Answers to maintain boundaries?

[r1ks]

Hey all. I did a search but didn't find what I was looking for. I don't know if maybe I used the wrong key words or what. If this has been discussed please point me in the right direction!

Quick background- I am a new grad LPN that has just started at my State Hospital. The unit I am assigned to is a medium security forensic unit. It is about 35 males, most with a diagnosis of antisocial personality disorder. I had a week of general orientation last week and another this coming week before seeing my unit and meeting my patients. Once on the floor I have a minimum of 1 month of orientation but can request up to 6 months (part of the union negotiation so I hear they can't pull you early from it). I had an opportunity to meet a couple of the nurses from my unit last week and they both said the same thing- that being a new, young 20's "attractive" female naturally makes me a target in this population for manipulation and sexual advances. My first priority should be maintenance of boundaries because it's easier to give a little slack later than to reign back in. Which leads me to my biggest question- how do I maintain boundaries without coming off as a huge jerk? Prior to this I was a CNA in acute care and have had to set boundaries a few times but for the most part my job was to help fluff patients that had spent a long time in ER and help get them admitted before shipping them to their inpatient room. 50% of my job was BSing and coddling them to increase satisfaction. So it wasn't uncommon for me to empathize (Yeah, those stretchers sure are hard on the backside. But they have to be able to do CPR on them- in the ER you can never be too careful. How about a couple extra pillows?), make jokes (Oh, 4 hours down there? You're lucky! The last guy was 8 ½!) and explain (Well, there are some labs and imaging tests that require you not to eat- they usually don't let you eat in the ER because it can delay treatment. Now that you have a diet order let's get you some food! Oh, and here's gift cards for your family to the coffee shop- they must be hungry too!). I have the strong feeling this type of communication is not going to fly. It is my default for now- it's all I've done for the last 2 years in the department I was in. I was hoping someone can help me with my answers- critique them and maybe give me some other options. Here is what I came up with so far:

Pt: Are you married?/Are you single?/Do you have a man?

Me: That's private and not up for discussion

Pt:You have nice breasts/buttocks/other anatomy (I'm sure it will be slang)

Me: As your nurse this conversation is not appropriate and won't be continued.

If I'm passing meds to the med line

Pt: What the f*** is this?

Me: Your meds. It's your ____,_____,_____.

Pt: Why the f*** did you crush my Wellbutrin? Nobody else crushes it!

Me: It is policy that I crush your Wellbutrin (or narc or other drug that has the potential to be pocketed in the cheek and sold or snorted)

Pt: Bulls***! You b****!

Me: You can either take your meds or you may refuse them

I'm having trouble knowing how I will hold conversations that don't reveal about my personal life. At my old job I loved telling my little old ladies about my 2 year old son and his antics. No way am I telling any of these guys about my son. I'll be working swing shift so most of my shift will be after treatment mall hours, rec yard hours and visiting hours. I was told a lot of my job will be to "hang out" with the patients. Safe conversation ideas?

Also, I would love to know what some good resources are for ASPD, psych care plans, psych drug books and books or sources of crisis /therapeutic communication. Where I'm going they really are cutting back on seclusion/restraints. Not to say they are not an option but they definitely lean heavy on Pro-Act and restraint/seclusion is last resort for as short a duration as possible. It's something I really respect about the facility. They all seem so focused on what's best for the client and still safe for others it's contagious. But as one of the nurses it will be up to me to decide if the patient will go in seclusion/restraints. I really do believe that good crisis communication with a person can prevent most restrictive events. I also know that takes lots of exposure to get good at. So I'm looking for all the nudging I can.

Thanks in advance for any idea/resources you can throw my way. I'm excited and nervous to have this new job. Being a licensed nurse carries so much more responsibility then being a CNA did. I think I'd be crazy if I didn't feel a bit anxious in this new level of responsibility.

[Davey Do]

r1ks:

Well, I must say from the get-go that I am impressed! Impressed by your: concerns, documentation style, history, insight, problem-solving endeavor, and tentative comeback plan.

Don't fear coming off as coming off as "a huge jerk". Continue to be factual and self-confident.

Individuals with Mental Illness do not perceive reality as the consensus. So, in a sense, their perception of you is moot. How you handle yourself and how you think of yourself is what's important.

I sense you as being a serious, focused Individual with a good sense of humor that is utilized in the right places.

My advice to you: Keep on keeping on.

Dave