margotnurse21

Give them choices!! This has proved VERY effective for me. "You can go to your room to calm down or you could journal about it. What would you like to do?" Again it all depends on the patient. If they are too aggressive and agitated, placing a pen on their hands to journal is not advised! :) I have also noticed that a crowd of people makes psych patients nervous. However, do NOT put yourself in a situation where you will be all alone and possible put yourself in an unsafe situation. I make a point to introduce myself to every patient at the start of every shift if they do not already know me. I want them to feel safe and comfortable with me as their nurse. I believe this helps tremendously when a patient is in crisis. Never underestimate the power of SIMPLE back to basics interventions.

I love seeing what my patience and compassion can do for one person. I also love that I can serve our Veterans just like they have served our country. I truly love these patients. They do say the darndest things sometimes too! Most of all I love to see them at discharge. Between therapy and medication, they may do a 180 during their stay and that tells me my job is worthwhile.

This individual sounds too unstable for such a facility as yours. He may need an acute inpatient psychiatric unit that is more equipped to handle such aggressive and threatening behaviors. Medications are key with aggressive patients. Giving them choices are also effective such as "You are going to receive this medication to help improve your mood and anxiety. You have the choice of where you would like me to give the medication. Right or Left arm? Right or left Buttock? Who would you like to administer the medication? (If they have a better rapport with someone else). And as for you, I don't believe there is anything quite as precious and priceless as a newborn baby. At least take some time off for now until you give birth and spend some time with your little one. These moments are priceless and very important. Sometimes finances are an issue, but there is always more to life than work!\ Peace and Love;)

I have been working in Inpatient Psychiatry for the VA medical center for almost two years. I had my share of bad days for the first year I started working, but NOTHING compared to what I have been facing for the past three or so months. I feel extremely pressured, stressed, scared/unsafe, and just downright tired. The Veterans have been challenging. They are so sick and they deserve the best care that a nurse can provide them. I cannot seem to be this nurse lately. I am still performing my job just as usual, but not with the same enthusiasm and patience that I had recently. Most alarming, I come home and I just cannot hold myself together. I feel completely exhausted and frustrated with the day and experiences that I encountered at work. I would like some advice from more experienced, seasoned psychiatry nurses. How do you decompress following a day like the ones I have been having? I have just joined this site today and writing some of my thoughts for the day has already helped tremendously but I want to be that compassionate, caring nurse that I was just a few months ago. I have been caring as usual, but it feels unnatural to me. It doesn't come easily like it did. I do not want to be one of those burned out, jaded nurses! Any advice is much appreciated! Peace and Love

I couldn't think of any other way to describe it. You hit the nail on the head here.

I've been working in Inpatient Psychiatry for the VA for almost two years. I LOVE my job. But there are days where I want to leave and never come back. As charge nurse, I am responsible for not only up to 20 psychiatric Veterans, but also nursing assistant staff. Sometimes just making sure I have enough time to get my work done is enough. On top of that, I am constantly checking to ensure that nursing assistant staff are completing their assigned work, which is NOT always as easy as one would think. I am also a safety nut. I am constantly on my feet, rounding the unit- looking in Veterans' rooms to ensure that they are not harming themselves, a peer or have any contraband in their room. I am also walking around cleaning up messes which include but are not limited to 1) medications that someone cheeked and spit out 2) a cup of juice that an agitated Veteran decided to dump in the middle of the hall, which now becomes a fall risk 3) URINE because psych patients LOVE to urinate on the floor for some reason. I am also CONSTANTLY assessing my Veterans for suicidal and homicidal ideation to monitor their need for 1:1 observation. I lead a second role on the unit, which I call Firefighter because I am constantly putting out fires between my Veterans. As anyone can imagine, a Veteran with severe psychosis and another with PTSD do not mix well, especially when my psychotic Veteran is screaming and entering their room uninvited because they are "looking for my dog". Veterans have quarrels over numerous other things such as meals, phone usage, slamming the doors, which channel the television should be on, etc. The list goes on and on. I feel that I am chasing the psychiatrists around all day. I am asking for a reassessment on so-and-so because I believe they should have their 1:1 observation discontinued. Or I need a STAT order for a 10 and 2. This is not as easy as it sounds. The psychiatrists are so busy with treatment team and fulfilling their daily duties that it makes it hard for nursing to always have them readily available. Admissions does not care WHAT is going on when they say "I'm bringing you a combative, agitated Veteran with Schizoaffective disorder in five minutes" I've literally been in the middle of a psychiatric emergency with someone screaming, hollering, threatening to beat me or a peer up and Admissions brings them anyway. What do I do? I cannot refuse care to that Veteran because I would then be wrong and neglectful. I've been punched, spit on, pushed and shoved, sexually harassed, verbally abused, etc. Most recently, the trend has become that Veterans enjoy displaying TOTALLY inappropriate sexual behaviors and acts right in front of myself and other staff. It has been a very testing environment for myself lately. It seems that our unit cannot catch a break on admissions. Then there are restraint situations. A LOT of paperwork, making phone calls, legality, etc. And besides that, it is by far my least favorite part of my job. I despise strapping someone to a bed. It feels so inhumane to me. That aside, I am smart and insightful enough to know that restraints are necessary when a Veteran is a danger to themselves or others when all other therapeutic measures have been unsuccessful. At the end of the day, I LOVE WHAT I DO. However, I do disagree with the statement that Psych nursing is easy. FAR FROM IT. And if it easy, maybe you're not doing all of it. The more encounters and experience you gain, I believe that you will see that psych nursing requires just as much skill as general/primary nursing. I believe that psychiatry is a specialty and it requires a special set of individuals to care for the mentally ill in society. And the most important lesson I have learned: WHEN IN DOUBT, MEDICATE!!!!! Peace and Love

I work for the VA and the only restraints we use on our unit are leather cuff and belts with require a key to release. It is my understanding that "soft" restraints are the cloth type used for medical reasons, ex. patient attempting to remove IV related to delirium. The VA is pretty "old fashioned" so I think we will be using leathers for a while.