Need help talking with new RN

[Crystle_clear]

I work in a 18 bed psychiatric facility. I was a case manager there, but now that I'm in my 2nd semester of nursing school I've switched posistions to a QMA. Recently a new RN was hired to work the 2 days the regular evening nurse is off. While she is a nice person and seems to know her basic nurising stuff, she has NO psych experience. Normally this wouldn't be a problem, but she is also very resistant to learning how to deal with psych patients from the staff with experience.

While I must admit it is hard form me to be working "under" someone with so little psych knowledge when I have my BA in psychology, I really have been trying hard to help her cope with her surroundings, (because I know how disorienting working the the severly psychotic can be at first) but she doesn't want to hear it. I'm not sure if it is an ego thing or if she is afriad of looking insecure but she won't take any advice that is offered. She is very overeager to medicate pts. whose perodic outbursts can be controlled with talking and quiet time. I honestly feel that she is afraid of the pts. and would rather overmedicate them till they drool, rather than take the time to redirect their behaviors.

The final straw for me has been the admission of a paranoid schizophrenic patient that we often treat. When he comes in he is always very psychotic and believes he is being held in a prisoner of war camp. Because he is commited to our facility so we have the right to force him to take medicaitions. For the last few admissions we have been mixing his Haldol, Ativan, and Clozaril in with his food because he is VERY resistant to taking medicaiontions when he is on this level. Once he clears he is a completley different person and is usually med compliant. The new RN refuses to "hide" his medications in his food. She thinks that it is unethical, despite the fact that it is perfectly legal. This means that every two or three times a shift we have to forcibly restrain him and she injects his medications. This poor man truly believes that we are killing him chemical injections and he cries and shakes after every episode. And of course this destroys all therapeutic rapport that has been developed with him. I don't think I can do that to him again. The past two shifts have been terrible and I want to cry everytime we have to hurt him that way when there is a much less invasive and traumatic way to get meds in to him.

I've spoken with our unit manager about it and she has recommended that the regular evening nurse and I talk with her about her about this since our DON is on a three week vacation. My question to you guys is what is the best way to approach this discussion? I don't want to hurt her feelings or put her on the offensive. How can we help her see that sometime psych patients have to be treated with a little bit more understanding and compassion than other types of patients. Thanks for any words of advice.

[fergus51]

If you work "under" her, I would not advise you be a part of the discussion at all. If you are right and part of her problem is ego, you being there will likely make her defensive right to begin with. If you want to be a part of the discussion, I would suggest focusing on that ONE patient period. The manager can deal with the rest when she gets back. Maybe starting the discussion with "We are trying to develop more continuity of care on the unit, including doing patient care plans. For Mr X, we all feel that it would be better for his meds to be hidden in the food until he is at a place to be med compliant. The psychiatrist wants this to be done because.....".

If she doesn't have psych experience, wasn't there some sort of orientation to the unit when she came that included how to deal with the repeat visitors?

[Crystle_clear]

We do have a two week orientation period where the new nurses follow another nurses around and learn the basics of the unit. After that period a case manager or therapist is assingned to the nurse to help them acclimate to the psych side of things, like thereapeutic rapport or psychosocial asssesments. Since she started evenings, I'm her assingned case manager to give her advice. Sorry I guess I shoud have mentioned that in the OP, just trying to get too many thoughts out at once.

[sjrn85]

I agree with fergus; direction should come from the nurse manager, not you (nothing personal, but you are not her supervisor).

I also understand where she's coming from in terms of "hiding" the pt's meds in his food...I don't think that's a good idea, either. Pts. with paranoid ideas can sometimes think that their food is being poisoned, and if this pt. discovers that you've been hiding meds in his food, not only do you give him a reason to validate his delusions, but you also blow any trust you may have with him. (For the record, yes, I did work psych for several years, and was board certified at the time, so I do have exp. in this area.)

Since she's a new nurse, another experienced nurse should be mentoring her, and another nurse should be evaluating her work. While you may have much useful experience that could help her, you are not a nurse and not in a position to fairly judge her work as a nurse. You'll probably understand this better whenyou yourself have finished your nursing education.

Two weeks with another nurse is a lousy orientation, especially for someone who is a new grad. I have to wonder about the quality of a place that would give a new nurse a two week orientation. Abysmal, IMO.

[Marie_LPN, RN, LPN, RN]

I agree with fergus; direction should come from the nurse manager, not you (nothing personal, but you are not her supervisor).

I also understand where she's coming from in terms of "hiding" the pt's meds in his food...I don't think that's a good idea, either. Pts. with paranoid ideas can sometimes think that their food is being poisoned, and if this pt. discovers that you've been hiding meds in his food, not only do you give him a reason to validate his delusions, but you also blow any trust you may have with him. (For the record, yes, I did work psych for several years, and was board certified at the time, so I do have exp. in this area.)

Since she's a new nurse, another experienced nurse should be mentoring her, and another nurse should be evaluating her work. While you may have much useful experience that could help her, you are not a nurse and not in a position to fairly judge her work as a nurse. You'll probably understand this better whenyou yourself have finished your nursing education.

Two weeks with another nurse is a lousy orientation, especially for someone who is a new grad. I have to wonder about the quality of a place that would give a new nurse a two week orientation. Abysmal, IMO.

Completely agree.

If the DON is on a three week vacation, chances are there's someone that's supposed to be "in charge" in their absence (perhaps the unit manager mentioned). It really should be up to that person to handle it, and not pawn it off on others.

[Bipley]

I don't like the idea of hiding meds in a pt's food, especially a psych pt. If they find the drugs they will believe they have been poisoned and just try getting them to eat after that. I don't blame the nurse in that aspect.

Seems to me there could be a middle ground here. Have another nurse talk to her about various possibilities and wait for the DON to come back for the rest.