BulkyMonster

Can anyone recommend a good resource about therapeutic approaches to children with RAD? I'm dealing with both types, primarily uninhibited, in a new job as a psychiatric nurse. I love my job so far, but I find myself missing a lot of information and playing it by ear. Internet, book, whatever would be really appreciated. Thanks.

Well, glad to know my little rant was helpful, I suppose :)

I didn't like the structure. I didn't like that my time was not my own. The snobbiness of officers (not all, but in general) bothered me. Also, the vapid patriotism... you weren't allowed to say "the President is an idiot." I love my country, but not blindly. And the religion. They cram it down your throat. I'm not christian, and sometimes it was ostracizing. There is a definite personality type and lifestyle attached to the military. Not everyone fits it the same, but some more than others, and it's easier for some people to tolerate than others. I felt very alone. I also had a mild "psychological" problem of forgetfulness/disorganization that they diagnosed as ADD, which turned out later to be a benign tumor and partial seizures, but they treated me like I was just some kind of deviant, idiot, or slacker. No matter that I was always on time to work, that I tried my best, that I did a good job most of the time. Every time I screwed up, it was like a witch hunt. Then when they found out I had an actual brain physiology problem, they stuck me in an office for a year before they managed to give me an honorable discharge - but even then, they didn't give me a medical one. They just sort of swept me under the rug and tried to apologize and placate me so I wouldnt' make any trouble, which I never did, regardless of what I had to put up with. And that ranged from another nurse grilling me about my medication, sleep habits, and all kinds of things. Not a nurse taking care of me, but a nurse who was supposed to be mentoring me. She called me at home, she called me at work from her home, she never let me alone and she wrote me up every time I so much as sneezed. They apologized to me for her behavior, but they never addressed it because although it was obvious to everyone she was mentally unstable, she was leaving in a few months and nobody wanted to deal with her. And then of course I was away from home... I loved seeing new places, but often, I had no support. I am single, but have a boyfriend of several years, and care a lot about my family of origin. As far as the military was concerned, though, I didn't have a family, and so I got less rights (free time, money, benefits) than married officers. Even married officers without kids. They didn't care about anything going on in my family either, didn't let me visit, wondered why I wanted to. I couldn't live on base. They're also pretty heartless. I realize that's kind of something everyone knows, but went in just a few months after losing two family members - my mom and my little brother - simultaneously in an accident, and they wondered why I was depressed and anxious, why I would come in to work twitchy after a sleepless night. They acted like I was being overly dramatic if I so much as frowned. They told me I should be "jumping for joy" over my new career. While deployed to Iraq, I witnessed these "patriotic, dutiful, hardworking, devoutly religious" people - other military nurses -abuse and threaten detainees. Patients in their care. I didn't like them either, but there I was, put in a position where I felt I had to protect them from the rest of us, so-called "good guys." I really hated it. Working in the civilian world now, I get more genuine respect (not the "mandatory" kind you get with rank) and am treated better by superiors as well. I'm so happy to be out of there. They were judgmental, closed-minded, uncaring, and often unthinking organization. There were a lot of cool individuals, but those were overshadowed by the whole. Don't get me wrong. I know I had a lot of specific bad experiences that won't apply to everyone, and some friends of mine really loved the job and the lifestyle. I don't regret it, I learned a lot, but I would never go back. Not in a million years. Not for a million dollars. Sorry if that's a bit more than you asked for, but you caught me at a weird time. Again, I liked a lot of individual people I met and places I visited in the Air Force. For some people it's a really great option, just not me. I'm a lot happier with my life now that I'm out of there.

To some extent, you're right. People should try and be pleasant and professional when at work, even if they do hate it. It's part of personal integrity. But venting on a forum is totally different. That's what I was trying to say. Sometimes we need a place to really be honest and say what's on our minds.

Here we go again with the judgmental attitude. Just because someone's unhappy doesn't mean they're letting it affect their behavior towards patients. We're here to discuss our perceptions and experiences on nursing. Some will be positive, and some will be negative. You're free to ignore it if the negativity bothers you, but please don't assume that just because a person chooses to vent here, among other nurses, that they're doing the same thing in the workplace. I saw plenty of people handling patients roughly, treating them rudely. I didn't let myself do that. I would hope that nurses in an anonymous setting like this would all give each other the benefit of a doubt, instead of jumping to conclusions like some in this thread have done. Of course, I'm someone who DID change careers... and yes, I had to accept I'd be making less money. You shouldn't have to medicate yourself every day just to be able to get through another shift. To anyone who's really unhappy and trying to figure out what to do: don't listen to any holier-than-thou nurses telling you you're selfish or a bad person for not loving your chosen career. If you hate your job, there are more opportunities out there than you think. Insurance companies, law firms, and medical supply companies are all looking for nurses to do non-clinical work. I have felt hopeless, crushed, and used up by my nursing jobs in the past. Now, I'm happy. I've found a way to change my situation. So can anyone else, if they keep trying.

Not really. You get to tell them where you'd LIKE to go, and they try those places first, but if they don't have a placement for you in your choice station, you could end up anywhere. Of course, there are little tricks and things once you've been in a while. Certain really unpopular duty stations will arrange that after you've done your time there, you get first pick of your next duty station. I'm actually glad I didn't get my first pick the one time. I asked for Misawa, Japan, but I got Lakenheath, England. I LOVED it there. Well, I hated my job and hated the military life, but I loved England

This is a bit of a late reply, but I agree. I did care about my patients. I tried hard to do my best. And I tried REALLY very hard to think positively. But it was horrible for me. I couldn't deal with it. Call me names, think of me what you will, judge me however you want. But you know, that's part of the reason I couldn't handle the job. Nurses, especially ones who claim to be most compassionate, seem to have little compassion for each other. When I was struggling with the loss of family members, the stress of returning from a war zone, and afterwards chronic anxiety and insomnia, I received nothing but criticism and scorn from other nurses. I was told I should be "jumping for joy" at the prospect of flushing my first PICC line, three months after losing my mother, my little brother, and our family home. My point is, I guess, that some of us are just not happy in the profession, and it's not because we're bad people or bad nurses. Maybe we're in a bad job. Maybe it just isn't the right career for us. But it doesn't mean we're not intelligent, compassionate, hardworking people. I finally found a nursing specialty I think I like. This one is causing me a little bit of stress, but only a little. I feel like I'm doing okay, whereas before, I was making med errors despite my best efforts, and going a bit crazy trying to find a system to help me remember everything I had to do, especially following up on things that came up unexpectedly. (As it turns out, I actually do have an abnormality with my working memory, which is totally beyond my control.) I've been working as a nurse paralegal for nearly three months now, and I can use all my knowledge, experience, intelligence, and compassion in this role. I use therapeutic communication as well as assessment and documentation skills. I research. I like it. I still, in a way, get to deal with patients - but the aspects of the nursing role that I most strongly disliked are not part of this job. I work in an office, 9-5. I can pee pretty much whenever I need to. I get my lunch break every day. I get treated like a professional, and spoken to respectfully. That was never the case in any previous nursing position I've held. Maybe it's true, you just have to find your niche.

Exactly... that's why I just quit my job yesterday. I was having trouble in a new position, terrible disorganization, understaffing, bad equipment, too many patients and too little orientation. The head nurse said she'd allow me to have more orientation time, so I was to follow the charge nurse around for a couple of shifts and learn more about my job. My epiphany came when she removed a bed pan full- and I mean full- of mushy, corn-filled BM. I realized: I don't want to do this anymore. Ever. And I don't want to waste any more time trying to convince myself otherwise. I spoke to the charge nurse, who didn't really need me that night, and then to the head nurse. I walked out after an hour on shift, and feel like a huge weight has been lifted from my shoulders. I feel fantastic. I have no job, no plans, nothing: but I'm free. Maybe an office job... maybe case management, or back to school to be a nurse legal consultant. I'm smart. Anyone who can get through nursing school has got to be. Don't go into nursing thinking you're going to love it. To me, it's not worth any amount of money to empty one more bed pan, be attacked by one more confused patient, clean underneath one more fat roll, or get eaten alive for one more med error because I'm trying to take care of too many patients in too little time.

I worked on a cardiac floor before now, before being diagnosed, and that is where it all started. My boss from there talked to my interim boss here and told him they'd had all kinds of problems with me. A lie! I'd only been in minor trouble, once or twice, and not even necessarily for nursing things. Military, more like. I'd really, really like to know more about how you've overcome your AD/HD in nursing. Do you find yourself prone to making mistakes? Or is that just me, not my diagnosis? Because if you can relate then you know I really am trying so hard. And if there's something that I am not doing that I could try, I would be extremely grateful to hear it. Besides it's nice just knowing I'm not the only one. It may yet. She has used the chain according to the book, but just recently, has contacted (as I said above) my old boss. This is really out of line. She is just a coworker, not a supervisor or rater. We're beginning to see compulsiveness in her behavior, anxiety, conflict with other coworkers... my current supervisor has talked to the higherups when they came to her with this coworker's concerns, and were shocked to find how much she'd exaggerated. I am wondering if, given enough rope, she'll eventually hang herself... Button, I do use a sort of sheet, a graphic chart drawn on my report sheets. Computer won't work for me because I cant carry it around. The report sheet trick really helps me remember all my paperwork though. I initially used the computer to design one but found this new way to be more efficient for me :) The binder thing I'd have to see to probably get, but it sounds similar to my grabbing the kardex, MAR and bedside flowsheets all as one before going to see a patient. I'll take a closer look at those suggestions when I'm not feeling so overwhelmed, As for a specific time to check charts, that's a good and simple idea. I have an "end of day" check ritual where I go through everything I can think of to make sure it's all done right, but it's still not a smoothly flowing habit. That might help. Blue Eyes, thank you! I sometimes wonder if I can ever break out of this cycle. Tiny and even non-existent things are being dragged up from 3 years ago and it gets so depressing. If you have any specific tips I'd love to hear them. Most nurses seem to be so organized, black-and-white linear thinkers. We think differently huh? I need to find methods that work for me. Besides panic mode. Thank you everyone SO much for your advice and support! I feel more determined and buoyed up now. I am taking leave and going home to the states in a few days. If I can get through these last few days with no errors I will be able to relax. I hope. If not, there's always maladaptive coping mechanisms. After all I will be on vacation!

Usually we work 6a/6p on the wards here. It's a bit nasty because some housing is as far away as half an hour, 45 min. and you need to be in by 5:45, but that's nursing. Thing is they don't give you total choice in where you live. I come in a couple times a week for a few hours to do outside tasks usually. Sometimes more, sometimes less. You work probably 4 shifts a week, sometimes 3 to balance out to a more normal 40-hour-ish schedule. If you get deployed, you will likely work 6 or 7 12-hour shifts a week.

Miranda, I haven't heard the note card suggestion before and will give it a try. Thanks for all the advice. I really appreciate your taking the time to spell things out for me. I'm already trying some of the de-stress stuff. Every day I try to greet my coworkers with a smile and hello and ask how they're doing. I am working on not blurting things out and screening what I say. Again, thank you so much. I go to work in a few hours and will use your index card trick starting today.

I don't know how to use the quote function for multiple replies so I'm just going to try ans answer everything. Well I can't change jobs or anything, I'm in the military. As for shifts, we only have 8 nurses, and she follows everything I do whether she is on the shift with me or if she follows me. I'm just now moving to mid-shift so I'll be on the 5 days a week 8 hour instead of 12 hour day or night. This is a new thing we're trying on our floor and I'm the second person to take this shift, so we'll see how it helps. My supervisor knows I feel harassed and is disapproving of the other nurse's over involvement. She says my coworker is overstepping her bounds as this other nurse is not my boss. She's also going around asking other people about my AD/HD and has written up paperwork containing statements I've made or other people have made. My supervisor has told the other nurse to come to her with problems and not take them into her own hands, especially as 75% of her concerns are extremely exaggerated, even patently false, not to mention inappropriate. However my supervisor and I both agree that my making errors is a problem. Having someone else watch me, though, just makes me so nervous and preoccupied about getting in trouble that it seems even more likely I'll mess up from nerves. I know very well its a catch-22 for the supervisor: she can't supervise me *less* when I'm messing up, and I can't think of another solution. I just feel so, so rotten. I can't think of anything else, can't figure out why this is happening, and can't think of how to stop it. "You've got to be more careful," they say. If only it were that easy for me. I wish I knew how to explain, to prove, that I'm doing everything I can. Thanks everyone who's given me input so far. It helps to have objective "ears" available.

I do have AD/HD diagnosed a year ago. Since taking medication I made a 180 degree turn for the better at work. Stupidly, I openly told coworkers I had it. I thought it would be good for others to know, like my strengths and weaknesses. I was wrong. I am very suspicious that this nurse has it in for me for that reason. At the moment maybe it's stress because since this all started (this nurse harassing me suddenly I'm making errors again the way I used to before medication. But sometimes they happen even on nonstressful days. Even now I'm paranoid she or someone else will search the internet and find this post, but I need advice, I need someone outside the situation who is a nurse to talk to.

In all likelihood you will be called up. If you're young and healthy, they'll need you out there. If you're okay with that, and okay with someone else making your decisions for you and putting a lot of restrictions on you, then there are a lot of benefits to being in the military. I don't like it. But I didn't mind Iraq, despite being mortared daily and sorely overworked, it was the experience of a lifetime. Most of the time you do a regular nurse's job though, and are made to jump through endless military hoops. Personally, I'm getting out as soon as my comission is up, but I know a lot of nurses who think it's definitely worth it to stay in and retire.

I keep identifying new ways to prevent them, but someting always slips through. Most commonly, an order will say something like: Tylenol 325mg I-II tabs PO Q6h prn. I will only see the 325 and not the "1 to 2" part. That's just an example. I have also missed a couple things outright. A few weeks ago I nearly gave the wrong heparin due to miscounting the zeroes... the patient would have got only a fraction of the dose. A nurse at work has been on me about it, a bit overly so. Okay, a lot overly so. I feel like she's obsessed with everything I do. She has taken her concerns to our boss, and wasn't happy with her response so is taking it to the next higher boss now. Our direct supervisor is trying to help me but has advised me not to make even the tiniest mistake while I'm under such scrutiny, and yesterday, I made a mistake. She's fed up with me even though she agrees that my coworkers is overstepping her bounds. In the past month I've made probably 4 real mistakes: -one near underdose of heparin, caught by the other nurse -one missed order which the MD did not flag (I was off the floor though on an ACLS run and left my patient in the care of another nurse for a while) -one wrong route of an antibiotic. -one antibiotic that didn't infuse, which I caught later and corrected, on an abnormally busy day... but it took me a long time to catch it I have been trying SO hard not to mess anything up. I've become nearly obsessive compulsive, checking everything over and over throughout the day. Even after I've already seen it. And at the end of the day I check over every bit of paperwork and the patients themselves, with a second set of eyes to help me. But this overzealous nurse has written up, along with these errors which were true errors that needed to be adressed, about three times as many things that never happened. For example I had a detox patient with a high BP and she thought I never gave him his blood pressure medication. She asked him and he said nobody had given him any pills all day. He also thought that something that had happened 4 hours ago, had happened "yesterday" (and this was day shift), that there were women in the bed near his, and that his walls and window were moving! Yet she is writing this up as an incident report, using sketchy circumstantial evidence to paint me in the most negative light possible. Even if most of them are false, enough write-ups and you look bad. I can't afford to make a single mistake. Even non-mistakes are getting me in deep hot water. I am utterly desperate and trying my hardest to do everything perfectly, but I am in a job where neither of us are likely to be fired or transferred, and I can't quit. Maybe I'm a terrible nurse for making these mistakes. All I can say is that I am doing my best. I am not stupid, careless, or lazy. For some reason I just keep messing up. And with this obsessive woman relentlessly breathing down my neck, it's so bad that I am losing confidence, losing sleep and losing weight from all the anxiety. Can anyone help? How do you prevent med errors? Why do I keep making them? I've been a nurse for almost 3 years now. How many med errors do you think each nurse makes on average anyway? Am I just in the wrong career field? Should I not be a nurse?