AtivanIM

DON: "Why is the medication room door open?" AtivanIM: "I'm just throwing away these documents." (The shred bin is literally 10ft. away) DON: "You need to NEVER have the door open if your not physically inside the room, regardless of just walking a couple of feet away." ****** The very NEXT day ****** As I was running around giving meds to 15 patients, going in and out of the room DON: "WHY WERE YOU IN HERE WITH THE DOOR CLOSED?!" (After a patient became violent and we had inadequate staff) AtivanIM: ...... "because you told me to." Then she had the nerve to still be huffy about it! Such a space cadet!

On my normally scheduled days, I work with children ages 5-17 in an acute care psych ward. Every day I hear stories that could break your heart. When I first began working there, I had a pre-psychotic break! Talking in my sleep, texing in my sleep complete word-salad. This was when I was actually able to sleep because I took my work home with me. The vast majority of my patients have been abused, usually to extreme levels, and oftentimes the abusive parents or CPS are involved. VERY recently I had an older teen that had begun being prostituted out by her mother at the age of 8. How could I even process that pain if I took it home? Admittedly, sometimes it's impossible. I hear stories that are beyond belief on a daily basis. I can't count how many times I have teared up while a child tells me their story. My job has shaken any religious beliefs I had, regardless of how small they were. I advocate for my kids as much as humanly possible. I will debate with social workers and MD's if I know that child could be going back to an abusive situation and explain my rationale. The only reason I do this type of nursing is because I can SEE the difference I have made. When a kiddo draws me a picture to say thank you or says "you're the coolest nurse I've ever had," or just a simple "Thank You" as I walk them out the door, it makes all of my emotional turmoil, to some extent, worth it if I've made a positive difference in their life. I always make sure to give the kids that had a connection with me a big hug as they go out the door, because I don't know when will be the next time they will get a genuine hug. :)

We must agree to disagree then. I don't think I'm whining about lateral violence at all! If I remember a prior post of yours, the title was something to the effect of - why does everyone think they are a good nurse?- Maybe she is not a good nurse and is trying to teach the OP nothing. I've seen a new grad cornered into a storage room by a veteren nurse for putting O2 on her patient when she answered her call bell for the patient. It was standing orders on the unit that if the O2 goes below a certain % to apply oxygen. Of course there could have been another reason blah blah, but she was doing right by the patient by not letting them struggle to breathe until the other nurse came into the room. Apparently that nurse tore her a new one and the newbie was hysterical. Was that a great teaching moment? Some people are just nasty, nurses included, and I don't think anyone should have to tolerate it.

Ruby, I never questioned the fact that the information about a valve is important. If it wasn't noted in an otherwise comprehensive report, and remembered on demand, then the oncoming nurse can go and find out the information for themselves. In a prior comment you mentioned to let the "rudeness roll of your back." I don't think putting up with rudeness and lateral violence under the cloak of -maybe they are trying to help you by tearing apart your self esteem- idea is a great one. You seem to have the same theme for new nurses who ask these types of questions: -take the harrassment or get out of the profession-

Without reading your post first, and just answering the question you presented, my knee-jerk thought was "because you let them." A way to avoid interrogation would be to keep giving report as you have been because you seem to give a very comprehensive report! If they were to ask me if a valve replacement was tissue or mechanical I would have just said: "Im sure that information is in the chart." If they replied: " Don't you think that information is important to know?" I would have replied: "Yes, that's why you should look it up in the chart." There is a difference between giving a good report and doing their work for them, which is what they are having you do. They need to get off their butts and look it up themselves!!! You need to learn to be assertive but not rude.... If that person reported it to the charge all they could say was: "He told me that I could go look in the patients chart to see if he had a mechanical or tissue valve replacement during report!!!" I'm guessing your charge nurse would roll her eyes, as any good nurse would do! I'm pretty new myself. For all of the nurses who try to "eat their young" you have to make sure your chewy and no fun to eat!

You got me beat hands down! That is hilarious!

I'm a psych nurse in an acute care psychiatric hospital. Nothing seems to phase me anymore when it comes to psychosis. Just when I think I've heard it all, a patient will do or say something so off-the-wall it's nearly impossible not to giggle. Of course I had to ask the patient why they were admitted, in their own words, during their initial nursing assessment... The only thing I knew about the patient was she was a middle-aged female, with psychosis, and that she had set her car on fire. When I asked her why she would set her car on fire she said in a matter of fact tone "So God could cook his BBQ!" I had to grab a tissue from the table to cover my giggle and act like I was blowing my nose, quickly excusing myself from the table so I could go to the back and have a good laugh that I no longer could control. I couldn't help it, I rarely ever have that reaction. I just totally wasn't expecting that response!!! Wow! Geodon and Seroquel STAT! Anyone else have a good giggle recently? :)

A couple of questions before I can provide meaningful feedback: 1. Is this your personal guidelines for clinical, all faculty use it, or is it pulled directly from the student handbook? 2. What semester are your students? 3. What is the students patient load? 4. How much time are they allowed to view patient data before preforming care?

Since I've delt with many situations in the past, I'm pretty well versed on how to be passive-agressive without it being led back to me. I just wasn't comfortable before, but with EVERY single nurse that has replied to my post is in aggreance, I have hatched a plan.... Without too many details, it's basically going to be a way of showing her all the consequences of her behavior that can affect her professionally. Do I think this will stop the behavior, nope! But, I do think it will have her absolutely furious that anyone dare point out her problem, quite blatently, and be unable to pin-point the individual who so generously brought it to her attention. This, in turn, will make her do something that cannot be ignored. :)

I hope this post does not make you take a break from allnurses or keep depressing you. Thank you for your reply, although my post was not uplifting, it was out of desperation to be validated in my feelings by other nurses. If it makes a difference, your reply was greatly appreciated, and I thank you for it!

In addition, I would like to add a conversation I had with another RN yesterday to add to this MD's ridulousness... I was told to NEVER give a child an anti-anxiety medication or sleep aids that were prescribed by the on-call doctor, regardless of the child's mental state. That this MD does not believe in these types of medications and that I will "get my ass chewed." I actually truly appreciate any heads-up that anyone gives to avoid "getting my ass chewed." It really should not be reprimanded if the on-call MD, that are also usually child psychiatrists themselves, write an order and not give it. Isn't it a fundamental rule that you follow Dr.'s orders unless they are detrimental to the patient? That if you call them about a heart rate in the 140's immediately after admission because they have been through something so traumatic that they just shake in terror and an order of Vistaril 25mg PO Q6 should not be denied because of the tirade you will recieve when she comes to the unit the next day. BTW, the anti-anxiety medications are almost always, with only very few exceptions, uncontrolled substances and the most liberal the MD's on call will be for insomnia is Benadryl. Now that I think about it, shouldn't she be on-call 24-7 if we are expected to NOT follow a Dr.'s orders?

Thank you all for your replies! I feel more motivated to look for new employment, regardless of my current work schedule of 50+ hours weekly that leave me physically and mentally drained. I finally feel like my concerns are validated and this Dr. should be reprimanded for their obscene behavior!!! Since you all have been so receptive, I would like to ask a few more questions so I can truly be "smart" about this... I had been told, when I asked a manager on what incidents were reportable, that to write them if in doubt and if the management feels that it is unimportant that it can "just be ripped up." With the management wanting to push this under the rug, do you think that my incident reports will go through the proper channels? I believe that it says on the IR, or at the very least I was told that an IR cannot be copied. Is this true? I do not want to violate any laws but I need a paper trail as was posted earlier. Would a time stamped word document to each incident be used as evidence to the Medical Board I plan on reporting her to? I am still very concerned with backlash, as I have seen it myself happen to competent nurses in the facility and was told by senior members of the facility that "it's best to stay under the radar around here." Since jobs are a rarity in our city right now, I feel like I have to stay at this facility until I have another job lined up or will be in financial ruins. How would you handle this situation if you knew that if you lost the job you could lose your home? Basically, what my safest and most effective plan should be. Regardless, if I did happen to lose my job, I would be hell-bent on this MD losing her licence. I really feel that she is so explosive with the staff on our youth unit, that it could trigger some of our kids, which at least half of our census is post-suicide attempt and can be as young as the age of 5. I really love what I am doing, I will work extra hours if I know that I could possibly save or change a life. This is especially true with our abused or CPS children that will admit after a couple of days in my care, that they have always felt like no one cares about them, a very disheartening theme with these kids. I always tell them that when they feel like no one cares they can bet that their nurse, AtivanIM will always care about their well-being and will never doubt their potential as individuals. The most rewarding part of my job is when a child writes me a thank you card or draws me a picture before they leave. I also get asked for a hug regularly before they leave. Although I've heard staff tell them this is a "boundry issue", I will give them a big hug anyway because who knows how long it will be until they get a genuine hug from someone who cares. Your advice and replies are not only appreciated but extremely refreshing as I had been doubting the severity of the situation because of the guilt of possibly losing my families financial security. Thank you all in advance if your willing to reply!

I currently work with an Psych MD that is also the Medical Director of a psych unit. I've never met such a rude doctor in my life! I'm a pretty new nurse and have only been working at the hospital for less than 6 months. She likes to raise her hand to dismiss us if she does not want to talk. If you say, but Dr._____ it's important" sometimes I get a "NO" AND a hand dismissal before I can tell her what is important. So of course I document and tell my charge. She is like this with other nurses and MHT's as well. The other day she was heard throughout our small hospital, psychiatric youth unit, scream "GET OUT!!!!" to a new nurse and MHT. We have been using the medical treatment room to record height and weight (the only scale on the entire unit), take initial vitals, and remove clothing to do a skin assessment and contraband check. It's where our managment has told us to do it. We are in charge of all admissions and assessments on the unit, and often the ambulance just rings the bell and we have no clue what is on the other side. Not to mention, this was done while a child was sitting inside the room, terrified because this was her first admission, with the door open to the community milieu, and her parents on the other side of the unit. How unprofessional can someone be? Apparently she had deemed this her "office", didn't mention it to ANYONE, and just went off because she can. The tech who is a 20+ year veteran was hysterically crying and said " no one has every spoken to me like that in my life!" She was quickly given an extra 30 minute break by the appauled RN's to calm down. When this issue went up to management we heard one say "well, that's just the way Dr._____ is" while another manager came on the unit and told us he would handle it. He hasn't. I've seen a tech told "you need to leave now, your not allowed on this unit" in a loud harsh tone as soon as she the MHT came into the room to listen to report. This happened in front of at least 15 people, including MHT's, Nurses and Therapists. I was later told by managment it was a "personal issue". Personal issue?! We were down an MHT, now having an unsafe level in staff because of a "personal issue." One RN who took the issue to HR because of the verbal abuse was called the very next day by the DON to tell her that they didn't think that she was ready for a full time position and she would have to stay PRN, with no explanation. I have worked with this nurse and she is attentive to our patients, never has any errors, is friendly with staff, and an all around great nurse in my opinion! I would leave the facility STAT, but can't due to financial reasons and leaving a job this early into my nursing career seems like professional suicide. If she was horrible all of the time it would be different, and more predictable, but she has many mood swings throughout the day and you never know what mood she will be in. Will she treat us like professionals or rip our heads off because we dare touch a chart (paper charts) that she hasn't reviewed yet. There is no way of knowing which charts she has reviewed while she is there so it's constant anxiety if we see her coming to put everything in it's "place." She is exceptionally more nasty with female staff. I'm normally an assertive person. I've gone head-to-head with the Director of Nursing and the president of our school when an entire class was failed, and won! Almost the entire class, of mostly "A" average students were not kicked out of the program. The nursing instructor was fired, years of tyranny going out the door with her. I've been nothing but respectful and "sweet" to this MD so it could never come back on me. But, enough is enough! It is not in my nature to not stand up for what I believe in. If she was not additionally the Medical Director of the unit, I wouldn't be as concerned with backlash. What would you do? Have you ever been insulted to a similar degree?

I would call them back. "Dr. ____ our phone call must have been disconnected. Give Mr.____ Ativan 2mg PO Q4 PRN, first dose NOW for anxiety, is that correct?" As he is doing his "yeah yeah yeah" dismissal, he is technically giving you consent 3 times. :)

I wonder how much money hospitals could save by having an MD in the triage area to deem certain ridiculous complaints unemergent. I would love to hear: "Yes, I understand that you felt that your ingrown toenail is a medical emergency and a reason to call for EMS at 2300. I've assessed your toe and believe this can be resolved at your PCP's office in the morning. If you currently do not have one, our front desk will supply you with a list of providers that have same day appointments available and pharmacies that are open 24/7. Here is a prescription for 10 tablets of IBuprofen 800mg to take orally, every six hours, as needed. AtivanIM, one of our triage RN's, will go over all this information with you before you leave the triage area and direct you to Angie at the front desk for the lists we discussed. Good luck with your toe, the Ibuprofen can hold you over until the morning."

Ben- great points! I cannot even wrap my head around having a human being suffer with a medical disease and debate why it is a "right." The real problem in this country is the prescription and medical supply companies that are charging ludacris amounts of money for the most basic things. Over $800 for a disposable forcept used in surgery? Why is this not enraging Americans? In my opinion, it is because they are not educating themselves on the issues before taking a stance! "Healthcare is bankrupting America" Well of course it is, because we let the real culprits get away with it. I truly believe that if someone with that stance had to go tell Granny that she does not have the right to die with dignity in hospice and now has to die without pain relief, because she can't afford it, they would change their minds...prehaps, maybe, even the bottom line might not be so important if they actually had to witness human suffering. The only group of people that I could see truly agreeing wholeheartedly in congruence with their religious beliefs or lack thereof are sociopathic atheists. I don't even feel like the OP is making a valid debate and is only encouraging splitting of members on the site, but because there are many insightful comments, I wanted to weigh in on the debate. :)

In our acute psychiatric facility we cannot make someone take their medications regardless of how delusional they are unless: 1. They are court ordered or revoked court ordered 2. They are actively hurting themselves or another patient and the MD must be called for an emergency NOW IM order first I believe in your case, the charge nurse made the judgement of the patient being mentally incompetent and should have been held down for the bladder scan that the MD had told you to disregard. Also, I'm assuming that a nurse can not independently deem a patient mentally incompetent in your facility and suggested you force orders. I'm pretty new myself and very new to my facility. I have been caught in a few political situations and have tried my best to stay under the radar, but occassionally I HAVE to say something, because in the end it is MY patient. Charts will get reviewed, and as nurses, we ultimately need to advocate for our patients. If you work with that nurse as your direct supervisor in the future, ask for their advice, but call the MD and say something to the effect of: Hello Dr. _____, this is AtivanIM on the ______ unit. I had talked to you earlier about the bladder scan on Mr. _____ in room _____. He is now also refusing all medications, in addition to the bladder scan you decided was not necessary earlier this evening. The reason I'm calling is, I've talked to the charge nurse about the situation with his refusal of medications and he/she feels that the patient is decompensating, may be mentally incompetent, and the medications are necessary. I would like to reclarify Mr._______'s orders with you quickly to ensure we are following the orders correctly. He is currently taking ---important meds and dosage--- (and list the names of the non-emergent medications.) Would you like to order any of these medications IV or IM since he is refusing all PO medications or would you like to wait until the morning when you can reasses Mr.______ to make this determination? :::Wait for MD orders::: Read back orders, then chart either the addition of new routes of medications and administer or the order to hold the medications until the reassessment by the MD during morning rounds....Forcefully giving medications or withholding all medications should be a MD's order. Ask your charge for advice but not for permission. Your job, your licence. In addition, chart what time the charge nurse was notified (but do not flame, there is a good chance that they may "review" your notes), when the MD was notified, and a basic description of his orders in addition to the nursing interventions. One more word of advice, when you call the MD, quickly say everything you need to, only leaving room for an "mmmmmhm" until you give a chance for orders. On night shift, the doc is usually more than happy to take your recommendation on the treatment so they can go back to sleep Good luck to you!

:::: I deal with Borderline Personality patients all day.... Your post makes me wonder...

Just a note of empathy... At our acute facility on nights we have one nurse and 2 MHT's for 22 patients. We have no secretary or admissions department and literally take the patients right off the stretchers from the ambulance. On the unit we have both acute psych and detoxers. The staffing in my facility and others is almost impossible and downright scary!!!

I made a very detailed "brain" sheet and I never use it, I don't have the time! You may find it helpful to make a word doc. with a column for Name/Room #/Diagnosis/MD/ and med times that can be circled.... ex: 0700 0800 0900 1000 for your entire shift. Plus, it's always helpful to have a spot for PRN meds, especially when you have drug seekers, to remind you it's time to pull the Oxycodone and assess for pain Q4...

I absolutely love being a nurse. Sometimes I really dislike my job, and maybe even "hate" a task I'm assigned, but I'll always love being a nurse!

I personally like 12 hour shifts. Honestly, where I work, the time flies by so quickly I wouldn't be able to tell if I was doing an 8 or 12. I rather only come into work 3 days a week!