mica/substance abuse...anyone?

[midnitelpn]

Anyone work a mica unit or substance abuse rehab? i've been an lpn for 11yrs, working in some type of psych setting all 11yrs; at the same facility. I have been on mica/substance abuse for the past 3yrs. I am the night charge nurse, with 2 aides and a avg. census of 70-80 between both floors. Since I have been here we have had 3 new nurse mgrs & 2 interim nurse mgrs. How are your units structured? Are they locked units or locked during the night only? Are you out pt.? Are your pt.s allowed to stay up all night, play cards, watch tv etc. Are they allowed to work off campus? Have their own vehicles & come & go? Are they allowed to self medicate (sans narcs & insulin) in their rms? Are they allowed to keep unlimited amts of personal belongings in their rms? I have these kinds of questions, because I, along with the majority of other staff on our unit feel, that our unit has become a complete free-for-all. We had some incidents last week, ex., live 22 gauge pistol rounds found in a common bath rm, 40 cartons of non-tax stampped cigarettes in a pts locker (pt selling cigarettes), empty vodka btls, and narcs found in the ceiling tiles......long story short, gun never found, pt. not discharged/disciplined for selling & distribution which violates a ton of policy, rm searches not done properly cause of too much personal junk & pts. going to the director stating that its a violation of their rights having their rms searched!. If we have someone come in intox or use while already in tx., we are asked to "sober them up", not "detox", cause if you were detoxing you would have to have some sort of protocol/policy to follow, which we dont. I have worked detox in this hospital on another unit that was closed, so I have alot of experience & know the proper way to do this. We dont even have beds on this unit that you can raise the head!!! Oh, your pt has a breathalizer of .280, just put him in bed & monitor his v/s & breathalizers till clear!!! 3 staff w/70 other pts. and one intox...now there is a exercise in frustration!!! I'm just wondering how other "residential rehabs are run". Our pts are not made to comply with any of our protocol/policy & its getting dangerous! I expect to find contriband, I expect to have intox pts, but I also expect management to have clear cut policy & procedure on dealing with all of this & adhering to these policies! The old, "everyones an individual" dosent fly with me when you are allowed to stay in the facillity after numerous uses in tx & conducting illegal behavior etc. We allow these folks to continue the same street behavior and lack of personal responsibility that they are supposed to be working on in tx!! Counter productive if you ask me!! How do your residential rehabs run?

[Whispera, MSN, RN]

Wow! WOW! WOW!!!! You are in a tremendously dangerous situation, and if I was you I'd RUN, not walk, out of there!

[inthesky]

guns and liquor?? The residential facilities in my area will not accept people with positive u-toxes. Anyone with a positive BAL must start at an IP facility (such as the one I work at). A few facilities will not accept people taking benzos. I have heard from my patients that residential treatment centers do sometimes have issues with current users sneaking substances. I wonder if some of those things can be reported to the state.

[RochesterRN-BSN, BSN, RN]

I can't believe your facility has not been shut down!! Yikes! If I was in your position I would feel obliged to call OASAS or what ever agency in your state is the licensing agency and report this stuff! If that stuff happened around here a place like that would be closed. And my ex-partner is a Social Worker in a residential Drug treatment house and they do room checks all the time....almost daily of at least a room or two and they don't allow ANY drug use, even smoking. All residents are urine tox tested like weekly. The have very strict guidelines under OASAS and if they are not within code then OASAS will come in and shut then down.

Nothing about what goes on there in your facility makes it sound remotely like a drug rehab but a hotel for drug addicts. What state are you in?

[midnitelpn]

I'm in a federal facility! I am told in report, when I recommend that some has their 2nd or 3rd +ive uds, they should be d/c'd, the response is "they are homeless & the refuse to go to the mission, they have no funds etc". I swear I couldnt make this stuff up! We had one pt. (admitted straight from prison) who was followed by parole, his casemgr reported his 2nd +ive & the p.o. wanted him to stay in tx. He was +ive 2 more times and given a voucher for housing!! And he was the most argumentative, verbally nasty, non-compliant pt (very well documented, even by physicians). I guess we would be paying for his housing reguardless if he went back to prison or given a voucher, but we did nothing to attempt to rehabilitate this pt! They miss mandatory groups and are given wknd passes to go home! We also have the largest pyxis in our facility. Have had pts sucking fentanyl patches that I give them. On any given morning I give dilaudid, morphine, percocet, lortab, xanax, ativan, fentanyl, klonopin and the list goes on & on. I am wondering if the truth be known, if mgmt is afraid to upset these people, because of the fear of retaliation! My colleagues and I are planning on reporting these incidents to the proper authorities this wk. Thanks for all the posts. I thought all rehabs were run kind of like ours, as I dont have any other experience to go by and it seems to be normal to mgmt. I used to love to come home when i worked straight psych and tell my kids how a pt was getting stabilized & coming out of their shell or just feeling mentally better, going to their first apartment etc. Now I dont have much good to say....or much good to feel about:(

[Whispera, MSN, RN]

You are truly working in an environment that is dangerous--for everyone who spends time there! It is not therapeutic at all, and not at all how most places are run! Do report this to the proper authorities and if nothing changes, do get yourself out of there before something happens that hurts you! I can see all sorts of disasters brewing there and you could be caught in the middle of any of them!!!