green12

We have had success on my adult inpt psych unit with Bingo, Pictionary (free-for-all style, the patients are more supportive of each other and no one feels like a loser), and Catchphrase. People of varying levels of physical and cognitive functioning are able to play.

JulesA- I can think of quite a few reasons but the first that comes to mind is that you don't want someone having EPS/dystonia in the midst of their behavioral crisis, they don't always calm down as quickly as we would like. I recently had a patient acting out for 7 hours who needed PO meds and 2 IMs before calming down. I have given Haldol in the deltoid on rare occasions (1ml). Any contraindications to this?

don't forget about seroquel. we give out anything and everything for sleep. how well it works and what type of med we give depends on the person. seroquel, lunesta, ambien, trazodone, benadryl, vistaril, temazepam, mirtazepine, risperdal, haldol, thorazine (last few of course not sleep meds but helpful when already ordered as a prn for anxiety/agitation and patient is up and agitated at 10pm or 2am).

The other folks here are correct in pointing out that psych illnesses aren't going anywhere and therefore neither is a career in psych. I know I'm staying in psych for my career in nursing and have also wondered what I can do when I'm tired of inpatient. Even if the dynamic of psych care changes in the US, and it does seem dire sometimes, we would go with the flow in order to keep taking care of these people. Other options currently available in my area are community health organizations, crisis screening, residential programs, or an advanced degree allowing one to be a psych nurse practitioner or therapist. Not sure if this helps, especially if you plan on staying at this facility until you retire, in which case job security would be hard to predict. If you plan on staying in psych but have more flexibility over the next 30+ years then job security will be much more likely.

I'm dealing with a similar situation now. I was in charge today and one of the patients on our locked sub-ward (3 bed unit within a locked unit- does anyone else have this btw?) flipped out when a certain staff was in there. She threatened assault but we avoided any actual harm. For all of the staff's safety we rearranged the schedule and kept him away from her for the shift. Manipulation and staff splitting? Maybe. Part of her enduring and inflexible pattern of perceiving and reacting to the world? Probably. I don't mind "playing into" behavior in some cases especially when safety is involved. I don't have aspirations to improve borderline traits on an inpatient unit and would rather keep everyone unharmed until the patients can go somewhere that will actually be therapeutic for them. It is awful to be assaulted by patients, and we don't always have the luxury to get away from them afterwards. RNKittyKat, I hope that you are taking care of yourself after this and getting support if you need it. :redbeathe

Also, sometimes delusions overlap with reality so be sure to listen carefully to what the patient is saying. I had a patient with religious delusions and on Easter sunday he asked me what Easter meant to me. I gave him a very brief non-religious answer (time of renewal, caring about others, blah, blah) while thinking oh-oh here we go. When I asked him his thoughts he said "Well since I'm god...etc." I must have had a look on my face (whoops, not good listening skills in this encounter) because he quickly said "I mean we are all god, god is within us, etc." So anyway I learned that within/aside from his delusions he also had a strong sense of spirituality and we were able to have a therapeutic conversation about it. :wink2:

Try your state board of nursing for some direction, or how about starting a union? Contact regulating agencies like OSHA, JHACO, etc. It's a lot of work but hospitals pick up their act quick when JHACO comes around, the state investigates complaints, or when they are being sued for negligence or malpractice by patients and families (which is more likely given the dangerous staffing you describe). Or just get the staff to band together as a group and pressure the administration, or ask for a meeting with administration. I work with a woman who demanded a meeting with the CEO of our (admittedly small) hospital and let him know her mind. Whatever you do, get LOUD!

I've been in psych for 2 years and I've found that I'm hypervigilant about loud noises. On the unit we all are, from housekeeping to social workers ("shh, did you hear that, did it sound like a bang?"- very useful response) but I'm annoyed that I'm like this even when I'm not at work and I don't know how to stop. If I hear loud noises/bangs/thuds I always note it (and occasionally startle) even if I know it's nothing. Anyone else affected this way? I would like to be able to not notice my neighbors falling down the stairs (if that's what that noise was) like I used to.

We have everything that elkpark mentioned except for nursing homes. I've seen a person or two sent to a nursing home but they have been ruled out for psych problems and are more likely organic (ie dementia). We more often send people to group homes or apartments with wrap-around services if they cannot live on their own. Can you clarify what you mean by: "in my area we have a few assisted living facilities that are especially designed for the mentally ill but once they no longer qualify for assisted living status, they are left to go to a nursing home. " I can't imagine sending a person with BorderlinePD and severe self-harming behavior to a nursing home! or even our psychotic people who live in very smelly apartments with intensive outpt services...

Thanks for all the replies, I'm working on finding a happy medium, it was too hard to not talk about work at all so I'm mostly focusing on cutting down. Are there any threads about bizarre psych patient stories? Your patients can really feed the eels at your hospital kiwipsychnurse? Did your patient go so far as to show you his radioactive feces RN2begin? This is funny stuff!:chuckle

I agree batgirl23- thanks for your 2 cents. Also, many of the patients at our facility don't have outpatient medical care and when they get to us they unload every discomfort/medical problem they can think of and some they haven't thought of yet. That helps to keep me on my toes. And all this talk about losing skills... I never wanted to do that stuff in the first place thank you very much.

Wondering what your thoughts and experiences are... My husband thinks I bring work home with me and doesn't want to hear about it (at all)... I think I'm just talking about work (inpatient psych) and it happens to be pretty strange/stressful/tragic/dangerous/funny. Is my sense of humor getting really weird, is a story about a patient eloping and swimming across a pond for a cheeseburger not as funny as I think it is? Is it unreasonable to want to talk about my feelings/experience after a patient suicide? Thanks to all who have posted in recent threads, it helps me to feel like it's ok to talk about work- without exposing my friends and family to it (although I am now not sure if posting here is bringing work home with me:uhoh3: !)

Balloons set my skin to crawling and make me cry. The popping and squeaking is what really bothers me but just the sight of a balloon is enough. I don't know why everyone thinks it's so funny when I react this way!

Our nurses all have their own style in the med room, and I have developed mine over time. If it's the am med pass I'll wake up the stragglers with my most annoying cheerful persistant attitude because I think they should be getting out of bed for tx/food/shower or whatever. If it's the hs pass then I will enlist the help of the other staff, especially census person, to steer patients to the med window which helps. If the patient has gone to bed I deliver- I want them to fall right back to sleep for the rest of the night! The stragglers used to get on my nerves but I have made peace with it. If you haven't noticed, nursing is like waiting tables, and I've made peace with that as well (it helps that I actually liked my waitressing career).

And sometimes there's a bright side to the mistakes... like a patient who got a few too many Thorazines (long story), she thought we were trying to kill her but at least she finally stopped screaming and fell asleep. I think I was fortunate to make some real doozies as a new grad which taught me all the usual lessons but also- it might not be as bad as it seems so don't panic.