Imarisk2

Before you make the choice, think carefully: if things get sticky, you can't step backward. If you are asked for "expert advice", how will you handle it? If they friend you on facebook and start commenting on your previous professional relationship, how will you respond? If they neeeeed a caring friend, and you start getting dragged by your nose through the dark corners of their lives, where will you start setting limits? If they suddenly start finding fault with the care they received at your hospital, and/or file a malpractice suit, where will you draw the line? I'm a psych nurse, and I've known a few patient/professional relationships outside the hospital to turn very very sick and nearly ruin careers. Are they worth it?

Hey! What are you doing here? This is MY CMS nightmare! Go find your own!

"Sometimes I cannot help ......., or they don't WANT the help, sometimes I cannot get what the (patient) wants and they see that as a lack of advocacy, and sometimes there are hospital wide things I don't necessarily agree with but I have to support as a (nurse)." Wow. Must be a nursey human interaction thing. I so see myself in your shoes......and you in mine! I'm peeking around looking for a direction for my next step. Maybe I'm better prepared for this than I thought!

Don't argue with them. Get a Doctor's order stating that these meds need to be given an hour apart, and clarifying which one should be given first. You could even make a valid argument for rearranging your standard protocols. About a month ago we were surveyed by Jhaco, and this was THEIR correction to our standard methodology. We changed our protocols to reflect that when two prn's are given for the same reason, the doctor's order MUST indicate which is to be given first. We already had the one hour apart thing going on but the surveyor was horrified that the nurse, and not the doctor, determined which med(s) to give for anxiety and/or sleep first. I tell my patients that this way, we can tell what works for them and what doesn't without overloading them on meds that may be working against each other, or producing horrible side effects. And when my rationale doesn't work, there's the doctor's order in black and white. I can't lose, and the addict's whining won't help either of us.

Seclusion and restraint. There is such a push today to maintain safety on inpatient units without the use of force by staff. With so many different programs like CPI, Moab, Brandt, etc, being promoted and taught to staff across the country, it would be interesting to make a comparison of which ones are the most successful in aggression management, and what direction might be indicated to promote increased patient AND staff safety in the future.

I have been an inpatient psych nurse for over 6 years, having come from being an LNA in LTC. I don't deal with lots of procedures and body fluids anymore. I DO deal with lots of people with psych issues and/or misaligned attitudes. Milieu management (relationship redirection and education in a safe and controlled environment) takes up most of my energy on a daily basis. I love what I do, but I know it truly isn't for everybody. Those of us who work comfortably and successfully with psych patients unsually have a history of confronting and overcoming our own personality disorders first........ and continue to face them down again daily.

It pains me to read about coworkers who throw each other under the bus. My motto has always been that if we the staff cannot keep each other safe, we have no business thinking we can keep the patients safe. And while our floor is known as the friendliest floor in the hospital I think our culture, hospital wide, is pretty healthy. Our patients are the victims of trauma of one type or another. They have survived by reading people, and they are experts. Therefore, role modeling is the first therapy we offer them; the level of safety we present to them is the level of safety most of them will mirror back as much as they possibly can, barring the lies of any psychosis. Walk in with your eyes wide open. Observe and listen. Work smart and hard when necessary. Ask for help. Be available to others. Make room for the way other nurses cope; sometimes it is snarkey and irreverent off the floor, but it hopefully never touches the way they treat their patients. I love my work! No day is the same as the one before. Welcome!

As above. Working in psych, you would have lots of opportunities to work with people in crisis. You will meet people suffering from addictions, joblessness, homelessness, and those with significant losses of important relationships. You will encounter all manner of moods and behaviors. Sometimes, you will be personally threatened emotionally, verbally, and physically....... either one at a time, or all three in the same incident. You might someday find yourself cutting somebody down from a hanging. If you are lucky, you will be in time. Every day on my way to work I pray that God sends me to the right place at the right time, and that I say what needs to be heard, or hear what needs to be said. A good employer will provide lots of education for their staff. Just as a nurse in cardiology can read heart stuff, you will learn to read behavior stuff. Lucky psych nurses like me work in and/or develop a phenominal tag team approach to caregiving. We learn to trust in each other and communicate across disciplines and shifts. It keeps us all safer. Patients feel more supported, and they have a chance to experience what healthy environments feel and look like, even if busy and stressful at times. Some folks have never known that before, or it has been so long they've forgotten what it feels like to be safe and respected. Safety risk assessments, detox assessments, medication education, DBT, mindfulness, coping skills, cognitive skill building.....the list of topics to learn and teach and apply to your own life is nearly endless. This either sounds like a dream-come-true or a nightmare to run from, or a big lot of both. Trust that voice.

I've been working in a psych hospital for over 6 years, and I used to be an LNA on a ten-bed geri psych unit located in a community hospital while stumbling through nursing school. These demented patients DO suffer. And we who care for them are often at great risk. I'm not quite sure what evidence evidence-based-practice is looking for, but someday folks will look back at this period of time and think our policies of undermedicating angry, hostile patients made no sense at all. It doesn't preserve their quality of life, their dignity, or their loved ones from suffering more, longer. I'm convinced that if most of these folks were in their right mind, they would beg to take the med that helped them sleep instead of wail and scream in the hallway. If I ever get there, please spare me. Give me the pills.

I'm on a consistent carb diet this year, so HE expects me to taste and spit Christmas cookies!

I have an ASN in Nursing. Found a 15 week psych internship program straight out of passing the NCLEX in 2006. I have been a psych nurse ever since. I have never drawn blood or set up an IV. I work at an inpatient psych hospital, and while we do have medically acute patients, none of them need that level of care. Good luck! I hope you follow your passion and find a home for your skills and grow.

We warriors need a different strategy for conquoring our stressful jobs. We cannot do this unless we present a unified front in healthcare. It is totally unacceptable to treat each other with less honor and consideration than we treat our patients. When we accept disrespect and mistreatment from each other, it has a negative impact on the care we are able to provide our patients. We need a new standard of care that endorses healthy treatment from the inside out of all healthcare organizations. Nurse managers and leaders should have special training in how to make this happen in their facilities. As a floor nurse, I know what is expected of me. I have supervision and constant upgrading of my skills. Nurse managers need supervision and constant upgrading of skills, too, but they often do not have mentors and preceptors to turn to. Therefore, everything heads south when their "big picture" starts to melt. In your shoes, I would try to set aside my anger before confronting my manager, and then I would try to open up a two-way conversation about the incident. Think about the way you might do that with a patient under your care who might have called you "ignorant". Be prepared to tell her how it made you feel. Remember that honor and respect are contageous for most of us, and she can only benefit if you model this for her instead of her own attitude mirrored back to her. If she can't or won't bend, get out. Find a place where you can be honored and respected for your work. Even your patients will benefit by your self-confidence and peace of mind.

To dress down anybody in this fashion is a travesty. To find others trying to laugh it off or downplay it as something somebody can get away with because of who they know and how many years they've been holding their own personal courtmarshalls is no less a travesty. Nobody heals in a hostile environment, including our patients. We all get sicker together. Walking on eggshellls is not good for our feet, much less our profession. Grow on, and spread your seed far and wide.

As a nurse who is also a human being, there are so many ways of expressing myself without wearing religious emblems on purpose. My goal, when I am working, is to help my patients be the healthiest best that they can be. Most of the time, the less folks know about me, the more we can concentrate on their needs. As a human being who needs good solid nursing care, I really don't want to know what you believe, as long as you have a clue how to respect and support my spiritual needs during my time of crisis. Just listen, please. You don't need to have all the answers. As a nurse, I find that when I open myself up to everything a patient chooses to share with me, I end up enriched by their gift. And sometimes, their words surprise them, too. They actually have the answers they were hoping to get from me!

I have more than 19 years to go to catch up with you. I've loved the nearly 6 years in psych nursing so far. I knew I "belonged" when I started on a floor with super-experienced psych RN's and techs, and they took me under their collective wing. They taught me what I needed to know to love my patients, my work, and be a successful team player. Maybe one of them was you! In any case, thank you for paving the way, and braving the many changes that psych nursing has seen. Thank you for sharing your knowledge and experiences with those of us who join your team. As you know, we can't keep our patients safe if we don't work together to create the safety first. Thank you for leading the way.....