TopazStone

It happens to me a lot and as the only scheduled nurse, I can't avoid caring for them. I do inform my supervisor and reassure the person that everything is confidential and will remain so. I do have the option of trading sites with another nurse but the client is usually receptive to having me as a provider. I even had this happen when I worked in another county! A friend's daughter was on my unit and she recognized me. After I ran down the confidentiality laws with her, she was accepting of my care too.

Thank you for writing this post. I am pretty sure I am reaching burnout levels as a psych nurse. I can still feel empathy for the patients who are in a psychotic break and I have a soft spot for the young adults who are entering the system for the first time. The people who manipulate the system to escape drug dealers, maintain public assistance, get out of legal charges, parents who want to get away from an unruly child, social workers who train people to abuse the system ("If you were suicidal, we could help you")....I've about had it. How did you get out of psych?

Spiders, heights and creepy old dolls. I guess when I was around 3, I bounced down to my grandma's basement where she had been trying to clean up some old dolls so they were all sitting out (some with missing limbs and mildew over their eyes). My mom says it scared the crud out of me and I ran screaming up the steps, thus creating an aversion to creepy old dolls (especially the old bisque dolls with teeth--UGH).

Sheesh-- I've been saying for ages now that the poor girl seems to be Bipolar and they should leave her alone. Can you imagine having your psychotic break publicized like this? It is unfortunate but I'm sure the media had access to a police scanner and heard a call go out for her address so they were able to chase the ambulance. I think she should be able to sue over the whole "involuntary hold" information being released by the media.

Good heavens! I work at a psych crisis facility and have been complaining about the ten to 16 patients I've had to manage. Of course, our tech is not able to complete VS or blood sugars and I am the only medical staff available on my shift (free standing facility so we can't rely on staff or house officers in a pinch). I can have a new arrival, one in restraints and a few in active detox on any given night with q2-4 hour VS, fasting BS on clients without diabetes (just because the doc feels like throwing that order on with the rest), and q15 min VS and circ checks on the restraint. What is it with psych (and nursing homes) that they can get away with this kind of staffing? Even in states that have mandatory staffing, psych units are usually the highest nurse to patient ratio!

This is one of my worst fears. It seems that psych is the bottom of the feeding chain everywhere as far as safety, staffing and funding are concerned. I worked nights on an in-patient unit and at change of shift, I had three patients. One of the med-surg nurses called over to DEMAND I send my single tech over to their unit to provide 1:1 with a suicidal patient. I'd had several run-ins with this particular nurse and I told her "First off, don't talk to me with that tone of voice. Second, it wouldn't matter if I had zero patients on the unit right now because State Law requires two staff members on the floor of a psych unit at all times. You will need to find another way to resolve YOUR staffing issues." She called the weekend nursing sup in a fury and was told I was right--on both counts. (The weekend sups were awesome and had all been required to work my unit at some point so they know the deal.) I really think the system has taught some of these patients that there are no consequences for their actions. "Suicide" is a word that has become a magic ticket in our community for 3 hots and a cot. The shelters won't take you if you've been violent there or you are currently under the influence, so they go from hospital to hospital to crisis center saying they are suicidal (and some of them even admit it without thinking about the fact it gets documented). We've had people admit they told the cops they were suicidal to get out of legal consequences. They tell us that while they were in jail or prison, they were given tips on what to say and how to act to get psych services or "the good drugs." When these people threaten staff, they are able to file a complaint that they felt "disrespected" and this is why they acted out. Staff gets raked over the coals and the patient gets confirmation that they are allowed to behave this way. I understand when a floridly psychotic patient goes over the edge. I know that many doctors have become conservative in treatment of aggressive/ agitated patients because of lawsuits. When I get orders to give Vistaril 50 mg or Risperdal 2 mg in a crisis, I always want to laugh and ask if I should wave it under their nose for all the therapeutic value it has. Management wants to scream about the number and length of restraints but then we have regulations for q15 minute VS on patients in restraints! I give a med to help them relax yet have to keep poking them for a BP check. I get spit at, attempts are made to bite me and why? It makes no sense when the person is on 1:1 observation. The people who make these regulations have been so far removed from direct care, they are clueless. I have been very lucky in the fact that I've worked mainly psych for 11 years and was hit two times while working a second job in a SNF (who woulda thunk gerians could move so quick) and once while restraining a patient, she reached over and sort of pushed my shoulder with her fist. My fault for not paying attention to her instead of the restraint strap. She wasn't trying to hurt me anyway, just putting on a show because she was supposed to be discharged in the morning. I agree you should file an incident report, an unsafe staffing complaint, and worker's comp (just in case there is an issue later). I'd find another job too as your life is worth more than a paycheck. I hate hearing these kind of stories. I am sorry you are going through this {{{hugs}}}. I know I am strongly considering going into med-surg or ED nursing.

Another method to block the manipulation is to use a single cell phone/ pager for the manager on-call. This gets rotated to the person on-call and is the only number provided for CNA (heck-- and nurse) contact. No exceptions, substitutions or refunds :)

As far as working with visible body piercing, remember we work with the elderly (for the most part). There are clear "holders" you can purchase to keep the hole open when you can't wear the jewelry. For safety, I would NEVER wear anything that a patient can grab and yank out of my body LOL!

We are mainly Medicaid. We manage meds and long term physical problems because the patients are constantly hospitalized if we don't assist (ie, check BS, apply skin treatments) and we do some social work as well. No, we don't decide when to D/C. I just had a patient probated for missing visits-- her mental stat has declined, she c/o back pain and vomiting (dx with acute renal failure and neurogenic bladder). Her BUN and creat are both elevated. She could very well die if she continues to refuse visits. Because this is the psych population, we bend quite a bit. It gets to the point at times where I could scream. The really sick ones-- I will do what it takes, but the ones that play games tork me off.

Now that the Summer is upon us, I have had an increase in missed visits. Either the patient calls to D/C or they just plain aren't home! The salary nurses have a weekly quota and visits are scheduled the week before. The missed visits do not count. Also, we get paid per visit after our quota has been met, so of course, we lose that bonus too. For the contingent nurse, they just get paid mileage-- not for time spent looking for these patients! Plus, we rarely D/C patients for noncompliance so we end up case managing people who are home for 3 of 7 scheduled visits! What does your agency do?

I have to take a notebook into the home with me to jot notes. You don't want your delusional, paranoid and agitated patient to see you document that they are "paranoid, delusional and agitated" lol. Our notes are due weekly and we are going to "officially" start using our new notes next week (YEAH!). Now I can do charting by exception. I have a few patients who have minimal physical problems so this is going to be a great time saver. Oh, and Hoolahan, I found out some info you might want. My QI manager talked to the OASIS specialist at the DHHS about the assessment questions in the OASIS form. We were going to use the new note as our comprehensive assessment and just develop a form with MO questions. We were told that the assessment is required to be integrated into the OASIS form in the areas related to that system. So much for "see note" If the assessment covers all systems, you do not have to do an additional progress note though.

Had a pt come in for psych eval after cutting her arm and getting sutures. I walk into the room and there is the >300# pt digging her fingers into her fatty tissue after puling out her own stitches. Tried not to gag and calmly said "Oh dear, that is going to have to heal from the inside out now". Also the patient who refused to let us into the home for two weeks. Finally got the key and found him stuck in bed (literally) from a mix of urine and feces. Needless to say, I peeled him out of bed, showered him and then called the squad for an involuntart admit (those ER nurses should be thanking me). Finally was the 80+ year old man with a parasite infestation who asked for the bedpan. He insisted in sitting in his chair so as I leaned in to place the pan, he begins defecating and flatulating right in my face (I mean inches here) ERRRGHH!

Gotta say, I was impressed. Our managers sat at lunch with us and told something that they appreciate about each and every nurse, plus the goodie bag. Wow! I do feel warm fuzzies tonight!

Hmmm, guess I have been lucky. I can't remenber last year's gift, but the year before we got the clipboards that open up to hold papers, files, pens, etc. and a little daily planner (not the one with the company logo). The admin at that time also laughed and said maybe this would help us get organized. They turned out to be useful and didn't break either.

O.K. everyone-- yes it is the 487:imbar . I just tend to flip it and keep writing LOL. We work with mainly with the chronic mentally ill Medicaid patient. Every 60 days, we send a summary to the physician that addresses VS range, physical status, and behavior/ mental status for that cert period. Our clients do not usually make much progress. Right now, our summaries are very disorganized. Some of us write "VS WNL. Remains noncompliant with meds and diabetic diet. Frequently misses visits and reports to mental health center that her nurses 'never show up'. Pt con't to speak in short phrases and occ has auditaory halls." Then we have some that will write a VS range, progress for the cert period towards goals, abnormalities consistently noted, etc. We need to get something in place that will put everyone on the same page. There is no way to really make this easier. We will still have to write it all out by hand but at least a form will remind us to hit all the info that needs to be there. That is where the question comes into play-- what to put on the summary form . . . Oh how I would love a copy of the checklist form. Right now I am the OASIS specialist. I do all recerts & admissions for the psych department and 15 visits a week. This week it is 7 recerts, 2 admissions and my regular 15 . . . Anything that scales down my writing, I want to do!