Pediatric Behavioral Health help

[pedspsychnurse]

I’m a fairly new nurse. I’ve been working in a residential and acute pediatric facility since I graduated in 2019.
Lately I’ve been dealing with boundary issues from my patients and some complaints from my coworkers. The boundary issues vary depending on the unit.
My mhts say I’m “too” nice or “overly” nice. I’ve talked to a couple of therapist and they’ve told me different things.

For example, on our female unit the girls run and cling to me (tho they do that with a lot of people) but also they’ll all have something wrong and need to talk. The therapists on that unit told me I’m not firm enough with my boundaries. I’m too “nurturing” and the girls have something wrong when I’m on the unit bc they want my attention. They see the mother figure they didn’t have.
I asked them what I can do to rectify it and they said nothing to try and stay off the unit. They also said that my nurturing nature is good for the girls in the long run though so it is confusing for me. Is it good or bad to be that way?? And I can’t just stay off the unit.

On the male unit, I have patients that also want my attention but they’ll act out for it, on occasion. I also have some of them make sexually inappropriate comments but I ALWAYS redirect and always tell them it makes me uncomfortable. I actually had a patient ask me why I like their unit. A group of them told me that several staff have told them or they have overheard how they hate being on their unit. I really hate that they have to hear things like that but try to explain that the sexual comments are inappropriate and make people feel uncomfortable. I think they also have some motherly issues towards me.

the therapist on that unit are very different

One told me I’m doing a great job because I treat them with respect and dignity. My kindness could be taken the wrong way or used at manipulation but she still thinks I do a good job

the other one is much more pessimistic in my opinion. He told me that I wear my heart on my sleeve and every single employee and child can see it and they use it to manipulate me. I’m kind and loving and everyone can see it and use it. He told me to put on a mask and be “aggressive” because that’s what they know and respond to, but honestly I just don’t agree with that.

I've also been told some of my coworkers say that any unit I go on the kids start acting out because of me. I’ve also had coworkers tell me that maybe I should cover up then and wear baggy scrubs. I can’t help that I have a large chest and butt, I have started wearing baggy sweatshirts though because of it.

it honestly hurts me that they say that bc I try so hard at de escalating and keeping the peace.
And there are days I work a unit and we have a great day!! It’s a mental health hospital, kids are going to act out!!

I guess the point is what can I do? How do you know when your being manipulated? Am I the problem? I don’t want to stop being kind to them. I enjoy sitting in the day room with them or taking them outside or whatever. It also helps because I pick up on the little things, the covert bullying that happens.
I really love my job and the kids and just want to be better at what I do without becoming tough and never doing anything extra for them.

[Davey Do]

I'm a little confused by " I’ve been working in a residential and acute pediatric facility" and "I asked them what I can do to rectify it and they said nothing to try and stay off the unit" but it won't affect my comment to you, pedspsychnurse.

If our interventions with patients do not go outside of established, appropriate boundaries, then the method we utilize with those patients shouldn't be negatively critiqued, when the results are positive.

All too often, people put personalities before principles and are motivated by emotions rather than logic or sound principles. Any type of approach, being it's appropriate, that is outside of a consensually typical methods of approach will be called into question.

For example, if we can achieve a therapeutic outcome with an appropriate unconventional method, those who don't have the ability to understand and/or utilize that method, will have their method called into question. "It's just the way we do it" is heard, when in actuality they're saying, "I can't or won't do it that way because I am uncomfortable that method".

Pedspsychnurse, I applaud your unconventional method which yields therapeutic results, as I can identify with you.

Case in point: A a big ex-con patient diagnosed with schizophrenia threatened the lives of two female staff members. I was able to talk him into going into the quiet room, and unbeknownst to me, one of the female staff members called a Code Green. As I was talking with the patient in the quiet room, two security guards appeared at the door. The patient got wide eyed upon seeing them and shouted, "NO!"

I asked the security guards to step away from the door and they went inside the nurses station to observe the quiet room from a monitor.

As I dealt with the patient, intervening by talking, directing, asking questions, being animated, using humor, and behaving in a way in which I felt comfortable, I later learned, from one of the female staff members, that one security guard watching the monitor said, "(Dave) shouldn't do that. It's going to make (the patient) go off".

During the intervention, I told the patient that he needed to stop interrupting me- we were having a conversation and we each of us needed to take turns. The patient asked, "Can I put a washcloth in my mouth to remind me?" which I, of course, allowed.

By the end of my intervention, the patient took two PO PRNs, an antianxiety and an antipsychotic, committed to safety, and apologized to the two female staff members for threatening them.

My intervention may have been appropriately unorthodox, but a therapeutic goal was attained.

If your interventions succeed in achieving a therapeutic goal, pedspsychnurse, by all means, "Damn the torpedoes, full steam ahead!"

Good luck and the very best to you!

[pedspsychnurse]

It’s a facility with 3 residential units, female adolescent, male adolescent, and male pediatric. There’s also an acute unit with female and male adolescents and children.

The therapists told me I could not do anything to stop the boundary issues on the female unit. They’d rather me stay away from that side of the facility because some of the girls confide they are having suicidal thoughts and then they have to do an suicide risk assessment. The therapist say the girls are fine and just want my attention though so they say things like that and would rather me not come into the unit. I don’t really like that either though because if they are being serious, one of the patients could get hurt. Considering UHS track record right now they should take any claim extremely serious.

I’ve found knowing your patient and just talking to them like that helps a majority of the time! Power struggles and demanding patients to do things ends in a restraint a lot of the time and it seems the preferred method by staff.

thank you!! Your story was helpful!