I need advice about my new RN job at a drug rehab center

[RandomPsychNurse]

Hello everyone! 

I am looking for 100% real advice and insight into my situation. To start I have been a nurse for 3 years but I have worked at a psychiatric facility for most of that time with one company.

I recently accepted a job at a recovery center for detoxing patients and residential. The staff is very friendly, so there are no issues there. Is it chaotic and disorganized? Yes, but that is almost every detox or psychiatric facility so I can manage that.

My issue with this is that I have been hearing that nurses have been left by themselves on the overnight shift with 18 or more patients that may be actively detoxing. They use recovery coaches (RCs) and sometimes an RN will have one RC or none at all on nights.

There is no security and it was a female RN left alone in a building with 18 male patients. To me, this is concerning because I am going to be working nights and I was not told that I may be alone on a night shift during my interview.

Is this typically the standard? Am I being paranoid about the situation?

I am just picturing a medical or behavioral emergency happening on the shift being by myself or with an RC ( they are not medically trained ). I am still on orientation (week 2) and by looking at my schedule, it looks like my orientation is ending next week. I have pondered on the thought of not continuing here based on this. When I work in psychiatric units the patient was more of a handful, but I was never alone with that many patients and I always had back up during code grays.

Can I please have some guidance here?  

[Davey Do]

1 hour ago, Sami DeLorenzo said:

I am looking for 100% real advice and insight into my situation.

Can I please have some guidance here?  

Fat chance of that happening.

Just kidding.

Please allow me to say that my experience with inpatient CD treatment is about 30 years ago, Sami, so it is dated.

Patients can experience life-threatening conditions while detoxing, and even under the best circumstances, could require immediate emergency medical interventions. So, cause for concern is valid.

Acting out behaviors is not uncommon with his group, also. Another area of cause for concern.

In my four years of CD treatment, and for examples, I've had a patient die while in detox and another require security intervention with restraints.

Good luck!

[JKL33]

I have no experience with this setting. But I am hard-pressed to think of a situation that requires an RN to monitor and manage acute situations while at the same time being appropriate for that RN to be the sole employee on the premises with 18 patients. Just my thinking, but either it is low-key enough that it doesn't require an RN--or it isn't low-key and it isn't right to leave the RN without the tools/support one would need to manage the situation that requires the license in the first place.

[TheMoonisMyLantern, ADN, LPN, RN]

I worked at a residential free standing drug an alcohol rehab facility for a while. Typically if there is a doubt to the patient's medical or psychiatric stability prior to admission or at the time of admission we would send them for medical clearance at the ER, so MOST of the time your patients are pretty stable that said, due to the nature of detox you will have some pretty sick patients. We had around 40 patients, a mix of detox and rehab, vital signs were q2-4hrs around the clock, most of the time we staffed with 2 nurses and 2 techs but there were quite of few nights of 1 nurse and 1-2 techs. It was busy but doable.

Behavioral emergencies did happen but were pretty rare because our policy was to administratively discharge if a patient became physically threatening and police would be called. Medical emergencies of course went 911.

In my opinion, I wouldn't be comfortable being the only person in the building in your situation, too many things could go south on you and it's just not worth the risk in my opinion. 

[CharleeFoxtrot, BSN, RN]

I don't have any experience in the OP's situation but I do counsel her to change her nursedotcom name and picture to something less identifiable. We know for a fact employers skim this board, and anything posted on the internet is forever. 

[caliotter3]

Guess I now know why there are a fair to large amount of ads for night shift at these facilities in my area.  I had thought it was due to offering low pay.

[Been there,done that, ASN, RN]

This is a for profit facility... that needs an RN on duty at all times for reimbursement. NO nurse should be solely responsible for 18 patients.. in any setting.

They are willing to put your license and safety at risk for their coffers.

Walk away... leave it off your resume.

[UrbanHealthRN, BSN, RN]

Sounds like they're cutting corners big time at this facility. Using recovery coaches for things besides coaching (I don't even have to ask, I just know). Claiming they do "medically supervised detox" to appeal to prospective customers, but really throwing you in there, alone, with no way to effectively manage patients. It doesn't matter if you have 4 patients, or 18- all it takes is 1 to be in crisis when you don't have any backup. 

What has your orientation been like? Have you seen any red flags since starting? What do the other staff think about being there?

[RandomPsychNurse]

On 2/7/2021 at 6:02 AM, CharleeFoxtrot said:

I don't have any experience in the OP's situation but I do counsel her to change her nursedotcom name and picture to something less identifiable. We know for a fact employers skim this board, and anything posted on the internet is forever. 

Thank you for looking out. I changed my account name to something less identifiable. 

[RandomPsychNurse]

27 minutes ago, UrbanHealthRN said:

Sounds like they're cutting corners big time at this facility. Using recovery coaches for things besides coaching (I don't even have to ask, I just know). Claiming they do "medically supervised detox" to appeal to prospective customers, but really throwing you in there, alone, with no way to effectively manage patients. It doesn't matter if you have 4 patients, or 18- all it takes is 1 to be in crisis when you don't have any backup. 

What has your orientation been like? Have you seen any red flags since starting? What do the other staff think about being there?

I have had maybe six shifts of orientation so far. The last time I was there a nurse called out so I was paired with a nurse in a building, so technically they never replaced the call out because I was there. I do feel some red flags- some of them have said " you should be good" without asking me what my comfort level is. I am not the type to feel comfortable with anything until it has been at least six months to a year somewhere new. 

[Gramo Nurse]

I don't understand how these companies don't think through the risk and liability of putting a single person in charge of this type of unit. I had think this through years ago when my husband was admitted to such a unit for drug detox. Word came back to me that he was having an affair with the 19 yo non-nurse female night supervisor. I went to the head of the company and laid out how many ways this situation was wrong; Including the risk of harm for an inexperienced young lady to be caring for some very seasoned addicts who were there because they couldn't go into better facilities for medical detox. I worked as a night RN in the hospital based substance abuse unit. So I was not naive about how addicts behaved. He got my point obviously and although I did not threaten to sue, they closed their doors 2 weeks later. 

That was 30 years ago. I am retired now and my ex husband died last year, homeless and still an addict. I have suffered at the hands of mentally impaired patients, only to have them say I struck them. if it were not for assistance and witnesses who could attest I had not touched the patient, I might have lost my job and my license. I loved being a nurse. Nursing is a dangerous job, don't let yourself get boxed into a situation where you cannot win. 

 

 

[TheMoonisMyLantern, ADN, LPN, RN]

8 minutes ago, Gramo Nurse said:

I don't understand how these companies don't think through the risk and liability of putting a single person in charge of this type of unit. I had think this through years ago when my husband was admitted to such a unit for drug detox. Word came back to me that he was having an affair with the 19 yo non-nurse female night supervisor. I went to the head of the company and laid out how many ways this situation was wrong; Including the risk of harm for an inexperienced young lady to be caring for some very seasoned addicts who were there because they couldn't go into better facilities for medical detox. I worked as a night RN in the hospital based substance abuse unit. So I was not naive about how addicts behaved. He got my point obviously and although I did not threaten to sue, they closed their doors 2 weeks later. 

That was 30 years ago. I am retired now and my ex husband died last year, homeless and still an addict. I have suffered at the hands of mentally impaired patients, only to have them say I struck them. if it were not for assistance and witnesses who could attest I had not touched the patient, I might have lost my job and my license. I loved being a nurse. Nursing is a dangerous job, don't let yourself get boxed into a situation where you cannot win. 

 

 

Sadly you are very right. There are a lot of drug rehabs out there that offer hardly any therapeutic services and yet charge thousands of dollars, and the families of addicts fork it over because they're desperate to help their loved one. It's really sick and predatory, these places need to be regulated and should have to prove their clinical effectiveness in order to remain open!