505rn

You were not a whimp!!!! This has been very interesting reading. I began a new job on a busy inpatient geripsych unit (fortunately we all are considerate about whoever is pregnant not being involved with getting control of or even having a patient who is out of control/a risk to become out of control) working night shift and shortly after found out I was pregnant. I lost 12 pounds before they admitted me for hyperemesis and dehydration and was on home IV's for a week, sick the entire pregnancy and on zofran, every month the doctor made me quit the zofran and every month I got sick again. I firmly believe I was as sick as I was because of working nights, now I did not have preterm labor but did work up until 2 days before I delivered and had some difficulties at delivery with meconium stained fluid and dropping heart rate, they got NICU staff in for the delivery but he was fine and still is. I am in a different job now and plan to become pregnant in the fall, will be interesting to see if I am as sick (I know mere chance could be the cause of not being sick as every pregnancy is different but still....)

Well, to give a rather jaded response, under our former management we were always allowed to have food, water, purses etc. in the nurses station because management did not want to cover the floor while we went to eat or to get a drink (that isn't encouraged as then you have to go to the bathroom, have to say the foley's look pretty good sometimes...). Our newer management is trying to cover but she is slowly losing ground and we are already keeping drinks and when she isn't there food is...

I was a CNA for many years before I got my BSN and thankfully, there are plenty of times that I still work in the role of a CNA. I say this because I vowed to remember how hard CNA's work when I was one and I had a "bad" nurse; although there were always "good" ones too...Now, don't get mad there is not a single role in health care that is easier or worse than another, each role has its pros and cons, "easies" and "hards", however, the physically backbreaking and repetitive nature of the CNA's job can take a toll!!!! Not to mention the lack of appreciation (at times anyway) and the abuse they often take from patients and families. Now, the reason I am posting is that it has long been a mystery, a disgraceful mystery, to me why people who TRY, people who have needed the state's help in the form of welfare or food stamps but are trying to get out of that cycle- why these people are penalized for getting a job. They are damned if they do and damned if they don't! They often can't get a very good paying job and many have daycare concerns and family issues, but they try and thus, risk losing their benefits- excuse the language but how bass-ackwards is that?!?!?!?! I guess this isn't a very constructive posting but I felt the need to empathisize and express my dismay. I also want to say THANK YOU to all health care workers but especially to those in the totally "thankless" jobs like laundry, housekeeping, dietary...and frequently CNA's. (Don't get me wrong, seems like many days nursing is thankless as far as management goes but it seems like there is always one patient who makes it all worthwhile!)

Hello Cyrstal, I used to be a nurses aid in nursing homes until I got my BSN and have been working the last four years on a geripsych unit in the hospital. I am sure that you know that the geriatric population is the fastest growing population and so in almost any area (generally not L&D...:-)) you might have patients in this age group. Having worked with this population for more than 11 years I will say that you need to be aware of the physiological changes and how that effects assessment, medications and disease processes. You also want to know about med interactions because it seems like the older they get, the more medicines they are on. Also, be "up" on psychotropics and what the state laws are in your area for inpatient and for LTC as that is a major issue. Also, know about death and dying grief/bereavement as these folks are losing friends fast and if they are old enough many of them have lost children which I think is the worst, not to mention spouses and siblings. I think that the main areas you will find this population is in LTC, assisted living, geriatric units such as geripsych and ortho (unsure of statistics but they seem to break a lot of bones...)and last but not least med surg treating their chronic conditions that exacerbate. There is a lot more to this wonderful group but this is a short version! Hope it helps!

I visited this site and I LOVE IT!!! There are times when you gotta laugh and there are times when you need to share the special moments which keep us in this field despite the difficulties, and I found things which did both, not to mention having a good cry while reading about the little girl and her daddy! I liked the rest of the site too and took a course on violence in the workplace (gee, why would I want to do that?? I'm just a psych nurse....)so, I give it an A. I hope they update that Heartbeats stuff, it looked like we can submit things too, which I like! Another funny site is that Nurstoons, I saw a couple of those cartoons there, I LOVE those, I don't know about anyone else, but I see myself in those particularly the one where they are going to make a commercial and are talking about the "angels of mercy" and the commercial guy asks about the psych patients gathering and come to find out, those are the angels of mercy, us, the psych nurses...I still laugh at that!!!! Keep up the good work!!!

I am a geripsych nurse and we had a program called C.P.I. -Crisis Prevention and Intervention -that one of our staff had to become certified in to train the rest of us- a two day training for us. One of the "moves" is one staff on each side of the aggressive patient holding one arm each. The patient's palm is to be facing out with a staff member holding the arm at the wrist and midway up the upper arm (the staff holds the wrist in a way which prevents the patient from yanking away but I forget how to describe it) and hold the arm straight by pushing forward on upper arm and backward on wrist (enough to control -not hurt, obviously). Then each staff member puts their leg (one closest to patient) between the patients feet (the staff will then have their feet apart a little for a wider base of balance and support) and gently pull the patient slightly forward, using their hip (staff's) to help balance the patients mid-body -the patient is now on the balls of his feet but his weight is supported by the staff. With practice amongst the team members it worked great! Try it and you will see that if it is done right, it is not painful and totally prevents you from being able to fight- we practiced it on each other so we knew. There were a lot of other components and basic principles as well. One of those was a method that a single staff member could use as self defense which used the patients attempt to hit (momentum) against him so it put him off balance, without hurting anyone and allowed the staff to get away/get help. This was about three years ago and our hospital has since dropped the course as the one person trained in it quit. The one problem was when little nurses like me tried it on 6 foot 250 pound farmers, that was more difficult but it has been my experience that the little old ladies who weigh 75 pounds soaking wet are the hardest to subdue anyway and this worked well on them (and on the kids)! The security guys were resistant at first because one of the principles is that one staff is calling the shots to decrease confusion and facilitate quickly getting the situation under control and the security guys were used to coming in and taking over and doing it their way. Once the training expired and the trainer left we have since returned to the old chaotic method and it doesn't work as well although those of us who can do it try to coach others but it is hard to find the time and to teach it properly when not a trained trainer...Good luck and hope this helps!

HemaStat, Sounds like you have had a rough time of it and I am sorry...the hospital definitely lost out!!! There are many good suggestions here! Have you considered going into Nurse Informatics or plain old information technology, distance education or working with deaf people/children or volunteering to translate (if you learned sign language- not that hard to do), help sign for nursing classes...something like that? I'm sure you could learn sign language, might even benefit you and your family if everyone learned it, something like that can really bring people together....Good luck and keep us posted! Christina

Thank you all so much for this! I really enjoyed reading it and vaguely remember a few things like the MOM and sugar and wounds from my earliest CNA days! I have only been in nursing for 13 years and only 6 of those as an RN but reading this inspired me and I posted about you and other peers sharing these wonderful memories and stories with the rest of the world (in the form of a Chicken Soup for the Nurses Soul book) I think it would be great for us and for the "cause" (improving patient care). It is thanks to you all that we have the wonderful heritage that we are now fighting to maintain!

Has anyone else read the Chicken Soup for the Soul books? I have read 3 and they are wonderful and I think that a Chicken Soup for Nurses would be great! (I don't think they already have one...) I sent the following letter via their website and plan to submit one of my stories which has helped me to remain a compassionate, caring nurse despite conditions... That is the kind of thing that will help to see us through these difficult times and I am going to post to this effect on the BB's I frequent. Won't you share and submit YOUR story? It will help us and the non-nurses of the world to remember what we are about- CARING! "To the editors, writers and creators, First, I want to thank you for all of the "heart" work that has gone, and is still going into, creating these Chicken Soup for the Soul books!!! My children got me two Chicken Soup books for Christmas- for the Mother's Soul and for the Parent's Soul- I love them and have shared them with MY mom (who got for the Christian's Soul- I liked that one too)! My husband requested a for the Writer's Soul book and his mother and he treasure that. Thank you so much! These stories have helped us all to remember to stop and cherish the wonderful, all to brief, moments of parenthood and of life in general; which has led me to be more appreciative of ALL of the people and moments in my life. Including my patients and my co-workers. I forgot to mention, I am a nurse. I can tell you that we (RN's, LPN's, CNA's, advanced practice- the care givers), as a whole, are becoming weary and dispirited.... This so-called "crisis in health care" is not a new or a soon-to-happen thing.... it has been progressing to the critical point it is at today, for several years. If you have occasion to "surf the net", get on the discussion boards at Allnurses.com or NursingSpectrum.com or the Million Nurse March sites (to name a few) and you will see that we are valiantly attempting to hold ourselves together collectively so that we can continue to ATTEMPT to give the kind of quality care...NO, attempt to give ANY care...to our patients and their families. Care that they deserve, care that they pay for and care that we LOVE to give...CARE that is the reason we went into nursing! There are some truly wonderful stories being told to help bolster the spirits of those who feel exhausted and hopeless after the days when you leave, after many hours of overtime, and cannot say that you made a difference to anyone- not one person (except maybe an administrator somewhere-not gratifying- also, in our darkest hours-questionably people). Days when you cannot say that you were able to hold someone's hand and listen, ease someone's pain, or allow someone to pass on with dignity. Days when you were not able to give someone the information they need to make an informed decision, ensure a warm bath and clean sheets, get the extra snack, talk to the loved one who needs someone to do just that, or do proper discharge teaching. Some of the "old timers", as they call themselves, are sharing their memories of how things used to be... and it tells a SAD story to see the differences between then and now...Technology is great, but if we are not allowed to do our job, to care for people, nurses will become like the Tin Man- and need a heart! On second thought, maybe the people who need a for the Soul book are the decision makers: the administrators and the money managers of the HMO's, the insurance companies, the pharmaceutical companies, and the large health care corporations...Maybe it would help them to make better decisions if they could read true stories from patients and nurses and "see" for themselves that all we want to do is be allowed to do our job, to give thorough, quality care and that that care DOES make a difference to patients. All health care workers need some "bolstering" right now! But I mostly speak for nursing (being a nurse and all) and I have to say, nurses are in a unique position. No one else, no other discipline, is involved in every aspect of care like nurses are. Nurses give direct patient care. We are the ones that see the patients, and their families, cry; that must explain why they can't have more pain medicine, why we cannot save their loved one and why they cannot stay until they feel better. We are the ones the patient's and their families yell at when they are upset, the ones wiping bottoms, holding the emesis basin (or being thrown up on) and sometimes being hit, kicked and bit (by the way, dentures really ARE like real teeth and Polygrip really DOES work!). We are expected to clean when there isn't enough housekeeping staff, to pass out food when there isn't enough dietary staff, to mediate between family members, straighten out insurance issues and make discharge plans when there are no social workers or care managers and to answer the phones when there are not enough unit secretaries. Not to mention the "standard duties" we perform. Nurses are at the bedside the most and thus are in the "line of fire" when the "you-know-what hits the fan" (this fan thing happens on a " secondly" -as opposed to daily or hourly-basis many days!) ... We just clean up and keep going...because we WANT to help people, to take CARE of people, to be the "light at the end of the tunnel" and help them to have hope... You see we really do CARE and we really do TRY-but we don't have much to work with anymore.... So, could you please consider doing a book about Nurses (collectively, as mentioned above), Patients, and/or other Health Care Workers? At this point in time WE need someone to be the light at the end of OUR tunnel- it looks pretty dark right now.... Christina LaMarche RN, BSN"

Don't give up yet!!!! I agree that you may be over extended, life is short and a life in the service is not always conducive to support systems but make time and make some friends, do fun things or volunteer...whatever it takes to replenish yourself, that will help you to enjoy nursing more! While I have never been a nurse in the service I do know that there are a LOT of different nursing opportunities out there...instead of working prn like you are now look to work or to volunteer in long-term care, Red Cross, volunteer to go hold babies or take bp's or give flu shots, work with paperwork (MDS, admissions) etc.deliver meals on wheels, work in a prison, do home health, teach at schools.....Be creative. At one point when I was looking for a job I looked in the administrative section and found some neat opportunities. I hope this helps....maybe you need a hobby to help replenish yourself, something that has nothing to do with taking care of others. Sometimes nurses get so focused on taking care of others we forget to care for ourselves or feel guilty taking care of ourselves....Christina

First off, I would like to say that with staff and friends like you, your ADON is very lucky as support/caring, assistance and prayers can do A LOT for an ill person!!! Good for you!!! Depending upon the type of person your ADON is, some inspirational books, pictures or a calendar might help (I bet they have a Chicken Soup for the Soul book that would be appropriate-you can check their website), telling her in a card or note that she can refer to during the tough times that you all care and, if appropriate for her, are praying for her is nice. Cleaning while she is gone (so as to not embarass her or make her feel weak, lazy or helpless) with not very fragrant cleaner is nice. As are fresh, soft sheets, blanket, robe or "lounging pj's" (so she feels comfortable without feeling like an invalid)...Music can be comforting and uplifting as can flowers. But never forget about humor- that goes a long way too, if you find jokes that she will enjoy, even some about chemo or cancer so she can laugh at it rather than be afraid of it might be helpful- depending upon her personality. Pretty scarves or hats (or funny ones) if she looses her hair. As for food, small amounts of basic things that are not real fragrant and crackers! I don't know if any of these things will help but I hope so... My only other suggestion (and I hope that I am not upsetting you too much, but one never knows what might happen and it is not nice to have regrets after someone you care about is already gone...) is that IF she finds out she cannot beat the cancer-be open and talk about it with her (if she wants), help her say good byes, make a dream come true etc. There are some really good books out there about helping someone who is going thru this stage/process of life ( as death is a part of life) and it is an honor to be able to help someone you care about to make that a relatively peaceful process.

Hello csnurse, I too love geriatrics! I have been in nursing for 13 years- all working with the elderly! I love it! My suggestions would be #1 do a little reading about the Great Depression and maybe a little about World War II, the Korean war etc., I know that sounds weird but it will give you some insight about how the elderly think and what they value- a BIG help in attempting to care for and assess the elderly! Also, take a death and dying class!!!!!!!!!!! This is a huge issue (and a process which we can help the elderly person and their family thru) and will give you some "ammunition" for many situations that you will find in geriatrics, also Pain management is very applicable. Be aware that there are many areas of nursing which will bring you into contact with geriatrics...geri psych units, long-term care, some hospice (not so many geris but some), some on ortho (high rate falls), home care, assisted living and probably more that I am not thinking of. As for the goal of being a DON, that's great, everyone should have a goal BUT give yourself some time "in the saddle" as that is an administrative position and the DON is frequently the scapegoat for any problems and I would think it would be nearly impossible to make good administrative decisions without having the experience upon which to base it!! If/when you do decide to be a DON...PLEASE take some management and communication classes to help you maximize your talents as well as the talents of those around you and to avoid miscommunication which is a nasty monster in healthcare administration! Sorry I do not know about any internships but some of the big corporations which do long-term care (LTC) may be able to do that OR the Veterans Administration may offer a program to help you get thru school if you work for them and a lot of their patients are elderly males!!! Hope this helps and good luck, it is a wonderful population to work with! Christina

Hi, I am an RN who worked full time in geri psych in the hospital(until recently, now on call). Restraint use is the biggist issue! JCAHO and HCFA make the rules regarding restraint use,as well as the state and the individual facility. JCAHO has a website for sure, I'm unsure about HCFA. It has been my experience that med surg units have some leeway and can use physical and chemical restraints, whereas we (mental health) have MANY stipulations and rules. We are not allowed to use restraints until every single, possible alternative, including "therapeutic holding" (or attempting to hold or hug the patient who is agitated until they calm- which if the patient is truly agitated is dangerous)has been tried and documented. Then the RN must assess the patient to determine what behavior is uncontrollable and get an order from a physician for a restraint such as vest,wrist, or seclusion; if medication is needed a one time only order for an IM, such as haldol or ativan may be ordered. However, the patient must be SEEN by the physician (within two hours I believe) and seen again if ordered needs to be renewed, and there is much paperwork, frequently the patient must be constantly monitored with documentation at least every 15 minutes and taken out of any physical restraints ASAP. If JACHO finds that documentation etc is incomplete there can be severe penalties, even including being "shut down". A year or two ago all psych staff where I worked had to become certified in a special technique in managing agitated patients called CPI, or Crisis Prevention and Intervention I believe, this was very effective with patients who are similar in size to the staff member, difficult for us to use on a 6 foot, 200 pound demented patient... The most accepted form of management is a "one to one" order where a patient has a staff member assigned to him/her 24 hours a day within arms length at all times, in hopes of heading off severe agitation episodes, or "quicker" management if patient did begin to escalate, this becomes expensive however. One of the biggest problems for us in the acute care setting is the "frequent flyer syndrome"- with our age population, and the type of patient- the demented- we see frequent readmissions due to state laws regarding the use of psychotropics. In long term care, if the patient is stable in their behaviors, the doctor must begin decreasing the dose of any/all psychotropics. My question here is- do we decrease the dose of insulin in a diabetic with stabilzed blood sugars? NO. For the episodically psychotic patient that rule is a good one, but for the chronically mentally ill, or demented patient who will only worsen, this causes frequent relapses, it is very sad and frustrating at times. I see other information posted as well regarding this issue, it is not a simple one and the misuse of a few has negatively impacted the rest, at times to the detriment of the patient. We have had to get creative about managing the environment in an effort to manage patients who become agitated. Other options to help keep a patient or his/her peers safe if the Vail Bed, Posey huggers, a gerichair with a tray, a low bed, padded side boards/rails, and for DT's a checklist of assessment designed to ID symptoms early and medicate to manage those symptoms until pt is safe with little risk of seizures. Hope this helps. It is my personal opinion that with better staffing in all healthcare facilities, the overall number of agitated patients would decrease as needs would be met and thorough assessments made for those patients who cannot express their needs and may become agitated when needs are unmet. [This message has been edited by 505rn (edited September 18, 2000).]

I worked at a major hospital in NE, full-time until last month, on call now... I worked on an inpatient geri psych unit- many medically ill agitated dementia patients, with a fair share of people suffering from depression/substance abuse and other mental illnesses such as bipolar disease or schizophrenia. Our staffing ratio was changed so that we each had more patients and we then proceeded to feel like the new float pool (until our census stabilized to more than full most days), we were told we were to float wherever they told us to go, including ICU! Now, we have good med surg skills as so many of our patients are medically ill, which exacerbates their psych problems, but ICU is ridiculous- and we were treated very rudely although we tried to be as helpful as possible. Other units refused to float to us even though we treated them VERY nicely as we understood the dislike of floating and that coming to our unit with the number of agitated patients was obviously scary. Unbelievable what all nurses are expected to do by admin, down right dangerous!!!

The method that we found to be most successful on our inpatient geri psych unit is that each nurse carries the kardexes for her patients and updates it throughout her shift & at the end of day, tapes report using an outline to hit most important info- keeping in mind most of our patients were not only mentally ill but had numerous medical illnesses/issues which exacerbated their combative, agitated or depressive symptoms. Walking rounds breached confidentiality and upset patients for various reasons, not to mention the guests or family on the unit... When the oncoming shift was done with report and came to unit the prior shift was available for about five minutes to answer questions or update as needed. Generally, we were able to tape/listen about all 22 complicated patients and have the five minutes for questions within 30 minutes and get the next shift started on time, keeping in mind that some info was on the kardex that each nurse carries and can refer to, which helps decrease the amount of info given verbally. e found that each unit must find the method We found that each unit must find what works for their individuals and type of patient. Good Luck!