gcja

while I would agree with you that it is possible and very likely for borderline to attempt to split staff, in this particular instance I don't believe that to be the case. the original problem was "which is the best way to deal with borderline female who claims she can't sleep." I worked two different nights with different nurses who had different styles. the first nurse felt it was better to allow patient to sit in "sitting area" quitely without disturbing other patients thus allowing her to settle down and eventually go to sleep. he felt it was a better outcome than to wind up in a restraint situation which would upset the whole unit. the outcome to that situation was patient hung around for about an hour or two and eventually went to sleep. the next evening, same situation, the other nurse immediately when to showdown scenario by calling for reinforcements and whith a show of force caused patient to go to her room. on the second scenario physician was called and he calmly spoke to patient and asked would she please go to her room. while doc was present patient complied. shortly after doc left, nurse called for reinforcements and informed patient either you go to your room or lockdown. I was just trying to figure out which is better approach. As far as what occurs on the day shift, we have a 24 patient unit with two nurses and two techs. In the best of situations it would be difficult to interact with the patients. unfortunately, in this facility 3 out of 7 days the two nurses are temporary agency nurses unfamiliar with the unit or the patients and only on the unit for the day. the next day we might have two entirely different nurses. So while, yes, it is very possible that a splitting situation can take place. It might also be possible that the patients are not getting the attention they deserve.

I have about 4 months in psych and love it. I work 11x7 shift for a psych hospital. unfortunately, it seems our patients don't get the 1:1 they need. course of treatment is usually meds. problem w/this psych hospital is they utilize mostly agency and per diem. so there is no consistency with the staff for the patients. everyday we have new nurses. we do have a few permanent employees (me being one) but not many. here is the problem: we have a f/borderline on our unit who is extremely attention seeking and constantly acting out "according to earlier shifts". she will not comply with the rules of the milieu. when asked to get away from nursing station - she won't. when asked to take her meds - she won't. when asked to go to her room - she won't. constantly looking to talk to nurses at desk and being shooed away. when she won't leave she ends up being put in restraints/seclusion. when report is given it is always "pt. is acting up looking for attention. problem is due to lack of staff it seems patients aren't getting any attention. anyway, here is the problem. I come into work on friday midnight. pt. indicates she cannot sleep. she looks physically exhausted but refuses to go to her room. she states that she doesn't like being alone in the bedroom and when she goes to her bedroom thoughts of suicide pop into her head. she indicates that she doesn't want to take all the meds that they are giving her because it makes her very tired in the day (which they let her sleep all day) and keeps her in a fog. she supposedly told the doctor this but to no avail. she shows me her diary about her feelings of loneliness and anxiety she experiences, how she wishes she didn't feel so lost. how she wants to fit in and have a job and lover like everyone else. she spends the next hour or so going from nursing station to sitting area in the back of unit. she pops up at nursing station every 20 minutes looking to talk. she finally requests prn for 2 mg ativan and 50 thorazine and goes to back of sitting area and falls asleep. the senior nurse (15 years) has no problem with this because patient is quiet and not disturbing anyone else so he lets her sleep on day couch in back room until she wakes up at 5:30 am and goes to her room. Now, Saturday night: same situation but different senior nurse. instead of allowing patient to sit in back sitting room. at 12 am nurse calls doctor for an order to put patient in seclusion because she is not complying with the rules of the milieu and won't go to bed. Senior nurse states patient is testing limits and has a history of not complying with staff. Pt. does what she wants and wont listen to anyone. there are now two other patients ( who can't sleep either) quietly sitting in sitting room with patient. this is part of the problem with allowing borderline to stay up. we will have the whole unit up. Mind you, the 3 patients up are quietly sitting and talking. a couple of techs from other units show up for support of the anticipated seclusion. the physician comes up to unit to personally interview patient and see what problem is. the dr. convinces patient to go to her room and issues a room search and a c/o (one on one) because patient indicated that she has suicidal thoughts and a plan. Dr. leaves. Patient spends about 10 minutes in her room when she is back out of it. This time senior nurse puts her in open seclusion room where she spends the night following voluntary administering of 2mg ativan/50 thorazine. So, as a new psych nurse which is the better way to go. I just experienced two different approaches. On Friday night, it required alot of effort on my part to listen and talk to her every 20 minutes until she passed out about 3 am. On Saturday, by 12:45 she was in seclusion and the rest of my night was easy. Help which is right approach.

from what I hear montefiore is a great hospital. their benefits are fabulous. they have a great tuition reimbursement plan. basically no wait to be covered by benefits and sick time. their salary starting off is mid 60's. my friend just got hired as right out of nursing school (passed nclex) into the pediatric e/r. it has a year long orientation that takes her throughout the whole pediatric division of the hospital from pediatric oncology to icu to regular floor to you name it. they are giving her her acls, pals and everything else. she loves it. if you interview with them just insist on going into a specialty otherwise they might try to steer you into med/surge. myself, I took the psych route and love it.

i understand your dilemna but I think you are a little off base. People most certainly do comment on other female professionals who enter the male dominated world. As a retired NYC police officer and now an RN, I can personally attest to the fact that my sexuality was often a topic of conversation. I was insulted and humiliated as a result of being a female cop by both the public and my peers. I was called some of the nastiest curses that you can imagine by people on the street. I simply chose to ignore it as I am a professional and have a job to do. As a matter of fact, I was required to ignore it. See we were given sensitivity training which supposedly trained us for the abusive public. I personally would have been pleased if all they called me was the "female cop". As far a female doctors are concerned, I have patients who request male doctors and won't let a female near them because they feel they are incompetent. I have witnessed patients request white doctors. You are not alone and you certainly are not discriminated against. Sometimes people just call it like they see it. If I see a red saab driving down the street, I will say to my husband, hey honey, "look at that red saab, isn't it beautiful". after all, the saab is red.

my best graduation gift was a lladro statue of a "nursing student". it is about 18 inches tall with a woman dressed in nursing uniform carrying nursing book. it came from my husband and ran somewhere about $150. it sits in my china cabinet where I look at it everyday.

I seem to be noticing that they typical response to each new nurse is "give it a year". It seems that the culture shock of too many patients, not enough time to chart, angry nurses who eat their young, nasty doctors, inadequate supplies, your own confidence level, medication errors, and all the atrocities experienced by the new nurse will seem to pass after a year. My question is this? what changes after a year? Or is it that we simply become used to the poor conditions we have been struggling to succeed with? I, mean, if you keep getting pricked on the arm over and over you eventually become immuned to the pain. Is this the same scenario? I don't doubt that your own confidence level will increase and that part of the stress that we are experiencing will pass. However, what about all the other issues. Do they pass? Or, again, is it that we simply learn to accept it. When, in reality, we shouldn't. Thanks.

nothing. they can't work till they pass nclex

have you tried psych. I knew i wouldn't, couldn't do med surge. tried psych and I absolutely, absolutely love it. I feel valued and I know I make a difference.

I am a fairly new graduate (12/05). right out of school I went into med surge. while I felt the job was OK, I hated the stress, lack of time available to perform adequate patient care, constant running around, no time at all to pee, (11x7 with 16 patients) continous mandation, sometimes resenting patients who rang the call bell over and over. despite all that, in those two months I have to say I learned a lot with regard to skill level. we were required to do everything. anyway, I left and took a job in a psych unit. I am completely fascinated and love this job. I find it extremely rewarding and I love each day. while it can definetely be hectic, I feel that this is the place I was meant to be. Each new day is a new experience. I feel that I have human contact with my patients and that I make their life a little better, just for a second or two, on most days. My problem is this. How do I stop beating myself up for leaving med surge. I see my fellow graduates goinng into er/ icu/ med surge and I wonder am I making a mistake by giving up my "medical skills" so early on. How do a rationalize with what I want to do (psych) with what I think I should be doing?

the hospital I worked for will pay .80 an hour for bs/bsn. that comes out to $32 extra a week for 40 hours. Over the course of the year I get a wopping $1664 a year. How do you justify the money and TIME you spent on the degree for $1664 a year extra. Sorry guys, but ADN or BSN, an RN is an RN and that in and of itself deserves the money and respect. As a staff nurse, we are both doing the same job and it is one tough job.

I am also a new rn. I , too, googled hospitals in the state that I wanted to work and then went onto individual hospital career openings. In northern NJ there are a ton of psych jobs.

waynesville & carolinapooh: your house is beautiful. nc sounds great. how much would a house like yours go for today , 20 minutes outside the city. thanks

My license was issued on March 22. I do not physically have license in hand. That can take 10 business days. I was fingerprinted on March 15, so 7 days later they verbally gave me my nj license # over the phone. However, I went into NJ to get fingerprinted by their scanning. If you do traditional fingerprints in your own state, it can take 2-3 monts.

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I just graduated in December. My nursing school provided the course two weeks after graduation and required that we attend. It was 8 hrs a day for 4 days. In my opinion, it was a waste. I studied from saunders and mosby. Passed at 75 questions.