FeelGDRN

I worked in inpatient psychiatric units. I received a course called CBI Crisis behavioral Intervention I think. It teaches how to safely intervene when a patient becomes physically combative. The course is usually patient focused to prevent injuries to them. In reality, your survival instinct takes over. Defusing a situation is much easier when you approach patient who is fidgeting or displaying othe anxiety symptoms and speak to them. You can easily speak to their strengths and ability to think through whats going on. Another good warning sign is when people are talking and you notice an increase in volume. Even if its only a slight increase, chances are the patients are experiencing some underlying agitation. Redirection is your best tool. Redirect patient together getting agitated to another activity, generally in seperate areas. Redirect anxious patients to an activity that they enjoy or one that requires some level of focus. My experience is that when these crisis events take place, a show of force can be extremely effective. If its not then the charge nurse will assign limbs to take(security and staff). He or she will take a direct approach to deflate the situation and give the patient a choice of avenues. If the patient has lost control of his/her ability to chose then we would intervene. Getting the patient down as safely as possible and then administering medication(IM) to help him/her gain better control. Its always an adrenaline pumping event. But it does become easier when you are familier with what happens. It becomes part of your job that you hate. But you know basically what to expect. Good luck. The majority of your time 95% will be working with disturbed patients who need an objective, clinical ear. You can "Walk with them on their journey for a few days" Thats something I said in nursing school. But it still has meaning.

Congratulations on your job. Its a big one no question. I started management on a skilled unit after 3 years of psych nursing. After a fiasco with an unsupportive DON, I resigned. But I learned a great deal. Firsat year nfl quarterbacks almost always have tough time. The game is faster than expected, they get hit harder. There is more pressure. They throw interceptions, fumble snaps, etc. The beginning is always rough. But.. After some time passes, the game "Slows Down". They begin to see open receivers, they feel more comfortable "in the pocket" Then their natural skills take over and alot become good quarterbacks in the league. My experience as a first time manager was absolutey stressful in the beginning. The employees would get away with what they knew they could because I was new. The families were demanding. Administration wanted better stats. The patients were sick sometimes critical. I had my share of worries, worked 11 hour days. Things did slow down. I started to see and understand what the position was about. I began to start problem solving. I turned a real corner when I typed my expectations for the staff. Accountability accross the board. They responded to clear expectations. I had each staff member sign my expectations. When they did not meet them, I pulled them in my office. Writing people up is the last management tool. I learned that too. Meeting with staff on a reg ular basis was helpful. That way no one says "I didnt know that" Seeing expectations in action is an awesome feeling and experience. You also get to see staff grow in their skills as you grow in yours. Your unit is like your child. Yall grow up together. Other things; I prayed day and night for guidance, communicate with other managers, learn to laugh and enjoy your staff, patients, and even families. A sense of humor, twisted or no is your best friend. Otherwise you will go crazy. Too late? Just kidding. It will work out how its supposed to. There will be days when you really suprise yourself. Hope that was helpful.

Good for you. Empathy is the first requirement for the field. Study the psychopharm. You will find, as in other areas of nursing, that you know the patient better than the doctor. It puts you in a better position to help. Rock On! Brian

Your friend exagerated,.... just slighty. Psych nursing does have its emergencies, which require restraints for protection of safety(patient and others). This does not constitute combat. I used to joke about going to combat training. But the deal is that the training you receive to handle physical altercations is focused on safety. If you worked in the ER, there would be similar scenarios. Security is present in just about every majore US hospital. When I worked inpatient, they responded for emergencies. Usually as a show of force. If you want to work with the population, all you need to do is get past people's misunderstanding of what you do. Once your there it becomes another part of nursing.

Whats up good people. I just responded to a thread about the Psych CNS role vs the Psych NP. Does any one know much about the new position of Psych Primary Care NP. I was all about the theory of the position. That many psych patients don't recieve quality medical care. Which is another thread for discussion. Does anyone have input on the practicality of this position. The theory is that the practitioner would be able to perform hx and physicals. Short term psychotherapy, primary care, medication mgmt in psych and medical arenas. The all purpose nurse, in other words. I started the program, I aced psychopharm and neurobiology. Its not the degree of difficulty. Its the length of the program and whether its practical after completion. I do agree this population needs better medical care. Is this jack of all trades approach realistic?

To tell you the truth. I have not run into discrimination on the black front in the profession. I have been given a few pokes about men being in leadership positions. I think work environments are going to have a few deals everywhere. Its always been my belief that the profession is hard on people going in. Another deal has always been the doctor situation. I were the name tag, tell em Im there nurse, and still get "thanks doc". In the end the unimportant bs is not worth my time. Some people are not going to like you. Thats their deal. "Laugh at yourself and you will never be unamused"

You dont need a link for good practice. I see things like this. First when dealing with that mental healt population you need to start with treatment interventions that dont violate their sense of control first. Offering the po gives them a chance to use their developing decision making skills and lets them feel that they had some control over the situation. Two, the decision to medicate a patient without them asking for it is done for their and others safety, and no other reason. Lastly doctors complain anyway, sounds like the one who was not there did the most complaining. It is a big challenge dealing with adolesents. Im an adult provider. Try the board of nursing ethics and scope of practice guidelines or psychiatric nursing association websites. Hope that was helpful.

I dont know about being a CNS in psychiatry. Im a psych RN. I started a program for Psych Primary Care Nurse Practitioner. I have not yet been able to gain some insight on this new phenonmenon in mental health nursing. Personally, after taking time for a management experience. I have just about concluded to focus on the psych np program. Which includes psychopharmacology( Rx principles, selection and discontinuation, case studies..) and neurobiolgy of mental disorders( Neurochemistry, and neuroanatomy). I can speak on those since they were the ones I completed. Psych nursing is still in demand. Nurse practitioners will replace the CNS role in my belief. Ive done alot of research. So the answer is based on why your looking at the CNS role. If you want to do therapy only and not have choices on medications then its fine. If you want to do therapy and meds do the the psych np. If you are "the few the proud" who want to do adult np, therapy, and meds I recommend the PPNP programs. Just for your information. There are demands every where.

Just wanted to add on here. I took microbiology, anatomy and physiology, and clinical nutrition as prerequisites to nursing school. You will find that all the science courses are selected for patient care. Each one is extremely important. Once in the nursing school I took pathophysiology, pharmacology, ... and so on. It was all useful to me when left school. You will here critical thinking a million times in school. They do that for a reason. Contrary to popular belief, nurses have to be alot smarter than doctors. We have to see and assess our patients, put 2 and 2 together, and take responsiblity for the treatment given. When its all said and done your future patients will be grateful to have some one looking out for them. Sounds like a good decision. Just remember its about the patients. Good Luck

Im a demographic minority in nursing too. Although I dont know that the numbers are that small. In my BSN class there were 5 or 6 of us. When I went to Univ of MD, there were an average of 3 in each grad class. Ive never been to influenced by stats though. No matter what demographic your in, nursing is the place to be.

Man I appreciate the feedback on this issue. I wrote the DON back and said it was a bad situation for all involved. I told her that we had a bad relationship but that I did what I felt to be in the best interest of the patients and my employees. There was a letter of resignation following, which she accepted. Punch line. My job was advertised in last sunday paper as being a positive work environment. Friggin hysterical. But whatever, I can place the position on my resume and move on. Nursing does look different after this position. I owe every nurse manager I worked for an apology for my behavior. Now I understand.

I start at the Beginning of this situation. I manage a 60 bed skilled unit. Last Wednesday I was called into the room of a patient who complained of itching and a rash. I assessed the resident and found the rash to be in the arm and trunk area. Raised red macules. Resident reported that the itching was severe. I made the DON aware of this and called the MD. The attending told me it sounded like scabies and gave me an order for elemite. I asked him for an order for his roomate. I then went to assess a resident down the hall who had a similar rash,and complaints of itching. I called her doctor and the attending for her roommate and got orders for them both. The order was to administer the ointment and let it sit overnight before washing the resident. The DON did not believe it was scabies. We followed the orders. No other action was taken. I talked to an evening shift cna that had gone to the ER and was dx'd with scabies. The next morning during the am nurses meeting, I told the DON that the 3-11 staff had requested treatment for scabies. The DON sent the Education/Infection Control nurse, the new ADON, and an MDS coordinator to see the rash. I read the definition of scabies from Tobers and everyone agreed that it did not sound like what we saw. I left at 3:30pm that day. The next day I was told that the institution had been reported to the state becuase there was an outbreak of scabies and that we did not act to treat the patients. I was told that the MD had come in and seen the orginal case and said it was definitely scabies. Two staff members were given treatment. The ADON ran the nursing meeting because the DON went out of town to New York. I left the meeting and grabbed a weight sheet because it had room numbers and boxes for information. I was asked to inspect residents for signs and symptoms to make sure we had identified all the cases by the administrator. I went room to room. I found a room on the same side as the other cases and found a resident who complained of itching for the last three days on his arm. I identified him as very high risk. At the end I had a list of room with residents that complained of itching and they were found to match as a group of rooms assigned to a cna. In other words the assignment for cnas on all three shifts had that set of rooms. I wrote a list of staff for all three shifts that provided direct patient care for that assignment. I had one side of the sheet with the rooms and residents that were dx'd and which ones had been treated with medication. I also used the same paper to identify the rooms which needed to cleaned per policy. I reported this to the Infection control nurse and the ADON. The director of housekeeping was there and we decided to treat the rooms on the assignment. Meanwhile I would get an order from the medical director for bottles of elemite. My plan was to treat residents in the assignment, clean the rooms and treat the staff who provided direct patient care. I called the adminstrator abou the order, she did not believe we needed to treat all the staff. I said we should do what the state would look for us to do. I said it sounded like we were treating selectively. She started screaming and said she was coming up. She was screaming because I "accused her of selectively treating staff, because we didnt follow the policy to begin with, and because we did not have plan. I told her what the plan was and she said to meet with the staff and treat on request. I coordinated the room cleaning with housekeeping and met with my staff. Several of the staff reported symptoms of itching and a rash. One cna was very upset because the night before the DON was yelling at her because she was complaining of itching. The DON said its not scabies and she did not need treatment. It was then that the MD went into the room and examined the resident and told the DON that it was scabies. I had 6 admissions coming that day. The elevators were out of order, and I ended up sending two residents out 911. I asked for help calling the families since I had all of this to do. The adminstrator told me to write a report of the events and turn it in to her at 3pm. I wrote a report of Days 1,2, 3 and the plan of treatment and communication to familes. No one called the familes, and I found out yesterday that two residents had not been treated. I told the DON that I was frustrated because I had informed the evening supervisor of the plan and no one got an order. I talked to the N.P. and had gotten an order for treatment. I called the families of all the residents and made sure the documentation was there. Today, I was going to report on a situation that had come up. The DON was talking to the administrator and a therapist. The administrator was screaming because she was told we treated two residents twice. The DON asked me about it and told her they were treated once. These were the residents that I had to talk to the NP about yesterday. She said the report that I had written for the state said they were treated yesterday and that it was "falsification of records"She said "Thats it, give me your keys." She had said prior that she was not comfortable with me. She has been hostile the last 2 months, despite our private discussions. I asked her yesterday point blank if I had her suport. She said yes. Today was a different story. I got no help with this from her. She seemed to antagonize my efforts. And of course everything is my fault. I called the nurses and told them they would have a new manager. I dont know what else "Give me your keys" could have meant. She never said your fired or terminated. She didnt say you were suspended. So if someone could give me some insight or advice Id appreciate it. I dont regret one thing I did on the unit. I was very determined to make it better. It seems like a cruddy set of events. I know now that I can function as a manager and perform well. I wonder how much easier it would have been to have a DON that was behind me. She had said herself, I have the brainpower, and determination to be a DON.

Hey Jeanne, Thank God, for Sobriety and Second Chances. I believe that as long as you keep sobriety number one, you can have alot of options. I know of more than a few second chances in the field. A good friend of mine is a counselor in a monitoring program for nurses. As long as your honest to future employers than there will be no need for suprise endings. As a manager, I would look for honesty during the interview as a good sign. It sets the tone. And remember, we are not the only field who has people with addiction histories. Lets start with the the Government, and go to Lawyers, and you could increase the list forever. So just do the next right thing. Brian

Thats a good question. I work in a SNF as a nurse manager. Every nurses' experience in a facility depends on the DON. Be careful about where you attach your license. If you go in as a DON and have poor staff, you can change from the top down. But not the other way around. Sounds like youve got a good head on your shoulders. Good luck finding your job. Brian