behavior managment or not???? HELP

[Shell5]

I am soooooooooooooooooooooooooooooooooo angry and confused right now. I feel sooooooooooooooo powerless right now. I work at a inpatient hospital with children/adolescents. There is so many differing opinions and views on how to treat these patients there. We are an acute care unit that has patients that have diagnosis ranging from Depression, PTSD, Borderline, Bipolar, CD, ODD, rarely Schizophrenia, ADHD. There is such a vast array of patients and they all need something different. We have techs that do things like make a patient turn their shirt inside out because it says "Sweet" on it and "they are not sweet" or have them do 9 assignments. These type of things have gone on for so long. I guess I see think some things are an issue that others don't ie; a 13 y/o male says they are confused about their sexuality and they want to not go home, but to residential treatment. They have been hitting younger siblings at home. Supposedly, mom and siblings have been making fun of pt because of the sexual confusion. I see that as an issue to deal with inpatient, but most others don't. I think that is one reason why the pt may be angry, because they are being made fun of. Others just brush it off to the side. I get sooooooooooooooo angry and frustrated. Am I just not getting it?

Then, yesterday night this other RN I work with told me she thought it was "strange" that patient "seek me out to talk to." That really hurt my feelings that she would say that. I couldn't believe she would say that. She thought it was strange tht patient told me about their identity confusion, got mad at me and said, "Oh, he doesn't know what he is, he would say anything." She thinks patients "seek me out alone" to talk to. I told her it's because I am interested and listen. Do I just not understand this psych business? I get really upset about it too. I think it's because I was in places locked up when I was young, away from home and I know what it is like to be away from home, yelled at and for other people to not understand. I think that is what some of the kids are going through and I want to protect them from mean people. I want to be their advocate and protector. It is difficult right now for me. The way some of the staff talk about the patients.

I have even turned some of it in to my supervisor and there has been some improvement. I just don't want to look like a constant nag or have all my coworkers hating me because I do like my job so much. Can anyone relate? Thank for letting me air. :redbeathe

[safiyarozz]

You seem like an asset to those poor children;you are the one whom seems to understand them whereas the other staff in your facility do not.When I was in hospital as a child;I sure as hell wish I had somebody that would have listened to me;that just made it harder for me to get better.Please keep up the good-work;mayb e you can help some very hurt children.

[Orca, ADN, ASN, RN]

She thinks patients "seek me out alone" to talk to. I told her it's because I am interested and listen.

Sounds like someone's ego might be getting in the way. One thing I discovered very early in psychiatry is that just because I was the charge nurse didn't mean that I was always the best person to take the lead in every situation. Patients develop a rapport with certain staff for various reasons, and the most important thing is that the patient gets what he or she needs while on the unit, not who does the intervention.

That being said, I worked with a psych tech who had a lot of one-on-one conversations with our young female patients. After these "sessions" the patients would only talk to her. We never found out exactly what she was telling them, but I have an idea. This tech had a BA in psychology and believed that she was therefore more qualified than anyone on the unit. She even openly stated that she ought to be supervising the nursing staff because she had more education. She was eventually fired for operating outside her scope of practice.

[whodatnurse]

One of your primary roles as an RN in this setting is to recognize that every encounter with a client has the potential to be a therapeutic one. Continue to apply the various techniques you've learned (offering self, etc.) with that goal in mind and with the goals outlined in your clients' treatment plans.

On the other hand, recognize the extent to which you're able to help. The instance you described as best being treated in an inpatient setting...that may indeed be the case...but the reality is that the majority of clients who are in one either:

1. Present a risk of harm to themselves

2. Present a risk of harm to others

3. Are not currently capable of taking care of themselves

I know how frustrating it must be to see so many young people who, given their home situations, you can see why they're suffering so much, and they then have to return to them. Hopefully, the courts can do their jobs and have kids removed when physical/sexual abuse is apparent, but it's more of a slippery slope for them when it's just that the parenting / home environment leaves a lot to be desired.

[Shell5]

The other RN is the one who is upset and said she thinks it's "strange" patient seek me out. I couldn't tell if the above writer was stating that I would say something outside the scope of my practice, but that is not the case. I do care because I was in places like that and I know what it is like to be locked up, away from home with people with egos running around. It is hard as a young person to feel powerless. To have just a few people that do seem interested and willing to listen and seem like care is a blessing. I sense that sometimes others get upset with me because a patient wants to talk to me. I am not goint to change being a good natured person for them. I will do what my Higher Power wants me to do as long as it is right. :redpinkhe

[whodatnurse]

Sounds like someone's ego might be getting in the way. One thing I discovered very early in psychiatry is that just because I was the charge nurse didn't mean that I was always the best person to take the lead in every situation. Patients develop a rapport with certain staff for various reasons, and the most important thing is that the patient gets what he or she needs while on the unit, not who does the intervention.

That being said, I worked with a psych tech who had a lot of one-on-one conversations with our young female patients. After these "sessions" the patients would only talk to her. We never found out exactly what she was telling them, but I have an idea. This tech had a BA in psychology and believed that she was therefore more qualified than anyone on the unit. She even openly stated that she ought to be supervising the nursing staff because she had more education. She was eventually fired for operating outside her scope of practice.

Yeah...building on what I previously wrote...be sure you're applying techniques known to be therapeutic that are within a nursing scope of practice. Counseling, and offering advice for example, as the above poster subtly pointed out, would be no-nos.

[Shell5]

Whodatnurse:

Thanks, That really help a lot! Gives me some perspective. I do get bogged down with some of their stories. They are so sad. I do just want to help because I care.

[whodatnurse]

Whodatnurse:

Thanks, That really help a lot! Gives me some perspective. I do get bogged down with some of their stories. They are so sad. I do just want to help because I care.

I'm glad you found what I said to be helpful. Please continue to care (especially when it starts to feel as if the rest of the world doesn't), and to balance the intense desire to help with a dash of pragmatism (for your own well-being and so you don't end up feeling defeated and give up on a career that obviously means a great deal to you.)