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.

Yeah I used Google translate on my phone and we had some dialogue. The problem was getting him to slow down so I could look up different words. An ADHD kid does not understand "hablar despacio". I was told that we have "access" to a translator, but it is "quicker" and more "efficient" to use our own translation device. Thankfully we had a Spanish speaking tech on our sister unit who was able to come during one crisis. It was then we realized it was a defiance issue moreao than a language barrier

I am super new in this field, but I will share what I have experienced. I am currently working the pediatric floor on the day shift in a stand-alone psychiatric facility that is affiliated with two major hospitals on the same campus. Full capacity in my unit is 9 kiddos. 7am: shift report 7:30 - 8:45: wake kids up and they shower and clean up their rooms; set out breakfasts away from each other. Orthostatics, morning meds, and a few minutes chilling out on their couches to watch some cartoons. At 7:30 charge nurse meets up with our sister units (adolescent and the Psych ED stepdown) to compare staffing notes and see if anyone needs to float and if there is enough staff for evenings. Kids can make phone calls or have visits. 8:45 morning meeting. Yes, we RNs run it more often than the techs. I'm on a kid unit, so I don't really care about the public speaking. Also, think about your crowd; It's a psych hospital, not a prestigious awards banquet. Your public speaking prowess or deficits will likely be overlooked by the clients. We go over the daily schedule, any housekeeping stuff, and then each kid gives us a goal and we give them feedback on that goal ("You do a good job following directions already, let's see if we can think of something else you can be working on" "How will I know if you are meeting your goal?") 9-11 is school down the hallway. There is staff there plus the techs so I will just pop in now and then. I mostly work on updating charts, care plans, placing phone calls, starting any discharge/admission paperwork, prepping for team. 11 is usually recreational therapy until 11:45. Tech's and RT do something fun while we are out. 11-12 is when we do team meeting. RN, Psychiatrist, social workers/clinicians, and private insurance reps come together and discuss how each kid's stay is going, what needs to be done to get them home, what services we can help them get, and what their tentative d/c date is. 11:45-12: cartoons, phone calls, visits. 12-12:30: lunch and noon meds. phone, visits. 12:30-1: quiet time. They get something off the quiet time cart and have to play by themselves during this time. I like to go around and really assess my kids at this time. I can get a good 5-10 minutes uninterrupted with each one. Sometimes they open up, sometimes it is all superficial chit chat. I try not to sweat it because my main job as an RN is to keep them safe. If they do not want to open up to me, I will let the clinicians work with them. Oftentimes the clinicians will take the kids to their offices at this time, too, to do a session. 1-1:45: Rec Therapy 1:45-2: phone calls 2-2:30: snack & pm meds & "Rounding" where we sit with the Pdoc and each kid comes up and we chat about what's going on in their stay and how it is going, med concerns, etc. It's amazing how much these kids know about their medications! 2:30-3: social skills group 3-4: quiet time while the shift changes and loose ends are tied up. I will be swapping over to second shift next week and that is generally: 4-5 freetime/playground 5-5:30 supper & any supper meds 5:30-6:30: rec therapy 6:30-7 showers, pj's phone calls. 7-8:30: movie time/ free time/ night meds I haven't done a night but getting report from the night nurse in the morning sounds like it is a lot of redirecting kids back to bed, helping with nightmares, trying to get kids back into bed if they are up before 6am, toileting, etc. Pyxis audit, chart audit, housekeeping things, etc. I'm sure I am missing some things, but this is the general M-F schedule. No school on weekends, instead is free time/playground if they have earned it. The adult and geri units are less structured with much more free time. Psych Pros: I get to pee within an hour of the urge WICKED interesting field!! I work right next to the Pdoc and we go back and forth about how each kid is doing. He knows me by name and that's important to me. I actually feel like I am making a difference to that person. On m/s I felt like I was making a difference to their ailment. You can only give so much "holistic nursing" on a med/surg floor. Psych floor is all about holistic nursing. Here I have 20+ minutes to talk, because that is my job. Who has that luxury on other floors? Cons: restraining is few and far between, but it still happens for safety reasons and i feel terribly when I have to. Hearing their stories... very few come in with average kiddo histories. Violence can happen at the drop of a hat (even if Broset said they were low risk). Some families are just as bad, if not worse, than the patient. Not everyone will open up so we can help them. That is the most frustrating aspect of the field in my opinion. When the whole team wants to help this one person, but they deny everything and insist they are okay. It's heartbreaking, no matter the age of the patient. I originally went into nursing school with the plan of CNM. So glad I got sidetracked!

I didn't know that. I will ask this morning. Thanks!

Nope, no translator phone. I tried the translation app on my phone but it had a hard time understanding the kiddo. He doesn't get "hablar despacio". But I also think this would be a good thing to learn. This is my first fall semester in 7 years that I haven't taken a class, so I feel the need to learn something :)

Yesterday we admitted a kiddo that is Spanish speaking only. Our facility is not particularly capable of handing this, and these past 24 hours have shown that our unit is probably the most poorly prepared unit in our facility. I made a cheat sheet of basic info (Sit down, this is quiet time, raise your hand, hands to yourself) but this obviously has become nothing more than mere babysitting. How am I supposed to have a conversation with this child about his SI if no one can translate? I would like to take a crash course in Spanish. Medical Spanish is probably not what I need, so what do I do? Is there such things as a Psych specific Spanish class?

I'm starting orientation on Monday for the under 14 crowd. I rotated through this floor during my clinicals and I'm not really all that excited. I originally wanted to get into adolescents (I did my capstone on adolescent unit) but now that I have a teen with BPD in my own house I'm singing a different tune. School health and women's health are my main interests. I would love to work acute detox. I often had to 1:1 for patients like these at my PCT job and I found them so interesting. It blew my mind to see them go from coherent to DTs and then start to come out again throughout their stay in the CCU. I can't deny that I also found their hallucinations somewhat entertaining, especially when this one older gentleman thought I was a prostitute and he was trying to get me to climb into the bed of his truck (the hospital bed).

I was a SAHM for 10 years and it was the hardest, most isolating thing I ever did (no family involved, but did join the cliquey-catty MOMS Club). If it were me knowing now what it was like (and if I had my license then), I would work part time through the pregnancy, enjoy the 3 month FMLA and then go back part time. My sanity is worth it. I'll be the first to admit it, and I don't care what other people think, but I am a much better part time mom than a full time mom. I have more patience, more interest in doing what they want to do (ever play baby dolls with a 3 year old for 8 hours straight while raising an actual baby?), etc. Totally not trying to dissuade you, I am more or less just thinking out loud. I know some people are born to be a parent and tend to their kids 24/7 but I learned quickly that wasn't me. This coming from the chick who wanted four kids and wanted to stay at home until the last one graduated. Then I had one and the world changed more than I could have ever imagined. Whatever your decision, I hope you find it is the best for you and your family. It is certainly not an easy decision. Thankfully you are never really bound to what you choose. You can always go back to work (keep in touch with your networks, take other courses in the meantime) or you can always reduce hours or quit. Congrats on the pregnancy!

With some digging around, I actually found out that per CT regulation 10-212-2B, they should not even be looking at hiring me: Each nurse or nurse practitioner shall have at least the equivalent of one year full time working experience as a registered nurse within five (5) years immediately prior to employment as a school nurse. Bummer. It was overwhelming and exciting idea that I was looking forward to potentially tackling. I guess I should email them that.

Today I interviewed for a school nurse job that splits between a middle college and a magnet arts school. Basically, they have no system. No nurse to guide me. No policies. ...NOTHING! It would basically be "here are the keys, I don't know what papers are necessary, holler if you need us but we probably can't help." Obviously the first thing I would do would be to find out if this is legal. Can two schools 30 minutes apart share a nurse? We are talking more than 200 kids on total. I guess administration holds down the fort at which ever school is nurse less that day. Second step would be to find a mentor. I was thinking about getting in contact with the school RN I had a clinical with, but I'm doubting that she will remember me. I went one day a week spring 2014. I'm sure a nurse around here would be nice enough to guide me. Not only running the nurse's office but they want me to do seminar-y things for the kids and staff now and then and also come up with and take some of the kids on field trips... my first thought was take them to help out at the cardiopulmonary rehab exercise class at the local hospital and see what smoking can do to you. I asked them what they expected to be accomplished in the first year and they were very vague...I guess because it is a newer school and they are still finding their way also. I am a go-getter and feel semi confident that I can slowly put this together but I want to be realistic. I do feel as if this is a job for someone who has a few school nursing years under their belt but I can't deny the fact that I love the freedom it offers and it follows my kids' school schedule. And the whole idea of being part of a community is so alluring. Sorry this is so long but any input would be greatly appreciated!

Funny TMI moment in labor with my 2nd... In the throes of transition I tell the nurse I need to use the bathroom. She reassures me that it's just the baby pushing down through the birth canal. I insisted. She insisted. I was squatting on the side of the bed. I said ok, I'll just push... Let's just say I was right