evil.. just so evil...

[nurse441]

I'm pretty heart broken right now seeing the type of care given at my facility. I work at an acute psych facility.. and i feel for the patients who has a hold, reised status, conserved.. a lot of times, these patient's basic rights are taken away. The other day i had a patient who was reised.. and complained that her med was giving her severe constipation- that is affecting her entire GI system, making her nauseated, extreme pressure. naturally, she refused the med and said "this med is giving me such a strong SE". I wasn't sure how to handle this situation since she is reised. She pleaded to me and said, "i know you nurses will shoot me with an injection if i dont take my oral pills.. please don't.. please, you're killing me".

When i contacted my charge nurse, she said just GIVE IT! these patients are psychotic, dont care about what they say! they are doing everything to manipulate you into thinking they don't have to take the meds. just give her the IM backup and get it over with!

So i decided to call the MD to see if we can change to another med (since the pt agreed to take another similar one). the MD disregarded the case. . the nurses yelled at me for picking up the phone =/ and said "i'm too new to know how manipulative these ppl are.. If you going to bother the Dr. about constipation, just wait to get your head chewed out. I know you're a new grad and you like to follow the book, but its NOT like that here. just freaking give the IM already!".

i was so heart broken.. i feel for the poor patients. this is not how i imagined being a nurse.. I struggle between the fine line of listening to someone's real concerns vs disregarding them because they are just manipulative and psychotic and "reised".

sometimes i hate my job. evil is another word to describe it.. nurse ratched anyone ?

[classicdame, MSN, EdD]

I don't understand - just because someone is psychotic does that mean they no longer have the right to refuse care???

[nurse441]

I guess it really falls down to "CYA" cover your ass documentation. I will sure document everything. maybe psych is a little bit too much for me-- the manipulation. I don't even know who to believe anymore. Its almost as if half the things they say are either lies, delusional thoughts, or plain hallucinations. At my place, i see a trend of older nurses just get into this mode of disregarding what patients say and just ignore their complaints because they are just "too psychotic to thick logically". Half the people there are at there against their will. obviously they will all try to tell lies and get away from things..

we did actually got her an enema. but she said 'i'm taking every ounce of dignity away from her" by doing the enema =/

i pushed the night nurse to give MOM.

but when do you actually listen to a psych patient and differentiate between a real concern vs lies..

[nurse441]

I don't understand - just because someone is psychotic does that mean they no longer have the right to refuse care???

Some people are conserved by the county- their decisions regarding health care is done by someone else. that's when they judge them to be too ill to make any logical decisions regarding health care.

some people are reised because they have a history of refusing meds, but are too mentally ill to make that decision.

so to your answer, some of these patients have no choice but to accept either the injection or pill. I feel pretty horrible calling a code and giving someone Haldol injection the minute they 'act up". mind you these codes happen 3x a day in the hospital.. and then some poor patient will be struggling and hollering for mercy while 7 people lock them down on to the ground. and the med nurse comes with 2 IM. it's like out of some crazy house movie or something!!!

and if they really act up-- you get the ultimate 5 point restraint for almost an hour =/

and that folks, is what happens in a locked up psych hospital.

[Muffy5]

What does your physical assessment show? Is their abdomen distended, how are their bowel sounds, did you do a rectal check? That would be an easy way to objectively back up the patients complaints...

When I was new to LTC I had a patient come to me with c/o of stomach pain and requesting MOM. He has been known to be a little melodramatic and have med seeking behavior. While I was talking to him, his distended belly popped a button off his shirt! I immediately took him to his room and found he had nearly absent bowel sounds in his right quadrant. My preceptor told me, oh he does that, lets just give him a supp. I had to respectfully disagree and call the MD. He ended up having a strangulated bowel...

Just saying trust your gut! You may be new, but have more confidence in yourself and your judgement!

[goats'r'us, ASN, RN]

if she's been 'reised' (not sure I spelled that right, hadn't heard the term before) I can totally understand why the other staff members thought she was being manipulative - it sounds like an order placed upon someone who has a history of manipulation.

that said, I really don't see the harm in giving an order for an aperient just in case. if she's really being genuine, a trade off of 'take the pill and I'll give you something for the constipation to go with it' might be enough to keep her willingly taking her meds, which is a very big step in the road to recovery, and if she's manipulating you, a mild aperient won't do her much harm anyway.

forgive me if my way of thinking's way off, all my patients are anaesthetised.

[leslie :-D]

but when do you actually listen to a psych patient and differentiate between a real concern vs lies..

in this case, you rely on your objective data to differentiate.

as stated, bowel sounds, abd distention, rectal check (if done, have witness w/you), kub, being familiar w/med se's...

if the med is known to be constipating, there's a darned good chance that pt complaint is valid.

and, it would seem therapeutic to add some senna to daily regimen.

even in psych, nurses need to use their med'l training to assess situations such as this.

leslie

[nursemike, ASN, RN]

My floor is neurosciences, so I see my share of behavioral problems, sometimes including psych co-morbidities (is my patient post-ictal, or back to baseline goofiness?). It ain't easy. Even reasonably nice people, after a few years, may say thoughtless things--like "baseline goofiness." I don't think it's necessarily bad to ventilate some of the evil thoughts that are bound to cross our mind. Sometimes when I have a neurology patient acting especially frontal, if I see a neurosurgeon on night rounds, I'll ask for a trepanation consult to let the evil spirits out.

I do think, though, that you have to be really careful not to let that sort of black humor influence your actual practice. Patients with altered mental status, whether temporary or permanent, can be really frustrating, and yes, they will try to manipulate you. It's a real balancing act, because being "too nice" can harm them, and not being nice is, well, not nice.

It sounds to me like the OP is working hard to maintain that balance. Kudos! It sounds like some co-workers have lost it. Actually, from the post, it does sound like they may need reported to your accrediting authority, but I hesitate to assume so since a lot of us do talk more evil than we do. I don't believe my facility has ever had a single incident of "pillow therapy," though I know it gets discussed on a daily basis.

I don't know what docs the OP deals with. I'm night shift in a teaching hospital, so I talk to residents. If they don't like being awakened at 0300 for a laxative, they can put them in prn with the admission. If they want to give me a lot of grief about it, I have pager numbers for their senior and their attending. I have never yet had to call the attending.

OP, you don't sound lazy or crazy to me. If you want to work on my floor, you'll be welcome. And you'll feel right at home.

[scoochy]

Just in my opinion Psyche nurses are either lazy or crazy. In this case its crazy. The nurse dont understand Constipation is Medical Diagnose, this would cause more problems than good. This patient can become medically unstable. I can believe this going on. Where I work, the psyche nurse drug the patient up so much then the patient not responding and they come down on the a tele unit to be monitored and this could have been prevented. The nurse on the Psych unit dont want to be bothered with the patients. It beats me.

How did you come to the conclusion that psych nurses "are either lazy or crazy?" I will not ask if you have ever been a psych nurse for obvious reasons. Please keep this type of comment to yourself; it is disrespectful. I worked for a very brief period in a psych facility; I was not cut out for it. IMO, it is very mentally taxing; I give psych nurses a lot of credit for the work they do, as it is often a long and arduous process in terms of helping a psych pt. make progress.

[scoochy]

Some people are conserved by the county- their decisions regarding health care is done by someone else. that's when they judge them to be too ill to make any logical decisions regarding health care.

some people are reised because they have a history of refusing meds, but are too mentally ill to make that decision.

so to your answer, some of these patients have no choice but to accept either the injection or pill. I feel pretty horrible calling a code and giving someone Haldol injection the minute they 'act up". mind you these codes happen 3x a day in the hospital.. and then some poor patient will be struggling and hollering for mercy while 7 people lock them down on to the ground. and the med nurse comes with 2 IM. it's like out of some crazy house movie or something!!!

and if they really act up-- you get the ultimate 5 point restraint for almost an hour =/

and that folks, is what happens in a locked up psych hospital.

Sounds like a scene from "One Flew Over The Cuckoo's Nest." It is such a sad situation for these people.

[ivanh3]

My two bits would have nothing to with how the patient should or should not be treated or if the patient is or is not manipulative. It would be regarding how you were treated. New grad or not a new grad, that is not how people, you know, human beings are supposed to talk to each other. I would start looking for a new job unless you really feel the positives outweigh the negatives. Life is too short relative to our careers to be treated that way.

[lkwashington]

For someone who can barely type the English language you sure don't have a problem using it offensively. Lazy or crazy, huh? I've worked per diem in pediatric psychiatry for two years and find the work interesting and gratifying. Compared to the extremely ill children I care for on a daily basis, caring for children with mental illness is a welcome break and based on our low readmission rate, we appear to make some sort of impact on them. It is unfortunate that the OP's work is such a toxic and undereducated environment, and I hope she will report them to the JC for investigation. It is true that some psych nurses have less experience in the medical component, but there are measures that can be taken to improve patient care, such as nursing care plans for constipation or side effects. At my hospital we have standing orders for certain side effects and medical conditions, and the physicians welcome input from nursing because their medical experience as psychiatrists is somewhat limited as well. We work as a team to give our patients quality care, and both nursing staff and the mental health counselors work very hard to help our patients get better. We have an extremely dedicated staff and I couldn't be more proud of them.

I'm not sure if you're careless with words or just plain ignorant, but I suggest you think about using such severe words before posting on a forum dedicated to all walks of nursing. Watch what you say, what goes around comes around, and you never know, perhaps someday you or one of your loved ones might be in need of us "lazy crazy nurses."

I apologize if I offended anyone. I can assure you that I no ignorant at all. Let me explain myself. I dont want anyone think I am against PSYCH nurses. Every nurse deals with PSYCH patients in some shape, form, and fashion. I care mostly for patients who are eldely...AMS, Dementia, and etc. Most nurses who work PSYCH units know that patients can manipulate them. Maybe the nurse didnt care medically about the patient just only mentally. Most PSYCH nurses deals with the patient physically and mentally. The medical aspect sometimes dont come in mind. The facility I work, before we can transfer a patient to the PSYCh unit the patient must be medically stable. If the patient goes to the special unit and needs some type of medical assistance they must be discharge from PSYCH and admitted on a medical floor.

I have care for patients who was going through ETOH/substance abuse withdrawal who broke out of a four point restraint. You have to be strong minded and sometimes think like these patients this is where the CRAZY comes in. The nurse has to be strong to try to prevent for be hurt and the patient no be harm. This patient was sent to ICU. The patient was sedated and intubated. I called the doctor personally to come down and reevaluate the patient before being transferred to the ICU. So trust and believe I had my share.

I have received patient friom our pysch unit who was so sedated it didnt make no sense. The psych nurses didnt want to care for the patient properly. The nurses just continued to give the patient their medication without holding some after the patient was lethargic to take. The nurse would crush meds and feed to them and usually this patient was able to feed self. Now, what do call this kind of nurse. The patient was so sedated the patient was unable to urinate. The abdomen was so distended. I place the foley. The urine took so long to come I had to palpate the bladder to increase the flow of the urine. The urine was dark and cloudy. The patient had a UTI after urine was sent to lab. Started an IV with fluids and place patient on seizure precautions and the whole nine yards. I do understand what you may go through. Before the patient went to the psych floor the patient was medically stable. This was the patient second admission on the same hospital visit.

It has came around before I became a nurse. My grandfather was diagnose with Dementia. Let me tell you it was one of the hardest jobs that my mother and I had to do, but we did what we had to do. He took good care of us so we made sure we did the same. He didnt want to go a nursing home. We did what we had to do to prevent this from happening.

[lkwashington]

How did you come to the conclusion that psych nurses "are either lazy or crazy?" I will not ask if you have ever been a psych nurse for obvious reasons. Please keep this type of comment to yourself; it is disrespectful. I worked for a very brief period in a psych facility; I was not cut out for it. IMO, it is very mentally taxing; I give psych nurses a lot of credit for the work they do, as it is often a long and arduous process in terms of helping a psych pt. make progress.

I have not been a psych nurse but I have cared for ones who had to be admitted to a psych unit and had to be admitted to a monitored unit where I work. Let me tell you it was not a pretty sight. I think some nurses are in the field for the wrong reasons. I just speaking of what I know. I previous posted situations on this post about what I had been through. Please read them. I know it is hard work.