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AMEN to RN writer and CharlieRN!!!!!!!! To Hseih, I wonder why you work with patients you feel are untreatable????

Amen to all of the previous posters, i too am a new manager and i am blessed to have a DON and a ADON wh o do back me up. I went from staff to management at the same time several of my peers did so we have each other to consult with and vent to and this has been a blessing. It is difficult but rewarding to see how we have all grown and the bottom line is that when you are a manager your relationships with your old peers will change. Communication skills are paramount and I think that being fair and openly communicating does gain you respect. You may win the popularity contest but respect of the staff does make you effective. I kind of look at it as the staff are my patients now and if i take care of them they are able to do their job and take care of the patients. This does not mean enabling them but supporting and advocating for them and modeling my behavior .

I am also angry on your behalf and very sad that you are treated this way. Unfortunately these things do happen. I agree that it is a toxic environment and hope that you will find a place where you can be appreciated. I work for a hospital that recently went corporate and while there are a lot of cons to this it has cut back on this behavior dramatically. We do have strict policies regarding these types of behaviors and I am fortunate to work with an awesome DON ADON and HR Director who adress these issues. I was treated this way as a child in elementary school and it was the hardest time of my life and have always been sensitive to these issues. I wish that you could come work for me you sound like an excellent nurse and i wish you the best in whatever you choose. You have my support!!!

Excellent thread!!!!!! I was actually going to ask for advice on this very topic. I think Charlie said exactly what I needed to hear. I have been in nursing for 18 years, 7 yrs in psych and am now working as a night supervisor and encounter this situation frequently. While i definitely agree with not staff splitting there was an occasion when a patient was up and agitated and wanted juice. She is VERY good at targeting the right staff and knowing just haw to push their buttons and had already been up 2 or 3 times that night for juice and the staff told her no. I heard the screaming from my office and went to investigate the situation. The patient was all worked up about smoking and went on to say that she was thirsty and couldn't drink water etc, etc, and was probably being manipulative but i told her that she needed to calm down and get in control, offered a prn and told her she could have the juice with her meds and then she needed to go to her room and stay in control and if she was in control at smoking time (7am) she could smoke. This decision did not win me a popularity contest with the staff as they felt that i was allowing the patient to manipulate and they had lost "control" I asked the staff to just try to listen to me for a minute and gave a spiel about "control" and that when the patients are admitted to the hospital the are essentially locked up, their clothes are taken at times, we tell them when to eat, sleep, smoke, etc... They are adults and not criminals and i often wake up at night and get thirsty and the meds we give them do cause dry mouth. ( This pt also had thrush from HIV) While the pt was manipulating she also had a need. I asked them that if in the grand scheme of things it was really going to matter if she "got over" for a cup of juice and they had to agree with me. I also did not want to have her disrupt 24 other acutely ill patients and have a real situation on my hands. I felt that I had made the right decision but I really was concerned about the staff feeling unsupported and was questioning myself and i asked one of my bosses and he made an excellent point. His response was that i acted appropriately as an advocate for the patient but sadly the patient got the message that if you carry on and scream and threaten you will get what you need not that we(the staff) care enough about you to give you juice if you are thirsty and pointed out that the difficulty the staff has when patients get out of control is that staff feels out of control and that is when we need to DO SOMETHING I have seen a lot of behaviors that are "normal" in the real world escalate to codes and restraints which could have been handled in a different way and we are working really hard at our hospital to change the culture while still ensuring the safety of all staff and patients. We are also succeeding, last year in May we had 85 restraints this year in May we had 15. We now include an anger management assessment on all admissions and include the patient in developing a safety plan Sorry for the length of this and i hope that i didn't stray too far from the topic but many of the acutely ill inpatients we serve suffer from personality disorders including borderline. BTW I have grown to actually like borderlines too Charlie, sadly I think that we are a minority

YES YES YES I can so relate I wish that i would have this site as a resource when i started my career. I have worked in many a small nonprofit facility where i have dealth with drs who were either incompetent, untrained or just unbeleivably unprofessional and downright scary. I learned so much the hard way, baptism by fire. I have finally learned to speak up and colloborate with the physicians and some of the new ones really do not know certain things and when they realize that you do they are actually grateful and work with you.. I also realize that i do not know everything and have learned to express my concerns in a non emotional way and have become a much better nurse and patient advocate. I grew up by becoming a nurse and learned how to communicate and i now choose to work with the mentally ill because this is a population that desperately needs advocates and are underserved and easily taken advantage of. I am definitely not trashing all drs but there are bad ones just like there are bad nurses etc... A forum like this would have been so helpful to me when i started out my career in 1989 I worked at a drug and alcohol facility for 6 yrs and one of the attending physicians there would have never survived anywhere else. I can tolerate some ego in a dr whose knowledge and expertise is respectable but an ego and ignorance that is a dangerous combination. EX(pt in acute resp distress, homeless, hx of COPD, smoking crack and ready to resp arrest, turned O2 up during night and clearly suffering CO2 narcosis, desperately needed emergency treatment intubation and ICU care physician doing EKG at bedside and "teaching" staff EKG changes show long term resp problems DUH tells me to give him water and watch him Pt ended up trached in ICU after suffering to breath for an hour while i desperately and finally contacted another dr and got him transferred. Doc, didn't you ever hear of ABCs if pt can not breath who CARES about EKG????????????? If this pt was well-to-do and had a family someone would have been able to advocate but when it comes to MI esp drug addicts no one seems to care. Whenever i attempted to write this physician up was told Oh you know how--- is, we don't want to upset him WELL WHY THE HECK NOT????????????? Upset him report him and try to improve him some people just should not be in the medical profession. Thank God for nurses who advocate for their patients, someone has to. Wow, really needed to vent. that situation happenned a few yrs ago and i still get sooo angry when i think about it. Started keepin my own documentation at home then cause i figured it was only a matter of time til i would need it. Also started educating my patients on their rights and their right to complain. As difficult as the substance abuse population is, addiction is a shame based disorder and these patients really do have low self esteem and don't want to cause waves with a dr. Any way, left that facility finally and now work in acute psych and just took management position. Change comes slowly and is difficult but i have grown from my experiences and now with the internet can do research myself quite easily and have learned that if i become emotional and lose logic i am ineffective but when i present facts and research and throw in the "legal/liability" part of the picture i do get results. Sorry about the rambling but this is topic that hits a nerve with me

My first job we also placed the meds in an envelope for passes and i had no idea that it was illegal but i found out that it was when i worked subsequent jobs. At my facility if meds are needed for a pass or discharge the dr must write an order ahead of time and it is sent to the pharmacy and labeled and then given to the patient. If this does not happen before pharmacy leaves for the day then i make the doctor give the meds to the patient and just explain to them that legally iam not allowed to do this. We have one dr that is infamous for waiting til the last minute (after pharmacy is closed) and she was surprised when i explained this to her but when i explained that i was not trying to inconvenience her that it was a legal issue she was cooperative and stated that where she had worked before the nurses always just gave out the meds. As nurses we need to now legally what we are able to do and not do according to our state's scope of practice and noone else is going to do that for us. And trust me if anything untoward occured you can be sure that we would be the ones to take the blame! Cardinal rule of nursing CYA!!!! Sad but true

I paged the attending dr on a child whose xray showed a fractured hand in a psych facility at 3pm She called me back at 11pm. No excuse and not unusual for her. I, of course, had already taken care of situation with another doctor.

AMEN TO THAT I am a aupervisor at an acute psych hospital and was actually toying with the idea of trying to make the staff be patients for a day, i actually thought that it would be good for them if we made them wear headphones with loud derogatory comments in different voices were playing blasted the TV and then expected them to do thier job. Sadly much of society even those working in the field are very insensitive to the pain of mental illness. As a seasoned psych nurse once told me at least we have effective medications for physical pain but none such exist as yet for emotional pain you sound like an excellent candidate for psych nursing. I would hire you

Errors happen and a most of the time they are part of the "system" and not just an individual error. In the 2 instances that you described you were not the only person at fault. In fact you did not even hang the bag of fluid if i am understanding this correctly and the allergy was missed and not reported to you I am in no way understating the importance of the responsibility of medication administration and giving nurses "permission" to be lax and not take every precaution to make patient safety a first priority but, that being said. I am shocked that you were asked not to provide direct patient care as a result of this. You are a new nurse and i can bet that you will never make these errors again and will be extra careful in these 2 areas and these experiences will make you a better nurse because you have lived firsthand through them. I am curious if the person who hung the wrong solution was also disciplined as harshly. In a perfect world we would have enough seasoned nurses to work with new nurses and help them to transition into their roles but i have seen and heard about countless events where a new nurse with a lack of experience was placed in charge of a floor and lacked the experience with far greater devastating results So you made mistakes that does not mean that you are incompetent and trust me any nurse who claims that they never made a mistake is not a nurse that i would want taking care of me or my family Please don't give up on yourself and don't quit your education learn from it and move one. If you need a little time to develop your skills and get comfortable fine but don't let this experience keep you from living up to your potential I have been a nurse for 17 years and have not taken risks and stayed at jobs that i felt were "safe" because i felt incompetent for a long time. I have just recently realized that i am far from incompetent and am planning to go back to school and took a management position and have found a new found sense of pride and exhilaration with my career. I also made a pretty serious error in my first year as a nurse. It involved an infant and morphine and thank god the child suffered no lasting ill effects. Also thank god that i was not treated as you were, believe me, i tortured myself enough but i can guarantee that i will never make that mistake again and have become a much better nurse as a result of it. Also the facility I worked with made changes and created a new med room from it which helped to keep the patients safer. YOU ARE NOT INCVOMPETENT BECAUSE YOU MADE A MISTAKE!!!!!!!!!!!!!!!!!!!

I can totally relate and i do think that this is normal for a nurse when you are learning and will probably get worse when you graduate and are "on your own" I also think that if this is interfering with your life to the point that you are unable to take proper care of yourself and have some time when you can relax and socialize and enjoy things that getting some couseling and perhaps meds would be in order. I also think that if you didn't worry at all and were overconfident that you knew everything that would make you a dangerous nurse. I still, after 17 years, will go home and think about things that happenned at work and try to come up with different solutions. Critical thinking, problem solving, and communication skills are essential for the nursing student to learn as nursing is a huge responsibility and over time you will develop more confidence. If you make a mistake, take a look at it, ask for feedback from your instructors and go easy on yourself. If it was your mistake, own it and learn from it and you will probably never make that mistake again. If it was something that was out of your control or someone elses mistake DO NOT OWN IT!!!!!!!!!!!!!!!!!!!!!!! Nurses seem to think that they are responsible for a lot of things that are out of our control. Patients make choices and we can not control that. We are not responsible for doctor's decisions and if we learn to communicate effectively and have honestly done our best then we have to let certain situations go. It will get easier with time, but if it doesn't or you truly can not fuction, are not sleeping or unable to eat properly or are becoming depressed where you can not enjoy anything then you should seek professional help. Mentors are also helpful in the process of having someone to vent and look for guidance. None of us is or ever will be perfect so don't put that expectation on yourself and as a nurse you will see a lot of things that are just very sad that you can't change but if you do your best to always do what is best for your patients you can sometimes make a difference. You will see all sides of humanity the good the bad and the ugly and soemtimes even the greatness. I have also found that it helps me to "debrief" If i have a very stressful and less than perfect shift i sometime call a friend or write about in a journal and then i am able to let it go. Nursing school was the hardest thing i ever did but it also gave me a wonderful career and i wouldn't change it for the world. I have made mistakes along the way but they were my best teachers. Best of luck to you and feel free to im me if i can be of any support We need good caring nurses like you

Have also dealth with this in more than one job. Think that there is probably one in every hospital. Ive found that being civil and keeping myself emotionally detached works best. Don't let her rent space in your head, it's not worth it and everything eventually comes out in the wash anyway. If not in the wash, then in the rinse! It seems to me that these people try to get close to people that they can manipulate and if you just don't engage her and not feed into her negativity it will probably drive her crazy and don't be surprised if that makes you her target in an attempt to get to you but if she realizes that her attempts are fruitless she will probably get bored and move on. If she seriously targets you and makes inappropriate or slanderous remarks i would keep my own documentation so when it all comes out you will have that to stand on. Management usually is aware but they usually won't do anything until things get pretty out of hand. I left a job once because my supervisor was very unprofessional, had no boundaries and had an extremely distant relationship with the truth! That was 2 years ago and she still works there but in the long run i got a better job and an better off. Good luck and just don't give her power over you. She is not worth it and probably enjoys all the chaos she creates. My mother used to say to people like that " I am not going to dignify that with a response" It worked pretty well some times and that is basically what i am trying to say. It also really pisses people off who want to waste time creating discord and chaos. Nothing is worse than being ignored and people like you describe usually crave attention. " Feeble minds discuss people, good minds discuss events, great minds discuss ideas"

anyone have any info on staffing and nurse:patient ratios for psych?

We don't have day supervisors anymore either and it is very fragmented as i have noone person in particular to give report to. We have an old fashioned hand written sheet with the census, admissions, discharges, code, special observations, transfers to medical hospitals etc. I work in a psych facility and recenly became a supervisor. I am relieved in the am by either the program director of the adult services, child/adolescent services, the ADON or sometimes a unit coordinator. On top of that we now share our office with the staffing coordinator and there is not a lot of room or privacy. I have handled this by keeping just the overall important items in the supervisor's report. ie census, codes, sentinel events etc reporting callouts and staffing issues on a sticky to the staffing coordinator and requesting to meet with the ADON in her office regarding more personal issues regarding employees and i keep a small notebook where i jot things down to keep them in my memory. I work on weekends from 8p to8a so i encouter all kinds of issues from all 3 shifts and from the weekend staff who do not have access to the upper management as they work during the week. This system has worked for me but it is difficult and time consuming and i sometimes am not ready to leave til 9 or 10 am depending on what is going on. Also we have recently restructered our management and now each of our units have their own unit coordinators and they are in the process of developing their roles. I feel that the unit coordinators are helpful to improve communication and cohesiveness on each individual unit and i will leave them voice mails or notes or discuss unit related issues with them. Like i said this is difficult and time consuming but we are also in a transitional process and i have found that most of the problems that i encoutner on my weekends stem from a lack of communication or communication to the wrong person. When i am there on the weekends i am basically the person to whom everything is communicated which is why i rely on my notebook

I totally agee with helping the staff out when they are genuinely overburdened however i have learned to stop myself when they are adequately staffed and the work load is within the norm. The reasons for this is because unfortunately some staff take advantage of your helping out and will expect it and become dependent on you. Also, i have learned to sometimes "lead from a distance" and not jump in and solve minor problems from the staff because i want them to develop problem solving skills. I am always aware of what is going on and make frequent rounds and talk to my staff and will jump in when i see that they are really unable to handle something or a potential crisis.My goal as a leader is to nurture, support and educate them so they wil need me less and less. I hope to develop better nurses this way and to help develop some nurse leaders in the process. This may or may not work out as i am new but i always make sure that the staff knows that they can come to me at anytime and discuss anyconcerns that they have. I also let them know that i can not help them if they do not ask for help and that asking for help is not a reflection of poor performance but a responsible and prudent way to practice. I do not know everything and i would never expect anyone else to. we learn every day and i am much more skeptical of the staff who think they "know everything"

I recently read an article about BMGs(bellyachers, moaners,and groaners) and how these few people can really harm morale and they basically donot want to be part of the solution. They like to dump problems and have management solve them although they are generally problems that are impossible for us to solve or out of our control. The author had many suggestions but one of them that sticks out in my mind is that no one can present a problem without at least trying to come up with a solution. I thought that this was a good idea. And sometimes with these type of people i just ignore them (not the best solution probably but i can use my energy to work with those who are invested and want to help find solutions)

I also would respect manager that would return as staff, best of luck to you and keep us posted

Thank you all so much wonderful advice, can definitely relate. New to management myself, took job as supervisor of 180 bed acute psychiatric hospital after 17 years of bedside nursing. Learning so much and can totally relate to everything posted here. Trying to boost morale and increase accountability and communication

Hi I just recently accepted a position of a supervisor of a 180 bed acute psychiatric hospital on weekends Inever wanted to go into management but i am surprised to find out how much i like it.. I am very new and my responsibilities are far less than a "manager" Mostly i handle staffing, patient and staff complaints, performance evaluations, and collobaorating with other departments such as dietary and admissions My experience has opened up a whole new world for me and i am very interested in pursuing this farther and i feel that my experience has also helped me to be a better staff nurse and see more of the "big picture" I also am struggling with the adjustment and dealing with some difficult personalities and the transition in some of my relationships with coworkers. I finally am at a point in my life where i really can say that i do not care if everyone likes me but i want to do a good job, be fair and be respected. Any suggestions from anyone with similar experiences would be appreciated

I agree with most of what i've read here. Nursing school is hard and nursing is not for everyone. There are some bad instructors and there are some bad nurses. There are also a lot of good ones, and really great ones. Nursing is a difficult and stressful and relatively young profession. One thing that i am starting to realize is, that we as a profession, can work together to make a difference in how we are percieved and how we are treated. We, as a profession, are very powerful. We provide a much needed service to the world and need to maintain high standards to continue to elevate our profession and serve humanity. One of my personal observations of my profession is that nurses really do complain a lot but rarely do anything about it and when offered solutions are resistant to them I am not trying to blame anyone or get anyone offended and i myself am guilty of this behavior at times (as anyone who is human is) I have however also become hopeful in much of what i have read lately, in the research that is being done and changes that i see happening. ie shared governance at hospitals, california nurse:patient ratios, evidence based parctice. This may have been around for a long time but i was never aware of it until recently and have found a new sense of pride in the profession that i have chosen for myself I loved some of the comments about the "self-esteem" generation. This is so evident today in our society not only in nursing but everywhere. Look at all of the ridiculous lawsuits. I don't know how it is in other cultures but in america is rampant and it really makes us look stupid. (we don't know that coffee is hot so if there is not a warning, we sue and get rewarded with millions of dollars) While self-esteem is vital to one's growth and development as a person it has gone too far and it seems as though we have missed the boat and not taught people that just because they were born and exist doesn't mean that they will excel in everything and where is the concept of accountability in all of this?????????? In my opinion we would do far better off as a nation to teach people how to communicate, be accountable, and be assertive than to try to give people self esteem Self esteem would come naturally to those who developed those skills I know that i went off of the topic but couldn't help myself. My nursing instructors did a very good job of educating me and while they were tough at times they had to be to prepare me for the enormous responibilities that lie ahead in my future career. I have thought about the possibility of taking up nursing education myself, god knows we are in desperate need and i would like to thank all of those who are giving of themselves in this much needed area. The best thing that we can do for the world is to help our nursing students become good nurses. After all, they will be the ones taking care of us , right?

This is a great topic, we can share these without upsetting family members at the dinner tableLOL I have a few As a student i walked into a sweet little old lady's room to collect her breakfast tray and found her disimpacting herself... WITH A METAL FORK!!!! I worked in a spinal cord injury unit for adolescents and saw horrendous pressure ulcers and we also had spina bifida kids before latex allergies were well known. These patients had a tendency to also be allergic to the metal hardware used in spinal fusions. we had a couple of patients who rejected the hardware so badly that it literally ate up their tissue and we would have to do sterile dressing changes in the OR and you could literally see their spines. In home health care, i had a patient that was trach vent dependent and would be hospitalized for respiratory distress only to stabilize immediately in the hospital. As soon as she would come home and be connected to her ventilator, she would almost immediately go into respiratory distress. It was a mystery. I was doing a program for Health Partners on asthma and learned that the cockroach mite was the leading cause of asthma in inner city children. Well, we put 2 and 2 together, opened up her ventilator and you guessed it,... it was full of cockroaches. Home care itself has a tons of material for this topic. This has been fun, thanks

Amen!!!!!!!

Hi I've been a nurse 17 years and switched to psych almost 2 years ago. I still feel incompetent at times but that is just part of my makeup i'm afraid. It really does get easier, the advice here has been great and don't be too hard on yourself. I am sure that you are a great nurse especially if you are taking the time to come here and ask questions, how do you like your new position so far? i love mine but it is an adjustment and i am probaly going to take a new position shortly as a "patient care coordinator"(glorified name for shift supervisor) I've also found that some of the best psych nurses have a medical background and can often see something that someone without a medical background can miss. It seems to me that the best nurses i work with have excellent communication skills, are able to work as part of a team, have a good amount of empathy and campassion and take good care of themselves. Oh and they are very nonjudgemental. Best of luck to you! Lisa

Congratulations!!!!! Only Have A Diploma But Hope To Get Into A Rn-msn Program And Would Love To Get Into Penn's Psych Msn Money Seems To Be The Issue Here Might Be Able To Go To Drexel Through Work Any Suggestions?

hi that statement was actually a reply to a post but i am new here and didn't realize that it would come up like that on its own. I also agree with statement but alone it sounded very cynical didn't it? I found this thread and was instantly drawn to it and stayed up all night reading. I, too, am a nurse who has suffered from MI probably my whole life and I do think that it probably has something to do with why i went into nursing and why i am good at it. Unfortnunately if you expose too much of yourself to the wrong people you can be left vulnerable and lack credibility with some of those in the health"care" profession. I have been fortunate in my experiences to allow my personal history to be of help to some colleagues and patients alike. Despite how far we have come in this world with technology and medications and science of the brain we are still very far behind when it comes to basic human compasssion and treating people with dignity in a nonjudgemental way in the mental health field. I think it is probably ignorance and fear. Also a lot of it has to do with the "business" side of health "care" I work as a psych nurse in a for profit acute psychiatric hospital and sadly despite my knowledge and experience and that of my colleagues and some physicians i work with, the insurance company decides a lot of what treatment the clients get. It is frustrating and the same way in medical hospitals also. I do not know the answers but i do feel that my own personal experiences have helped me to be a more compassionate, empathatic nurse and a lot less judgemental than many of my peers. Another thing that i have come to realize is that my co-workers aren't neccesarily my friends just because we work together and i can't have the same expectations of them as i would have of a friend. Some of them have grown into friends and for that i am grateful This realization has become a survival tool for me and helped me to flourish in my career. I want to truly thank all of you who have posted here for your courage and your ability to be "real" people. This thread is truly a lifesaver. God bless you all, i could relate to every single person here Lisa

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