psychRN27

"nurses eat their young" and it seems from what I have experienced... men get the brunt of it. As a male nurse in his 30's with ADHD... I have faced lots of hostility (99% behind my back). I was targeted by 2 professors in particular in nursing school... but that made me a stronger nurse... we had dinner only 90 mins into shift that semester... and I had 3-4 very sick GI and Onco patients and would get asked what are new med orders for today, whats H&H, whats d/c plan at dinner... and "vital signs are vital" so I worked out in my head... to get vitals and check in with sickest patient first (not always the squeaky wheel) and found 2 acute situations at shift change... one was in fluid overload from afternoon chemo.. another stoic patient tried to ambulate self to bathroom and was on the floor.. When you get into real world of nursing... if I had to do it over again.. is to be quiet... and observe... and don't say anything if a peer misses something... fix it if you can.. and move on... sometimes people are resentful even if you bring it up to them personally and confidentially.. but getting critical assessments like SAD, AUDIT, BROSET, BRADEN, is for patient safety and so that CMS doesn't cut your facilities money... its in all your interest to get it done.

Yikes... I hope you are doing well... opiate addicts are a challenging population... even with almost a decade of work as a social worker in the community... I couldn't get a psych RN job right away and worked on a "rehab" facility... where 70% of patients had dementia. So I learned Geri psych fast. I think the toughest part of any behavioral health nurse is getting hopeful that a patient is ready to make a change... and then seeing them high or drunk or in police logs a month later. When I have a dual diagnosis client with insight (no magic pill unfortunately)... I am quite blunt.. and tell them its up to them to make an effort... meds only go so far... they need to stop focusing on blaming others... "helping" others etc and get themselves sober and get their mental illness stable first.

In my just over a year inpatient acute psych, couple years mainly geri psych with some rehab (love rehab facilities), and many years as a social worker in the community... I would say the most serious risk for injury is somebody with dementia.... then acute psychosis (schizoaffective of schizophrenia) I got my knee twisted assisting a very large patient to his bed for an IM as he was walking into others holding a chair over his head... figured that was reason enough... I've heard of another unit having nurses seriously injured when a psychotic patient got his hands on pens... and I've been popped a few times in geri psych... now why this APRN who had that unit in the facility refused to d/c the timolol when the pt got violent every time anybody went near her eyes is besides me... her BP was consistenly 140s over 90s... if you are that worried about the Glaucoma of a 94 year old... order some Diamox and monitor lytes... geez.... And the drama... it takes experience in dealing with personality disorders to minimize that. Its mostly borderline personality disorder. Dealing with them is like an art... some do better with 2 or 3 1 min check ins... some need 1 5-10 min session a shift on reframing or some other skill. Limit setting and consistency are important! (limit setting/consistency RE the rules of unit... its another art if you have 2 people with BPD and they notice you spent a few more minutes on another patient than they got)