Mashira

Hey yall! So Christmas time is drawing near, and I'm doing something special for the patients. I got a bunch of mini stalkings and stuffed them with Christmas candy. I also got a box of cards. There is enough for each patient on the unit to get a stuffed stalking and a card come Christmas morning. I just figure, everyone should have a Christmas gift, kid or not. (My hospital is doing things for the kids units, but not adults) I'm unsure of what to write on the cards. I want to write the same thing in each card (no personalized messages because my patients tend to have fixation/boundary issues). Any ideas of what could be universally caring/inspiring? My patient population is 18-63yr/o males and females on a locked acute crisis stabilization unit. The majority of them are schizophrenic/schizoaffective, bipolar, or psychotic d/o and suicidal. It can't be too profound, because I want them to be able to understand it. I can't come up with a darn thing! Thoughts? Thanks in advance!

I've attempted to look it up for my state but I'm not finding anything. Anyone have something for Texas or are we SOL over here?

Great so far. We were PSI, now UHS. More PTO, more staff, and better guidelines that actually DO something on the unit as opposed to just meeting minimal standards to pass inspections. Better benefits, and FINALLY a matching 401K. It's looking up!

*giggles a little at Meriwhen* Very empowering answer. Very psych nurse answer I agreee, abnormal and talk to HR if you pass up the job.

At my facility the precautions that were in place prior to needing the brace/sling (assuming pt. was injured at facility) remain the same. If the pt. was on q15's only, then they remain on q15 only. If they were LOS they remain LOS. If they were 1:1 they remain 1:1. The difference comes in when we're talking about night time. The pt. must return the brace/sling if they are on q15 checks or LOS. If they are a 1:1 then they need not return the brace at night as there will be a staff member at arms reach at all times. Same goes for if they are admitted with a brace. The precautions on admit stand.

Agreed. This should never happen, it's a safety issue. I would safe harbor that if it came right down to it.

I went to school right out of high school. In my graduating class of thirty or so, at least half were over the age of 30. It seemed those that started out young were more likely to get caught up in 'campus life' where as those that were older, or more serious about an actual career, were those that succeeded. I think it would be a great idea to go back to school with full knowledge of exactly what it is you want to do. Sound like you would have a real advantage.

Keys, Pen, Small Keychain Flashlight (I work nights), Sticky notepad

What is the PTO per year FunnyPsychRN? We just got word that we'll be going from ESL/SICK/VACATION time to a pool of PTO for the year. Just wondering how large a pool that's going to be.

Update: Took it to the nurse supervisor. Nurse manager said the behavior was unacceptable. We are not allowed to give any med at our facility, even a scheduled med, more than one hour prior to it's scheduled time without the docs order. Supervisor told me to file a grievance with HR, at which time it will go to the CNO, who will take it to the CEO of our small private facility. CEO will give it to medical director. The chain of command agreed that considering the patient population of my unit (extreme acuity, just flat dangerous patients) the doc was far, far out of line. Dave, I agree with you as well as MrChicago, however the messed up policies at my hospital prevent me from making that 'nursing judgment' call, and would instead have called it 'practicing medicine' and had me kicked out. Screwy, I know.

This is what I have written: To Whom It May Concern: Writer contacted Dr. X on 8/18/11 at 0235 from XYZ Unit. A patient of Dr. X was agitated, yelling, verbally aggressive, threatening physical aggression, oppositional and progressively escalating throughout the night. The patient was threatening to kill an opposite sex peer on the unit. The patient was posturing, walking towards, cursing at, and threatening staff and above mentioned peer. The patient severely agitated the opposite sex peer, who also began posturing towards patient and pacing. Dr. X was informed of the situation, as well as of the patients refusal of previously prescribed PRN agitation medication. The patient requested to staff a dose of their regularly scheduled anxiety /agitation medication. The patient request was relayed to Dr. X by writer. Dr. X began to loudly address writer, asking why he was being bothered with the situation at 0235 in the morning regarding a patient request for scheduled medication. Writer readdressed the patient situation, clarified and emphasized the urgency and agitation of the patient, and detailed the patients threats. Dr. X continued to question the necessity of being called at 0235, stated, “Haldol Ten”, and disconnected the phone line. No route or frequency was specified. The patient refused any medication, and therefore a phone call was not made to clarify the prescription. In order to use the least restrictive intervention possible, the patient did not require a Special Treatment Procedure. Although labile, the patient was willing to speak with staff. Writer processed with patient until patient was able to control behavior. As previously stated, the ordered medication was refused, and the patient continued to intermittently escalate. Had the patient not been willing to process with staff after Dr. X was called, the unit staff, milieu, and other patients were at potential risk for harm. The act of disconnecting before clarification of an order, and unwillingness to listen to a situation that posed a threat to both staff and other patients put the safety of the unit at risk. Opinions please. Is this professional/factual enough? Would you file the grievance or let it go as a "butthole doctors, what do you expect" kind of thing?

I don't know about where you live, but in my city in Texas we have two or three Psych ER's. They can usually be found in hospitals that have a psych wing built into them, but those are waning these days, as the trend is towards specialized facilities and private practices.

So here is my situation... I am a new grad RN working in an adult acute care unit. I work night shift 11p-7a. The day shift RN is also a fairly new nurse (18 months, possibly two years). She has been at the facility a little over a year. I have been there a little over four months. She is very narcissictic. She considered working night shift at one point but didn't because she wouldn't get "enough attention". She is a cute 24-ish yr/o single girl. I am 22 and also cute. The men at the facility take note of me, previously, she was the center of attention. I am ENGAGED, and have NO interest in ANYONE. However, because the focus of the attention has recently been taken off of her and put on to me, regardless of if I want it or not, she is angry with me. She is very rude to me, and goes running to the nurse manager to complain about every little thing I do wrong, or for my not knowing specific information that quite frankly is irrelevant to the patients care (What police department ED'd the patient? How many children does he/she have?) Now, I know that this information can be useful, and may come in handy, but when I get an emergency detention patient at 6:20am, they come in kicking, screaming, throwing punches, and in handcuffs, I FRANKLY DON'T GIVE A RATS BEHIND HOW MANY KIDS S/HE HAS! I'm focusing on does s/he have asthma? If we have to take him down to the ground, does s/he have any spinal Sx, or Hx we should know about, ect... Not having insignificant information in report is NOT something to go running to the Nurse Manager complaining about. The unit I work has a reputation for being the worst unit because we have the most acutely ill patients. They're psychotic. Period. It's hard to work the day shift there, and she does a damn good job in my opinion, but that's no reason to think you're the ONLY shift that matters. What takes the cake? The nurse manager takes her side. I obviously do nothing on night shift and all of my acutely ill psych patients MUST sleep ALL night, and I should be doing more to make HER day easier?! I DO NOT WORK TO MAKE HER DAY EASIER! I work to take care of my patients at night. I don't understand. I just don't understand... anyone ever been in this position? What do I do? ARGH!

I certainly know the feeling. If your facility is anything like mine, you got little to no orientation and then were thrown into the deep end, expected to sink or swim. It's rough, however, it's VERY satisfying to swim your way out. Feel free to add me as a friend and send any questions my way. I'm not on here a lot (mainly facebook) but I'm willing to help out any way I can. Lord knows I could have used the help in the beginning! You'll do wonderfully, and you have a great support system and tons of knowledge to tap into on this forum!

I'm also a new grad psych nurse. I've been working for almost four months now and I've realized that a lot of what we learn in school is 'perfect world' scenario. Sometimes, there is just no 'textbook' answer for what the patients say. It's taken me a while to learn how to take what you get from a textbook and apply it to a real life situation. For the most part I've learned from watching more experienced nurses in my facility that aren't burned out. There are a lot of bad habits (power struggles, yelling, and acting superior) that you could pick up from others that work in this type of setting. Be careful to pick your mentors wisely. I never let my 'mentor' know that she was teaching me. Just observe. Observe everything, the good, the bad, the ugly. Then analyze the crap out of it. How did the patient respond? How could the response have been better on both parts? How would what the nurse say make you feel? Why? What would you rather hear? And then go off of that. At least, that's what I've been doing and I'm willing to say I don't feel half as clueless as I did four months ago. It's a process, and if we're doing our job, we'll never feel like we've really 'got it', there's always something to learn! Best of luck and congrats on your new job!

I work in adult acute inpatient setting. We get the worst of the worst. We are the only unit that takes ED patients. I work nights. At night, it's 16-20 patients, myself (RN), my LVN, and my MHW/MHT (mental health worker/tech). When census hits below 13, it's just me and an LVN or a MHW. On days/swings it's 5:1 so there is an RN, LVN, and two MHW's. More staff for a one to one patient of course. How is your unit staffing set up? Just curious... Side note: We do not use agency staffing. Everyone is either FT or Pool.

I graduated December 2010, passed NCLEX January 2011, and found my job February 2011. I live in Texas and work an Acute Care Psychiatric Inpatient hospital. My sign on bonus was $3,000. No tuition reimbursement. (Private facility)

You walk on to the floor, look at the bed board, and realize that they have moved a male room to the female hall because we've got too many guys, and three of them are on SAO precautions. (Psych)

I hope mine is weekend diff for Sunday nights! I was originally hired for M-F 11p-7a. I agreed to move to S-Th 11p-7a because they needed it, and it felt more like a 'real' work week and a 'real' weekend. The diff is kind of a big deal for me. Weekday night diff is $3.50 an hour, and Weekend night diff is $5.50 an hour. Not too much, but every bit counts while I'm trying to plan a wedding, buy a house, and pay off my student loans!

I work 11p to 7a and I was wondering: do you guys get weekend differential for Friday night 11p - 7 (Saturday) am? How about Sunday 11p - Monday 7am? I'm all turned around and confused! I called my hospitals payroll department and the lady is out until Monday. I'm impatient and curious to see how it works elsewhere.

https://allnurses.com/first-year-after/a-happy-thread-544633.html

You would think so, but unfortunately I've had a lot of pool staff that are similar to those that atypical_psych describes. I think they gravitate towards my facility b/c we have 8 hour shifts so they can pick up a lot of overtime as pool, and it seems that's all they care about. I had a pool rn giving me report at night when I was coming into work. I asked her, "Is Mr.X still endorsing AH and responding to internal stimuli?" and she said, "Internal what?" .....

What is your pet peeve with staff or patients? Mine... when on the report sheet or on the board, they write "BPD" to signify Bipolar Disorder, Axis I. "BPD" is the abbreviation for Borderline Personality Disorder, an Axis II Dx, and it drives me NUTS!

Hm... perhaps I should have added he was pointing to his genitals? It thought it was easily assumed. Or you are being sarcastic... and I didn't catch on

I see a lot of threads in here about people hating their first year of nursing. I know that right before I graduated, and right after I passed my NCLEX I was constantly in here worrying myself silly over how many people seemed to be dissatisfied. I thought I would turn the tide a little bit. I started my job as a Psych RN at a private facility in Feb. it is now March and I've been on my own for about a week and a half. I LOVE IT! It was a big learning curve as it is all paper charting. It was challenging, it was hard, and it was the best time of my life! I love work. I love knowing that every night I get to go in and see my patients. I actually look forward to going to work, and on weekends where I don't have anything to do, I'll even WANT to go in! I love making mistakes in report, because it gives me something to work towards the next day. I love my co-workers and have been blessed with amazing staff that are helpful and kind. I have also met those that eat their young, and I get a kick out of doing my job, and doing it well, and killing them with kindness. It's absolutely wonderful. Are there bad times? OF COURSE! But this (Psych Nursing) is what I wanted to do, and I can't be happier that I'm actually getting to do it! So for those of you who were like me, going through the threads, getting more and more discouraged, I thought I would put out a little hope!