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elizabethgrad09

elizabethgrad09

Content by elizabethgrad09

  1. elizabethgrad09

    Any other autistic nurses out there?

    I went to an autism conference recently put on by a friend who has Asperger's, and I related very strongly to some of the things that the presenters were saying about people with autism. I don't have all of the characteristics they talked about, but some of the ones I do have are: difficulty picking up social cues such as body language, difficulty scanning the environment in order to find something, and difficulty knowing where my body is in space (problem with proprioceptors). Does anyone relate to this?
  2. elizabethgrad09

    Any other autistic nurses out there?

    I have been working in psych for the past 8 years, and it is a pretty good fit for me for a number of reasons. One is that I've always been interested in psych. Also, our hospital does not use press gainey or other customer satisfaction surveys, which seems to be standard in psych. Interaction with family members is quite limited as they do not come on the unit. Visitation only happens a few times a week and it is off the unit, so our family interaction is usually limited to short phone calls. I still struggle a lot with the stress as we are usually quite busy on day shift. The night shift is usually less busy, but sometimes they get a lot of admits. I have no experience with it, but OR sounds technical with less social interaction. Someone earlier in the discussion said they liked ICU on nights because the patients are sedated and there is less contact with families. Blessings to you! You are definitely not alone. I hope you find a niche that works for you.
  3. The other day on a neighboring psych unit, I heard a pt tell his nurse "I lost my dog and I'm going to kill myself if I don't find him! I need you to search for him online!" I wondered what I would have said to him if I was his nurse. Also because I have been preparing for an RN interview, I have been thinking about the question, "Tell of a time when you went above and beyond for a patient." My thought is that we really need to distinguish between appropriate and inappropriate requests. If we can do that, then it will be much easier to say no to the inappropriate requests, because we are saying yes to something better - keeping the patients safe and helping with appropriate requests. In my opinion, the pt's request was not reasonable not only because nurses don't have time to do that, but because he is taking no responsibility for his own life, he's putting it all on his nurse. I thought about a response like "Have you considered calling a friend or family member to do the search for you?" Then I thought about what I would answer if the person said "I have no friends." I thought about saying "How did that happen?" but that didn't seem optimal. So I thought I would call on you trusty psych nurses, like Davey Do, to give me your thoughts on these type of situations. What are some good things to say to people who don't take responsibility for themselves? Also, any tips you have for responding to typical requests/comments would be helpful. I had one situation recently when my response seemed to work. The pt stayed back from lunch, then asked to be taken to the cafeteria. We were lacking staff to do so, so I told him that I would try to find someone. He said "It seems like you don't care." I responded "It may seem that way, but that's not really how it is."
  4. elizabethgrad09

    Responding to psych patient requests/comments

    Answering my own question... I guess it provides an opportunity to teach on putting a collar on with an ID, microchipping, etc. (I think they have programs to make those things affordable). A pack of cigarettes is about $8 in my state, and one of the most popular activities on our adult psych units are smoke breaks. Yes, our hospital has smoke breaks in order to increase our census and it works! (Shaking my head as a nurse). People are not logical...
  5. elizabethgrad09

    Responding to psych patient requests/comments

    But what if the dog is killed by animal control/shelter in the meantime?
  6. elizabethgrad09

    Responding to psych patient requests/comments

    That is fabulous! Actually, I agree that my answers were bad, that is why I was asking for feedback. Later in the thread I clarified the situation to explain that the pt didn't seem distraught, but instead seemed demanding by his demeanor, body language, etc. which was one reason that I was struggling to come up with an empathetic response. I really do appreciate your feedback. Great points! Yes, I did find someone to take him to the cafeteria. For some patients, I find it much easier to provide an empathetic response than with others. Maybe some of them trigger something in me. I have tried to work on past hurts so that I don't have vulnerabilities, but am still a work in progress. I do want to grow as a psych nurse so that I can be more therapeutic for all of my patients.
  7. elizabethgrad09

    Responding to psych patient requests/comments

    Yes, Orca, I agree that it appeared to be a clear attempt at manipulation, which I can understand was not evident in my original post which was why I clarified it. I'm wondering if there is a better response to these types of requests. If a pt says to me "But nurse x lets me do y!" I have learned to say "It doesn't matter what nurse x does, I am your nurse today, and this is the way we're going to do it" which generally works well in shutting down the staff-splitting. But in the case of the "lost dog" story, I was wondering what I would have said. I'm not sure "I don't believe you" is appropriate even thought that's what I'm thinking.
  8. elizabethgrad09

    Responding to psych patient requests/comments

    Thanks, Sour Lemon, I really appreciate your feedback. One thing didn't describe about this situation was that the patient was alert, oriented, and did not even appear upset (it is hard to convey tone of voice and body language online). So when he said "I'm going to commit suicide if I don't find my dog" it did not strike me as credible at all. Instead, he came across as demanding. Contrast that with another patient a few years ago who tried to AWOL because he was worried about his dog that was alone in his apartment with no one to care for him. That patient was genuinely distraught, and in that case the social worker contacted his clinical team and made sure that his dog was taken care of. Because of the demeanor of the patient with the "lost dog" my judgment was that either 1) He was making it up, or 2) He might really have an issue, but since he didn't seem upset, I thought it would be better to help him find his own solution by contacting family/friends, like the saying "give a man a fish you feed him for one day, teach him to fish you feed him for a lifetime." I am reminded of another incident that happened a few years ago when a patient told me that he needed to be discharged because his infant daughter was in the ICU. When I informed the psychiatrist, he told me to call the children's hospital and ask if they had any infants with the name the patient had given me. When I did so, the hospital said they had no infants with that name. When I told the patient this, he said "It's harder to get out of this hospital than I thought". So maybe the bigger issue is distinguishing between truth and fiction. How would you verify the "lost dog" story?
  9. elizabethgrad09

    New grad psych

    I wanted to start my career in psych, but was unable to find a psych job out of nursing school. Like RNdh, I am a second career nurse so I didn't mind possibly getting "pigeonholed." After an initial job in a nursing home that lasted six months (where I really struggled), I was able to get a psych job when a psych hospital started a new grad program. I am very grateful because I truly believe that psych is my niche. I have seen a number of nurses go from my psych hospital into other kinds of nursing, but I think it can be difficult. One idea is to go into gero-psych or some kind of combo job where the medical acuity is higher than in many psych hospitals - in my psych hospital we don't have any IVs, and only do simple wound care. Also, I work in a standalone psych hospital, but if you choose a psych unit that is attached to a medical center, you might have an opportunity to transfer to another type of unit.
  10. elizabethgrad09

    Is this legal?

    When patients bring medications into our psych Hospital, they are locked up for return at discharge. Controlled substances are locked up in a separate bag. But, part of the discharge process is that the doctor marks whether or not their medications should be returned to them (check box for each separate Med). I had a patient who came in for opiate detox and his Suboxone was marked as do not return. We give it to pharmacy where it is presumably destroyed. The patient was not happy.
  11. elizabethgrad09

    In five years, I see myself...

    Recently, there was a thread here at allnurses that included a cartoon with a person at an interview stating "in 5 years I see myself making about the same amount of money but with significantly more responsibilities". It cracked me up, but I forgot to save a copy. I have scanned dozens of threads but have not been able to find it. Does anyone have it? Thanks!
  12. elizabethgrad09

    In five years, I see myself...

    Thank you Davey! I love it!
  13. elizabethgrad09

    CURRENT info regarding the use of Suboxone while nursing?

    Buprenorphine is on the standard urine drug screen that we use in our psych hospital. We have patients in our hospital who detox from opiates using a subutex taper, starting at a maximum of 16mg the first day (depends on how much they were taking), with a reduction of 2-4mg each day until they are done.
  14. elizabethgrad09

    Waste of Insulin

    In my psych hospital, insulin vials are kept in a refrigerator and are withdrawn through a pyxis. Whenever a new vial of insulin is opened, the nurse is supposed to place a label on it with the date that it was opened. These labels are in the refrigerator with the insulin and the label states that the bottle should be discarded after 28 days. Most of the time people remember to put the label on the bottle after opening it.
  15. elizabethgrad09

    Teamwork: What is Going to Make or Break Nursing

    I work in a psychiatric/behavioral health hospital, and one of the primary reasons that I keep working there is because there is fairly good teamwork. It depends on who you are working with, though. Some nurses are great teammates, and if a code is called (or even if they just hear a disturbance), they will be there to assist in a flash. However, there are other nurses who seem to be completely focused on getting their own tasks done, and rarely help others. Some of the latter will even make negative comments about nurses who fall behind, stating things like "That person is not a good nurse! They are not very efficient." It appears to me that they think "getting out on time" is the most important thing and the mark of a good nurse. Well, fortunately, being a psych nurse helps you realize that other people's approval is not important. Yes, I try to be efficient and to "get out on time", but I am not going to make that my primary goal/idol. If I need to stay a little longer to meet a patient's need and to be the kind of nurse that I want to be, then I will do it. I believe in the golden rule (Matthew 7:12) "Treat people the same way you want them to treat you", so I try to be a good teammate to everyone, regardless.
  16. As a new grad BSN, I worked for six months in a SNF in 2010 before being terminated (long story that I could elaborate on but is not really the point of this post). I have been looking for a new job for about 2 months, have had several interviews with hospice agencies (which I would really like to get into), but no job offers; I don't have as much experience as they would like. I signed up for a home health agency that a friend recommended and went for my first day of training the other day. The child had a trach, a vent, and a feeding tube. My only previous experience with a vent and trach was one of my clinical days in nursing school over a year ago. After one 8 hour training session I was supposed to work independently on children with vents/trachs, but I did not feel comfortable being on my own after just one day. I asked for another training day and they are going to set me up with one. My question is, what kind of training is reasonable in this situation? I felt after one day that I was getting it, but needed more time. For example, I did not yet know where everything was in the home, as well as the documentation requirements of the agency (I studied the forms ahead of time but I feel like I need more practice), and wanted more practice with the new equipment. Is having just one day of training when you have not done this kind of work before the norm? One problem that contributes to this is that I find that adjusting to new environments takes me longer than other people (i.e. I am kind of a slow starter) and do not know what to do about it. I have overcome this in the past in other (non-nursing) jobs and been an excellent worker, but so far my nursing career has not gotten off to a very good start and I am discouraged. Any feedback and advice would be appreciated. Thanks.
  17. elizabethgrad09

    Free CNA training still available?

    Another Phoenix area CNA school to consider is Star Canyon School of Nursing at 8900 N. Central Ave, Suite 104A (just South of Dunlap). Their phone number is 602-943-1337. A member of my church got his training there and recommended it to me. I was there yesterday with a young friend who wants to become a CNA. It is a small no-frills place, cost is $895.
  18. elizabethgrad09

    Any other autistic nurses out there?

    Whichone: my first job after graduation was in a nursing home where the majority of the other nurses were mean also. I had a very difficult time, and ended up being let go. But, three months later, I got a new job as a psych nurse, and I love it. One of the best things is that the people I work with are mostly great - good team players, supportive of new nurses. There ARE non-toxic and even supportive environments out there, so I encourage you to seek out a better environment for your talents - you deserve it! I don't make as much money in my new job as I did at the nursing home, but who cares? I no longer have to dread going to work because my supervisor would pick on me. I now have a supportive supervisor and co-workers, and that has made all the difference.
  19. elizabethgrad09

    Any other autistic nurses out there?

    Thank you to everyone for your replies. I especially thank the person who posted the "Autism Spectrum Criteria" from the DSM-V; that was very interesting and helpful. I'm glad that I'm not the only nurse with some of these characteristics, and I agree that many of these things can be overcome/compensated for as well as finding the right niche that minimizes your weaknesses/maximizes your strengths. My proprioceptor issues make me a little clumsy at times, but I can still give insulin injections, etc. with no problems. When I said that I can not do progressive relaxation, I did not mean that I cannot tense/relax any of my muscles, but there are certain muscles (more internal ones) that I am unable to do that with. Anyway, I agree with those that said that human diversity is vast and should be appreciated.
  20. elizabethgrad09

    Any other autistic nurses out there?

    I bump into things sometimes. I hold things with too much/too little pressure at times which means I drop or break things occasionally (like in microbiology when I broke a specimen slide). Also, when I went to the gym recently and a person was showing me how to use a machine, she said, "you should feel that stretch at [such and such a place]" and sometimes I cannot feel where it is stretching. You know that "progressive relaxation" exercise where you are supposed to tense up and then relax parts of your body? I cannot do that. As I replied elsewhere, these issues were one of the things that steered me toward psych nursing where I do not have to (at least in my facility) insert IVs or foleys.
  21. elizabethgrad09

    Any other autistic nurses out there?

    I agree that the proprioception issue makes it more difficult for me to do some skills. That is one reason that I went into psych nursing. The assessment is a little different in psych also. Of course I still assess for medical issues as well as psych issues. So far I have been successful. I think psych nursing is a good fit for me.
  22. elizabethgrad09

    Any other autistic nurses out there?

    Interesting. I am also a psych nurse now, and I like it a lot. It fits me a lot better than the nursing home that was my first job.
  23. elizabethgrad09

    Any other autistic nurses out there?

    No, I admit that I used that title to make it more attention-getting. I thought the title "Any other nurses who have some characteristics of autism?" would not draw as much interest.
  24. elizabethgrad09

    Best Psych/CD nursing facilities in AZ

    Aurora Behavioral Health is hiring.
  25. elizabethgrad09

    Newbie psych nurse seeking feedback (long)

    I am a second career new grad RN. My first job was six months at a nursing home, and I have now been working for 2 months at a freestanding psych hospital. I have loved psychology since childhood, and am enjoying this opportunity, but would like some feedback on how to better handle some situations. Prior to nursing school, I recognized that I have codependent issues, and I worked on them for several years and continue to do so. I no longer worry about what people think of me, but I must still present as a people pleaser, based on how people react to me - that is part of my problem. So, I am working on becoming more assertive and confident in my reactions to people. Yesterday at the start of PM shift all the rooms were taken, so we decided to do report in the day room. One patient I'll call A was in there. I asked him to leave temporarily, and he said in a very irritated voice "I'm not leaving, you people treat me like crap, I have a right to this room." I need to exert my authority, but I feel like if you meet anger with anger, it escalates the situation. What would have been a good response? How about "A, we're just asking you to leave the dayroom for 15 minutes so we can take report. You can come back here then." Is that too soft a response? Do I need to confront A's bad attitude because he is being disrespectful and if I don't confront it it will just lead to more of the same? I truly am not bothered by whether or not A is respectful to me or what he thinks of me, I just want to get my job done and have a good milieu. Next scenario: recently a "frequent flyer" came back, a young woman. Another fairly new nurse assessed her. She appeared completely out of it, kept repeating some nonsense phrase, and had to be practically carried to her room because she was too limp to walk. A little while later, she walked to the day room and calmly ate a snack, stating "I was just tired". My colleague said "She was just faking it!" (which I think she had suspected already, this just confirmed it). What would be a therapeutic response to this behavior? Next scenario: a 40-ish female pt is admitted. She claims to be a BSN who just got fired from her job "for teaching the MAs how to give IVs", had her two kids taken away by CPS because of her boyfriend's drug use, etc. She claims to be in a lot of pain. I call for initial orders and am able to get her 1 Percocet every 6 hours. She isn't happy about this, but I explain that this is all she can get now and will have to talk to the internist tomorrow if she needs more pain meds (our hospital is cracking down on pain meds so as not to enable drug seekers). She is constantly at the nurses station and tries to split the nurses. I am polite to her, but not real attentive as I don't want to encourage her attention and pain seeking behavior. I was off for a few days, and then she was my pt again. By this time we had found out she was not an RN or any other licensed professional by checking the BON website. She told me that she had 10/10 chest pain that was radiating down her arm. I thought I detected BS, so I had her VS taken and they were OK (BP a little high, but not majorly). Since she had no other objective s/s, I didn't do anything else. I found out yesterday that a colleague sent her out to the ER while I was off for these same complaints (she was sent right back after getting some morphine, which I guess is what she wanted). My colleague stated "she knew just what to say". My question: should we call her on her BS i.e. "we checked and found out that you are not a nurse"? I don't feel offended by her behavior but just want to be wise and therapeutic. Also, what's the best way to chart on this? "pt c/o chest pain 10/10 radiating down arm but after assessment & VS found no objective evidence so just continued to monitor"? Doesn't seem very CYA which they are always telling me to do. Sorry this is so long! I appreciate any feedback.
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