Thank you for letting me know I am not alone in how I feel. The other night nurses I work with seem fine, so I feel like I am just being weak, but I see from everyone's posts that this can happen to some people who work nights. I am so sorry to hear that you are going through a similar situation. I wouldn't wish this feeling on anyone. I hope you're able to get the changes you want made.
I have been a nurse a little over half a year. I started working night shifts in the ER (7p-7a) in mid December (I worked in the ER prior to that so I knew what I was getting into). Since then, I have gained 25 lbs, I sleep up to 18-20 hours a day when I am not working, and I despise going to work. I have lost all desire to do anything on my off days. I feel ill all the time. I have withdrawn from everyone, my friends and family, because I don't want to bring them down. It's so bad many times I wish I would have a car accident on the way to work. I'm careful only because I don't want to hurt anyone else on the road because of my stupidity and self-centeredness. I have never been this depressed in my life. My co-workers are mostly ok, the work is hard of course and we're always busy and understaffed, but usually I deal ok with that when I am at work. So far, my state of mind has not affected the care I give--I am actually getting the hang of things at work and have received compliments from the higher ups and other nurses on how well I am doing. If they only knew what was going on inside.
Could it be just working night shifts? I really think working night shift has messed with my mind. Unfortunately, there are no earlier shifts available. I did tell my manager when I started that I have always been a day person and to please keep me in mind for a day position when one becomes available. I thought, I would pay my dues. I thought I would be fine after I adjusted, but my mental and physical health are at the lowest I have ever felt in my life. I am already on anti-depressants (not working) and I had my physical recently (nothing unusual except for a depressed WBC count).
Am I just too weak? Should I give it more time? It's only two months, but instead of improving, I am getting worse, having thoughts that would get me involuntarily committed if I ever told anyone in the ER about them. Should I talk to my manager and beg her for a transfer? My ER has no day shifts, but two of our sister hospitals do. The problem is my dept paid for this internship program and I agreed to stay with them for a year. At the same time I don't think I will make a year in my current state of mind. I tell myself to snap out of it and quit the pity party, but it's not working. I hate that I feel so mentally weak. Any words of wisdom or advice would be appreciated. I am desperate. Thank you.
ok, so i'm a new nurse in the er. i am in my 5th week after finishing a 12 wk emergency nurse internship program which consisted of classroom time and clinicals. yesterday, my preceptor and i met with our nurse educator. the good news was that she told me she is hearing good things about me (phew)! she asked me where i felt i was in my training. i told her i felt my weakness was time management. my preceptor agreed, telling her that i am very smart, that i have good judgment, and that i am very focused, however, sometimes i focus too much on my more critical patients and spend too little time with my other patients (although i kind of feel if you're not acute, you can wait--i'll glance at you and make sure you're pwd, and then i'm more worried about the guy who can die within the next 5 minutes). i guess part of the reason is that i prefer the more challenging cases as opposed to the otherwise healthy 20 yr olds who have the sniffles yet feel that merits a trip to the er, but i know they come with the deal too. anyhow, my nurse educator asked me to come up with a document listing some strategies to improve my time management skills. i have no clue--if i knew, i would do them! do any of you more experienced nurses have some strategies i could use? i did a search through the threads, but i'm looking for more specific strategies. what makes it worse is that we're one of those hospitals with a 30 minute promise (which i dislike, because i think it encourages non-emergent patients to come to the er), so i always feel rushed, rushed, rushed. the good news is that my preceptor said no one expected me to be as fast as a more experienced nurse. she says it will come with time and experience. also, i don't know if this will affect the advice you have, but i work the night shift.
i think one thing i could suggest is that my preceptor stop trying to assist me with my assignments. she should supervise, review my charts, but otherwise back off unless i am absolutely drowning. although she doesn't say it, i know she gets impatient because i am not as fast as the others so she jumps in, but if the patients are not critical and we don't have a waiting room full of people or ambulances backed up (we're a relatively small er, so we do have our down time), she should just let me do things at my own pace because it's the only way i'll learn to become faster--practice. what do you think?
(and please, no offense, but no lectures about me needing med-surg experience first. i know a lot of nurses feel that way, but it just motivates me to work harder to prove them wrong. the reality is that i'm here and i'm not going anywhere. i know it's not the same thing, but i was a tech in the same er prior to becoming a nurse, so i am familiar with the pace. all i need is some help to get up to speed and i would really appreciate any advice that you have. thank you so much!!)
as an undergrad, i volunteered for a suicide hotline and in our training, we were always taught that a person on the verge of suicide would have a plan--a method, a time, a place. i always wondered though, and i am not being facetious, what if this person just isn't that organized? what if they're the impulsive disorganized type (e.g. bipolar mood disorders or borderline personalities) who doesn't plan anything and all they know is they want to die? the particulars will occur to them when they do it--jump out in front of traffic, drive the car of a cliff, grab a knife, take every pill in the house etc. it doesn't take that much planning to kill yourself, you know?
coincidentally, a story about one of the hospitals in my area discharging a suicidal patient who went on to commit suicide by throwing himself from the top story of the hospital parking garage was on the front page of our sunday paper today: http://www.sptimes.com/2007/10/14/hi...th_his_d.shtml
sad story. wasted life.
discharged with his demons
the son needed more help. now the father needs more answers.
by justin george, times staff writer
published october 14, 2007
james allen left tampa general hospital's psychiatric unit on july 31 with a bus pass and a pledge to check out a list of homeless shelters a nurse gave him. but four hours later he was back, saying he was so depressed he thought about jumping in front of a car. it wasn't an idle threat. a month before, another hospital had discharged him, and allen, 43, walked in front of a bus - something tampa general had record of. but doctors evaluated him again and released allen at 12:30 p.m. with instructions to go to a mental health care center the next morning. turned away, he climbed to the fifth floor of the hospital's parking garage that evening and walked to the edge. the revolving door had stopped. allen, who had asked for help so many times, wouldn't ask again.
how could a man with a clear history of mental illness, who had tried suicide at least once, return to a hospital for help and not be saved, his father wonders.
"i probably will never get all the answers," john allen said, "but i'd like more."
james allen became homeless after he left his father's forgiving safety net for one last shot at rehabilitation in the tampa bay area. at home in new mexico, his dad always caught him when he relapsed into alcohol or drugs. but alone in florida, no one did.
tampa general declined to talk about allen's case, citing confidentiality laws.
"there has never been a tool published, a set of questions to ask, a blood test to run; there has never been an instrument or a tool to predict who will kill themselves and who wouldn't," said dr. brian keefe, tampa general's director of psychiatric services.
the length of allen's stay at tampa general - a total of six days - indicated serious mental problems, said martha lenderman, who ran the state program that oversaw involuntary psychiatric examinations, as well as pinellas and pasco county mental health offices for the department of children and families. drug tests show he had come in clean.
lenderman said he would have qualified to be screened for institutional placement. the legal burden of proof is tough, however, since judges don't want to deprive patients of civil rights and lock them up when voluntary - typically outpatient - treatment is available. but options are slim in florida, which ranks 48th in how much it spends per psychiatric patient.
keefe described resources in hillsborough county for mental health treatment as "abysmal." he said his hospital routinely keeps patients longer than required because treatment centers are overbooked or there's no medically supervised "step down" shelter to help the homeless back into the community.
sandra tabor, spokeswoman for mental health care inc., the county's largest aid provider, said that keefe hadn't expressed his complaints to mental health care providers and that most people's needs are met quickly.
all john allen knows is that his son needed help and seemed to go to the right place to get it.
"you tend to like to trust the medical profession, because they tend to try and do a good job," allen said, "but sometimes they fail." * * * john allen, 76, a retired nuclear laboratory field engineer, says he succeeded at nearly everything in life but fatherhood. he guesses he has spent about $100,000 trying to rehabilitate james and an older son, who was also hooked on drugs.
he kept the parable of the prodigal son in mind, hoping for one last homecoming. only his older son returned to albuquerque, n.m. he still lives at home at age 53, hooked to oxygen after emphysema ruined his lungs.
as for his youngest, john allen still searches for clues.
there was no apparent childhood trauma. dad worked, mom took care of the two boys. the couple rarely drank. a bottle of wine spenta year in the refrigerator.
james backpacked in colorado, camped in national parks, raced sailboats. a bit of a loner, he played guitar. he built an early motorola computer from a kit and rebuilt car engines as a teen.
but he also discovered marijuana.james barely graduated from high school. he dropped out of college and technical school, stole money from his parents for cocaine and spent months in treatment.
in his 30s, he was drinking a fifth of liquor a day. his dad gave him $3,000 and kicked him out. three weeks later, he asked for more. he laid in the street so he could be taken to a mental hospital, where he could get vouchers for methadone, a drug he abused. clean. relapse. clean. his life was like the tide. when brother richard received a $1,500 car accident settlement, the pair went on a cocaine binge, and james hit one of his counselors, earning a night in jail.
john allen once asked his son how things had gone so wrong. james couldn't explain, except to say he felt hooked to marijuana the first time he tried it. james' grandfather was an alcoholic. addiction might be in the genes, john allen surmises.
his son slept in shelters, abandoned cars and under a sheet of plastic in a field near the airport.
two years ago, james called home for help. he was bloody and bruised, mugged for $3. john allen picked him up and told his tearful son about the spencer recovery center in st. pete beach, a place a colleague had recommended.
two days later john allen put his son on a plane and paid about $25,000 for three months of treatment.
he gave james a new wallet before he left. * * * james allen spent five months at spencer in 2005. he was taking prozac, his brother recalled.
"he seemed to be doing well," john allen said.
james allen moved to the mustard seed inn in st. petersburg, a drug and alcohol recovery center. he went to alcoholics anonymous meetings and washed dishes at a nearby cafe. then he went to the sophie sampson center of hope, where they gave him his own room. james went to bible study. his father sent him a laptop to do freelance computer work.
but in april, james relapsed. he was evicted for drinking or abusing prescription drugs, john allen said. the father called st. petersburg police in may and reported his son missing. they told him james was admitted to a mental hospital. john allen called everywhere, but privacy laws stonewalled him.
he felt like he was following a ghost.
"any time i got close to finding him," allen said, "they would tell me he wasn't there or had been discharged." he wonders how hospitals cared for his son or other homeless people. no one can check because of privacy laws, he says.
"sometimes you wonder if it's being used as an excuse," said rosanna esposito, senior legislative and policy counsel for the treatment and advocacy center, a national nonprofit.
john allen didn't know his son had gone to the st. pete beach police department on may 10 and talked about walking into traffic. an officer drove james to treatment under protective custody, a police report states.
in late june, john allen hired tampa bay investigators to find his son. the next day, unknown to him, a bus driver swerved to avoid a man who "didn't look right" on fifth avenue n in st. petersburg.
james allen told police he tried to kill himself because his life was a mess. paramedics drove him to st. anthony's hospital, where he was again held under the baker act, the state law allowing for involuntary psychiatric examinations. he had just been released from there after a week of treatment for suicidal thoughts, police records show. his father's private investigator found james allen there and left him a prepaid calling card.
james never called home.
"the father really cared about his son and went out of his way to try and find him," said carol sciannameo, who owned the investigation firm."it's a really sad story." * * * on july 31, two nurses on the fourth floor of the parking garage saw a body fall past them. they raced to the bottom and found james allen face down on the sidewalk. for two hours, doctors tried to save him; his ribs were fractured, aorta shredded, lungs and liver lacerated. he died at 9:35 p.m. * * * his ashes remain in an urn to be buried in the family's arkansas hometown. john allen won't bury him yet. he wants explanations from tampa general and st. anthony's hospitals. it's not even clear how james allen got to tampa general.
"they kept releasing him with all those suicidal tendencies," he said. "that's the part that's disturbing." like tampa general, st. anthony's says it can't comment.
to qualify for involuntary placement in a mental health facility, the state requires a person to be mentally ill. he would have to refuse treatment - it's unknown if allen did at any point - or be unable to understand treatment was needed. he also would have to be either incapable of surviving alone and be in danger of neglect or seem likely to hurt himself or others.
james allen's history of walking into traffic may not have been enough for a judge to commit him. "you're going to have to have clear and convincing evidence," lenderman said.
to john allen, nothing could be more clear than his son's track record of attempting suicide after being discharged, something tampa general had record of, according to the hillsborough medical examiner's investigation.
james allen left no note. his only belongings, a wallet and eyeglasses, were returned to his father recently.
in the wallet, john allen found the phone card the private investigator had slipped to james.
john allen now has proof that james knew his father reached out to him one last time. he wonders why he never called home.
fast facts: after the hospital although hospitals do sometimes keep psychiatric patients when long-term treatment centers are full, most are released after initial treatment at hospitals or mental health centers.
mark engelhardt, a faculty member at the florida mental health institute at the university of south florida, said that makes discharge planning crucial.
the state requires hospitals to keep written discharge policies. tampa general's, updated in 2001, assigns responsibilities from doctors and nurses to social workers and dietitians.
the goal, engelhardt said, is to meet as many of a psychiatric patient's needs as possible; from treatment and transportation to medication and monitoring. giving patients a sheet of outpatient recommendations should be the least hospitals do, engelhardt said.
they should coordinate with mental health or substance abuse treatment providers in the community and inform them a patient is on the way, he said.
tampa general won't comment on its discharge plans for james allen. 24-hour suicide prevention help in hillsborough county: 211 in pinellas county: suicide hotline, 727-791-3131; mental health assistance, 727-541-4628 elsewhere: 1-800-784-2433
I don't think you would be seen as a poser if you brought in a stethoscope. I know most techs don't carry them, but it's a tool of the trade. There are many times when you need to take a manual bp--machines don't always pick up everyone's bp. And I can't tell you how many times a nurse asked to borrow my stethoscope when I was a PCT because she (or he) forgot to bring hers into the room (I kept mine in my HUGE pockets). I even had one of our doctors ask me once. Now, if you brought in a $500 Littmann you might be seen as a poser... :wink2: It's so cool you're so excited. I wish you could come work in our ED!
I had to check to see your location to make sure you weren't working in my ED! Your experience is so similar to mine. I'm a new nurse in the ED too dealing with similar situations. I'm sorry I don't have any advice to give since I haven't figured out how to deal with it. I just wanted you to know that I can definitely feel your pain and empathize with your situation. Hang in there.
Thanks for saying that cmo421--you're right. I should clarify that I personally don't think you or any PCT is the lowest on the "totem pole" either, not in the least. What I should have written is that unfortunately you are perceived as that by some insecure people on the patient care team because you are new and because of your title, and you have to be able to stand up for yourself if and when that happens because ultimately, it's the patient that suffers. I have to watch for that too--as a new nurse, I'm being felt out in the same way too. I don't think anyone outranks anyone, regardless of how many fancy initials you put behind your last name. I won't forget where I came from! :spin:
I am a recent grad who was an ER PCT prior to becoming an ER nurse so I can understand where you're coming from. As a PCT, I truly didn't realize just how busy the nurses are even though I was a nursing student myself. Your perspective will totally change when the patient belongs to you! As for what I like in a PCT now that I am nurse:
1) Take initiative. As a nurse, I appreciate a PCT who takes initiative and doesn't stand around waiting to be told what to do. If you don't know what you can do, take the initiative to ask. I LOVE it when a tech asks me, "Do you need help with anything?" I could just hug you.
2) Communicate. Let your nurse or MD know when you see a change in your patient for the worse. You went to take Mrs. Jones' vitals and her BP went from 128/84 to 72/40? Sats went from 98 to 86? Inquiring minds want to know. I've heard of some PCTs not sharing this sort of info, believe it or not.
2) Learn to prioritize. Don't stock rooms when patient needs are not being met. Remember the patient comes first. When Granny is sitting in her own urine soaked stretcher, stocking the tongue depressors can wait.
3) Do the most critical task and communicate. If you're on your way to get a urine sample for HCG for a stable healthy looking 20 yr and another nurse asks you to do an EKG for the code that just came through the door, hold off on the urine. (But don't forget to get to it later or let the nurse know why the urine wasn't collected.)
4) Document what you've done. I admit, as a PCT, I was not always the best at this, and I didn't understand how difficult I was making the nurses' life. I hope the karma gods forgive me.
5) Be willing to learn. If you're asked to do something you don't know how to do, don't say, "No, I don't know how to do it." Just say, "I have never done it before, but if you show me how, I can learn."
6) Don't let anyone bully you. You're the lowest on the totem pole and some people will try to make you feel worthless and make your job more difficult, which ultimately endangers the patient (monitor techs are famous for this, but doctors, PAs and nurses are guilty as well). Be assertive--not aggressive, and don't be afraid to use the chain of command.
If you have any questions, feel free to contact me. I hope this helps! Good luck!
I have to defend my old hometown. NYers aren't the only ones who complain down south about having to wait or having someone else going before them, not realizing that a stroke gets priority over a toothache no matter how long they've waited. I get plenty of complainers from native Floridians and Southern twangs too. Whining knows no borders. People are basically self-centered no matter where they're from, especially when they're not feeling 100%.
Anyone from NYC who says the wait to get into an ER isn't 8 hours on a good night is a liar. My dad still lives in NYC, and I was born and raised there, and a 24 hour waiting room wait is not unheard of. Now I know why. I had no idea the ratio of patients to nurses was that high. No wonder patients have to wait so long. I would move out of the tri-state before I worked 8:1. Oh wait, I did move! Phew...
the way my preceptor with 35 years of experience put it was: "med-surg floors make med-surg nurses. the er makes er nurses." i do not subscribe to the old school thinking that med-surg nursing is the only way to learn how to be a nurse and it sounds like your hospital doesn't either. that's why they're offering this course to new nurses only.
i just got my nursing license in july and i am currently taking my hospital's version of your hospital's "critical care university" and i love it! they are paying me to learn!!!! paying me to do what i love to do! does it get any better??? like you, i knew even before i started nursing school where i wanted to work: the ed. i also know that eventually, i want to move to the icu environment. working in med-surg is a waste of time, to me, when i know i hate it and am poorly suited to that environment.
if you know this is what you want to do, then take advantage of this wonderful opportunity. if you love the critical care environment and the er as much as i do, you won't regret it. :spin:
The fact that you are nervous, while uncomfortable for you, is actually comforting to observers. If you were going into this after a few weeks or months of orientation 100% confident and sure of yourself, then *I* would be seriously worried for your patients! Your anxiety means that you take your responsibility very seriously, more proof that the positive feedback you have received was justified. It will subside with time. Remember to ask for help before you're buried. You'll be great! :spin:
I always knew I wanted to work in an ED. I get bored easily, I like the adrenaline, and I like seeing different things--ED suited me. HOWEVER.... I spent 120 hours in the ICU last semester of nursing school. Before I started I thought I would be bored and that I wouldn't like it. I was so wrong. I loved it too, and surprised myself by being a good ICU nurse. So now I know, when I get burnt out from the ER, I'll give the ICU a try.
Sometimes you know, but keep an open mind. Try something--you just might like it. And if you don't, try something else. Eventually, you'll find your niche. Usually your gut instinct is right but if isn't, give something a try that you never thought you would like.
Aprilequinox, I knew you passed as soon as I read your first post. Your experience sounded IDENTICAL to mine--the type of questions you got, the # of questions you got, even the having to go pee so bad but waiting till 75 questions to take a break--and I passed. My heartfelt congratulations to you.
Thank you for letting me know I am not alone in how I feel. The other night nurses I work with seem fine, so I feel like I am just being weak, but I see from everyone's posts that this can happen to some people who work nights. I am so sorry to hear that you are going through a similar situation. I wouldn't wish this feeling on anyone. I hope you're able to get the changes you want made.
I have been a nurse a little over half a year. I started working night shifts in the ER (7p-7a) in mid December (I worked in the ER prior to that so I knew what I was getting into). Since then, I have gained 25 lbs, I sleep up to 18-20 hours a day when I am not working, and I despise going to work. I have lost all desire to do anything on my off days. I feel ill all the time. I have withdrawn from everyone, my friends and family, because I don't want to bring them down. It's so bad many times I wish I would have a car accident on the way to work. I'm careful only because I don't want to hurt anyone else on the road because of my stupidity and self-centeredness. I have never been this depressed in my life. My co-workers are mostly ok, the work is hard of course and we're always busy and understaffed, but usually I deal ok with that when I am at work. So far, my state of mind has not affected the care I give--I am actually getting the hang of things at work and have received compliments from the higher ups and other nurses on how well I am doing. If they only knew what was going on inside.
Could it be just working night shifts? I really think working night shift has messed with my mind. Unfortunately, there are no earlier shifts available. I did tell my manager when I started that I have always been a day person and to please keep me in mind for a day position when one becomes available. I thought, I would pay my dues. I thought I would be fine after I adjusted, but my mental and physical health are at the lowest I have ever felt in my life. I am already on anti-depressants (not working) and I had my physical recently (nothing unusual except for a depressed WBC count).
Am I just too weak? Should I give it more time? It's only two months, but instead of improving, I am getting worse, having thoughts that would get me involuntarily committed if I ever told anyone in the ER about them. Should I talk to my manager and beg her for a transfer? My ER has no day shifts, but two of our sister hospitals do. The problem is my dept paid for this internship program and I agreed to stay with them for a year. At the same time I don't think I will make a year in my current state of mind. I tell myself to snap out of it and quit the pity party, but it's not working. I hate that I feel so mentally weak. Any words of wisdom or advice would be appreciated. I am desperate. Thank you.
ok, so i'm a new nurse in the er. i am in my 5th week after finishing a 12 wk emergency nurse internship program which consisted of classroom time and clinicals. yesterday, my preceptor and i met with our nurse educator. the good news was that she told me she is hearing good things about me (phew)! she asked me where i felt i was in my training. i told her i felt my weakness was time management. my preceptor agreed, telling her that i am very smart, that i have good judgment, and that i am very focused, however, sometimes i focus too much on my more critical patients and spend too little time with my other patients (although i kind of feel if you're not acute, you can wait--i'll glance at you and make sure you're pwd, and then i'm more worried about the guy who can die within the next 5 minutes). i guess part of the reason is that i prefer the more challenging cases as opposed to the otherwise healthy 20 yr olds who have the sniffles yet feel that merits a trip to the er, but i know they come with the deal too. anyhow, my nurse educator asked me to come up with a document listing some strategies to improve my time management skills. i have no clue--if i knew, i would do them! do any of you more experienced nurses have some strategies i could use? i did a search through the threads, but i'm looking for more specific strategies. what makes it worse is that we're one of those hospitals with a 30 minute promise (which i dislike, because i think it encourages non-emergent patients to come to the er), so i always feel rushed, rushed, rushed. the good news is that my preceptor said no one expected me to be as fast as a more experienced nurse. she says it will come with time and experience. also, i don't know if this will affect the advice you have, but i work the night shift.
i think one thing i could suggest is that my preceptor stop trying to assist me with my assignments. she should supervise, review my charts, but otherwise back off unless i am absolutely drowning. although she doesn't say it, i know she gets impatient because i am not as fast as the others so she jumps in, but if the patients are not critical and we don't have a waiting room full of people or ambulances backed up (we're a relatively small er, so we do have our down time), she should just let me do things at my own pace because it's the only way i'll learn to become faster--practice. what do you think?
(and please, no offense, but no lectures about me needing med-surg experience first. i know a lot of nurses feel that way, but it just motivates me to work harder to prove them wrong. the reality is that i'm here and i'm not going anywhere. i know it's not the same thing, but i was a tech in the same er prior to becoming a nurse, so i am familiar with the pace. all i need is some help to get up to speed and i would really appreciate any advice that you have. thank you so much!!)
Usually PCTs, but RNs aren't above the job if no techs are available.
as an undergrad, i volunteered for a suicide hotline and in our training, we were always taught that a person on the verge of suicide would have a plan--a method, a time, a place. i always wondered though, and i am not being facetious, what if this person just isn't that organized? what if they're the impulsive disorganized type (e.g. bipolar mood disorders or borderline personalities) who doesn't plan anything and all they know is they want to die? the particulars will occur to them when they do it--jump out in front of traffic, drive the car of a cliff, grab a knife, take every pill in the house etc. it doesn't take that much planning to kill yourself, you know?
coincidentally, a story about one of the hospitals in my area discharging a suicidal patient who went on to commit suicide by throwing himself from the top story of the hospital parking garage was on the front page of our sunday paper today:
http://www.sptimes.com/2007/10/14/hi...th_his_d.shtml
sad story. wasted life.
discharged with his demons
published october 14, 2007
james allen left tampa general hospital's psychiatric unit on july 31 with a bus pass and a pledge to check out a list of homeless shelters a nurse gave him. but four hours later he was back, saying he was so depressed he thought about jumping in front of a car. it wasn't an idle threat. a month before, another hospital had discharged him, and allen, 43, walked in front of a bus - something tampa general had record of. but doctors evaluated him again and released allen at 12:30 p.m. with instructions to go to a mental health care center the next morning. turned away, he climbed to the fifth floor of the hospital's parking garage that evening and walked to the edge. the revolving door had stopped. allen, who had asked for help so many times, wouldn't ask again.
how could a man with a clear history of mental illness, who had tried suicide at least once, return to a hospital for help and not be saved, his father wonders.
"i probably will never get all the answers," john allen said, "but i'd like more."
james allen became homeless after he left his father's forgiving safety net for one last shot at rehabilitation in the tampa bay area. at home in new mexico, his dad always caught him when he relapsed into alcohol or drugs. but alone in florida, no one did.
tampa general declined to talk about allen's case, citing confidentiality laws.
"there has never been a tool published, a set of questions to ask, a blood test to run; there has never been an instrument or a tool to predict who will kill themselves and who wouldn't," said dr. brian keefe, tampa general's director of psychiatric services.
the length of allen's stay at tampa general - a total of six days - indicated serious mental problems, said martha lenderman, who ran the state program that oversaw involuntary psychiatric examinations, as well as pinellas and pasco county mental health offices for the department of children and families. drug tests show he had come in clean.
lenderman said he would have qualified to be screened for institutional placement. the legal burden of proof is tough, however, since judges don't want to deprive patients of civil rights and lock them up when voluntary - typically outpatient - treatment is available. but options are slim in florida, which ranks 48th in how much it spends per psychiatric patient.
keefe described resources in hillsborough county for mental health treatment as "abysmal." he said his hospital routinely keeps patients longer than required because treatment centers are overbooked or there's no medically supervised "step down" shelter to help the homeless back into the community.
sandra tabor, spokeswoman for mental health care inc., the county's largest aid provider, said that keefe hadn't expressed his complaints to mental health care providers and that most people's needs are met quickly.
all john allen knows is that his son needed help and seemed to go to the right place to get it.
"you tend to like to trust the medical profession, because they tend to try and do a good job," allen said, "but sometimes they fail."
* * *
john allen, 76, a retired nuclear laboratory field engineer, says he succeeded at nearly everything in life but fatherhood. he guesses he has spent about $100,000 trying to rehabilitate james and an older son, who was also hooked on drugs.
he kept the parable of the prodigal son in mind, hoping for one last homecoming. only his older son returned to albuquerque, n.m. he still lives at home at age 53, hooked to oxygen after emphysema ruined his lungs.
as for his youngest, john allen still searches for clues.
there was no apparent childhood trauma. dad worked, mom took care of the two boys. the couple rarely drank. a bottle of wine spenta year in the refrigerator.
james backpacked in colorado, camped in national parks, raced sailboats. a bit of a loner, he played guitar. he built an early motorola computer from a kit and rebuilt car engines as a teen.
but he also discovered marijuana.james barely graduated from high school. he dropped out of college and technical school, stole money from his parents for cocaine and spent months in treatment.
in his 30s, he was drinking a fifth of liquor a day. his dad gave him $3,000 and kicked him out. three weeks later, he asked for more.
he laid in the street so he could be taken to a mental hospital, where he could get vouchers for methadone, a drug he abused.
clean. relapse. clean. his life was like the tide.
when brother richard received a $1,500 car accident settlement, the pair went on a cocaine binge, and james hit one of his counselors, earning a night in jail.
john allen once asked his son how things had gone so wrong.
james couldn't explain, except to say he felt hooked to marijuana the first time he tried it. james' grandfather was an alcoholic. addiction might be in the genes, john allen surmises.
his son slept in shelters, abandoned cars and under a sheet of plastic in a field near the airport.
two years ago, james called home for help. he was bloody and bruised, mugged for $3. john allen picked him up and told his tearful son about the spencer recovery center in st. pete beach, a place a colleague had recommended.
two days later john allen put his son on a plane and paid about $25,000 for three months of treatment.
he gave james a new wallet before he left.
* * *
james allen spent five months at spencer in 2005. he was taking prozac, his brother recalled.
"he seemed to be doing well," john allen said.
james allen moved to the mustard seed inn in st. petersburg, a drug and alcohol recovery center. he went to alcoholics anonymous meetings and washed dishes at a nearby cafe. then he went to the sophie sampson center of hope, where they gave him his own room. james went to bible study. his father sent him a laptop to do freelance computer work.
but in april, james relapsed. he was evicted for drinking or abusing prescription drugs, john allen said. the father called st. petersburg police in may and reported his son missing. they told him james was admitted to a mental hospital. john allen called everywhere, but privacy laws stonewalled him.
he felt like he was following a ghost.
"any time i got close to finding him," allen said, "they would tell me he wasn't there or had been discharged." he wonders how hospitals cared for his son or other homeless people. no one can check because of privacy laws, he says.
"sometimes you wonder if it's being used as an excuse," said rosanna esposito, senior legislative and policy counsel for the treatment and advocacy center, a national nonprofit.
john allen didn't know his son had gone to the st. pete beach police department on may 10 and talked about walking into traffic. an officer drove james to treatment under protective custody, a police report states.
in late june, john allen hired tampa bay investigators to find his son. the next day, unknown to him, a bus driver swerved to avoid a man who "didn't look right" on fifth avenue n in st. petersburg.
james allen told police he tried to kill himself because his life was a mess. paramedics drove him to st. anthony's hospital, where he was again held under the baker act, the state law allowing for involuntary psychiatric examinations. he had just been released from there after a week of treatment for suicidal thoughts, police records show. his father's private investigator found james allen there and left him a prepaid calling card.
james never called home.
"the father really cared about his son and went out of his way to try and find him," said carol sciannameo, who owned the investigation firm."it's a really sad story."
* * *
on july 31, two nurses on the fourth floor of the parking garage saw a body fall past them. they raced to the bottom and found james allen face down on the sidewalk. for two hours, doctors tried to save him; his ribs were fractured, aorta shredded, lungs and liver lacerated. he died at 9:35 p.m.
* * *
his ashes remain in an urn to be buried in the family's arkansas hometown. john allen won't bury him yet. he wants explanations from tampa general and st. anthony's hospitals. it's not even clear how james allen got to tampa general.
"they kept releasing him with all those suicidal tendencies," he said. "that's the part that's disturbing." like tampa general, st. anthony's says it can't comment.
to qualify for involuntary placement in a mental health facility, the state requires a person to be mentally ill. he would have to refuse treatment - it's unknown if allen did at any point - or be unable to understand treatment was needed. he also would have to be either incapable of surviving alone and be in danger of neglect or seem likely to hurt himself or others.
james allen's history of walking into traffic may not have been enough for a judge to commit him. "you're going to have to have clear and convincing evidence," lenderman said.
to john allen, nothing could be more clear than his son's track record of attempting suicide after being discharged, something tampa general had record of, according to the hillsborough medical examiner's investigation.
james allen left no note. his only belongings, a wallet and eyeglasses, were returned to his father recently.
in the wallet, john allen found the phone card the private investigator had slipped to james.
john allen now has proof that james knew his father reached out to him one last time. he wonders why he never called home.
justin george can be reached at jgeorge@sptimes.com or 813 226-3368.
fast facts:
after the hospital
although hospitals do sometimes keep psychiatric patients when long-term treatment centers are full, most are released after initial treatment at hospitals or mental health centers.
mark engelhardt, a faculty member at the florida mental health institute at the university of south florida, said that makes discharge planning crucial.
the state requires hospitals to keep written discharge policies. tampa general's, updated in 2001, assigns responsibilities from doctors and nurses to social workers and dietitians.
the goal, engelhardt said, is to meet as many of a psychiatric patient's needs as possible; from treatment and transportation to medication and monitoring. giving patients a sheet of outpatient recommendations should be the least hospitals do, engelhardt said.
they should coordinate with mental health or substance abuse treatment providers in the community and inform them a patient is on the way, he said.
tampa general won't comment on its discharge plans for james allen.
24-hour suicide prevention help
in hillsborough county: 211
in pinellas county: suicide hotline, 727-791-3131; mental health assistance, 727-541-4628
elsewhere: 1-800-784-2433
I don't think you would be seen as a poser if you brought in a stethoscope. I know most techs don't carry them, but it's a tool of the trade. There are many times when you need to take a manual bp--machines don't always pick up everyone's bp. And I can't tell you how many times a nurse asked to borrow my stethoscope when I was a PCT because she (or he) forgot to bring hers into the room (I kept mine in my HUGE pockets). I even had one of our doctors ask me once. Now, if you brought in a $500 Littmann you might be seen as a poser... :wink2: It's so cool you're so excited. I wish you could come work in our ED!
I had to check to see your location to make sure you weren't working in my ED! Your experience is so similar to mine. I'm a new nurse in the ED too dealing with similar situations. I'm sorry I don't have any advice to give since I haven't figured out how to deal with it. I just wanted you to know that I can definitely feel your pain and empathize with your situation. Hang in there.
Thanks for saying that cmo421--you're right. I should clarify that I personally don't think you or any PCT is the lowest on the "totem pole" either, not in the least. What I should have written is that unfortunately you are perceived as that by some insecure people on the patient care team because you are new and because of your title, and you have to be able to stand up for yourself if and when that happens because ultimately, it's the patient that suffers. I have to watch for that too--as a new nurse, I'm being felt out in the same way too. I don't think anyone outranks anyone, regardless of how many fancy initials you put behind your last name. I won't forget where I came from! :spin:
I am a recent grad who was an ER PCT prior to becoming an ER nurse so I can understand where you're coming from. As a PCT, I truly didn't realize just how busy the nurses are even though I was a nursing student myself. Your perspective will totally change when the patient belongs to you! As for what I like in a PCT now that I am nurse:
1) Take initiative. As a nurse, I appreciate a PCT who takes initiative and doesn't stand around waiting to be told what to do. If you don't know what you can do, take the initiative to ask. I LOVE it when a tech asks me, "Do you need help with anything?" I could just hug you.
2) Communicate. Let your nurse or MD know when you see a change in your patient for the worse. You went to take Mrs. Jones' vitals and her BP went from 128/84 to 72/40? Sats went from 98 to 86? Inquiring minds want to know. I've heard of some PCTs not sharing this sort of info, believe it or not.
2) Learn to prioritize. Don't stock rooms when patient needs are not being met. Remember the patient comes first. When Granny is sitting in her own urine soaked stretcher, stocking the tongue depressors can wait.
3) Do the most critical task and communicate. If you're on your way to get a urine sample for HCG for a stable healthy looking 20 yr and another nurse asks you to do an EKG for the code that just came through the door, hold off on the urine. (But don't forget to get to it later or let the nurse know why the urine wasn't collected.)
4) Document what you've done. I admit, as a PCT, I was not always the best at this, and I didn't understand how difficult I was making the nurses' life. I hope the karma gods forgive me.
5) Be willing to learn. If you're asked to do something you don't know how to do, don't say, "No, I don't know how to do it." Just say, "I have never done it before, but if you show me how, I can learn."
6) Don't let anyone bully you. You're the lowest on the totem pole and some people will try to make you feel worthless and make your job more difficult, which ultimately endangers the patient (monitor techs are famous for this, but doctors, PAs and nurses are guilty as well). Be assertive--not aggressive, and don't be afraid to use the chain of command.
If you have any questions, feel free to contact me. I hope this helps! Good luck!
I have to defend my old hometown. NYers aren't the only ones who complain down south about having to wait or having someone else going before them, not realizing that a stroke gets priority over a toothache no matter how long they've waited. I get plenty of complainers from native Floridians and Southern twangs too. Whining knows no borders. People are basically self-centered no matter where they're from, especially when they're not feeling 100%.
Anyone from NYC who says the wait to get into an ER isn't 8 hours on a good night is a liar. My dad still lives in NYC, and I was born and raised there, and a 24 hour waiting room wait is not unheard of. Now I know why. I had no idea the ratio of patients to nurses was that high. No wonder patients have to wait so long. I would move out of the tri-state before I worked 8:1. Oh wait, I did move! Phew...
the way my preceptor with 35 years of experience put it was: "med-surg floors make med-surg nurses. the er makes er nurses." i do not subscribe to the old school thinking that med-surg nursing is the only way to learn how to be a nurse and it sounds like your hospital doesn't either. that's why they're offering this course to new nurses only.
i just got my nursing license in july and i am currently taking my hospital's version of your hospital's "critical care university" and i love it! they are paying me to learn!!!! paying me to do what i love to do! does it get any better??? like you, i knew even before i started nursing school where i wanted to work: the ed. i also know that eventually, i want to move to the icu environment. working in med-surg is a waste of time, to me, when i know i hate it and am poorly suited to that environment.
if you know this is what you want to do, then take advantage of this wonderful opportunity. if you love the critical care environment and the er as much as i do, you won't regret it. :spin:
The fact that you are nervous, while uncomfortable for you, is actually comforting to observers. If you were going into this after a few weeks or months of orientation 100% confident and sure of yourself, then *I* would be seriously worried for your patients! Your anxiety means that you take your responsibility very seriously, more proof that the positive feedback you have received was justified. It will subside with time. Remember to ask for help before you're buried. You'll be great! :spin:
I always knew I wanted to work in an ED. I get bored easily, I like the adrenaline, and I like seeing different things--ED suited me. HOWEVER.... I spent 120 hours in the ICU last semester of nursing school. Before I started I thought I would be bored and that I wouldn't like it. I was so wrong. I loved it too, and surprised myself by being a good ICU nurse. So now I know, when I get burnt out from the ER, I'll give the ICU a try.
Sometimes you know, but keep an open mind. Try something--you just might like it. And if you don't, try something else. Eventually, you'll find your niche. Usually your gut instinct is right but if isn't, give something a try that you never thought you would like.
Aprilequinox, I knew you passed as soon as I read your first post. Your experience sounded IDENTICAL to mine--the type of questions you got, the # of questions you got, even the having to go pee so bad but waiting till 75 questions to take a break--and I passed. My heartfelt congratulations to you.