Meraki

I think language changes too over time. Most of the younger generation now has rarely if ever heard people referred to as having mental retardation as that word is less frequently used. So the slang use of 'retard' to mean ridiculous or foolish or stupid - for many is not actually connected in their mind to someone with an intellectual disability. It is just a slang term. It is the same with how now insane, idiotic and crazy have just become part of slang language. Those are all pejorative words to describe people with mental illness but most people who use them aren't deliberately making fun of people with mental illness, they just use it as slang. In the past idiot or insane was always in reference to someone with mental illness - but we have over time disconnected the two and the same thing is happening in time with saying an object or event is retarded.

I find your perspective that you can only help people if you have had the same diagnosis to actually be somewhat shocking. I believe that I and the nurses on my team are able to personalize care, to humanize ourselves, and connect without self disclosure. Many of our patients are very appreciative of the support we have provided towards their recovery, without that support being self-disclosure. I would never assume that my experience is their experience and therefore sharing my experience is what they need to hear. As someone who has sought medical help for both physical and mental health care, I search for health practitioners who are knowledgeable about the illnesses, about current treatment options, and who are empathetic and respectful; and not for others who have had a similar diagnosis and want me to tell their personal story. I want them to hear my story and to provide me with their expertise and the best care possible. I couldn't' care less if they have experienced it themselves. Would you only see an oncologist who had already survived cancer? Or only see a dentist who could tell you about his root canal? Or only an eating disorder nurse who herself had an eating disorder? There is a great deal of expertise that exists outside of personal experience.

I think you have to be very, very careful with self-disclosure. You can advocate for mental health and work towards decreasing stigma without self-disclosing to patients. There are lots of pitfalls in disclosing and I have rarely seen it go well in my 15 years of psych nursing. It is quite a skill and a challenge to ensure the disclosure is therapeutic. Some of the possible pitfalls are... - patient feels unheard or invalidated, sees disclosure as you shifting the focus to being about yourself. - patient had an emotional response to your disclosure and it impacts their mental health - for example they are worried about you, upset by what you said - patient feels the need to support you, or wants to support you, or thinks you want their support - patient doesn't want to bother you with more of their problems / emotions because they now see you as someone who already has enough on their plate and they don't want to burden you further. - patient misinterprets your self-disclosure and the reasons for it (why are they telling me this?), impacts the therapeutic relationship and leads to boundary violations. - patient now wants more detail, wants to know more, asks you about personal events in your life now that you 'opened the door'. Feels hurt if you then pull back after some disclosure. - focus of conversation shifts to you or to you trying to get focus off of yourself -patent does not react or respond to your disclosure as expected. Doesn't find it helpful, it doesn't give them hope, they can't relate as you though they might - again shifts dynamic of therapeutic relationship, nurse can feel hurt or rejected -patient under no obligation to maintain confidentiality of what you tell them. They share it with other patients, families, team members and information gets modified as it moves around. You no longer have any control of the information you put out there -the reality that the message sent (intentions) is often not the message received (outcomes) Perhaps in a setting where you have a long term relationship with pretty stable clients, it could be beneficial but in acute care or with clients already emotionally vulnerable, it is a bit of a minefield. I still think you can use personal experience extensively in psych without self disclosure. Use a third party - "a friend", "another patient I worked with", "something I have seen is..." Basically sure your experience and what worked without directly connecting it to you.

I work in nursing management in an Ontario hospital. I have many nurses who struggle with mental health issues and some who have diagnoses of mental illnesses. I am under no obligation to report these nurses to the CNO. Over the last few years, I have reported two nurses to the CNO due to mental health issues because in both cases their mental health issue were interfering with their ability to provide safe, competent patient care. I tried to work with both of them to resolve the issues however they lacked insight into how their illnesses were impacting patient care and they refused to collaboratively work towards a solution. They both felt I had targeted them and was victimizing them and that I was discriminating against them because of their illnesses. Unfortunately cognitive distortions, and a lack of insight and judgement are part of mental illness creating a barrier that is difficult to navigate. Investigations are certainly a massive stressor, however if the end result is that the nurse accepts support that allows him/her to be a safe and competent practitioner, then that is a good result.

I am looking for fresh ideas for written assignments for a mental health theory course I am teaching. I have done research papers, ethical dilemmas etc. i am looking for other assignment ideas that you have done that you think have been good learning experiences for students. I want them to think critically but still something that can be objectively marked. Thanks!

I am teaching a mental health nursing course next semester to undergraduate students and I am looking for suggestions for good meaningful written assignments to give students. If they are going to put the work in, I want them to really take something from it! Any ideas?

I teach in a nursing program and I am looking to change up the syllabus and assignments next year. I am interested in hearing form nursing students as to any written assignments you did in school that were meaningful to you and that you learned the most from? What kind of assignments would you want to be given. It is a mental health nursing class but examples from any class are welcome to give me an idea of the types of assignments. Thanks!

I disagree and I think this is a dangerous position to take. Of course there is as you say frustration about changes in routine or new people. However I think to dismiss all complaints as just being resident complaining is dangerous - especially as in this case my grandmother said the CNA caused her pain and discomfort because she was going to do things her way no matter what my grandmother said - . There are aides that can be rude, disrespectful and actually abusive in some cases. While I don't think what happened was abuse I would never accept that it is okay to hurt a resident in order to get things done in their own ' new' personal way. My grandmother complains all the time about one thing or another but when I find her in a state of extreme agitation as I described and in pain from being twisted in a way she doesn't bend I am not going to tell her that is okay and she needs to give the new CNA more time.

I haven't been back on this site for a while! just to respond... The system in this home is that only the night CNA and the admin have keys to the supply room so whatever the night CNA leaves out is ALL that is available for the next 24 hours. It used to be that the nurses also had keys but these were taken away form them as they were getting supplies for residents. the admin here are very much about the budget and don't want a single extra supply going out. I met with the DON three times months ago trying to get them to leave her an extra brief for the days she needed it but was refused (well to my face she said yes but it never happened and when I followed up she had 1000 reasons why) This facility is not family friendly and I agree they are even less staff friendly. I have gotten to know the nurses well over the years and while all the good ones leave I have heard many vents about admin just before they leave. It bothers me that they treat staff so poorly. I know many of the staff are very scared of the admin and have asked me not to say things because it is always put back on them (even if it is a policy thing out of their control). This does happen a bit on evenings - the night CNA leaves a box of a few extra briefs and these get fought over and hidden I have no idea why you are offended - I said very explicitly that the issue was with these two particular people and I was not generalizing to all admin. I have gone to them many times, they do not help, yes it is a problem. That is great you are family friendly - not all admins are. As I have said - these admin will spend time with me but do absolutely nothing in terms of action. Thankfully I just heard that the DON is retiring so maybe there is hope they will get someone decent. Oh and as to the original problem - the new CNA only lasted two weeks then was never seen again. We also buy briefs and these are strategically hidden throughout her room!

seeing as she spoke such minimal english that her son had to interpret it is quite possible she misunderstood you. i have lived in many parts of canada and have never come across 2nd and 3rd generation canadians who don't speak any english or french. they would have had to go through their entire education in english or french which would be impossible to do without learning or speaking the language. many still go to chinese school on weekends and evenings but their education is in english / french. even if they live in chinese communities and shop in chinese shops they would have been educated in english / french. most first generation chinese are pretty adamant that their children will have good educations and i have never met anyone who kept their children home and not in school and kept them from learning french / english. there may be an extreme case where they were homeschooled or not schooled at all but from my experience that is pretty rare in the chinese community.

Sounds like you did absolutely everything you could. I am really sorry your co-workers aren't more understanding. They didn't experience it the way you did and really shouldn't be judging you in any way. You can't go back until you are healthy...and I am glad your boss and doctors are enforcing that. You had some pretty significant injuries that need time to heal. Are there friends / family outside of work you can moral support from? Hopefully your co-workers are actually more empathetic than they are coming across....I don't think any of them would want this in their lives. Maybe they just miss you or are short staffed and want you back, but actually do understand why you need to be off? I'm hoping that is it. Definitely call your EAP...staying on top of your mental health is just as important as your physical health. It sounds like you are on top of this too...recognizing symptoms and seeking help before it gets worse. All the best.

I am not sure what you see in her post that fits with a diagnosis of PTSD? It sounds like a terrifying, even traumatizing experience and she speaks of high anxiety but that doesn't necessarily mean PTSD. It is quite possible that if the OP seeks out support now and gets professional help to work through the situation that she can recover emotionally as well and hopefully not develop PTSD. I also struggle with calling someone who is autistic and psychotic a criminal and referring to this as a crime. Truly, that is a very stigmatizing attitude. Often when someone is autistic they do not fully understand what is happening and become terrified. Add to that psychosis and possible paranoia or persecutory delusions and you have a petrified teen trying to defend / protect himself from what he may think is people attacking / trying to hurt him. Tying someone in that state down for hours can greatly increase their fear / agitation. Fear and terror gives people superhuman strength. OP, please do seek out help to recover from this emotionally as well as physically. It sounds like a terrifying experience and having anxiety after something like that is a normal response. Also don't make a decision now about returning or not to the ER. Hopefully a therapist can also work through that piece with you, depending on how your anxiety and feelings are at the time of returning to work. One thing that can help as well is to look at what can be done to prevent this in the future and make you feel safer....are there policies or practices that could be put in place to prevent further similar incidents? Can you get psych support in your ER? Kudos to your hard work in recovering thus far and hopefully you will have a full recovery. You will get back to excelling as a nurse...in the ER or in another area.

It is really hard to never talk about any situation with any patient as it is what we do all day and there are funny stories, sad stories and things we just want to share. I agree with the others who say never use any identifying information. What I do if I am vaguely talking about a patient is I change details...man to woman, old to young or young to old, change family members from daughter to sister etc.... This way it kind of becomes a composite story and is definitely not identifiable. I don't think there is anything wrong with saying you once looked after a patient who left the floor - that is pretty vague!

How many 12s did she do in a row? you said coming off a week... Being new it is hard to say no and it may be she accepted way to many shifts. The management may realize they kind of took advantage of her and feel partial responsibility hence not firing or suspending her. Staying wide awake while sitting with one pt all night is hard to do even when you are rested - especially when starting out and adjusting to night shift. If she did too many shifts in a row it may have just been more than her body could handle. 3 12s in a row is plenty.

BScN has been entry to practice in Ontario since 2005 so the CNO will not let you write without a BScN. Do you have a degree in another field? If so I know McGill (and maybe other schools?) has a program (2 or 3 yr) that gives you an MSN and makes you eligible to write the CRNE - but you definitely need to already have a degree to apply. I don't think an online MSN will help if you still don't have a BScN. Can you get a MSN without an undergraduate degree? That doesn't seem right. There are as the other poster mentioned bridging programs. Here it is called a Post RN BN - they are becoming fewer as many diploma RNs who wanted a degree have already started or completed the bridging program. I think Athabasca has a distance Post RN BN program, at least they used to. Look into Post RN programs rather than BScNs - although those may only be for nurses already registered as RNs in Ontario, I'm not sure.

There is truly no point in this case in going to admin, DNS, DON. They are not family friendly. Their knowing about it will have zero effect. I understand in most cases that would be the right approach but in this particular LTC they will do absolutely nothing. To my face they will tell me all kinds of wonderful things they will do....and they will do absolutely nothing. That is why I can go to them but the sole outcome would be that it had been documented. There is a well established history of this. It isn't about management/admin as a whole it is about these particular 2 people. Therefore my only option is to go above them...either to the company that owns the LTC or through the government complaint line. I have gone through both before however I don't really think they are going to act on this...it isn't significant enough. I wish there was a regular night nurse I could speak to but they haven't replaced the one that left...they are just filling the nights at the moment with whoever they can find so there is no consistency. I will wait and see how it goes this weekend when she is back on. My grandmother can stand up for herself in the moment however it leaves her very agitated, anxious and upset and then she obsesses about it for days/weeks.

I went to pick up my grandmother yesterday (from an LTC) to go out for lunch and when I got there she was agitated and angry. She was so upset she could barely get herself together to leave with me. According to her there was a new CNA on nights the night before (my grandmother had never seen her before) who was rude, abrupt and "mean". She had no idea how anything worked and couldn't get the pad (diaper) on right. My grandmother tried to tell her what works but the CNA refused to listen and kept trying to do it her way, and in the process caused my grandmother pain/discomfort. Examples being telling her she had to stay standing (my grandmother can only stand for a short time - so she sits because she collapses - not from noncompliance) and trying to roll her a way she physically can't move. Then the CNA left her 1 pad for 24 hours!! My grandmother immediately asked for more and the CNA said there was no more. When my grandmother got upset the CNA told her she's just have to "make do" as it was only for one day and that she could probably get more the next night. At this point my grandmother told her to leave the room and never come back! I get the CNA was brand new and didn't know any routines or any of the people and probably had minimal orientation but to me there is no excuse for her behavior. I mentioned it to the RN on days (who is wonderful) and she kind of threw up her hands in a "I can barely keep everything on days together, I can't do much about nights" way. That RN did track down a couple more pads (wrong size but better than nothing) to get her through the day. Also they are short staffed so pretty much have to take anyone they can get. The regular night RN left awhile ago so there have been random RNs filling in. So should I have this documented? Is it sufficiently inappropriate to make an issue of it? The admin is truly useless so I would go to them solely to have it documented - not because I would think they would do anything about it. There is only one CNA on nights on her wing so if this woman is on, then I'm not sure what the options are. My grandmother told me "I'll die before I let her touch me again"! So any thoughts on anything I can do to resolve this? I should add that this new CNA has been hired to fill in on the regular night CNA's nights off (so 2 nights a week). The regular CNA is gentle, kind, and absolutely amazing.

While I think you definitely overreacted emotionally in the moment and your actions may have actually made the situation worse, I am not as quick to jump on the bandwagon that your father was lying and that the nurse was providing attentive, wonderful care. Yes, some patients do not remember accurately what happened but I would never write off a patient's (aka your father's) concerns as invalid just because he is a patient. The reality is there are some lazy, incompetent nurses out there. Read all the threads of people complaining about their colleagues! Maybe she didn't check on your dad and had no idea he had been coughing, or maybe she did. We really don't know. My grandmother was hospitalized a few years back and the nursing care she received was absolutely appalling. I was shocked and horrified at the manner in which 2 of the nurses in particular treated my grandmother. Not every nurse is honest or competent or caring. I think it is really dangerous to dismiss a patient's concerns and complaints if what they say conflicts with what the nurse says. I do think thought that it would actually help your father more to address your concerns through more official channels so that they are documented. I understand your emotion in the moment - it is incredibly hard to see someone you love suffering and feeling as though more could be done. You can't take back how you acted on those emotions but seeing the conflict it caused, hopefully in future efforts to get your dad's needs met, you can work with the team. All the best to your dad and to you in the days and weeks ahead.

Edited

I think you have to define shortage. There is a nursing shortage in many rural / remote areas. There is a nursing shortage of experienced nurses in certain specialties. There is not a nursing shortage when it comes to new grads looking for full time jobs in big cities in acute care. There are still many, many employed nursing recruiters because there are still nursing jobs out there. I agree with the excessive documentation piece - takes so much time away from patient care.

I agree with your post noahsmama. And what you say is very true. ultimately OP needs this knowledge and if not gotten in school then better she get it here than nowhere.

It is an interesting mix of threads - one is suggesting hospitals hire new grads and other show the very reasons why hiring new grads is very challenging. There was another thread where a new grad was frustrated because her preceptor expected her to know things like vitals and she was feeling this wasn't fair as she was just starting her orientation. I think it is very important to know what you don't know. And maybe it is really a failure of the school programs when new grads don't have knowledge of basic concepts. At the same time is there any expectation that nursing school should provide you with a basic skill set or is new hire orientation truly expected to teach you everything from square one? I do think it is not an extreme view to expect that someone graduated and licensed as a nurse would know how to do vital signs or have an understanding of the benefits of mobility. I have no expectation that a new grad knows how to do everything but I do expect that as they are bringing years of education and clinical practice with them that they bring with them basic skills and foundational knowledge. I agree bashing anyone for not knowing something serves no purpose but I think the question of exploring why they don't know this is a valid one.

I think we have to be careful about assuming that because one has had an addiction that working in addictions is the best place for them. For some people, part of their recovery is avoiding people / places where drugs are present. Also hearing people talk about their issues related to drug use can put someone in recovery back into that negative place or bring up issues of over identifying, projection, countertransference etc... Additionally there is a skill set involved in being a nurse working with substance users and having a similar experience is not necessarily going to mean one has the needed skills. Also each person's experience is individual and one persons addiction / recovery may have little in common with another person - so just having been through it doesn't necessarily mean you can relate to everyone. I am not at all saying it CAN'T be a good fit - just that it isn't automatically a good fit just because you have had an addiction. In the same way having had a severe injury/illness and spending considerable time in ICU doesn't necessarily mean you would make a great critical care nurse - despite the fact you could relate to the patients. Good luck to the OP - don't lose hope. There are success stories on here of nurses who have gotten employment after their licenses were reinstated. .

Hi Op. I think it would be helpful to have a little background from you about why you asked this question. I am guessing perhaps there is something about your personal situation that makes this a question for you? Maybe you are younger and have had very limited exposure to the nursing field? What were you worried about? I am sure there are many communities where a young black male hasn't had the opportunity to meet many black male nurses prompting his question. (I don't know - speculating here!)

I want to tell you the story of Sarah – her story is just one of hundreds like her I have worked with. Sarah was born to a 14 year old mother, the result of a rape. Sarah’s mom already had a drug problem, one made worse by the rape and birth of the baby. They lived with Sarah grandma for the first four years in a home filled with conflict, addiction and emotional suffering. At 18 Sarah moved out taking Sarah with her. The next years for Sarah were filled with sexual and physical abuse, neglect, and exposure to violence. Sarah was given her first sip of alcohol at age 7, she smoked her first cigarette at age 9 and her first joint at age 10, all courtesy of a mother lost in mental illness, addiction and domestic violence. At 8 or 9 Sarah moved back to her grandmothers who loved her dearly but who was in poor health and had little energy to deal with Sarah. So Sarah continued to visit her mother to give grandma a break and the abuse continued. Sarah was 13 when one night her grandmother collapsed in front of her, Sarah unsuccessfully tried to revive her and sat on the floor alone as the only person who had every loved her died in front of her. With no one to take her in, Sarah was placed in a group home, where drug use was rampant. Within six months she was using crack, at 14 she was working the streets under the control of a pimp to fund her drug use. The next four years are a blur for Sarah – by the time she turned 18 she had moved 16 times, still hadn’t completed grade 9, and had become a hardened experienced prostitute. Drugs were how she coped, they numbed her, they allowed her escape, they allowed her to survive. At 18 Sarah was discharged from the ‘system’ and moved away, determined to start fresh. Years of therapy and rehab followed as Sarah has fought year after year to deal with her past and to make better choices. She has lived in the same apartment for 3 years, hasn’t prostituted since she left at 18, recently got her GED. Yet months of drug free living could be undone though by a reminder, a memory too difficult to deal with. No therapeutic strategy, no medication, no support person could ever remove the pain. Has Sarah made bad decisions in life? Hundreds, probably thousands of them and she lives with the consequences of these every day. And sometimes the self-loathing over the choices she has made are what make her use again, to get through the days when life feels unliveable - only to continue the cycle. Sarah’s hospital chart doesn’t tell her life story, she rarely shares it. Instead it contains words like addict, dysfunction, non-compliant, poor self care – all true. Her labs show liver damage, her first interaction with a nurse is usually to ask when she can get a cigarette. She can be defensive and difficult...pushing people away with her words and actions to protect herself from being hurt. Trust comes slowly. She can see easily through thinly veiled disdain or through insincerity in words and actions. People think they are keeping their judgments to themselves but she sees it in their body language, their tone of voice, their indifference. In that moment when you interact with Sarah as her nurse you have a choice. You can suspend judgment and show her genuine care and respect, sending her the message that her life has value and worth. Or you can join the long list of those who since birth have judged her and found her unworthy, undeserving of love, of respect; just another pathetic, irresponsible person choosing to make bad decisions.