Bjo

I've been offended on this site, too. When that happens, I just log off for a while until I feel like I'm ready to come back. You have to realize that a lot of people can look at others and judge them, but it takes a bold person to judge themselves. You will be a great psych nurse because you have the desire. And thunderwolf is right; the stigma of mental health is very difficult to overcome. And whether a person practices mental health nursing or not, everyone has had "issues" that gives them a little experience in life's lessons. The difference with psych nurses is that they take that experience and try to help others overcome what they are dealing with. Other people keep things to themselves. It's just a difference in people and the way they use what they have. Just keep believing in yourself, moon30. You will do great things!

You can check out the requirements at www.nursingworld.org I'm actually due to be recertified this year so I need to be looking into it myself. Good Luck!!

Your story was so touching! As for the guy at work, if you lose his friendship at least you can be sure you made a difference in his life. You've had to endure so much pain in your life and to turn all that experience into a way to help others is, in my opinion, one of the bravest things a person can do. :kiss

Very well said. Thank you for your post. You are absolutely correct in all that you said. I don't think the problems and issues being listed are only seen in psychiatric nurses, but in all nurses. I also don't believe that a true desire to help others is anything to be wary of. Nurses are supposed to be compassionate and caring. That's what we do, isn't it? When I stop wanting to help other people, I should stop being a nurse. Whether I work in OB, OR, Med Surg, Peds, or Psych; it's going to feel better at the end of the day to know I did the best I could to help someone get better than to think I put in eight or twelve hours not caring what happened to them.

Our State hospital takes anyone. We have court committed, voluntary, and emergency admits. We also have forensic patients who have been there for many years. After the patients are sent on an emergency pink slip, the doctors have to decide whether or not they need to stay. If the patients sign a voluntary, they stay until the doctor discharges them. If they won't sign a voluntary and the doctor thinks they are in need of further treatment then the doctor signs for them to go to probate court where the judge will decide if they need to stay. They can be committed for 90 days to two years. We are regulated by the local mental health boards and it depends on which county the patients are from as to what hospital they can be admitted to.

I was just wondering what was the worst about OSU? I think the nurses there are unionized, aren't they? Or maybe they are just working for the state. I always thought that would be a good place to work but now I am doubting it.

I stand corrected. I didn't mean that ALL who strongly oppose should be suspect. I should have said that SOME may be more likely to have contraband. You're right that many will have other issues relating to the invasion of privacy. I should have been more clear. I also wanted to add that the approach the staff take during the searches can have an impact on how the patients accept it also.

Just a couple of suggestions. We have the tank lids on the commodes bolted down so we don't have to check inside of them. Secondly, we don't search visitors but they aren't allowed to bring purses or packages on the unit. We have a visitors locker that they have to use for these things. They hold the key until visitation is over and then remove their belongings to take home with them. Any packages brought in for patients during the visitation must be checked before the patient receives them. We have off ward privileges as well. We don't do a full search but we do use a hand held scanner to check for anything that would be metal. We still do ward searches as well. Just a quick look over at the start and end of every shift. We don't do the complete top to bottom search unless we suspect contraband. If this is something new you have just started, the patients should adjust to it as long as you are consistent and explain to them that it is to ensure everyone's safety. If they are strongly opposed to it, perhaps these patients need a more thorough search!

www.genesishcs.org You can try this link. It is for Genesis Hospital in Zanesville. That may be somewhat farther than you want to drive but they have twelve hour shifts and the pay is rather alluring! Welcome to the area. I work at the State hospital in Cambridge. Our sister hospital is beside of Obleness there in Athens. If you decide you want to try psychiatric nursing let me know. We aren't hiring full time but could probably use what's called an ETI. (Established Term Irregular). You aren't promised any certain shift so it isn't the ideal job. I'll keep my eyes and ears open for anything that comes up and let you know.

I've never seen the movie. However, a couple of things off the top of my head is the reduction of people being placed in restraints and moving mentally ill patients out into the community rather than keeping them institutionalized for years and years.

That's hard to say given the individuality of each case. If the person is acutely psychotic, you may not want to encourage them to start beating up on a punching bag. They might not be able to back off from it! My experience with psychotic patients is that they come in to the hospital because they went off their medication. If they are truly psychotic, they probably have to have the medication. There are many other things you can do in addition to medication, but that will depend on the individual's personal circumstances and the degree of psychosis.

Teens can be tough to work with. Lots of times they come across as being angry when they really have a lot of emotional pain that they don't know how to deal with. Just be patient with them and don't take it personally when one or more of them offend you in some way. Be the adult but still give them respect as an individual. They will appreciate that more than anything. Just let them be aware that you expect them to give you the same kind of respect. Many of the teens I've worked with were different (more reachable) after they knew where we stood with each other.

Are you, by chance, in SEIU?

What state are you in?

You may want to check about a waiver. I know there is such a thing when there is a survey coming up and you have extreme circumstances that can effect the outcome. Look on the JCAHO website for some info. They may have something posted there.

The priority of the healthcare staff involved should be to do no harm to the situation. There is no evidence that mental health services can do anything to alleviate personality disorder. There is plenty of evidence that providing support can be a damaging process. It doesn't matter that BPD is mentioned in the DSM or the ICD-10, it is still just a description of a list of personality problems. It doesn't have the characteristics or more importantly the treatablity of serious mental illness. The fewer therapuetic interventions this girl is subjected to the better. You may be absolutely right. I just don't think that is the issue for this family. Wth all due respect. :-)

It doesn't sound like your daugher has a mental illness. I agree that it does look like Borderline Personality Disorder. The best thing the staff can do is to lift all the restrictions and play each event of self harm down. In reality the fact that she is getting such intense input is probably making the situation worse. In the UK she would probably not be admitted to hospital, she would be patched up with a minimum fuss in A&E and given an opportunity to talk with someone briefly. I disagree. Borderline Personality Disorder has specific criteria in the DSM- IV and this is absolutely a mental illness/ psychiatric disorder, or whatever name it can be given. Either way, the issue is that this family is in distress and is asking for help. That's my !

Congrats on the promotion. Try the following link. It has some great sample policies and a multitude of questions that you could be asked by JCAHO. www.4nursingmanagers.com If we can help you out at all, just post!

I don't take it as being rude at all. You are the only one who can fathom the whole situation and I'm sure you've heard all the excuses from staff. I sincerely do wish you the best of luck in this. I apoligize if this comes off as rude but, I feel that this statement is little more than an excuse designed to absolve staff for incompetence. The girl was allowed to purchase razors and bring them to her room on the floor undected. That in no way is akin to using her fingernails, teeth, or paper. Again I am not trying to be rude here but when something happens that is the very first thing we hear. And thanks for you genuine concern for me and my family. j-mac

Every facility has their own policies and protocol. However, I don't think you can open all of the packages and put them in little cups prior to medication administration according to JCAHO standards. You need to identify the patient using two identifiers. We use name and date of birth. Compare that to a picture ID or something similar on the MAR and then open the medication. I think it is ok to put the medication in the cups prior to giving them as long as they are unopened but you should ask your supervisor first. If you are using bubble packs, you probably won't be able to do it.

in ohio, the department of health regulates staffing in nursing homes. however, the ratio is very high (1 stna to 15 residents). you figure in an eight hour shift you can give less than 30 minutes to each person on your hall and maybe you'll have time for a 30 minute lunch. there have been several studies done by hcfa about the relationship to quality care and minimum required staff. this has been going on for about 4 or 5 years i think. the reports i've read always say "there wasn't sufficient evidence to make it an issue." staffing in nursing homes needs to be adequate as well. now, with the cuts to medicare being proposed, it is going to make it even harder to give the quality care the residents need.

I sent the letter via private message. You can also check out other political actions at the following site: www.seiu.org

i worked in an adolescent psychiatric hospital for 10 years. i know how much you love your daughter and you are justified in being concerned for her. however, i would have to question if they have explained her diagnosis thoroughly. bi-polar is an "axis i" diagnosis. there are actually four other axis's that could have a diagnosis associated with them. on axis ii, you probably need to find out if she has anything related to personality disorders. this could be borderline traits (usually given to teens) or something else. if you find out that she does have borderline traits, i would recommend that you read all you can about borderline personality disorder. it is one of the hardest diagnosis's to deal with. it is very sad that she ended up with stitches. many times, (and this is all in general and not directed personally at your daughter :-) "cutters" don't really want to commit suicide. they want the pain to stop. more often than not, when they cut deeply enough for it to be life threatening, they didn't mean to do it. as for the staff, "cutters" can wear them down very quickly. throughout all the best efforts to stop them, if a cutter wants to cut, they are going to find a way to do it. they will even use their fingernails if they have nothing else. they can be very manupulative and it is very hard to try to help them find better ways to cope with their pain. try the following links below and see if you can find out anything that will help you and your family. my heart goes out to you because your pain and frustration shows in your post. www.selfinjury.net http://www.palace.net/~llama/psych/injury.html

Has anyone seen this new bill summary? I think we need to all write to our representatives and support it. If anyone is interested, I have a sample letter that I would be glad to forward on to you to send. We need to fight for the safer ratios in hospitals and long term care facilities. We have a voice in what we are subjected to. I just thought this was a great start. The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2004 (H.R. 4316) Introduced by Rep. Jan Schakowsky (D-IL) The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2004 establishes minimum registered nurse-to-patient staffing ratios to improve patient safety and quality of care and to address the nursing shortage that has left our nation's hospitals critically understaffed. Bill Summary By January 2007--two years later for rural hospitals--hospitals will be expected to develop and implement nurse staffing plans that meet newly-established minimum direct care registered nurse-to-patient ratios, adjust staffing levels based on acuity of patients and other factors, and ensure quality care and patient safety. Minimum direct care registered nurse-to-patient ratios: A hospital would be required during each shift, except during a declared emergency, to assign a direct care registered nurse to no more than the following number of patients in designated units: 1 patient in an operating room and trauma emergency unit 2 patients in all critical care units, intensive care, labor and delivery and postanesthesia units 3 patients in antepartum, emergency, pediatrics, step-down and telemetry units 4 patients in intermediate care nursery, medical/surgical and acute care psychiatric care units 5 patients in rehabilitation units 6 patients in postpartum (3 couplets) and well baby nursery units Based on the outcome of a required study, staffing requirements will be established for licensed practical nurses and will be required to be implemented in all hospitals by January 2007. Staffing Plans Developed Together with Direct Care Nurses: Hospitals will be required to develop staffing plans no later than January 1, 2006 and must involve direct care nurses and other health care workers or their representatives in the development and the annual re-evaluation of those plans. The plans must identify and employ an approved acuity system that will establish guidelines by which the hospital must increase staffing above the required minimums based on patient need. The plans must also factor in an appropriate skill mix of other health care workers to ensure that staffing levels account for patient care needs that do not require a direct care registered nurse. Beginning in 2007, plans must at least comply with minimum ratio standards, but may need to meet higher standards based on hospital specifics. Enforcement: Uniform notices stating the requirements of this bill including the actual direct care nurse-to-patient ratios for each unit must be posted in a visible, conspicuous and accessible location for both patients and direct care staff. Hospitals that fail to comply with the nurse staffing plan requirements could face a range of corrective actions, including civil monetary penalties and loss of funds. Whistleblower Protection: This bill would provide whistleblower protection for nurses by securing a nurse's right and obligation to refuse assignment if doing so threatens the safety and health of a patient by violating the minimum ratios as set forth in this bill or if a nurse is not professionally prepared to fulfill an assignment. The bill also provides protections to any hospital employee who reports a violation of this Act. Reimbursement: The bill allows for hospitals to receive additional Medicare reimbursement related to costs incurred related to compliance with this bill. Such reimbursement will be based on recommendations by Medicare Payment Advisory Commission (MedPAC).

We have designated times for smoking right now also. But they have to go outside on an enclosed patio and they only are allowed to smoke one cigarette at that time. There hasn't been any smoking inside the facility for several years. My main thing about it is that admin is banning all smoking for the mental health patients. They said it's because it is on state grounds. But if you walk outside the back door of the unit, the mrdd facility is about 15 feet away. That facility isn't banning smoking and they are sitting on the same piece of state ground that our place is. When our patients are outside, after July, and the mrdd patients are smoking away to their hearts content, I can just see the problems looming!