Only had 8 days orientation!

[Little Panda RN, ASN, RN]

I only had 8 days of orientation. I feel comftorable with med pass and paperwork but I do not feel comftorable with my ability to interact with my patients, especially the adolescents. I feel like I am going to be baptized by fire.

The facility of course is short nursing staff and we are running short almost every shift. Right after I was hired the DON and ADON resigned. Then we recently lost 2 social workers so that leaves one lone social worker for access calls. I have heard that anyone could be history at any time. Of course this is just heresay, but I am like "what the heck is going on".

"THE REST OF THE STORY"

Lately a few of the adolescents have been out of control. They have been swearing, hitting the walls and absolutely defiant. No matter what the staff does, what consequences they give, it is not working. There is one adolescent that is toxic to the whole group. This adolescent has to spend one hour a day in low stim, but it is still not working. This adolescent has the other ones also punching the wall and being very defiant. Seems like the whole situation is heading for a melt down.

How in the world do we get this under control? A large majority of us are new and are at a lost. I understand that adolescents are just that, with emotions that run high along with the background that they come from. We are there to help, but it seems to no avail the swearing and hitting things continue along with chairs being thrown.

I know we are not supposed to show them that we are nervous, but it is difficult. I do not want to get hit and these kids could very well throw a punch at any time.

I really need some advice on how to interact with this population. How to you redirect this situation. Consequences are not working and we seem to be playing by their rules if you know what I mean. It is exhausting to say the least.

Please share your wisdom:bowingpur.

[bollweevil]

I think you should be asking your supervisor and the doctor for advice. Perhaps a team conference is in order. Have you read the kid's history? Sounds borderline.

Personally, I'd be doing spiritual warfare for this. That is, I'd be taking the authority I have as a Christian and commanding the demonic spirits to leave this person and the whole area. I'd be annointing the place with oil, sealing the devil out, covering the place with the blood of Jesus. I'd do it very quietly, very secretly, so as not to call any unnecessary attention to myself but I'd be doing it. I'd be commanding the spirit of fear and the spirit of intimidation to be still, yet I'd be wary. If you're not a Christian, skip this part. No offense is meant to anyone, this is just how I, as a Christian, would be using the authority I have as a Christian to take charge of my scary, unsafe work world. And, having done the battle, I'd spend lots of time praising God. Station your angels round about you to keep you safe, too. And know your escape routes.

You are right to not let it be known that you are scared, I think, although on more than 1 occasion, I have said to patients that "when you act that way, it is scary." They have looked at me increduously. The scary stuff diminished. IT was as if they felt trapped but could now accept permission to behave better.

Do you guys have activities for the residents? Board games, movies, crafts, exercise, cards? What do they do all day? If your aides are not interacting with them but are instead sitting at the nurses' station, start assigning them to interact with the residents out in the Activity Room. Try talking about baseball or whatever with this particular one. What are his interests?

I wish you well.

[vashtee, RN]

How much exercise are these kids getting? I personally think that poorly exercised children behave badly.

And maybe they need a better selection of privileges to earn.

[Little Panda RN, ASN, RN]

The adolescents are in groups all day. Thier time is very structured. But this certain adolescent acts up all day long, during groups, during quiet times and so on. We do have MHT's on the floor with the patients at all times. They are never left unsupervised.

This certain group of adolescents just will not listen. They continue to swear, hit things and complain. One complains because they are asked not to swear or hit things. We have offered the punching bag but it has not seemed to help.

I truly want to help, but just dont know where to begin!

[Little Panda RN, ASN, RN]

How much exercise are these kids getting? I personally think that poorly exercised children behave badly.

And maybe they need a better selection of privileges to earn.

I agree with you natania, maybe they do need a better selection. I do know that they get to go to the gym, but what they do there I do not know.

I am new to this facility and my orientation was only 8 days, me and a new RN were talking that we really do not even know the rules for the unit. So as of this moment we are punting.

[wonderbee, BSN, RN]

nd-mom, you and I have a lot in common. "Batized by fire" are the exact words I used on my first shift. I'm wondering if these circumstances are common in mental health centers with management constantly in flux and retention of staff in general just not in the vocabulary. 8 days is ridiculous. It does seem though like passing meds, putting out fires and charting is all we have time to do in an 8 hour shift. Probably the people skills will come with practice. The important thing is that you know how to keep yourself and your patients safe.

As for your patient population, the others here have so much more experience but why not use locked seclusion for the bad apple? Let him earn his privileges back? Throwing chairs is pretty threatening behavior. Once again, I have lots to learn so just correct me please everyone... gently:idea:

[Little Panda RN, ASN, RN]

nd-mom, you and I have a lot in common. "Batized by fire" are the exact words I used on my first shift. I'm wondering if these circumstances are common in mental health centers with management constantly in flux and retention of staff in general just not in the vocabulary. 8 days is ridiculous. It does seem though like passing meds, putting out fires and charting is all we have time to do in an 8 hour shift. Probably the people skills will come with practice. The important thing is that you know how to keep yourself and your patients safe.

As for your patient population, the others here have so much more experience but why not use locked seclusion for the bad apple? Let him earn his privileges back? Throwing chairs is pretty threatening behavior. Once again, I have lots to learn so just correct me please everyone... gently:idea:

From what I understand seclusion has to be ordered by the physician just as if you ordered restraints (I could be wrong on this). I guess there is alot of paperwork that goes along with seclusion and it is only used for patients who are in a psychotic phase and are a threat to the population, which swearing and hitting the wall are even throwing a chair is not considered to be a threat.

I am perplexed!

[wonderbee, BSN, RN]

From what I understand seclusion has to be ordered by the physician just as if you ordered restraints (I could be wrong on this). I guess there is alot of paperwork that goes along with seclusion and it is only used for patients who are in a psychotic phase and are a threat to the population, which swearing and hitting the wall are even throwing a chair is not considered to be a threat.

I am perplexed!

What I know for sure is that we are able to restrict a patient to a small general area and even open seclusion without an order. We are to write a behavior plan for every patient that acts out in a threatening manner. Yeah, I know. Lots more paperwork but it provides needed structure and a degree of isolation from others on the unit.

Maybe you will get a new DON who can sort out these problems. In the meantime, keep posting.

[Little Panda RN, ASN, RN]

I have been on the job since Feb 18th and this week is our orientation. I did learn that seclusion can not be used as a punishment for bad behavior. I also asked questions about what resources we had as staff when this type of behavior continues. It was our human resources person going over standards and procedures so he said that on friday we will be having orientation with those who are over the nursing staff and to present my questions to them since they would know the answer.

I will keep everyone updated on what I find out.

[aloevera]

When a child on our unit acts out, hits, kicks, etc. he goes directly to the quiet room....we do not need a Dr. order for that. We leave the door open but he is in the room. We cannot risk injury to another pt. on the unit by one. When Doc. comes to make rounds, she is told and pt. then gets PRN med for these outbursts and is placed on LOS.

He cannot leave unit for meal, etc. this usually works and pt. generally stabilized by the next day.