Feeling burnt out

[Joy4021]

I work at a hospital with 7 psych units consisting of 130 beds. My unit consists of intermediate care and psych intensive care patients. We seem to get the same patients over and over. We will hold them for 3-4 months to send them to the state hospital where they will stay a few days before being released. Then within days many are readmitted and then the cycle repeats. Even ones that aren't committed, many come right back in. Many of these patients will freely admit that they lied about being suicidal to get admitted. I feel like I,as a nurse, do nothing but house homeless people and people hiding from the law. I don't understand how the doctors get away with rarely "fixing" anyone and can only imagine how much it costs the state paying these psychiatrists and this hospital for what is essentially a bed and breakfast. I feel like everything here is shady and corrupt.

[oceanblue52]

Some of the older nurses I work with call these patients as seeking "three hots and a cot." It's easy to get frustrated with them, especially if your state has a bed shortage and having to turn away people that actually need services.

Two perspectives I adopted that have helped: a) focus your effort on the people that really need help, usually on an Acute/Intensve Treatment floor you have at least a few of these people, and if you keep them in mind and watch them get stabilized it makes the job less thankless. And b) Consider that this is a larger systemic issue. I can't imagine that very many people LIKE being on a locked, regimented unit...they likely only go to the ER wth SI because other social services (affordable housing, shelters, job retraining), are not widespread enough to help them. It's pretty disheartening, but we do our best and hopefully get a few in a better place by the time they are discharged.

[Psycho-APRN]

Good discharge planning can go a long way. A stable shelter an IOP program that helps meet their needs. Always remember Maslow. Basic needs play a huge role. A lot of the patients we get are grown ups who grew up in the foster care system who are very institutionalize and need help learning how to live outside of a hospital or institution.

[Orca, ADN, ASN, RN]

Before you begin throwing around terms like "shady and corrupt", consider the legal position that your facility would be in if they turned these people away and then they committed suicide. No matter how many times anyone fakes suicidal ideation, legally facilities cannot run the risk of being wrong if these people are turned away.

Anyone who works in mental health for any length of time has had patients who are gaming the system. On one occasion, I overheard a patient on the phone telling one of his friends, "I will tell them that I'm still suicidal for another two or three days, and by then my welfare check should be in." A quick call to the psychiatrist, and our young friend was back on the streets a few days sooner than he had planned.

[audreysmagic, RN]

I feel you. I've been crispy at the edges lately...*apply head to desk PRN* So many of my adolescent patients lately have been avoiding law enforcement/court dates/overall consequences for their actions and they've been in the system since they were much younger, so they know how to exploit it. And those are the ones that take teenage entitlement and then triple it, usually... It does wear on you after awhile.

I usually keep myself grounded during these rough spots by thinking of that story of the guy who keeps throwing starfish back into the ocean, though there are so many it seems futile... "It made a difference to that one." I try to focus on the patients that really WILL benefit from their stay, the ones that need the attention the most (and often don't get as much as they should from us, because they're quiet and not in our faces demanding attention). But weeks like the one I've had, it's hard. My usual coping skills aren't as effective when I get like this, but I've developed enough awareness from prior crash-and-burn experiences to know that's a red flag and I need to try something else.

Hang in there! I wish I had more sage wisdom to impart, but I can at least offer some solidarity...