SwampCat

How weird, I did two years in child psych and just transferred to the "older adult" unit. That staffing is unsafe in my opinion. We have pts with stable med issues (maybe an iv a few times a yr) and for 22 pts there are 4 nurses and 4 techs (2/4 nights) and when I pick up eves I feel like it is nonstop. I can't imagine having medical issues thrown into it

I'm not an MSN either, but at least once a month we get a kid on the floor that is here for one thing but the kid is also questioning their gender identity. The youngest I've seen dealing with this was 10. My floor does 5-12 years old.

One of the great things of geripsych is you don't lose all med/surg skills. I will go and help out on the geri floor now and then and it is always busy! It appears to me that morning is the same as afternoon which is the same as night. A lot of sundowning. Med passes often. Quite a bit of reality orienting.

How often does one work with a violent/aggressive patient? (daily, weekly, monthly?) Verbally aggressive is a all day thing where I am. Physically aggressive is usually at least once a week. Aggressive to the point of full blown restraints, a couple times a month (all depends on the crew of kids I have). Is being a psychiatric nurse rewarding and satisfying? Is it an interesting career? Currently the floor I am on is not rewarding whatsoever. We all feel as if it has become a detention center for boys with aggression issues. When we do get an actual psychiatric patient (yes behavioral is psychiatric, but you know what I mean) then I feel as if it is rewarding. How emotionally draining can the work be? I excel at not bringing work home with me, unless it is a funny story. While I'm at work I am constantly drained. I take none of it personal, but it is incredibly draining to have insults and swears hurled at you when all you did was ask a simple question. If it is one kid, then it's usually easy to keep it from dragging me down, but when I have this kid over here throwing chairs, and that kid over there cussing staff out, and this other kid running around without regard to staff's directions it gets old very fast. It's also exponentially draining if your teammates are useless (or worse: escalate the kid because they feel like they need to have the last word). I know other areas of nursing are draining, too (I was a tech on a med surg floor), but in different ways

We really try not to use it, but we have a restraint chair which is essentially a wheelchair with restraint straps. We have a de-escalation team we page and they come down (maybe, if their units aren't acute) and help try to talk the pt down or help place them in the chair.

Every day I thank the gods of my place of employment for hiring me onto pedi instead of adolescent. I wanted adolescent, now I cringe when I float up there. I've seen 17 year olds trying to kill themselves because mom took the phone away. I've seen 13 year olds with PTSD from sex trafficking. Once in a great while we'll see a psychotic patient. A majority has bpd and are so emotionally draining. Many are runaways who then state they will kill themselves if they go back home. Many are kids having been through the system. Maybe 1/10 interactions I have with the adolescents make me feel like I made the slightest difference. Most of the time I feel like I am putting out fires and trying to reverse bad parenting. I have zero job satisfaction when I am up there. Of course, ymmv. May you find your niche. I am still searching, too.

Jenga with questions about goals, coping skills, aspirations, etc on each block

We could sure use some magical de-escalation powers on my unit! Especially when there are two seclusions and everyone else is feeding off the frenzy.

Let me show you my bruises from my last restraint/IM and you can guess how laid back psych can be. And ignore that healing bite mark. Kids do the darnedest things...

This. Daily I feel like little more than a well-paid babysitter. Yes there are certain kids that you will reach and you will get the warm fuzzies like you made a little difference in the world, but I'll be honest: I get that maybe once or twice a week. The rest of the time I am stressed out being the only nurse, constantly redirecting kids, and babysitting staff. I'll still take it over med/surg, though! :)

We have 8's but some of the adult units have 12's. Our unit is a bunch of younger-ish nurses who are trying to come up with a way to switch many of us to 12's. We can do 16's either voluntarily or not.

I found it interesting that my unit gets animal abusers quite often. I just remind myself that it's not the child's fault. Ot's not like any healthy 7 year old would stab a cat or try to hang himself.

Our facility has been basing a lot of our changes on Butler Hospital (Providence, RI) 's methods. I'd start with their Director of Nursing

I work with the under 12 group. In my facility we just get them into seclusion asap, even if that means two people escorting a child whose feet aren't even touching the floor. Legend has it that we used to use something like Elkpark burrito thing but it has since been scratched due to possible restriction of breathing. We have a restraint chair (with wheels) but are only supposed to use it if the kid's feet touch the foot base. I feel that thing is much less traumatizing (if there is a traumatization scale) than strapping a kid to a board, but many of my coworkers think it can end up being a liability. In your situation the restraint chair might be beneficial since you can get the kid in the chair wherever you need to and then wheel into seclusion.

Day Kimball is cutting jobs. Windham cut jobs. Anything owned by Hartford Healthcare is either cutting jobs or only looking at BSN. Middlesex is magnet therefore will only hire BSN.