Do as I say, and not as I do.

[Davey Do]

I'm currently in the process of processing the events of this past weekend's three 12 hour shifts working in the psych division of Wrongway regional Medical Center. Processing does not always follow a chronological timeline so, like doing art, I tend to start at point a of reference and work from there.

Chronologically, I need to digress to about two weeks ago when it was mandated that I attend...

A portion of this mandated inservice entailed a CPI training where we learned to deal with acting out psych patients. Wadley, a tech, certified us in CPI for years but he passed away recently and is sorely missed...

So now one of the instructors who I don't really know all that well, Clark, teaches CPI. Clark was once a tech, now has the title of art therapist, is a well built man in his early thirties, solemn, and possibly possessing a vertically-challenged syndrome.

The book portion of CPI, where we learn and/or review legalities, policy & procedure, etc that was taught by Clark was a real bore. Basically, all Clark did was to read from the handouts in a low monotone.

However, the actual physical portion was a real hands-on learning experience. I have taken CPI since the mid '80's and I learned a new thing or two and I let Clark know that I appreciated the tidbits. At the end of the training, I led a round of applause for Clark.

Actually, I was relieved to be done with the day, for it truly was...

Okay, that's enough of the background information.

Sunday night, I was assigned to work the adult women's psych unit. I don't think it was my turn to be pulled, but as I told Mandy the house sup, "The next time it's my turn to be pulled, I want a Get Out of Jail Free card!"

After getting shift report at about 1920, I introduced myself to the patients in the day room, and met them each personally. Then, in the company of the LPN, I went looking for the infamous patient, Marie A, who had been responsible for at least six staff injuries. Marie A truly was, the Psych Patient From Hell. I could go on and on and on, but please accept my label.

At 1925, the LPN and I found Marie A on the floor, laying face down, between the beds, unresponsive. We couldn't see her breathing, she did not respond to our shake n shout, so we log rolled her to a supine position, as she was wearing a neck brace. The LPN did sternal rubs while I checked for a radial pulse to no avail. I told the LPN to go call a Code Blue and I tilted the patient's head back as best I could and got an sound like a snoring suck of air. Spontaneous respirations were present, I found a pulse, so I yelled, "Make that a Rapid Response!" and I checked her pupils and lightly patted her cheek.

Marie A was groggy and slow to respond when the RR team arrived, we assessed her, backboard, gurney, yadda yadda yadd, and she left the unit at 1945 for one of her many trips to ER.

At about 2200, I was in the process of admitting and getting med orders for a suicidal patient sent from ER suicidal positive for heroin, amphetamines, and cocaine who was yelling profanities and acting out when she knocked over a WOW. The tech and I assisted her into the locked seclusion room.

About that time, Marie A returned from ER via wheelchair. I advised that she return to her room when Clark started some ramma lamma ding dong with her. I got between Marie A and Clark and proclaimed, for safety's sake, she needed to return to her room.

In assisting Marie A to her bed, she became threatening and combative. A code Green was called and, with the assistance of Clark, techs, and security guards, Marie was therapeutically held. I recited, in a voice to be heard by everyone from rote memory, my spiel about the reason for the therapeutic hold, the legal process, and the criteria for the restraint to cease. I also said that I was going to contact the doctor for a chemical restraint.

I went back to the nurses station and Mandy the house sup, God bless her, had gotten an order from the psychiatrist for Thorazine 50/Ativan 2 IM now. I set up two syringes and returned to the room to find Marie A out of a therapeutic hold. I said, looking at Clark, the staff member who certified me in CPI, and recited, "Only a licensed practitioner can discontinue the restraint process"!

Or, "Do as I say and not as I do".

[dream'n, BSN, RN]

I know this Clark. He has many, many twins working in psych around the nation. I often wonder who he slept with (or has the dirt on) to get admin to justify his every action. He thinks he's the director of the place.

[RNNPICU, BSN, RN]

Davey Do:

What I wouldn't give to have had eyes ? in that room to see Clark's reaction. ?

Nicely played.

[Jedrnurse, BSN, RN]

14 hours ago, pixierose said:

You kinda just want to stab the Clark with the IM yourself but ... what a waste.

I don't know; Clark may benefit from the administration of whatever chemical cocktail your doc favors...

[Davey Do]

21 hours ago, OldDude said:

Are you sure Clark didn't play Eddie Haskell on Leave it to Beaver?

To you, Mr. OldDude- and BTW, that's a lovely dress you're wearing today- Clark is more solemn. Like I said before, a well built vertically-challenged man in his early 30's... more like a Mini Me version of Bruce Willis!

I believe Clark has sociopathic tendencies.

Yep that about nails it:

[Davey Do]

22 hours ago, Workitinurfava said:

Maybe Clark misses the old days when he was a tech but he needs to stay in his place (Art Therapist).

Last year on geriatric psych, Clark, who I didn't know at the time, and I had a different perspective on the method of dealing with a patient with pretty severe dementia who was a 1:1.

I asked Clark who he was, learned his name and title, and thanked him for his input. Then I asked him what he was doing on geriatric psych, as sometimes administration will place staff on a unit without informing the RN. Clark said he was just visiting some other staff member. I replied with something like, "So you're not assigned to be on this unit, you're just passing through". My statement was passive-aggressive enough that I believe Clark got the point and left the unit.

I sense that Clark needs to feel like the alpha dog with any pack in which he is involved.

So, in reply to your poignant post, workitinurfava, I believe it feeds Clark's need is to NOT have to "stay in his place" where he may roam the medical center marking his territory.

Thank you so very much for your perspective, workitinnurfava, as your perspective allowed me to examine another aspect of Clark, thereby increasing my understanding of why Clark's presence makes the hair on the back of my neck bristle!

[Davey Do]

15 hours ago, Hoosier_RN said:

I've worked waaaaayyy too many hours today. I thought it said refried...

Maybe I didn't say, "Where's that REfriend button", Hoosier...

[Davey Do]

15 hours ago, pixierose said:

You kinda just want to stab the Clark with the IM yourself but ...

Ain't no butts about it pixierose.

However, medication is only a portion of the therapy in dealing with one's illness.

It's like Dr. S once told me: "You can give medication to people with personality disorders, but it doesn't do very much".

[Davey Do]

12 hours ago, dream'n said:

I know this Clark. He has many, many twins working in psych around the nation. I often wonder who he slept with (or has the dirt on) to get admin to justify his every action. He thinks he's the director of the place.

Amen, dream'n.

Sometimes administration picks golden children for no apparent reason and I do believe Clark is a golden child.

Just a thought: They might choose a golden child because hat staff member is a means to an end. I believe Wadley- the tech CPI/instructor who passed away recently- was one of those golden children. The difference between Wadley and Clark is that Wadley was pleasant and knew his boundaries, whereas Clark believes he is omnipotent.

I really do appreciate you all discussing this situation with me. Discussing Clark's behavior helps give me new perspectives and allows me to get my head around it.

[Night__Owl, BSN, RN]

I'm fairy certain we had a Clark in the ICU I worked in. A tech who iirc had failed out of nursing school, but had just enough knowledge to be dangerous. Unit Clark went into the room of a vent patient, saw that the IV pump was alarming and said "infusion complete" and turned off said propofol infusion. Without telling anybody.

[Jedrnurse, BSN, RN]

1 minute ago, Night__Owl said:

I'm fairy certain we had a Clark in the ICU I worked in. A tech who iirc had failed out of nursing school, but had just enough knowledge to be dangerous. Unit Clark went into the room of a vent patient, saw that the IV pump was alarming and said "infusion complete" and turned off said propofol infusion. Without telling anybody.

Was this particular Clark fired?

[Davey Do]

2 hours ago, RNNPICU said:

Davey Do:

What I wouldn't give to have had eyes ? in that room to see Clark's reaction. ?

Nicely played.

Thank you, RNNPICU. Through the magic of manipulating media, you may be that fly on that wall:

This may have been the first time that I ever saw the whites of Clark's eyes as he nodded his head at me and positioned himself to resume the restraint.

However, I believe Clark experienced no epiphany. After I injected first the Ativan in one gluteal muscle and put down the protected syringe to alcohol wipe the area, Clark picked up the used syringe.

Without looking at Clark, I took the syringe back and said loudly, in my best irritated John Cleese Monty Python voice, ""Thank you!"

I thought perhaps Clark would take the hint to keep his nubbin' shuckers off my spent syringe, but after we rolled Marie A over and I gave the Thorazine injection in her other gluteus, and I put down the spent syringe to do the alcohol wipe thing, Clark again picked it up and handed it to me.

Maybe Clark picked up the spent syringes as a safety precaution. Maybe Clark was playing nurse assistant to me being the nurse. But somehow, deep in my heart, I really believe Clark was again playing alpha dog and marking his territory.

[Davey Do]

On 3/5/2019 at 12:03 AM, Davey Do said:

I'm currently in the process of processing the events of this past weekend's three 12 hour shifts working in the psych division of Wrongway regional Medical Center.

Sunday night, I was assigned to work the adult women's psych unit. I don't think it was my turn to be pulled, but as I told Mandy the house sup, "The next time it's my turn to be pulled, I want a Get Out of Jail Free card!"

After getting shift report at about 1920, I introduced myself to the patients in the day room, and met them each personally.

At 1925, the LPN and I found Marie A on the floor, laying face down, between the beds, unresponsive.

A code Green was called

I went back to the nurses station and Mandy the house sup, God bless her, had gotten an order from the psychiatrist for Thorazine 50/Ativan 2 IM now.

I copied some portions of the opening post because I wanted to take the negative focus off of Clark for a moment and focus on the positive people and aspects of these interventions.

Mandy, the house sup, was incredible and was integral in the success of these interventions. Mandy not only contacted the psychiatrist for a chemical restraint order but also charted on the other patients, completed the paperwork for the seclusion, therapeutic hold, chemical and mechanical restraint.

I told Mandy how much I appreciated her involvement and said, "Professionally speaking, I love you!" She replied, "And the feeling is mutual!"

I shook the hand of Nan, the LPN who found Marie A down, thanked her and told her, "You did a good job!" She replied, "Likewise!"

I thanked the techs and security guards as well.

Then, I went into the day room where the majority of the other patients were, told them we had a crisis which had been resolved, and thanked them. I loudly said, "Give yourselves a big round of applause!" and led the round.

One patient said, "But we didn't do anything!" to which I replied, "Sometimes doing nothing is the best thing to do!"

Another patient, identified in report as manifesting behaviors like that of a Borderline Personality, asked "What happened?" I said, "What happened is on a need-to-know basis and you don't need to know. Just know this: Everything has been dealt with and you helped by taking care of yourself!"

Yeah!