs. But, a good pharmacology book can help you review psych drugs and get up to speed. This is what I expect I am going to have to do if I take this job.
Please be aware that changing to psych doesn't mean we are looking for an "easier" job, not by any means. But, sometimes something totally different looks so good. Give her a break, offer resources and anything to help her make it... you may be in her position one day..
mentalhealthRN
433 Posts
If you return to travel nursing that would help with the housing situation wouldn't it? Sorry to hear about your situation but just keep in mind........look what you have been strong enough to overcome. Think about it this way.....what would you tell a patient who told a story to you just like you have told us. You should also look into the "Alternatives for Battered Women" in your area. They have a lot of resources. Good luck to you.