Crazed

As a professional psych nurse sometimes we use colorful language to meet our patients where they are in order to form a relationship that allows them to trust. If a few four letter words is the difference between calm and agreeing to take a PO or restraints and an IM... Well the choice is pretty clear. Just sayin'.

We don't have those parameters, I just do it because I'm not a fan of piling meds. Controlled not unconscious is what I aim for.

Psych ED - there is no typical day. You can go from everyone is quiet to 2 in restraints and 2 in seclusion because they've been set off by the two in restraints quickly. The medical side of the ED feels anyone is okay to be there including patients with anxiety and the floor has no idea what we do and frequently critizises us. Oddly enough our strongest relationship is with security. Our pace is fast, our patients are very acute and at times very dangerous, and our station is not enclosed. You have to have very good situational awareness and be able to think and act fast. Oh and you have to be able to tolerate someone screaming for hours because what ever med you throw at them isn't combating the (usually) meth onboard. It's a hard job, it's dangerous if done incorrectly, and most nights I give limits to people who have no boundaries.

We do a good deal of zyprexa/Ativan in medically stable patients. I like to lead with zyprexa and see if they calm down and then follow with Ativan.

I went to school wanting to be a psych nurse. Then I graduated and landed an ED job. Then I decided that it wasn't for me and landed a psych ED job. Couldn't be happier now. The only constant about nursing is change.

For the very obese it is also important to remember that there is also a psychological component involved. It is theorized that creating the physical barrier of obesity is a way to ensure others stay away for emotional protection. Now while this is not the case all the time it does happen. When I lost a lot of weight the world at large looked at me differently. I stopped being treated as if I was invisible because I was finally an acceptable member of society, but I was personally far more miserable thinner than I was fatter. This had everything to do with why I lost weight. Then I gained it all back. Five years to take it off a year to put it back on. It was very disheartening but it forced me to figure out how I felt about myself and what I wanted to do with my life. Unless you've lived that struggle it's very hard to know how it affects a person esp when others feel entitled to tell you how you should feel about your weight. Why should I feel ashamed of myself because my body is larger than someone else's? We are reminded daily that we are not the ideal and never will be in our society. Now I say things like, "Oh I'm not fat it's just my personality is too large to fit into a smaller body." If I had any other chronic illness no one would be outwardly cruel to me but we've decided that in the interest of health that it's okay to fat shame. Funny enough though I had a very thin instructor and her experience and mine were almost the same. Society tells her too that there is something wrong with her body because she's too thin.

This made me think of a time when I met someone who is now my friend. She's a model (like seriously) and when I first met her I had this thought that she was one of "those" women. You know the type that had everything handed to her because she was beautiful, but I realized soon enough that she had her own insecurities and she always felt dumb. So instead of building her up by focusing on her appearance I would tell her that she is smart, and a good nurse, and that when people know her they know she's more than just a beautiful girl. Everyone has a demon or two in the closet.

People can learn a lot from drag queens. "What other people think of you is none of your business." RuPaul

It takes 18 months in any job to begin to feel competent.

Funny you should mention this - as a fatty and a nurse I always hard a hard time when someone who was very thin was telling me they "understood" how hard it was to lose weight. You should always trust fat people regarding diet because we've spent countless hours researching. You name the diet and I've been on it. I understand the struggle of setting a work out schedule, of measuring and weighing everything, of feeling like weight loss impedes your ability to go out and be normal with friends and family, and I understand what it feels like to try and learn how to love yourself in the face of a society that tells you that you're not worthy of that love. To that end I work, I move constantly when at work, and I'm fun to work with. I'm just a little sturdier than the standard ideal of what a nurse should be. I also think I'm pretty awesome and accept myself just the way I am - extra fat and all. Having been there and done that I can help other people learn to accept and love themselves too. And when you love yourself you stop doing things that are self destructive. Like getting into yet another thread about how fat nurses are bad for the profession.

98 percent passed with 75 questions in under an hour.

I hope you're right. Last night I was snapping the necks of rats but they didn't die and instead ran sideways across the floor.

I've been told like elevendy billion times that while I am most certainly either a psych nurse or an ED nurse that if I begin my career in psych it will be difficult for me to do anything else. Is this a true statement in your opinion? Ultimately I'm interested in transition from crisis in the ED, to inpatient, to community and how we can improve outcomes. I feel that in order to make this work possible in addition to more education I'll also need experience in all of these areas. I have a fear that if I start with psych that it will be difficult to later obtain an ED position.

One of the best nursing instructors I had used her experience and teaching to learning into a game. She had a game she called "Name that Assessment" and would say things like, "A 20 year old, sexually active woman presents to the ED with complaints of pain 8/10 in her abdominal area," and basically we would all ask her assessment questions as if she was the patient. In the end she'd tell us the story of the patient and what happened to the best of her knowledge. My last semester I had an instructor who made us hand write the full head to toe assessment on two patients every shift, and write full nursing notes - something that was really lacking in other rotations. She also made you think through medications before you gave them asking you to think ahead about what could possibly happen with that medication(s) and how you would act if something did happen. I was very impressed with her as it was her first semester teaching. For theory instruction the more interactive a class is - the better. The problem is usually theory instruction turns into power points and a room full of people taking notes. There is also little continuity between teachers. One teacher might give you some direction while the other one says to know everything because you have to. It's difficult and quite honestly students want to get by on as little work as possible. I think there needs to be more reflective journaling in nursing school honestly. I also think instructors need to give out more ways to learn material. I've did a lot of tutoring and mentoring through nursing school and it honestly surprised me how so many people had no idea how to study or prepare for a test. You open their text book and it looked like rainbow brite and her band of highlighters lived in there and note cards became extra sheets of notes that no one could recall. Students need to be taught how to take information and phrase, and rephrase, until they can be asked from multiple angles about a process, medication, or intervention and be able to answer the question.

For all of my time in nursing school I believed that I was somehow broken. You know those students who walk into tests with that annoying, "What will be will be," attitude? Yup that was me. When I failed a test I wasn't even upset. I just saw it as something I needed to work on, an opportunity to up my student nursing game as the case may be. In short, every single type A in my class (which was pretty much everyone but me) was convinced I had some sort of mental illness. *Crazed note - given that I had the highest score on the mental health portion of our curriculum I'm pretty sure that if I do have a mental illness it's a nice one. So with my trusty ATI com predictor score in hand (98%) and having done well over 3k questions by this point from multiple sources I registered for NCLEX. Then that night I went to sleep. The following events are so weird I'm not sure I could make them up. I had a dream where I went to a facility to donate clothing. All of the elevators looked like they belonged on submarines or they were some sort of Victorian/steampunk mash up, and they were all broken. So instead of taking the elevator I had to walk through an indoor court yard, and hand the items to a woman behind a door (which strangely looked like the backdoor of my house). Once I had given her the bags I felt like she wouldn't get them to the people that needed them so I turned to get them from her. She then slammed the door in my face. At this juncture the only thing that seemed reasonable in my dream was to grab the curtain rod (located now on the outside of the door) and attempt to break the window. The moment I started this, the woman behind the door pulled out a light saber (you know, like from star wars). At this point I woke up angry because, you know, light sabers? My dreams every night since I've registered have been full of nightmares. Fancy hat parties where I didn't have a fancy hat, shelter dogs who have learned to talk and tell me that I need to help them escape except Tommy Lee Jones stands in my way (and who can sneak anything past Tommy Lee Jones?), my ninth grade English teacher having me read Romeo and Juliet but in a way to make it a rap song, etc. Every night something equally as stupid, and every night I wake up multiple times, kind of angry at my own brain for making me dream stupid things. I'm sure it's just some underlying anxiety but it's annoying. Sorry just wanted to vent.