New nurse in a psychiatric facility concerned about preceptor's behavior/attitude

[gasuperstar]

I am working in a psychiatric facility for my first nursing job. The nurse who has been given the (unwanted) job of training me has been nursing for 30 years. We have a patient who goes for days without sleeping, and I approached her to talk to her about why she felt she could not sleep. I tried to let her know that I cared about how she felt and wanted to know what I could do to help her feel comfortable enough to sleep. After this conversation she went to bed and slept for 4 1/2 hours. The next night I did the same thing, but she was afraid to go to her room because her roomate had been yelling at her for waking the roomate up so often throughout the night. I asked my nurse if we could put a mattress in the hall or a different location so the patient could get some rest, and I was laughed at (even though this is a regular practice for other patients). I was told that the patient would not go to sleep anyway (her sleep the night before went unnoticed). I assured the patient I would walk with her to her room and not allow any remarks by the roomate and would then stand at the door for a few minutes until all was settled. After this she slept for 3 1/2 hours. I asked my training nurse if we could put in the shift report what helped the patient to get some rest at night, and she said it didn't matter...the patient would never 'get better' and no one would be willing to do anything like that for the patient the following evening.

I was told that one day I would be 'cold' too, and that some people would just never get better...I was told to stop caring so much! I am heartbroken at the way this patient's needs were ignored. I did my best, but I don't understand why it isn't part of the job to help every patient as much as possible...even if they will never get 'better'! Who is wrong here? The new nurse or the training nurse?

[singingtothewheat]

You know. I have two things to say about this. (and then I have a bunch more stuff to say about this. LOL)

1. fresh perspective can mean everything

2. your new at this and really have little idea of how strange things can be

I'm not a psych nurse for a real good reason. I don't like it at all.

You may have been able to help that patient because you had a different attitude that she could feel comfortable with

or

She may have simply been using your newness as a way to manipulate the situation.

It isn't new news that some psych patients can be very manipulative.

This is not an excuse but also remember that for the most part, psych nurses are part of a terribly broken system. There is no where NEAR enough inpatient treatment for the seriously mentally ill. The nurses who choose this as a profession often get very little support for their work and the general climate for psychiatric care in many parts of the country is chosen disregard of the problem. It's very sad. If your a diabetic and your blood sugar goes to 800 and your family finds you unresponsive, you might get heath care. If your a mentally ill person and you crash chances are you get nada.

I hope that it was your attitude and fresh perspective. Always do your best to give people the benefit of the doubt.

[Davey Do]

gasuperstar:

Please allow me to commend you on approaching and intervening in a problem when you were basically informed that it was an exercise in futility. It would seem that the little attention you gave went a long way. Many times, we just need to be heard. That action alone will lessen anxiety.

A defense mechanism a lot of so-called burn-outs use is called pigeon-holing: Label a patient as a lost cause and we're no longer responsible for their outcome. They're hopeless and any excessive energy expended on them is silly.

Remember your current perspective in the days to come. Any one of us can become an unempathetic burn-out. Self-examination is required. Know your limitations. Your well-being is not contingent on what anyone else does or says or what happens around you. Your well-being is a result of being at peace with what you do and who you are.

When you are the RN responsible for your group of patients, you can do whatever you believe is therapeutic. (Within the boundaries of ethical practise, of course.) That's really an exciting learning experience. I believe that you will utilize your atypical methods in order to achieve therapeutic outcomes. And don't expect to be honored. The glory needs to come from the realization that you have done what you set out to do and done the right thing to do.

Best wishes to you in your endeavors, gasuperstar. Keep on keeping on.

Dave

[Mish56, BSN, RN]

Sorry your preceptor is such a burn out! What a lovely intro to nursing. I've been doing acute inpatient psych for 32 years. I hate the fact that some of our patients will "never get better". For many....yes, they will have their illness the rest of their days. Does that mean we don't bother?? Lord knows I hope not! We may just be helping someone return to THEIR optimum level of function, even if that includes living with delusions or hallucinations. And sometimes that means we focus on the basics, such as sleep and nutrition (oh I can hear some of you now, "3 hots and a cot").

I can't tell from here if you were "manipulated" or not, but these are things you will learn as you go. And if that's the worst thing that happens in your day, your still a heck of a lot better off than some of our patients.

Hang in there!

[pleasantly mad]

First of all good on ya for having the initiative and ability to care about the patients' need. At the end of the day there are many in psychiatric who attribute 'no hope' to a patient, I dont like this and don't think I ever will. Although I have only been in psych 2 years post reg I am by no means niave and have always though that even in the most (seemingly) hopeless cases there is always a chance for recovery, even if it is slim. There is a reason the word unwell can have many meanings in psych, A patient who still hallucinates can be very well due to his/her reactions to the situation. Some may look on an individual who still hallucinates as unwell, but if they are happy, of no harm to themselves or others and functioning I cannot see what the problem is. All in all I like to believe there is hope. In further note a perceptor is only a guide, having someone who laughs at an idea like yours did should be a guide into not doing as they do. Be your own nurse not follow in the short sightedness of others, learn from others mistakes and use it to your advandage, believe me even when others put you down, if you can fight for yourself and your decisions, it will make you a stronger individual and a better nurse. Even if your collegues don't appreciate you, your patients will.

[pinkiepie_RN]

Some patients can be manipulative and it's necessary to set appropriate limits, but it's important that patients get sleep when they can and that we facilitate it when we can. I see no problem in letting a patient sleep in the milieu if they're not a bother or interfering with other patients' sleep. We have a frequent flyer who is a patient with borderline personality disorder and although she is manipulative, it's usually both in her best interest and our best interests to let her sleep on the couch in the living room. Not every nurse allows it and some say it crosses the line, but I say that if the patient isn't causing harm and it's not an unreasonable request, pick your battles.