PsychRN45

It has been discussed often this week, some staff is calling BS and others are leaning towards DID. What do you think? Real or FOS? If you have cared for this type of patient, what has worked intervention wise and any other tips would be helpful. I don't really have an opinion yet since I haven't had a patient like this before or at least is hasn't been Dx'd yet.

Is this a PM or NOC or 12 hour Nights? In my facility, when I do a NOC it's mostly auditing charts and getting the paperwork ready for the next day. On occasion there is an admission but mostly just auditing. As for DXs: maybe a manic or a psychotic pt up late at night but mainly my patients are sleeping. The money is good for NOCs and Nights but if you really want to deal with the special diagnosis' or behaviors then look for a AM or Day shift.

I know exactly what you mean. I've had the kids break apart their soap dispenser to cut with or last week this boy broke a PS2 game and used it to cut. What gets me is when they ask "Why do you give us sheets when we can hang ourselves with them?" or "You can't keep me safe" and start scratching on their arms with their fingers. I had one girl purposely look though the entire bookcase to find staples then show it to me with the smart comment of "You can't keep me safe." I always tell my patients when they start being unsafe, "You make your own choices. You can either make a good choice or I can make your choices." You have to be able to make a decision and stick with it. Once you draw that line in the sand you have to stand by it. When you show a patient you're wishy washy then they know they can get a way with stuff. Kids need rules and boundries. That's how they feel safe and know we care about them.

:chuckle Patients have done that to my team a lot..."Well the PM staff let us do it." I always tell the kids "That's great but this is the AM shift." The kids usually don't push it after that and if they do I break out the rules &/or policies (if there is one) then they leave it alone.

Actaully, we have female security guards but she doens't get involved in the codes or restraints. She'll show up and document who was there for the paperwork and debrief. When a code is called, either full on code or a silent code, a lot of guys show up along with a few females. Mainly the females who show up are RNs to call the MD. We're supposed to have an assigned Code Green Team at the beginning of each shift but our hospital is so small that any available male will pretty much show up. At our main champus, which is a medical hospital, they have a Code Green Team and Security which is trained to handle these situations.

Psych can be hard if you can't handle the mental games that patients and staff play. It can change at the drop of a hat! You always have to know what's going on. I'm the charge of a Child / Adol Unit. Some days are better than others but basically my day is assessments, passing meds, making sure staff is doing what they're supposed to and making sure everyone is safe. You have to make sure you have precise communication skills and can think quickly especially if there is a Code Green / Restraint. There is a lot of legal stuff that is interesting and you need to be on your toes all the time regarding the legal stuff. Last thing you want to do is piss off a Pt Advocate or someone's attorney.

Unfortunately a lot of my co-workers fit these scenarios.

I love Child / Adol! There's nothing like being cussed out by a 6yo! :) I like the little ones who are all behavioral and I like the adolescents that are happy psychotic who's voices tell them jokes. I also like borderline pts. I know what you're thinking...I'm crazy! :roll I love this field.

Inpt Child / Adol Unit M-F 5-8, Weekend 12-8