batgirl23

IMHO = In My Humble Opinion

Be careful though. We all have "Borderline" tendancies when under stress or feeling powerless. IMHO this is a very over-used term in psych and almost always used in a judgemental way and/or with derogatory intent.

I have been a psych nurse for over 25 years with absolutely no regrets. I went into psych straight out of school. In fact I finished my senior preceptorship on Thursday and started full-time on that unit the following Tuesday. I personally found med-surg nursing very frustrating. I wanted to talk to patients, to spend time with them. There just wasn't the time in med-surg to nurse the way I wanted to. I remember getting my knuckles rapped by my Instructor during a student surgery rotation because I spent 15 minutes talking to a pre-op patient about her fears and anxieties. The Instructor felt I should have just given her an Ativan and moved on. I think my approach was better and the patient appreciated it. :-) In psych, I found my niche. There are enough physical-medical things to appeal to the side of me that wanted the "task-y" stuff, but I also had time - in fact it is my job - to talk to people! As for doing med-surg first - you will hear this a lot! Don't do it if you feel psych is where you need to be. My faculty advisor (who was not a psych nurse btw) told me in my final year that the technical skills / technology can be learned or re-learned at any time - the skills you learn in psych nursing are invaluable and will always be relevant wherever you go in nursing or in life. I have never forgotten that and I have found it to be true. I started on Geriatric psychiatry and Neuropsychiatry units where there was a fair amount of basic physical care required. I got to hone my assessment skills and practice good basic nursing care. At the same time I was starting to develop my psych nursing skills - communication techniques, crisis intervention skills, therapeutic use of self, etc. Over the years I have changed specialty areas frequently (always in psych, though). I have worked in forensics, mood disorders, schizophrenia, both with inpatients and outpatients. I also worked as a study co-ordinator for drug study research. I currently work as a nurse educator doing staff development. (Teaching is my other passion, so I am incredibly lucky!) Good luck to you!

Could be personality issues and/or bipolar but very hard to assess with a current opiate addiction (may be a chicken-egg thing: addiction could be causing the "syptoms", could be exacerbating underlying/pre-existing issues and/or may have started as a means of self-medication). Sounds very challenging!

These two presentations are nothing alike. Do you have a specific question or an example?

Personally I try never to lie directly or make false promises to patients. In this case I would say something like: "I/We will do everything we can to make sure that doesn't happen / you don't die." In a less acute situation, I might explore their reasons to want to live / survive in order to instill hope.

I think it is important to be clear about the language we use. It is never okay to "reinforce delusions" or to challenge them. As others have mentioned though, you can re-focus on what is most relevant - the feelings or the experience of the patient with those (often disturbing) beliefs. My experience working with folks living with delusions is that if you explore what it is like for them to have those beliefs, they get a sense of relief from the fear and anxiety. They don't feel challenged. Once there is a trust relationship built, they will often ask about your experience of their reality. If asked directly I always answer truthfully: that I am not experiencing whatever it is or I don't see it, believe it, etc. BUT I only do this if asked directly and I always re-iterate that I understand how real their beliefs / experiences are to them. With Dementia patients, I see things a little differently. I do not see them as being "delusional" in the same way as people in psychosis. Rather, I see it as they are living in multiple realities simultaneously. They can be physically here with you and at the same time be a 5 year old child looking for their mother. The patient doesn't believe they have been sent back in time. They are just experiencing this moment as they did when they were a child. Going along with that is not reinforcing a delusion, it is merely being present with them in their current experience of reality.

This is beyond verbal abuse. It is unprofessional, unethical and may be considered illegal (threats, coercion, unlawful confinement (in the quiet room) & assault come to mind...). It must be reported and stopped. If it is not reported then it is condoned which makes you as guilty as the perpetrator. Patients have rights and this nurse is clearly violating them and on a regular basis by the sounds of it. Sorry if I sound harsh but this kind of "Nurse Ratched" behaviour is what gives psychiatry a bad name. And don't think I don't understand about dealing with aggressive, violent, challenging patients. I have worked in psych my entire career (26+ years - 11 years on inpatient acute care units, 7 in outpatients and 9 years in education supporting frontline staff) and for 4 years before that as an aide in along-term residential facility for the mentally ill. I have worked in all specialty MH areas except addiction and children's, including an Acute Obs Unit (PICU) and a medium secure Forensic Unit. Our facility treats very chronic, treatment-resistant, complex patients.

I guess it's the Psych nurse in me but I love these challenging type of patients. Years ago when I was a student there was a post-op patient on an oncology unit who had had lots of post-op complications following a vulvectomy. She was a very fussy & demanding woman and complained frequently about EVERYTHING. The nurses were happy to assign her to students to get a bit of a break. Of course I had extra time, being a student, but I made it my mission to satisfy this woman. I got water for her flowers, found out just how she liked her care routines, tried to anticipate her needs, etc. Within a couple of shifts she was a pussycat and no longer nearly so demanding. She started doing more for herself too. All she needed was to feel a bit more in control of her life and that empowered her to start to want to be more independent. Of course there are always going to be patients who want to take advantage but a lot are just scared or feeling overwhelmed and sometimes a small gesture like getting a glass of water for them is very comforting. I think the best approach though was offering to walk with her to get the water!

Back in the 60s & 70s my father was in the military. He would always check off the "Bilingual" box on forms because he was fluent in German and English. The powers-that-be were NOT amused!

Hi Robert You could definitely apply at the Civic but it is a campus of the Ottawa Hospital and I believe most of their postings would be for bilingual nurses. The Civic Campus is in the west end so most of the patients are English vs the General Campus where there are a higher percentage of Francophones. The thing about Ottawa is that, being Ottawa, there is a push for bilingual services. The fact is that something like less than 2% of people in this area are unilingual Francophones. We see a lot more unilingual patients who speak Russian, Somalian or Chinese. :-)

Hi Robert I can't really speak to Cornwall but I live in Ottawa. There are lots of opportunities for English nurses here but bilingualism is definitely an asset. The Montfort is primarily a French hospital. The Ottawa Hospital (the largest hospital with something like 3800 nurses) is bilingual and rarely hires anglophones. CHEO (the children's hospital) provides bilingual services but not all their staff is bilingual, though I understand most postings are for bilingual staff. The Queensway Carleton (a smaller community hospital) is primarily English. Public health is bilingual. I work in Mental Health at the Royal. We are all psych. Our working language is English but we have some designated bilingual programs where 50% of the staff must be bilingual. That said, the other 50% are English-speaking. Most of our outpatient and community positions are bilingual. As far as I know, there is language training offered at all the local hospitals if you do decide to pursue that. Ottawa is generally more francophone in the east end and more anglophone as you go west and south. In terms of the commute, lots of people live outside the city and commute 45 min to an hour. If you are to the east of the city (between Montreal and Ottawa) be aware that if you work in the west end (where more of the English hospitals are) you will need to add the time to drive across the city to get to work. Could add another 30 - 45 minutes to the commute depending on traffic and time of day. Good luck!

Do you not have a regulatory body??? This is abuse, pure & simple. Just read anything on Therapeutic Relationships and Boundary violations! It is totally unacceptable behaviour for ANY nurse and needs to be stopped. It is your professional and ethical responsibility to report this behaviour and protect your patient(s)! If talking to the nurse directly doesn't help, report, in writing to your manager. If they do nothing or put you off, go over their heads until someone listens, up to and including your state board. As others have mentioned psych patients: 1. are vulnerable and have the right to expect good treatment; 2. may not be able to articulate a complaint on their own if they are significantly ill; and 3. may not have their complaints given the weight they deserve due to stigma. I understand it may be difficult as a new nurse but as nurses it is our responsibility to protect our patients as well as the integrity of our profession. Looking the other way and hoping the situation will magically get better is contributing to the abuse. Sorry for the rant but I have been a psych nurse for 26+ years and this is the kind of situation that makes me crazy! :-)

I have been a psych nurse for over 25 years with absolutely no regrets. I went into psych straight out of school. In fact I finished my senior preceptorship on Thursday and started full-time on that unit the following Tuesday. In nursing, as in anything, if you can find something you are passionate in you should do it. Life is way too short to do something because other people tell you you should. I personally found med-surg nursing very frustrating. I wanted to talk to patients, to spend time with them. There just wasn't the time in med-surg to nurse the way I wanted to. In psych, I found my niche. There are enough physical-medical things to appeal to the side of me that wanted the "task-y" stuff, but I also had time - in fact it is my job - to talk to people! I started on Geriatric psychiatry and Neuropsychiatry units where there was a fair amount of basic physical care required. I got to hone my assessment skills and practice good nursing care. At the same time I was starting to develop my psych nursing skills - communication techniques, crisis intervention skills, therapeutic use of self, etc. Over the years I have changed specialty areas frequently (always in psych, though). I have worked in forensics, mood disorders, schizophrenia, both with inpatients and outpatients. I also worked as a study co-ordinator for drug study research. I currently work as a nurse educator doing staff development. (Teaching is my other passion, so I am incredibly lucky!) If you feel drawn to a career in psych - mental health, then go for it!! My faculty advisor (who was not a psych nurse btw) told me in my final year that the technical skills / technology can be learned or re-learned at any time - the skills you learn in psych nursing are invaluable and will always be relevant wherever you go in nursing or in life. I have never forgotten that and I have found it to be true. Best of luck to you!

I did a BSc in Biology/Biochemistry at Dalhousie in the early 80s and then started my BN. I had to do all 4 years of nursing courses and clinicals (albeit part-time for the first 3 years) but I did get credit for my science courses (organic chemistry, biology, microbiology, stats, etc.). Nowadays, with the new accelerated nursing programmes, you should be able to do your nursing in 2 years at any number of universities. You dovetail into the nursing programme in third year (those doing a 4 year basic programme do their electives and no nursing clinical work the first 2 years). Good luck to you!