Published Mar 8, 2005
I have been working as a charge nurse in a 12 bed psych unit for almost a year now. Lately, I feel burned out and useless. I dread going to work. I don't feel like anything I do is really helping anyone and I struggle with figuring out why I'm still here.
I went into psych nursing because I wanted to help people by providing a safe place for them and to direct them to resources so they could begin to get well. I didn't count on having an overwhelming majority of patient's who don't want to get well because they are either:
A. BPD and enjoy being a victim OR
B. meth addicts who have no desire to quit using
On an average day approximately 4 of my patient's are BPD, 2 meth addicts, 1 alcoholic, 1 with depression and SI, 2 adolescents with behavioral problems, and possibly a geriatric patient who is suffering from dementia. We do treat patient's with bipolar/schizophrenia and others, but they are not as common as the amount of BPD and substance abuse patient's we see. Most days I literally feel like the life is being sucked out of me.
I am NOT trying to fix my patient's... I know it's not mine to fix. But I am lost trying to determine what my purpose is here.
It doesn't help that we are woefully understaffed. I miss one on one talks with the patient's. I am so buried under paperwork that I rarely have a chance to just "sit" and talk with anyone. I have tried to think of ways to be better organized with my paperwork so I can spend more time with patient's but so far it has not been very effective. I have tried to talk to other RN's and upper management but have not found any helpful information.
Any advice would be much appreciated.
I read your post this am and have been thinking about it. I have been working in psych about 13 years. To answer some of your questions. Some of what your role is is to be the resposible person on the unit. You set the tone for how compassionate and caring your staff we be. Some settings your staff will only be required to have a GED to work as a floor staff so how you direct the care is very important. Yes you do a lot of documntation again part of that is so you can demonstrate that the care you give and the care given under your direction is competent and safe. As the RN I have a dierect responsibility for my patients I can direct the level of observation for my shift for example. I am the care-giver for the staff in that they get burned and need support. To feel a little better maybe you can remember that in psych you have to appreciate the small, small changes.Psych is never, never boring.
To suggest how to make documentaation easier maybe have a clipboard handy where you have a template, example of all the areas you want to cover when documentating. It is quicker for me to make a quicl reference to my hospital portocols than to rely on my memory. I make a little lisit of when I need to do my documentaions anything to make it so I don't have to keep thinking about the tasks and use my brain for other things. good luck. I hope you get some more posts to your issue
Mostly, when we stumble, it's due to our feet, not where we're walking. I have worked in psych for the last 7 years. Although I work in an outpatient clinic (CMH) our mix of patients sounds similar to yours, although I would substitute ETOH for crystal, as we're in a rural area. That aside, when I'm stressed over my life, the BPD's and S/A's are much more difficult to tolerate. Seem's I can only handle so much emotional stuff at a time, and when I'm busy with mine, there isn't room for every one elses.
It sounds like a big piece of the issue is the BPD pts. They can be draining to deal with, but there are some tricks.
Number one. Get support for yourself. Seek supervision from your clinical supervisor. Join a staff support group. If nothing else is available get involved in a 12 step group, Al-anon perferably, since it is a support for persons dealing with addicts.
Realistic expectations: What you do not control, you are not responsible for. You are responsible for what you do because you and only you control your own behavior. You do not control the behavior of BPD patients. So no matter how much they would like to make you to blame for their misbehavior, you are not. Only the patients themselves are responsible for what they do. Only they are responsible for wanting to change their behavior.
You are not the therapist. The therapist has a duty to heal. You are the nurse. You have a duty to nurture. You attempt to provide an environment in which healing can happen, but you are not the one who "makes" it happen. In psych the lines are blurry, so think about the duties of a nurse on a surgical ward. You are not in the role of surgeon!
As your would if you had a medical question on a med-surg unit, ask the doctors to clarify the guidlines for treatment of their patients. (Document that you do so.)
Thank you for you advice, support, and ideas. I made up a check off list to place on my clip board to help me to be better organized. It helps me to remember what I need to chart on as well as what to pass on in report to the next shift. I am not sure if it saves me any time but it definately helps me to feel less frazzled and like I "forgot something".
Do you have internal rotation where you work? I have been working in Acute and Forensic Psychiatry for 15 years, I find that if I move every 6 months to a year I stay fresh and active, I move around from Intensive Care to Home Treatment, to Regional Secure to Admissions wards and also have the opportunity of some community work with substance misuse team, I am trying to get working in U.S. but am having trouble finding a place where my UK qualifications are recognised can you help me?
Create well-written care plans that meets your patient's health goals.
This study guide will help you focus your time on what's most important.
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