Assistance needed! Feeling overly paranoid

[worrywart01]

fellow workers of the dark side, I am new to this realm of patient care. I recently started working as a mental health tech on a locked crisis unit for a private psych facility. I really enjoy the work, but one thing I am still so paranoid on is when I admit a new patient and have to search them and make sure they are not bringing any contraband onto the unit.

A situation I had on Thursday at work was when we had 2 patients return from court. The patients were allowed to put their shoelaces back into their shoes for court and they were brought to the courthouse via a sheriff's van with 2 officers. When said patients returned from court, I brought them back to the unit with another RN and was informed by a co-worker that I needed to wand them and make sure they didn't have anything.

So, I took their shoelaces, put them in their contraband bag and then asked each of them to empty of their pant pockets. One patient had our hospital lotion and the other had his soft cover bible which had been allowed on the unit previously. The metal detector we use on our unit is extremely sensitive and will go off for the slightest bit of metal (i.e. buttons on pants, zippers, etc).

One of the patient's was wearing a zip-up hoodie that had 2 small pockets on each side of the chest and when I scanned the patient, the detector went off but I assumed it was because of the zipper and I didn't pat down pocket! and I feel like an idiot. The floor was hectic and I just assumed that since these patients were in the custody of cops, they weren't going to be able to have contraband on themselves, so the thought of patting the pt. down never crossed my mind and the thought of not having them take off their shoes never crossed my mind.

I didn't really think about it until like 10 minutes later when my OCD personality started kicking in and so I went to the patient's room (they were out in the day room) looked in his jacket pockets and didn't find anything. But I still was freaking out. I thought about telling the charge nurse, but I didn't want to come across as sounding like a complete basket case.

It was towards the end of my shift, so I clocked out, but I have not been able to stop thinking about the worst case scenario. and when I say worst case scenario, I mean patient killing themselves or another patient, stabbing a co-worker, etc. I was scheduled to work the next day and wanted to casually bring up my fears to someone at work as sort of a "haha, hey guys, guess what I'm totally freaking out about", but I was called off d/t low census and I'm not back for another 2 days. Am I making this out to be a bigger deal than it actually is? I have this strong urge that I need to confess what I did to someone at work and it is making me feel like I am losing my cool.

what would you guys do in my situation? Should I say something? how should I word it so I don't come across as being a weirdo? should I let it go and enjoy my Sunday afternoon? Please don't read this and blow it off. I will take any comments, criticism, advice. Anything to make me stop feeling so paranoid.

[worrywart01]

Anyone?

[Jules A, MSN]

First breathe. If you were serious and you have OCD it is an anxiety disorder and that is going to haunt you so you are going to have to learn how to adjust and cope. What you describe is initially a normal reaction and I defy anyone to say they haven't done something in hindsight they wish they did differently or had this type of worry later at some point in their nursing career but now you are taking it to the extreme. Yes it could have ended in disaster but at this point I would let it go and use this as the learning experience it is. Despite the wand being overly sensitive you must thoroughly check every single time which I guess you will do going forward. Hang in there and attempt to rein in your anxiety while remaining conscientious which will make you a wonderful tech and then nurse if that is your plan. I'm not saying this at all in a mean spirited way but if you aren't in therapy and haven't had a medication evaluation now would be a good time because there might be some relief available.

[Cat365]

I don't work in mental health and I don't know the issues that the person you didn't search well might have, but I don't see how you can do anything about your faulty search at this point. If the patient had something in their pockets it's gone now. If you confessed at this point hours/days later what could be done? Mount a search for a probably non-existent item? Unless the patient is a high risk offender (not the correct term I'm sure, but you get my point) I would pray that nothing happens and make it a point to never again get sloppy with a search. If you think that there is a good possibility that you missed something and that the risk to the patient/other patients/staff is real. I would bring it up. Otherwise confession is not always a good thing. We all make mistakes and if there is something to be done I would do it, but I really don't see what could be done a this point to find an item that you don't really think exists.

[cleback]

I worked in a locked unit. We didn't have metal detectors, so your unit is already more advanced than was mine. You could call the charge nurse and say you forgot to check the pocket but it might be a lost cause now if they hid it. Take your experience as a learning opportunity and be more concientious next time. As much as we try, units will never be 100% safe... Once we even had a visitor bring a gun to the unit.

[TheCommuter, BSN, RN]

Duplicate threads have been merged.

[worrywart01]

First breathe. If you were serious and you have OCD it is an anxiety disorder and that is going to haunt you so you are going to have to learn how to adjust and cope. What you describe is initially a normal reaction and I defy anyone to say they haven't done something in hindsight they wish they did differently or had this type of worry later at some point in their nursing career but now you are taking it to the extreme. Yes it could have ended in disaster but at this point I would let it go and use this as the learning experience it is. Despite the wand being overly sensitive you must thoroughly check every single time which I guess you will do going forward. Hang in there and attempt to rein in your anxiety while remaining conscientious which will make you a wonderful tech and then nurse if that is your plan. I'm not saying this at all in a mean spirited way but if you aren't in therapy and haven't had a medication evaluation now would be a good time because there might be some relief available.

I do agree that I'm being a little over the top, but only because I would feel HORRIBLE if something were to happen. Apparently an RN is supposed to do a skin check when the patient comes back, but that was never done either. As far as the patient's go, one was being discharged the following day and the other was not DTO, he was just saying off the wall things that caused him to be admitted in the first place.

and going forward, I will most definitely be more thorough. When I first admit a patient, I check all their belongings, make them take off their shoes and socks and carefully wand them. This was the first time I had a patient coming back onto the unit and I guess I didn't think much of it since they had been in the custody of the cops for the duration they were off the unit.

[worrywart01]

I worked in a locked unit. We didn't have metal detectors, so your unit is already more advanced than was mine. You could call the charge nurse and say you forgot to check the pocket but it might be a lost cause now if they hid it. Take your experience as a learning opportunity and be more concientious next time. As much as we try, units will never be 100% safe... Once we even had a visitor bring a gun to the unit.

I had thought about calling, but I didn't know how to voice my concerns without coming across very strange (which I'm sure is what is happening now). I have this strange urge to.confess what happened to someone because it will be one of those weight off my chest sort of things, but it will be a week since it happened by the time I go back to work at which time both patients could potentially be discharged anyways.

[MrChicagoRN, RN]

I had thought about calling, but I didn't know how to voice my concerns without coming across very strange (which I'm sure is what is happening now). I have this strange urge to.confess what happened to someone because it will be one of those weight off my chest sort of things, but it will be a week since it happened by the time I go back to work at which time both patients could potentially be discharged anyways.

Is this a violent population?

Call your manager, say you feel like you might have missed something in the search. Then it's out in the open, and your manager can make the decision if any further action is necessary.

[TriciaJ, RN]

First of all, the term "paranoid" means to be having delusions of persecution. I try not to be pedantic, but if you're working psych you'll lose credibility by misusing the terminology.

It is normal when you're new to be excessively worried about making a mistake. It's actually a good sign; it means you take your responsibilities seriously. If ever you feel you could have done something better, it's usually a good idea to talk to the charge nurse and voice your concerns. He/she might be able to allay your concerns and might be impressed that you care enough to own up to an error and try to learn from it.

As you continue to seek feedback and show your employers that you're conscientious, you will be able to relax and start to enjoy getting good at your job. If you keep on being excessively anxious, to the point where you can't seek input from your charge nurse or coworkers, then like Jules said, it might be a good idea to get some help.

I have a feeling you're going to be really good at your job. Hopefully you can ease up on yourself. Good luck!

[Krzysztof]

I try not to be pedantic, but if you're working psych you'll lose credibility by misusing the terminology.

pe·dan·tic /pəˈdan(t)ik/ adjective: of or like a pedant

ped·ant /ˈpednt/ noun: a person who is excessively concerned with minor details and rules or with displaying academic learning

First time I've actually looked that one up, Tricia.

Got my word of the day in early. Thanks!

[needlesmcgeeRN, ASN, RN]

While we are at it, let's stop using "OCD" outside of an actual diagnosis.

And now you'll know better for next time, always be thorough.

First of all, the term "paranoid" means to be having delusions of persecution. I try not to be pedantic, but if you're working psych you'll lose credibility by misusing the terminology.