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Do as I say, and not as I do.

Nurses   (1,941 Views 43 Comments)
by Davey Do Davey Do (Guide) Guide Expert

Davey Do has 35 years experience and works as a Behavioral Health RN.

1,839 Likes; 13 Followers; 71,739 Visitors; 5,772 Posts

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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...

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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...

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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...

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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"!

 

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

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TriciaJ has 35 years experience as a RN and works as a Retired.

1,096 Likes; 5 Followers; 30,758 Visitors; 2,770 Posts

Every psych unit needs a Clark.  Or at least, every psych unit has a Clark, whether they need one or not.

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NurseCard has 13 years experience as a ADN and works as a RN.

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Stealing the thread for a minute.

I envy Clark.   I wish I could be an art therapist.  I considered going to school for it once upon a time.  Until I realized what a gigantic pay cut I would take, going from RN to art therapist!!!

 

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Davey Do has 35 years experience and works as a Behavioral Health RN.

1,839 Likes; 13 Followers; 71,739 Visitors; 5,772 Posts

19 minutes ago, TriciaJ said:

Every psych unit needs a Clark.  Or at least, every psych unit has a Clark, whether they need one or not.

Oh I do wish you would expand on your statement, TriciaJ.

In the meantime, I will interpret your premise from my perspective:

Clark, an an employee whose duty is to teach and certify others, is well aware of  the of the process and guidelines of an intervention yet chose to overstep his authority as a result of his personality. Clark has a need to be in control and misuses the power given to him.

Clark does not have the right or power to release Marie A from the restraint; the therapeutic hold. Yet he probably instructed the techs and security guards to  remove their hold upon the patient as he was, at the time without a licensed practitioner present, the team leader.

Staff members present were probably aware that Clark is a CPI instructor and followed his advisement to release Marie A from the restraint. 

When I entered the room and saw Marie A no longer being restrained, I was miffed. I reacted and proclaimed the legal guidelines to which Clark nodded.

Clark knows he was at fault. Clark knows I know he was at fault. For the time being, that was enough for me.

 

 

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Davey Do has 35 years experience and works as a Behavioral Health RN.

1,839 Likes; 13 Followers; 71,739 Visitors; 5,772 Posts

36 minutes ago, NurseCard said:

Stealing the thread for a minute.

I envy Clark.   I wish I could be an art therapist.

 

With all due love and respect, Nursecard, Clark having the title of art therapist is not the essence of this thread. I'm stealing this thread back.

The essence of this thread is to show an example of those with some power who believe they are above the rules. Hence: "Do as I say and not as I do".

But to approach the art therapist thing, I'mot sure Clark is truly an ATR- registered art therapist, a position referred to in these parts as "rare as hen's teeth".

Clark previously held the title of tech, then, all of a sudden, was an art therapist. I believe he may be an assistant, working under the license of an ATR. Clark behaves in a way with a personality that I've not seen in any other art therapist in which I have ever worked.

But mine is all conjecture. I need to gain empirical data.

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NurseCard has 13 years experience as a ADN and works as a RN.

140 Likes; 3 Followers; 2 Articles; 34,907 Visitors; 2,844 Posts

He's not even a real art therapist?  Bogus, man!

I'm sorry that you are having to deal with little man overstepping his power.  Where does his "power" come from anyway?  

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TriciaJ has 35 years experience as a RN and works as a Retired.

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The first line of my post was facetious.  The rest of it was grim reality.  Every psych unit has someone who inflates his credentials, assumes authority he doesn't possess, and does completely boneheaded things.

He managed to get on the good side of somebody.  How else do you call yourself a therapist for handing out crayons?

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Davey Do has 35 years experience and works as a Behavioral Health RN.

1,839 Likes; 13 Followers; 71,739 Visitors; 5,772 Posts

9 minutes ago, NurseCard said:

  Where does his "power" come from anyway?  

His power comes from WRMC administration whose motto is "We can do whatever we want at any time and if you don't like it, you can just lump it".

I've not been given the P&P on how to justly lump it.

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Davey Do has 35 years experience and works as a Behavioral Health RN.

1,839 Likes; 13 Followers; 71,739 Visitors; 5,772 Posts

5 hours ago, TriciaJ said:

Every psych unit needs a Clark.  

Is that synonymous with: "Every party needs a pooper, that's why we invited you!"?

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Davey Do has 35 years experience and works as a Behavioral Health RN.

1,839 Likes; 13 Followers; 71,739 Visitors; 5,772 Posts

5 minutes ago, TriciaJ said:

Every psych unit has someone who inflates his credentials, assumes authority he doesn't possess, and does completely boneheaded things.

 

Simply, yet beautifully, stated TriciaJ.

Now: Where's the REfriend button?

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Davey Do has 35 years experience and works as a Behavioral Health RN.

1,839 Likes; 13 Followers; 71,739 Visitors; 5,772 Posts

8 minutes ago, TriciaJ said:

How else do you call yourself a therapist for handing out crayons?

I worked with a therapist at Anomaly State Hospital who had his doctorate in recreational therapy.

He called himself a Play Doctor.

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TriciaJ has 35 years experience as a RN and works as a Retired.

1,096 Likes; 5 Followers; 30,758 Visitors; 2,770 Posts

A doctorate in recreational therapy?  What was his master's in?  Macaroni art or ring toss?

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