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medsurgrnco 8,564 Views

Joined: Jan 20, '08; Posts: 580 (35% Liked) ; Likes: 365

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  • Apr 17 '09

    I don't think the union should represent you before the bON.

    You can help your union representative with the links. It may help the arbitrator understand how common medication errors are.

    I'm sure your union rep will ask but I feel i have to suggest you have the hospital policies for your unit regarding medication administration and the same for pharmacy.

    Seems your manager and the other nurse did not follow the five rights.
    Make a large type handout with them for your union representative, who may not be a nurse.

  • Apr 17 '09

    I am still confused.....was the med you prepared given to the wrong pt???
    if you did not tell the other nurse to do this, how are you to blame? Did you instruct her to give it? If not, then I don't see how it is your fault..
    also, if you did not give that med to the pt, then you definately should not have signed it what did the pt. get that that med was prepared for?
    excuse me, I am slow tonight....(am just finished with my 5 day straignt)

  • Apr 17 '09

    I strongly suggest that you do the med-surg thing first. As well as reinforcing what you learned in school, you learn something that is invaluable to a nurse in any setting. ORGANIZATION skills.
    All of the things you listed about med-surg basically means that you have to learn to juggle. Once you go into psych, you have to be organized. I think I spend most of my time managing things or people. I am in charge most of the time, so that means I have to make the schedule and assign the techs. Depending on the acuity of the patients, I may have up to 12 techs that need assignments and breaks assigned. Then you are having to manage the patients. On an acute psych ward, you aren't really doing therapeutic stuff as much as you are redirecting them.
    I have only worked psych in state hospitals, so I don't know if the population in a private psych hospital is different, but in my experience, there is a lot of behavioral stuff that you have to deal with. The majority of the patients have been to jail at some point and there is a mentality associated with the jailhouse that is difficult to deal with. Common basic manners, or simple things like attention to ADLs, and especially the substance abuse are issues for them.
    In an adult psych unit you are going to have a broad spectrum of personalities. You could have young guys with a chronic mental illness who have been in the system since they were kids, then you could have older ones who aren't old enough to be on geriatric ward, but are in a wheelchair and have a laundry list of medical problems. Having that med-surg background will just make you a better well rounded nurse. I know that sounds like something your instructors would say, but it is the truth. I despise med-surg but would not trade that experience for anything now! Give it a lot of thought before you commit to a specialty like psych without a solid foundation.

  • Apr 17 '09

    I did med ed groups on adult psych. I didn't ever identify what drugs anyone was on. Sometimes they brought it up themselves in discussion, but that was their choice. One of my favorite ways to do it, and one the patients seemed to engage well in, was to do something like this on a dry erase board:


    and then list several examples under each heading. Then we'd talk about what made one kind of medication different from another; side effects; a little bit about how they work; odds and ends about any specific meds; and so forth. As well as to include a discussion about compliance, safety issues, etc. It may sound kind of boring but it usually got a pretty good discussion going, and patients asked a lot of questions. I kept a med book handy in case I needed to look something up for someone.

  • Apr 17 '09

    Everyone who has already posted has offered good advice, but I'll just offer a couple of bullet points because it's late and I'm too tired to do anything else!

    - This applies to any interpersonal communication, but just remember that communication isn't just about words. Ever seen Conan O'Brien sing the lullaby song? Here's another example. I work with a nurse who is incredibly high-strung and has a way of making everyone around her, staff and patients, feel tense because of the frantic pace of her speech, her sharp tone, and the way she flails around when she's frustrated. I've seen her try to deal with a psychotic patient in the midst of a panic attack by yelling "CALM DOWN!!!!" Needless to say, she's not very effective in a psych setting. If a patient approaches you yelling, use a quieter tone so that they have to quiet down to listen to you, and always be aware of what your face looks like. As you already know, patients will tell you some WEIRD stuff and it's your job to keep on your sympathetic face, or at the very least, your poker face.

    -Try to anticipate some of the issues you'll run into as a new person on the floor and think of how you'll respond. The first time a patient said to me "I hate this &%*# place and I want to get the &%)! out of here because all the nurses are @#& horrible," I had absolutely NO IDEA what to say. I was similarly dumbfounded the first time a pt asked if I would hypothetically go out with him if he wasn't my patient. Talk to your coworkers about how they handle weird/tough conversations. Good luck!

  • Apr 10 '09

    hey there, new grad! i recommend the pocket guide called "psych notes" put out by the people that put out other pocket guides. i got mine off i usually recommend it to all new psych nurses. it has info on the differential dx, s/s, interventions, interviews, & some of the newer psych meds.
    hope this helps you.

  • Apr 10 '09

    I live and work in the UK. A few years ago we introduced smoking bans and we have some of the same problems mentioned here. The idea that you should just ban smoking entirely would only be suggested by someone with no experience of working in this field. If you have just been admitted a psch ward you are most likely highly distressed, disorientated and scared. This is NOT the time to start preaching the virtues of being a non smoker to someone. The ward I work on is lucky in that it has a secure outside area where patients can smoke. For other wards it is the daily grind of escorted leave to outside areas and being pestered every five minutes by patients desperate for a cigarette.
    It was a bad idea to introduce smoking bans while such a high degree of mental health service users still smoked. A properly ventilated room should be provided but the self righteous health facists with no psychiatric experience got their way unfortunatley.

  • Apr 5 '09

    I have worked detox and rehab units and the thing to remember is that people in recovery have developed coping skills that appear highly manipulative,they can be extremely demanding and assertive and are often not like the grateful clients you find in a hospital medical/surgical setting.You have to have very good personal boundaries and be aware that the clients are often suffering physically as they detox but emotionally as well as they are being forced to come to terms with their own pain and the pain they have caused others.They can become aggressive and inappropriate at times in a way that you rarely see in a medical may also find yourself administering medications to large numbers of people,i had 28 clients on varying detox protocols,they vary significantly from drug to drug,and this requires concentration and patience as people in withdrawal may come to the med window and yell at you. It can be very rewarding to work with these clients but you have to know yourself well and be able to separate your own personal issues from theirs and not be too crestfallen when a large number relapse...people have lots of different reasons for ending up in rehab,many of them having nothing to do with actually getting clean,but there is a lot to learn in this milieu and i would not trade the 3 years i worked with this population for anything...good luck with your choices

  • Apr 5 '09

    I agree that there are confidentiality/HIPPA issues with doing a medication education group unless it's handled in a very broad, general way -- you cannot disclose which medications individuals are on to other members of the group without their consent. Of course, if they choose to ask a question which reveals something personal about their medications or medical history, that is their choice to make.

    However, it's always "safe" to talk about groups/categories of meds, or the specific medications that are most commonly used on the unit if you don't identify which clients are or aren't taking them. One place to start could be the printed client education material (about specific medications) that is available from lots of sources, inc. your hospital pharmacy. Another topic that is frequently useful is talking generally about why it's important to take any meds as prescribed, inform providers of all the meds you're on, be aware of interactions with herbs/supplements, etc. Also, the drug companies have videos about many of the common/popular psych disorders, emphasizing (that company's) applicable medications, that are intended for client education (of course, these videos are basically sales pitches and strongly emphasize the positive aspects of the drug while glossing over the negatives ...) They typically give these videos away for free to professionals/facilities. Those could also be useful as discussion-starters, since psych comorbidity is so common in CD populations.

  • Apr 5 '09

    I have an objection to having a GROUP for medications if it shares what each person is prescribed, since that's personal and some people don't want everyone else to know, AND hearing about everyone else's medication can be boring if one isn't taking the same thing. I prefer to do medication education on a 1:1 basis, and do that during group time and outside of it. I imagine it's a policy that patients must be informed about their meds, and a group is one way to do it.

    But, I are some random thoughts...

    --Ask them what they'd like to know.
    --Take the medication administration book to the group and even take copies of their own MAR for each person (make sure this is ok according to the boss). Then ask if they have questions.
    --They probably won't. It's likely many won't even know what they've been prescribed.
    --Think in terms of categories of drugs that are being prescribed....benzos, antidepression meds--what they do, how they work in the body. Depression often goes hand in hand with chemical dependency. I'd bet money lots of your patients are on antidepression medications.
    --Discuss the reasons some of them are being given vitamins and minerals
    --Give handouts about their medications, give time to read them, and then ask if there are questions (this assumes all can read and are in a condition where reading would work)
    --discuss how the drugs they took that brought them to you have altered their minds and bodies (alcohol, opiates, benzos, cocaine, meth, etc.). Your unit might even have a movie
    --talk about smoking

  • Apr 5 '09

    Im not a psych nurse but I am an ex smoker and I dont think an inpatient acute care setting is the right time for people to try to quit smoking. They are already dealing with whatever stressors brought them there in the first place, why add more?
    Also, why cant we cut smokers a break? Would it really kill us to give them a room or an enclosed porch/area or something to smoke on? I think we really over do it in this country when it comes to stuff like this.
    My entire hospital campus is smoke free. You cant even leave the building, you have to walk off the property if you want to smoke. I just think its a bit extreme.

  • Apr 5 '09

    Quote from Whispera
    I don't believe a staff member in the US can refuse to take patients to smoke, by the way...
    In the most litigious country in the world - I'd like to see an employer force an employee to be exposed to a carcinogenic and feel perfectly safe about that.

  • Apr 5 '09

    I love the ability to just sit down and talk to my patients, going over plans, goals, hopes and dreams for their future. I love that I get to be the person who is their for them when they are most vulnerable and needing our support (even if they don't think they need us at the time). I LOVE watching an extremely manic, psychotic, depressed (the list goes on) patient get on meds for a week and become so much happier and healthier. Almost like meeting a whole new person.
    I am a female working on a psych unit but as far as liking having males, yeah their is the element of having a stronger person availble if we need to a "show of support" ie intervention when someone goes off. I also think their is something to be said about just being a male presenece when someone is just beginning to escalate. Many patients will allow themselves to become a lot scaier when they think they are only up against a small female nurse. I personally also love having the combination. Men and women often have different styles and ways at looking at things, at least this is the case with myself and the male nurses I work with. We seem to work well and complement each other. Its also nice having both when you are needing to do some of the more intimite nursing tasks that some patients would perfer their same sex nurse for.

  • Mar 31 '09

    I have to say, I am very impressed with this man...taking that extra step.

    Again, you can throw tons of pills at the patient or perform tons of surgeries to patch a patient up, but if you don't begin to address the major problems which bring the patient to you...then what are you truly doing as a physician? This physician seems to have the answer...or at least, the most correct one.

    It is an approach that folks in mental health have known for a long time.

    Dr. Cooper essentially validates this for us.

    Dr. Carnell Cooper, a Baltimore surgeon, is saving lives inside and outside the operating room. Dr. Carnell Cooper's Violence Intervention Program provides training and support to trauma victims.

    Since becoming a trauma surgeon 16 years ago, he has dedicated himself to treating the many young African-American men who've been shot, stabbed or beaten, only to see them return to the ER with another severe injury just months later.

    But when one of his patients was readmitted with a fatal gunshot wound to the head in 1996, it changed Cooper's life.

    "The night that we pronounced that young man dead and my colleagues said there's really nothing we can do in these situations. ... I just didn't believe that," said Cooper, 54. "From that day forward, I said, 'Let's see what we can do.' "

    Cooper created the Violence Intervention Program (VIP) at the Shock Trauma Unit of the University of Maryland Medical Center, the state's busiest hospital for violent injuries. It became one of the country's first hospital-based anti-violence programs.

    "We approached this problem like any public health crisis, like heart disease or smoking," he said. "We tried to work on the root causes."

    Since 1998, VIP has provided substance abuse counseling, job skills training and other support services to nearly 500 trauma victims.

    "Using that scalpel blade to save their life is the first step," Cooper said. "The next step is to try to keep them from coming back."

    A 2006 study by Cooper and his colleagues, published in the Journal of Trauma, showed that people in the program were six times less likely to be readmitted with a violent injury and three times less likely to be arrested for a violent crime.

  • Mar 31 '09

    It really doesn't make sense that you got turned over the BON - unless you were the supervisor, and even then thats not a clear shot. Sounds like they have a bone to pick with you (Union!) and the state board should be able to see through this. A humble attitude would probably play best there, if it even goes that far. Its going to be tough to keep working in such a place, wow! Don't give up, sounds like you are in the right!