Felixa

Hi, apparently it's commonly cut with cocaine - maybe your man was selling it? I can't check at the moment,(I'm on a train) but from memory it has a similar melting point to cocaine, so it can be used for freebase. In Julia Philips's book " You'll Never Eat Lunch in this Town Again" (she was a movie producer for such filled as Close Encounters and Taxi Driver, who became addicted to just about everything), she has a sample of hers analysed which turned out to be mostly lidocaine.

As I live in the UK, the stats that come up first are for the UK, so apologies if they are not directly relevant to the US. http://news.bbc.co.uk/1/hi/scotland/525509.stm - this article cites 1 in 10 health professionals will face violence in the workplace, and 7 national health service workers per 1000 are attacked each month. THe percentage is higher for certain areas of work. http://www.nhsbsa.nhs.uk/3013.aspx - The Security Management Strategic business unit of the whole National Health service reports "In 2008/09 there were 54,758 reported physical assaults against NHS staff in England. This is a reduction of 1,235 compared to the previous year. There were 941 criminal sanctions in cases of assault, compared to 992 in 2007/08." - hardly the 'zero tolerance' policy they preach, I think. http://www.nhsbsa.nhs.uk/2948.aspx - breaks it down further - 11,088 against staff on acute wards, 1240 agains ambulance staff, 38958 against mental health or learning disability staff and 3472 against people in primary care settings (GPs, etc). Number of employees in the NHS - about 1,432,000, so 54758/1432000 = 0.038 assaults per person per year, or almost 4 staff in 100. That's just the ones that people file an incident form about. This is a publication that separates out violent threats and physical abuse and verbal abuse, saying that the most common assualts were actually against doctors, particularly in A&E (i.e. Casualty or ER), in the sexual health clinic, and mental health units. Also receptionists and complaints advisors came in for the most verbal abuse. Sorry, I've going to leave it there for research - hoped to find some US figures, and some breaking the assualt figures down by profession, but I got distracted and now have to go and make dinner! Maybe someone else will be able to find some other stats.

I've noticed in mental health that the higher the status of the assaulted person, the more drastic the consequences. It's not unusual to hear something like 'well after the two assaults on the ward we tried to get him moved to the Intensive Care Unit and were told no. But then he went into his ward round and threw a cup of tea at the consultant, and was moved in the next hour.' There definitely are statistics about violence on wards and Emergency rooms. I will try and look them up when I get the chance.

As llg says, this poll (and most polls on here) are likely to have a self-selecting sample. However it's also interesting to note that of those people with alcoholic dads, their mums often suffer/ed from mental illnesses.

My employer is also wanting to introduce trousers and polo shirts or button-up shirts as a uniform, across all the hospitals in my region. I work in an adult forensic unit, and I think it will only enhance the 'us and them' problem already illustrated by our heavy keys and custodial function. And what do we do about community escorts? Are we supposed to wear our uniforms then and draw attention to our client, or bring spare clothes to work every day because we might be taking someone out that day? We have worn plain clothes for decades, so I don't know what the justification is for going back to uniforms. I can understand for Older Adult psych, as older people are less confused and violent when they realise it is nurses washing and dressing them rather than random strangers! But why adult psych?

Just a little update from my Trust's smoking ban. My unit went 'smoke-free' in August. In practice it has not been particularly smoke-free. The smoke room has been locked off, but patients are allowed to smoke in the ward garden if they wish, or out on leave if they have it/use it. While the weather has been warm, we have been having the garden open most of the time, but now it is beginning to cool down, the garden is just open for set times - about once an hour for 15 minutes. Most patients have reacted remarkably well, although one is a bit irritable about it, and is (understandably!) annoyed if we are a bit late about opening the door on time. We have offered people support to stop, but only one guy on my ward took up the offer, and he was back on the cigarrettes within a day or too - smoking his usual but with added nicotine from his arm-patch! The upside of people smoking supervised in the garden is that non-smoking nurses can have more interaction with the patients than when they just stayed in the smoke room all day. The downside is that there are adverse health effects on some of the staff. An asthmatic member of staff has noticed her asthma getting worse, and there is a pregnant member of staff who has to be careful about when she is in the garden or the common room leading onto it. But so far, so good. We shall see during the winter months whether that has any effect on smoking behaviour. Side-note: in our 'smoking cessation' training, they told us that certain anti-psychotics are hindered by nicotine, notably Clozapine. A lot of guys in our unit are on Clozapine, so this could be an attraction to giving up, and something to be aware of if people's smoking behaviour reduces. Will keep you posted Felixa

I work in a medium secure unit in the UK. Our patients may have commited violence, murder, sexual crimes or arson, or some combination. Most of the patients I work with have schizophrenia or bipolar, and many of them have a history of abusing drugs or alcohol as well. Quite a few also have a personality disorder of some kind. I work on a rehab ward with all males, and although I am trained in control & restraint (where we might have to bring someone down to the ground and back up to move them to another room), I have never had to use it in the year I have been trained. Our patients are usually there for a minimum of 2 years. We had one guy who has been in the system 40 years. If someone needs to go to maximum security, it's usually about 10 years before they make their way back down the system and are discharged to the community. Otherwise it could take 2-5 years. When people go, they are often conditionally discharged, which means they can be readmitted swiftly if they break the terms of their agreement, e.g. taking medication, keeping in contact with the community team. If someone is agitated, a nurse may choose to administer 'PRN' (can't remember what it stands for - it means 'as required') medication, if a doctor has authorised it on the prescription chart. There are certain medications that nurses are allowed to give without a prescription. And they don't have to give it, it's all considered part of a nurse's professional judgement. We don't use non-human physical restraints - no strait-jackets or strapping people into bed. There is a seclusion room on the higher security wards, which is a last resort. If someone does need restraining, the UK tends to favour chemical restraints, giving an injection of Haloperidol and/or lorazepam. How's that for starters? What kind of ward do you work on?

Hiya Bjo, Just wondering how your smoke-free hospital was going? I also work on a Forensic unit (in the UK), and the management have just announced that they want to ban smoking on hospital property from June. Most of the patients in the unit, and all the patients on my ward smoke. We have a smoking room on the ward, well-ventilated, and the lads spend a good part of every day there. Those who can be trusted sign a lighter contract, and have to book out their lighter each morning and turn it in at curfew - they lose it if they are smoking irresponsibly. I suppose we'll have to gradually wean them off by shutting the smoke room except for certain increasingly longer periods of the day. What's it like with a whole ward-full of potentially dangerous people going through nicotine withdrawal? - I know we can use patches, so the physical side won't be so bad, but the psychological effects will still be there. What are the patients doing more of instead? (we do have ward activites but a lot of them aren't that motivated).

A lot of people posting here seem to take the view that once a criminal, always a criminal. Some people are career criminals, others fall into crime again because it seems so much easier, but others again actually make a go of going straight. Most people in prison today are there for drug-related crimes (so I'm told) - either drug crimes, or getting money for the habit, or violence fuelled by drugs. And a great predictor of whether you can kick drug habits/alcoholism/ get back on your feet after prison or even rebuild your life after a mental breakdown, is a strong support network. So I think there are benefits to writing to guys in prison. However I do think (along with others on the thread) that lots of people do it for the wrong reasons - they glamourise the crimes or they think they can save the person rather than just giving them contact with someone unrelated to their prison life and accepting everything they say with a grain of salt. I'm married already, but even if I wasn't, I would have great difficulty having a relationship with someone who has been in jail. But then that's my preferences and my prejudices. I know some people who have families that have always been on the wrong side of the law, and dating or marrying an ex-prisoner would not be a big deal. There are some incredibly forgiving people out there - okay some are doormats, but others are very strong and willing to forgive what others would think of as unforgiveable. After all that starry-eyed idealisn, as a practical safeguard I would think it sensible to wait till someone was out of prison and see what sort of life they made before deciding whether to marry them or not - maybe a year or more. It's hard to know what someone will be like in a different environment.

The relatives are always more evil than that patients, even on psychiatric wards. In my experience, the more trivial the problem, the worse the behaviour. I was doing a student nurse placement on a dementia ward, and noticing some people who were obviously family members of a guy from the functional side, I asked them if I could do anything for them. The woman (?wife of the patient?) replied that they were there for a case conference and wanted to know what room they were in. I replied that I was only a student, and didn't know what room they would be in, but if she took a seat I could find someone who could tell her. I looked in the ward diary and didn't see any mention of the meeting, found the named nurse who said he would be out in a minute, the ward manager was interviewing, the were several staff sick, and I couldn't find anyone else at that time who could take over. I explained all this to the woman, and she was disgusted that no one was ready to receive her - she didn't seem to realise that it was a hospital ward where patients don't always wait for a convenient time to display their symptoms. Trying to be helpful, I told her that I knew that the meeting would not be on the ward as there was building work taking place so we didn't have any meeting rooms. She was quite angry at this as no one had told her that the meeting had moved. Thinking it would give her some understanding and move her to compassion, I explained that the building work was an emergency measure, as a ward at the other main hospital had its roof collapse, so we had to make another ten beds to accommodate their patients on our ward. "The expression 'not my problem' comes to mind," she said. I was outraged by her selfishness. She also said that she had parked in a staff only parking space and that she expected not to get fined for it. "What will I do if I get a fine on my windshield?" And I wish, how I wish I'd said "The expression 'not my problem' comes to mind"... What I actually said was that 'you do that at your own risk. There is parking for patients and visitors on site or you can park out on one of the roads outside the hospital'. Eventually the named nurse appeared, apologised for his delay and all was well, except for one very shaken-up student nurse. I haven't been able to convey just how rude she was to me. What really annoyed me was how much I let her get to me. Before nursing I had done several years of customer service, and I'm usually quite good at dealing with angry and imperious people. I suppose I sympathised with her a bit as we weren't as organised as we should have been, and to be greeted by only a student who doesn't know what's going on is not encouraging. What I realise now is that we all have off days. Some people just know which buttons to press, and sometimes our buttons are much more sensitive than others. It was comforting to find out later that she was known as a dragon lady on the ward, that it wasn't just me. I did sympathise with her in a way, as being a carer of someone with a mental health problem is very stressful, and she only wanted the best for him, and as others have said in this thread, having your loved one go into hospital means you lose control over their care and of course no one else can do it so well! (I also understand why the patient wanted to come into hospital!!)

Sounds like an interesting research topic. I got sidetracked looking up references, but I better go and research my own assignments now! I found a survey noting the professions with the most obesity, but it doesn't posit any reasons for it. It's called "Obesity in US Workers: The National Health Interview Survey, 1986 to 2002", by Caban, Lee and others, in the American Journal of Public Health, in 2005, vol 95(9), pp1614-1622. Yes, nurses are among the occupations with the highest rates of obesity. I guess to test my theories you'd also want references for obesity in socio economic groups, as well as proportion of nurses who come from there, obesity among shift workers and the proportion of nurses who work shifts. There probably isn't any research whether career choice is influenced by weight to test if people who are already overweight are more likely to choose nursing. Argh! This is far more interesting than what I was intending to research on the internet! I'll be quiet now.

I have worked in mental health for a while, first as admin and then as a nursing assistant and now as a student. I have also noticed that there seem to be a disproportionate number of nurses who appear obese. Yes, there are overweight people in all walks of life, but out of all the different professions I work with - psychiatrists, occupational therapists, physiotherapists, admin, psychologists, psychotherapists and nurses, the nurses are more likely to be not merely overweight, but obese-looking (obviously I don't know people's actual BMIs). (Administrators come a respectable second, but I would say they tend to be overweight rather than obese). Myself I was obese and am currently overweight, so I'm not throwing any stones here - it's an observation, and it's a bit worrying given the health implications. I think shift work has a lot to do with it - when you work from 7 till 2:30 or 1:30 to 9:30 with only a tea break if anything, you're bound to dig into the biscuits (cookies for those americans among us!), and eat a larger meal when we finish because we're hungrier. And night shifts can be dangerous as well - it's so easy to comfort eat to get you through the night. But also, I think that nursing is a career where weight is not as important as in some other careers. It matters more what your skills are, and how you are with people. So people who have a weight problem may be more attracted to nursing. My third point would be that compared to the other careers I have mentioned (excepting admin, again), nurses tend to come from lower socioeconomic backgrounds, which have a higher proportion of overweight and obese people. (sorry, I know that these will not be popular observations!!)