mhadvrn34

About a year ago, I was hired as a staff nurse in a locked in-patient psych unit. Typically on any given day, we have one charge nurse, three staff nurses, one MHW and one break relief nurse. The nurse's role depends on seniority; those who have been there longer get patient assignments and the one with the least seniority either becomes break relief or gets floated. When I first started, I usually was an assigned nurse as one of the seasoned nurses was on medical leave. When they came back, I gradually became more frequently assigned as break relief/float nurse to the point where about half my shifts were break relief. Most nurses I work with despise being break relief because part of that duty is being assigned to do Q15 min rounds all shift, which can be exhausting. I shared that same sentiment but accepted it and never said anything as I am the type who usually does not speak up and hates conflict. In the past, there have been disagreements on who would be break relief and many times I would take meal relief to keep the peace. To make matters worse, as of last week, a nurse from a different unit who has been in the hospital longer transferred to our unit and now my seniority is even lower. If half of my shifts before were meal relief/float now with the new staff nearly all of my shifts will be break relief/float. It's like in basketball when a player was once a rotation player but then the team signs a better/more experienced player and now that nurse has been knocked out of the rotation. When I was first hired, I was hired to be staff nurse, not break relief/float. I am considering bringing this up with my manager. If anyone has been in a similar situation, I would be happy to hear some of your input.

DTO. Psychosis. Had an accident and went into road rage. No he of substance abuse.

Thank you to everyone who has responded so far. Posting about this incident has helped me see this situation in a whole new light. I forgot go mention that when I had discussed this with my nurse manager, he believed that mistakes were made on both sides. We agreed that there should have been better communication between providers: nurse, psychiatrist and hospitalist. One responder made a good point, assessment could have been better. It was wrong for me to assume the cause of her pain was endometriosis. It was wrong of the psychiatrist to assume the reason for her pain was psychosomatic. For all we know, the patient could have had peritonitis, gone septic and died. Yes this is extreme, but you cannot know unless you assess for yourself. The psychiatrist did not even lay her eyes on the patient. Confirmation bias is dangerous. All in all, I do not regret what I did. I regret the way I approached the situation but if I could turn back time, I would not hesitate to advocate for my patient again. Oftentimes, we forget why we went into this field in the first place. Nursing is the caring profession. There is nothing more I care about than my patient's wellbeing. Ignore the politics, disregard the hurt feelings and broken egos, at the end of the day if my patient leaves the unit safe, healthier and better than when they first came in, we have accomplished our job. If we do not advocate for our patients who will? As another poster mentioned, you live and you learn. Again, thank you everyone for your responses. I have learned a lot! Cheers and good luck and safe wished to all!

Hello all, I am a psychiatric nurse who has been working in the field for about a year now. Today, I had a patient who complained of severe abdominal pain and had a history of endometriosis which had gotten so bad to the point where they recommended she have a hysterectomy. She was currently being medicated on Ibuprofen and Tylenol which had no effect. I knew that these would not even touch her. Come on Tylenol and Ibuprofen for endometriotic pain? I then contacted the psychiatrist to see if I could get an order for breakthrough pain to which she declined. Narcotics are typically not prescribed in the psychiatric setting due to how common opioid addiction is within this population. The only patient I have even had who was on opioids was my patient who was post op ORIF after having jumped off a two story building. There is a common misconception in the psychiatric field that many patients are "faking it." I believe that pain is subjective and try to give my patients the benefit of the doubt. That being said, as a psych nurse I am not oblivious to the fact that some patients are "medication seeking." I typically am a good judge of character, but this was not one of those moments. She was wrenching in pain to the point of tears. If she was "faking it" she was doing a really good job at it. At this point, I decided to advocate for my patient and escalate the situation. I asked again and she [psychiatrist] continued to refuse. I then relayed this to my charge nurse and she recommended getting an order from the hospitalist because all medical issues are under the jurisdiction of the medical doctor. The hospitalist agreed to order a one time breakthrough pain med. I told the psychiatrist what I had done and then she proceeded to berate me over the phone spurting profanities, saying I was insubordinate and said "I was being played by [my] patient." I then escalated the issue to my nurse manager who recommended I follow the psychiatrist orders and let it go. When I asked if I did the right thing, he praised my efforts in advocating for my patient, but believed at the end of the day, the doctor's orders should be respected and followed. I followed his advise and after all was said and done, the patient had to bear through the pain and eventually it subsided. Nursing community, did I do the right thing? Should I have done more?

Let me clarify. By "errors," I mean incorrectly charting something or forgetting to do something. I've caused three med errors since I've started. One was getting meds mixed up between two patients. At my old facility, we pulled medications from sheets of 30 or so meds, put them in a med cup and put them in little cubby holes for 50 patients. It's a metal rectangle with 50 holes which each patient's faces by them. They then line up at the nurse's station and hand them their meds. We had no med scanner. Not the safest way of doing things. Accidentally put one patient's cup in another person's cubby. Another was giving Zyprexa instead of Zyprexa Zydis. The one today was accidentally giving a patient Seroquel which the doctor didn't seem too concerned about and later gave me a one time order for. The patient ended up doing better with the medication vs never having gotten it at all.

Less responsibility. Social workers dont pass meds and Psychologists cant prescribe meds at least in California.

Straight to the point but the sad part is I agree with you. E Errors have been minor so far no one's been harmed, but eventually my luck will run out.

It was an urgent situation. Received report that they traded beds and forgot. No, I didn't ask for his name this time which I should have. I have this guy feeling I'll get called in to my boss's office tomorrow and get the axe.

Hey y'all. I've been a nurse for almost 9 months now and I'm seriously considering leaving the profession altogether. I graduated in December of 2018 and was ecstatic when I got a position as a new grad RN in a med surg residency program starting July of 2019. Packed up all my things and moved three hours away to a very rural community knowing no one. From the moment I started, I struggled heavily, mostly due to anxiety which I was clinically diagnosed with two years ago and take meds for. I made a lot of mistakes and was constantly on the radar of my nurse educator and supervisor. Two months later, I got called in to my boss's office and she let me go over lying to my preceptor over charting something which I didn't. They felt as if they couldn't trust me anymore. My options were get fired or be forced to resign. I was devastated. Moved back home to my parent's house and began looking for a new position. Luckily, I landed another job in a psychiatric rehabilitation facility. Even before starting nursing school, mental health was my passion. I knew I wanted to work psych in the long term. I started this position late October of 2019 and lasted 3 1/2 months until Valentines day. I worked NOC's and was the only licensed staff for that shift. I was overwhelmed, had virtually no support and had to deal with toxic coworkers. On February 12th, I made the mistake of covering an AM shift and was responsible for pulling meds from a med cart in sheets the old fashioned way and giving them to 50 patients. The next day my boss found out I made a ton of med errors and I seriously thought I was going to be fired on the spot. He gave me another chance to my surprise, but I had had enough and decided to quit. My current position is in an acute psych facility which I started per diem in January of 2020. Here I feel like I have tons of support, charge nurses who are constantly checking up on me. I've only been called into my boss's office once in 5 months over messing up charting. I feel as if this is less hectic than my last job but I am very unhappy with it. Psych nursing is not what I glorified it to be. What I thought psych nursing was vs what it really is is not what I expected it to be. What I feel like I really want to do is more in the line of social work or clinical psychology. On top of all this I screw up constantly and have this fear of getting fired every time I step into the hospital. Today, I made a med error and sort of freaked out and stormed outside the patient's room after realizing I gave meds to the wrong patient. My coworkers tried to comfort me but now I feel like they feel like I can't be trusted. I'm starting to think nursing is just not for me. I'm fed up, burned out and I've come to the point where I just don't care anymore and I feel numb. I've had 3 jobs in 9 months which says a lot. Opinions?

Congrats everyone who's made it into the nursing program! I know you've all worked very hard to get to this point in your lives! As a second semester nursing student, I was surprised to hear how competitive this term was :/ In response to @yesucan, yes orientation day is on the first day of school. The nursing staff will go over the expectations and major assignments and projects over the course of the semester. Day 1 can seem really overwhelming. Just make sure to buy a really good planner lol Also, don't forget to bring your blue orientation folders!

First, I'm looking forward to meeting you all in the Spring! I received the email two days ago on the 14th and thank god 90 points got me in 😌 I was probably the 40th ranked applicant taking into account that this semester's cutoff was 89.75 points lol

Also, how did transferring units from UC, as you know is on a quarter system, work out. Will I be able to have the 39 minimum non-quarter units finished by the October application deadline for the university if I had 45 quarter units from UCSC and will have 21-24 semester units from my local CC by the fall of 2014?

Thank you Lord! Finally someone who can understand my situation. Last year I attended UC Santa Cruz as a bio major and decided to become a nurse and transfer to a community college to take my prerequisites to apply to a CSU. As of now, I've completed Gen Chem, the long and painful 15 units, stats, writing, English, and intro psych. All A's but a dreaded B+ in stats. I took speech over the summer at my local CC. Now this fall sem, my worst nightmares have come alive. I was unable to get into the Human Bio class and had to settle for general bio to satisfy my prereqs for anatomy, physio and microbio. I also could not get into ochem. 5th on waitlist. So this quarter I'm sadly only taking 10 units, Bio, human dev psych and sociology. I've come to the realization that I will have to stay 2 years unlike you. At least I'll have my classes spanned out. Next sem, Ochem and anatomy. Fall 2014: Physio critical thinking and possibly spanish. Spring 2014 sem: Microbio and Nutrition since only one core requisite can be in progress at the time of application. My question is, what do you think about this track, will I satisfy all my prereqs for a CSU and if doubling up on ochem and anatomy will be difficult.