catebsn25

involuntarily committed for a psych issue? if that's the case that will have no effect whatsoever on obtaining a nursing license. that is your past medical history and the BON would have no way of knowing. I currently work at an acute locked inpatient unit and one of my fellow nurses was actually a patient herself here about 6 years ago before she went to school. :) hope this helps!

"Tending the fires within so others can feel the warmth." "If you worked for me I would fire you right this second."

I think you're right... thank you so much for the kind words and advice

I agree... My thoughts were some type of Axis II pt and possibly Bipolar I D/O, currently manic. OP, try to meet the patient where they are. Instigating them by insulting their behavior during an acute psychiatric episode is never a good idea. And your opinion on their mental illness is completely irrelevant. Unfortunately sick patients are sometimes rude. If you can't accept that and learn to not take these things personally, nursing might not be for you.

One more thing I forgot to mention that also is bothering me... When I dragged him from his bed to the floor his shorts were inadvertently pulled down to his knees. The pt wasn't exposed as he was wearing boxers but as EMS had taken over and we're trying to administer the nasal Narcan I started to pull his shorts up gently (without jostling the patient around) and was sharply told "Don't bother." I wanted to protect his dignity and it bothered me that they didn't seem to care. Sorry for all the posts guys, I just can't stop replaying everything in my mind...

Unfortunately I work at a very small organization and we don't have an employee assistance program. I have been talking a lot with the staff who were with me at the time and other coworkers and it has been helpful. In case anyone is interested I will post the story... When I started the thread last night I just didn't have it in me. Pt was admitted voluntarily for +SI w/ multiple plans, and reported ETOH and Opiate dependence. Pt has a long psych/substance abuse history with multiple past inpt admissions. I'm one of two RN's who work the overnight 12a-830a shift on the locked unit. Last Thursday into Friday was my last shift of 7 in a row. I knew the patient well as I had been with him every night/early morning throughout this admission. Pt was initially put on a detox protocol for his reported substance abuse but throughout admission VSS and no physical s/sx of withdrawal. After every medication dose per the protocol the patient would become somnolent and appear to be "nodding out." All sedating meds were held after 3pm one day and after waking on the next day his VS were still perfect and no outward symptoms of withdrawal so one med was D/C'd and the other was held by the med nurses during the day. The patient remained somnolent but arousable by verbal stimuli despite the fact that all sedating meds had been held for almost 24hrs. Since we are a small psychiatric facility we can only effectively handle so much in terms of acute medical problems and due to the continued somnolence we sent the pt out by ambulance to the nearby ER where he was hydrated with NS and sent back to us about 3 hours later. I came in for my shift that night with no reported issues. On the noc shift it is just me and two "techs" for support staff who do Q15min checks. The patient had a very loud snore throughout his admission. I had checked on him every night since he had been with us due to the snoring to find the patient in no acute distress, so he was considered just to be a person who snores loudly, probably has sleep apnea but that wouldn't be something for us to address during his acute psychiatric hospitalization. I went in to visualize him at 5am with no issues at that time. When one of my techs was doing his 630am check and waking the patients up he came to the nurses station and told me I needed to check on said patient. I went into his room and up to him and he was nonresponsive, skin tone dusky/ashen, not breathing and I could not detect a heart rate. I hardly remember thinking, just acting immediately. Told one of the techs to call 911 and the other to go get me the O2 machine and AED. As they left the room I dragged him from his bed to the floor (gently yet quickly) and immediately began chest compressions. I noticed he had pink frothy sputum coming out of his mouth and nares, and when the O2 tank and AED were brought to me I sent them to get our portable suction machine and to plug it in. Chest compressions were maintained other than allowing the AED to analyze the pt. AED cycled X3 with no shockable rhythm found. As I was suctioning the patients mouth and nose EMS arrived and took over. One of the first responders asked me if he could've snuck in any opiates and I said I don't believe so but it's possible it has happened in the past no matter how diligent we try to be. They start setting up their nasal Narcan and I pointed out that his nares were completely full of frothy sputum and asked if they had Narcan IM, offering ours if they didn't. I was ignored and they still attempted to administer the narcan nasally. At this time more EMS personelle had arrived and I assisted them in switching the O2 and AED wires onto their equipment and helped transfer him onto the stretcher and off they went. Everything happened so fast. Later as I was meeting with the Hospital Administrator/DON and explaining what had happened we got a call from the ER MD and he told me that the patient had "expired." I kept my composure and was calm until I hung up the phone with him and then started crying. My coworkers (including the DON) were all supportive and I believe I did everything in my power in that moment to try to save him. But I'm still so sad for this man. I knew when I started compressions alone in the room with him that he was already gone. I still tried as hard as I could for him and was still hopeful that the ER might have better meds/resources and bring him back, but I guess it was his time. I don't feel responsible for his death but I can't help but think I should've picked up on something being wrong when I checked on him at 5am... Anyway, if you got through this whole thing thanks for reading. I know I'll be okay and move on at some point, but for now it's all I can think about. It was the first time a patient coded under my charge and the first time a patient died under my charge. I hope he is at peace now. I'm not religious but I made sure to open the windows in his room. We are also leaving that bed open until all of the patients who were there and knew him have been D/C'd. Thanks for listening, guys.

I've been a nurse for about 2.5yrs now... and have been working at an acute locked inpatient psych unit for the majority of them. This past Friday at 0630 I had my first code and the patient didn't survive. I feel confident that I did all I could for him with what I had but I can't stop thinking about him. 28 years old. Any advice or wisdom from my allnurses colleagues? Having a hard time with this...

the hospital I work at is trying to cut staffing now for the noc shift in the locked/hospital unit... we can have a census of up to 18 but on average it's 13/14. I am the only RN in that building and always had 3 mental health techs (love my night team!) as of late they're "experimenting" on running with 2 techs and it is so chaotic now. I've spoken with my supervisors about it and they tell me that "most hospitals in the area have less staffing than that for overnights" so basically I should feel lucky for having 2 support staff. so frustrating. I hate leaving work in the morning feeling that it was only luck that got me through that shift without a catastrophe!

At my hospital the protocols taper down day by day... if a patient is able to take every prn dose of whichever protocol they're on then the chances are we will need to then detox them from the Librium/Serax even longer... Also if you gave them every prn when it wasn't indicated they would most likely be snowed and unable to actively participate in treatment at all

Do you ever converse with the CNA's about anything other than when you are delegating tasks? Try getting to know them on a more personal level... Another suggestion that could be helpful in improving your rapport with your coworkers is to be sure to express gratitude and appreciation when you see them working hard and doing a good job with a patient of yours... A thank you and kind word really goes a long way.

oh boy I wonder if we were wrong! anyone else have the answer??

In my rehab clinical I had to document an ulcer forming in a patient's buttcrack... I asked the nurse I was assigned to, "How do I document this? Do I write buttcrack?" We laughed so hard! She wasn't sure... The general consensus ended up being "sacral fold." I work in psych now so it's never relevant... but I'll never forget it.

Not the same for everyone, but getting a therapist and seeing her regularly helped me immensely... Just a thought. Good luck to you!

I might chart 0 even if a patient is NPO because it shows that you checked, and also I don't like to leave anything empty while charting. I doubt my coworkers would do any such thing, but just as a "CYA" practice I don't want to leave room for anyone to falsely chart something under my signature. Also, my facility is still all paper charting so it could be easy to do.

I am not in the same state as you but I can tell you what my experience was. I have a few misdemeanors on my record and was able to be licensed in MA and NH after going through similar steps (court documents, explanations, hearing in front of the board, etc). What they are mostly looking for is accepting responsibility for your actions and why it is unlikely to happen again in the future. Since your mistakes were so long ago and they were minor, it seems you would have a good chance in becoming licensed without restrictions. Good luck.