YukonSean

Your state is probably not represented because its nurses are not unionised. The posted web link is for the United American Nurses (UAN) union. As a Canadian, I am quite surprised to see such little unionisation, only around 20% of American RNs. In Canada, the vast majority of nurses belong to unions. Non-union employers are mainly nurse staffing agencies (often called 'registries'), or non-government organisations. The few hospitals without unions are considered to be undesirable employers, i.e., using casual employees ('per diem' in US vernacular) in order to avoid extending benefits to permanent staff, idiosyncratic hiring and firing practices as some of you have cited here, etc. For those interested, the Canadian Federation of Nurses Unions (CFNU) is analogous to your UAN. http://www.nursesunions.ca/ Sean

Moon rose, Around here, we refer to that phenomenon as "finger-painting". I recently had one confused fellow add some frank red to the chocolate: He yanked out the Foley, with 30 cc still in the balloon.

Katana Perhaps they should search for your turd monster (serpentis faecesentis) in Loch Ness.

My stomach is in knots from reading these vile stories. (Yet, I admit that, as in the "train wreck" phenomenon, I could not stop looking until I reached the last posting on this list.) Why do you think I do psych? I would rather be spat upon than shat on.

Hello Canoe Head As other subscribers have stated, contracting on admission is negotiated between patient and clinician in order to define not only inpatient rights, but also responsibilities and expectations of conduct while on ward. We all recognise that there is a vast difference between acting-out behaviours, e.g., self-mutilation with burning cigarettes or razor blades, vs. genuine suicide gestures or attempts. This said, the admission contract needs to clearly state what the consequences for unacceptable behaviour will be. For example, here we have one frequent flyer who self-inflicts burns with oven cleaner. The patient knows that while admitted, any slashing, burning, overdosing on smuggled OTC drugs, or whatever, will result in immediate discharge. This one aspect in the care plan is not on the table for debate. One of the major nooses around the necks of care providers is that old belief in some sort of vicarious liability. I often hear police officers, residential counsellors, etc., wanting some sort of "guarantee" that a patient will not go out and complete a suicide, after being refused admission. The only hope in this case is to educate the community service providers that some patients are chronically at risk for self-harm. Threats (to act-out) do not equal absolute danger, just as promises (not to) can easily be broken (if they were stated truthfully in the first place). Agencies are worried about being left open to legal responsibility. I suppose that this is a very real concern in the United States, where one can sue anybody for anything at anytime. On the other hand, adults are owed the right to self-determination, i.e., they cannot be detained forever because there is a suspicion that they might maim themselves. In terms of legislation, you must find out what is contained within the Mental Health Act in your particular jurisdiction. Barneyridge is describing what sounds like Community Treatment Orders, which are not universal. In Canada, only one region out of 13 provinces and territories has these orders, although another is working on them. Most (if not all) of the current literature points to assertive management, which minimises the positive reinforcement of the hospital experience for patients with borderline personality disorder. I have a copy of, I hate you: Don't leave me (Kriesman & Strauss, 1991; ISBN = 0895866595), but I have not read the others cited by Dana E. My strongest recommendation to you would be, Relationship management of the borderline patient: From understanding to treatment (Dawson & MacMillan, 1993; ISBN = 0876307144).

I agree that we can become "ghettoised" as psych RNs. For example, this morning, when I d/c a patient's IV, the family member exclaimed, "I forgot: you must be a real nurse too!". I also trained in the big city tertiary hospitals (in Toronto, Canada) where MH nursing was discouraged. I worked as a psych orderly at a provincial psychiatric facilty while in nursing school, but after graduating, I did the med-surg gig: a full year in cardiovascular sugery, which I hated. I found that the highly efficient and specialised areas, meant for streamlined service, had a side effect for me of boredom. Ever worked in a unit doing only CABGs and valve jobs? I thought that every patient came in with the same Dx, same Rx, same Tx...I then did some palliative care, a lot of agency work, and finally returned to my true love: psychiatry. Now, I see that every day is different. I am the MHN in a remote hospital, which means that I must assess anybody who comes in the door...not just the "big" Axis I things, but all the AODA stuff, eating disorders, PDs, etc. Each day presents brand new challenges. After more than a decade, I would not do any other type of nursing, unless I were to specialise within psych itself, e.g., forensics, dual dignosis, etc. My own personal opinion is that all of those other med-surg skills are just those: skills. We can teach lay people to administer their own insulin, regulate their PCAs, or whatever. In the same way, the MH nurse can learn to do bloods and the like. My manager recently tried to coerce me into ACLS, which I think was intended to meet his agenda of having a greater pool for the ICU! (Fortunately, I am at graduate schol on the ACLS days!) In sum, I would say to you, not to worry. You will always be able to work in general nursing, concurrently with, or after, your psych days. As a psych RN, you can do both, but you might discover that you don't want to!

Why is it that male nurses tend to gravitate to the ER?... We do? I thought that we went in for psychiatry and forensics! Actually, I do the triage for mental health, AODA, and psychosocial presentataions in our Emerg department, but I work out of the medical ward, where the psych patients are cohorted along with general medicine. I also see surgical patients, if say, ETOH was involved in the MVA which brought them into hospital! The majority of male staff at our hospital do ICU or medicine, and the two mental health nurses are male, but we have no men in Emerg. I do agree that the "no touchy, no feely" theorem would explain the ICU crowd! Sean

Hello Barb Inpatient mental health services at our small hospital (49 beds) in northwestern Canada are provided by two registered nurses, who work opposite one another on 12 hour days. There is no standardised admission eligibilty criteria for personality disorders or acting out behaviours. Patients must be assessed and triaged through Emerg, with an eye to suicidal ideation, threat to others, substance abuse, etc. However, the other RN and I have been working on individualised care plans for our "frequent flyers". We have many locum physicians coming through the north, and having a frequent flyer plan in place helps with continuity of care, especially if inpatient admission is countertherapeutic for these folks. You might need to do some planning with other services in your area in order to implement such plans (eg, transient shelters, detox centres, or wherever). Sean