Gregmercer601

I've worked inpatient Psych for twelve years, generally on the most acute units in our all-Psych facility. Many confrontations with violent patients over the years, but never injured. I've learned a few things : always work on strong rapport, with everyone : you build a reputation with patients and they listen more often, enough to make it worth your while. Show no emotion, speak slow. And clear. We have private security but mostly rely on staff coming from other units - I call early and often, and it ends up we need less force, as I give options with consequences - go here, take this or this will happen, time limit, go. Many folks back down, many at the last minute, and I then defer restraints, give Medication PO - very clear it's IM unless I'm convinced it's taken. Whenever you can avoid force, you gain a better working relationship, no grudge. As soon as thru back down, no hard feelings,judy monitoring as needed, backing off ASAP - whole unit learns you're good to them if they play safe, and the alternative is no fun. Most staff I've seen get hurt (many) took too many chances, tried to be a hero. You need to learn movements that are allowed in your culture - I too took martial arts, mostly used it to position self well, dodge, soft block - defections really, open hand, stay to pts side, stay on top of unit & team so they know what I want fast & we see problems coming. I can't speak to your unit - not there - but I've seen acuity vary wildly shift to shift based on different staff approaches. As I've gotten better at it, same patients get violent less, and most emergencies that used to go violent don't - not all, but much better. When you assume violence is inevitable or avoidable, either way you greatly influence the odds in favor of your expectations. I've even learned to pretend I'm fearless when I'm surely not - it helps. You can't change others nearly as much as you can yourself, so that's where I focus -learning how to become accepted by patients & staff as a trusted respected leader - its more possible than most people think.

I've been full-time in Psych for 12 years - now I teach it. I'd suggest psych-appropriate assessment and documentation, as they are very different than you're likely used to. There's lots of other stuff but it takes time to learn and you don't need it ahead of time. I've put considerable study and practice into one point - if you treat your patients like people, all the same courtesy, respect, etc you offer everyone else - you will be much more successful. You'll stand out from coworkers, likely, and they may tell you you're wasting your time being so nice or folks will take a mile if you give an inch - nonsense, it improves cooperation, makes every task with patients easier and quicker, and reduces both the frequency and severity of behavioral emergencies. It enhances your influence in the neighborhood that every inpatient unit is. You need a spine, and you need to be tough, but never confuse that with mean, cruel, callous, or lazy. If you send me an e-mail, I have some assessment and documentation references I should scan anyway, and I could send you PDFs. I'm at [email protected], and a blog: grchealthcareblog.com One more tip: if you feel uncomfortable giving a total stranger your e-mail (as you should - you're begging for spam), the solution is simple: get a second email address and forward mail from it to your mailbox. I do it - hence the hotmail. It's easy, gives you control and protects your privacy. Good luck and welcome to Psych! - Greg

Hang tough! Profits have all too thoroughly corrupted clinical care, and Nurses have the means, the will, and the credibility to fight back for patients. Keep us posted - you have many more supporters than you may realize. If its helpful, let me know what you think of a labor tactic some of us have been trying out in another labor issue involving a Nurse fired for providing education as trained, that happend to interfere with a profitable surgery (i.e. the patient decided to consider other options first). Link: wp.me/s278fi-178

I've met lots of nice and helpful and conscientious folks in HR over the years, but I have long been wary of any human endeavor that refers to human beings as a "resource." A commodity, like a unit of gasoline or coal, or a slave - a cog in the machine to be 'managed.' Its partly an attempt to take unpleasant realities and mask them with abstractions, technicalities and professional veneer, to compartmentalize all the interpersonal stuff too toxic for most managers to deal with. Its not just gangsters in movies who often excuse their ruthlessness with the phrase, "Its not personal. Its just business." With human beings, this phrase is always dishonest, unless the person voicing it is a sociopath. The truth is, when A fires B, A feels B deserves it, or often enough, feels that 'deserve' is beside the point: A's takes care of A as top priority, as does the company take care of itself first, and on the whole A feels better off without B around. Its a tough message to give, though, very tough, and so no surprise that people evade the conversation entirely or sugar-coat it. Firing is easy as an idea, but not when face to face with B. Plenty of people have earned a comfortable living simply taking this unpleasant task off the hands of people willing to pay it.

That's tough - its quite understandable that you find it a challenge to get past it. I'm an experienced Psych Nurse, and I wouldn't begin to get diagnostic on you with so little information, but I wouldn't assume you have any diagnosis. Just as not every headache means a brain mass, not every distress of nightmare or worry, etc means a Psych illness. Find supports, seek professional assessment if it seems to you or someone you trust. Learning and practicing simple meditation can be helpful in times of stress - check on the web, perhaps DR Herbert Benson's Relaxation Response, he's a leader in the field and trains Harvard Medical Students in meditation for their own self-care. Also, keep in mind that you have a tough job, and if you've been managing, you're tough and resilient. Everyone hits their limits here and there, or they're not challenging themselves. I'll never forget my first death - it was years before I was a Nurse, fresh out of college. Guy was an obese heavy-duty chain smoker, beloved by all in the Group Home, one of the nicest, kindest, gentlest people I've ever met, but also rather impaired with Schizophrenia. He'd smoke most of his waking hours, sucking on each butt hard enough you could see it dwindling, tamping it with each exhale without breaking rhythm, starting a new one without having to slow down - very impressive in its way, a true expert in this form of slow self-destruction. I met him, then soon had my first team meeting, advocating like only a novice can for a full-court press to help this guy stop "before he dies," I said. Folks had tried without success for years, and had given up. Groups homes generally have their hands full or more most of the time, and the issue was considered an untenable waste of resources. So a few days later, Guy hadn't come downstairs by noon, so we went to check on him. He was face down on the floor, dead for hours, his shirt half-pulled over his head, nose smashed. It seemed clear he was undressing, fell like a tree. Now I've had CPR but no other health care training, I don't know how long he's been down. I sent my peer to call 911, rolled the guy over with much effort (400 lbs or so). Had no barrier device, so I'm struggling with whether to give mouth-to-mouth, but it was moot - tongue was too stiff and sticking out, and after a few minutes of not realizing this wasn't a matter of my inadequate skills but a hopeless situation (it seemed to last for hours, alone with a corpse), an EMT came in, looked down all casual, and said - "Forget it - he's done." I've had lots of codes, deaths, emergencies, terrible violence, a fire that destroyed that same group home, lots of scary days and low times, but that was the worst - I didn't even know enough to know no knowledge could affect outcome.

While glad there are people able and willing to take this work on, I find it intolerable. Except in a position where no other option was possible, I would never take any job that involves anything more than rare nights - I've covered perhaps ten in 12 years, when there were sick calls we could fill no other way. I'd switch specialties, geographical region, whatever it takes - it takes me days to weeks to really feel normal again after a night shift. We all have different priorities, of course, and I know lots of people who don't mind nights, don't care one way or the other, or prefer them. Fantastic, I say, it helps me avoid them having others around to take my place. Nursing's a big tent, with tremendous diversity, and we need all kinds to fill all those niches.

A worthy effort - health care is so large, so complex, and so thoroughly infected with pervasive conflicts of interest that any attempts at reform attract foes that are numerous, powerful, highly motivated, and well-connected. The FDA has come to largely serve to provide Pharma with the appearance of regulation, not the actual variety - a form of public relations, very effective in its way. Most people, for instance, imagine that approved drugs have been proven safe or more effective than older ones. they mistakenly assume that claims for 'dietary supplements' are any more trustworthy more than they did a century ago - nothing. Only tort lawyers keep manufacturers on their toes. Insurance companies are routinely allowed some of the most pronounced conflicts of interest in modern times - your need for care is determined by the very people who profit form denying or obstructing it. And so on - top to bottom, our system is a bloated, wasteful, corrupt disaster, wildly successful in bringing tremendous wealth to those who provide no care, and keeping the rest of us distracted, divided, and too busy for most of us to care or do anything about it. Your approach might be the way to go - make small focused workable attacks where possible. Large-scale improvement, if possible, will only come through political organization, a tough road for certain. There is an example of an experimental project at wp.me/s278fi-178