Abbyrose

I've been working nights on a psych unit for 5 years. For the most part, nights is much more laid back. Nightshift has limited staff, which can be dangerous when patients become aggressive and violent. Also, it can be challenging when acutely manic patients are awake all night with nothing to do and meds haven't taken effect yet. Sometimes they wake theirs peers while trying to entertain themselves by singing, running the halls etc. Also, many admissions tend to arrive on nights. Some general psych tips would be : -use therapeutic communication (don't give advice, don't judge, don't minimize...I once had a coworker suggest to a patient that they use religion to cope. The patient was NOT religious and was triggered by the suggestion, and she began destroying the unit right before she squatted in front of the nursing station and pooped. There's been many times when a patient is tearful and telling me about something terrible that made them feel suicidal. I try to not speak and just listen. Most people don't want advice or cliches, they just want someone to listen to them. I once had a new admission who was irritate and involuntarily committed. She was demanding to leave and said we were holding her hostage. We tried explaining things...Nope! We tried to ignore the behavior...Another fail. I cringed and crossed my fingers when I sat next to her and said " I understand why you want to leave and I would probably feel the same way. I sat quietly and just listened (and nodded) as she began yelling about the Dr, her sister, and everything else (if she would have appeared agitated that I was there or told me to leave, I would have) during her rant she began deescalting. after a while when she seemed to have gotten everything off her chest I asked what I could do to help her (aside from helping her escape). She thanked me for listening and said "you were the first person to actually listen to me. Thank you." Don't engage in power struggles. I try to bend and give in to little things (extra snacks or leaving the tv on longer) when possible. I notice patients are more understanding when I have to say no or ask them to wait. Have thick skin. They will point out your wide hips, the zit on your chin, your chipped nail polish etc. pretend you didn't hear it and redirect the conversation back to the topic. Don't get defensive or argue back. They're trying to get to you. Don't let it. Good luck!

This might sound wild, but has anyone else who has worked in psych for a while ever have a schizophrenic or psychotic patient say or know things about you that's impossible for them to know? In the past few years, I've had a couple patients say things that I thought, "that's weird, how would they know that?"For example, one patient who was actively responding to internal stimuli, was laughing and chatting away with himself, stopped and turned to me and said you and Abby (my daughters name) were playing scrabble. Then resumed his self-talk....Earlier that day, I was playing words with friends with Abby! Another instance, a couple nights after having a friendly debate with a coworker about prolife vs pro choice, a pt came up to me and said "I have a message from God....'Before I formed you in the womb I knew you, before you were born I set you apart; I appointed you as a prophet ...". We were not around any patients and it was the middle of the night when my coworker and I were talking.... Okay, i realize these and a couple other circumstances could be chalked up to me reading into things, but a couple nights ago the wildest one yet was when a pt said "Bill wants you to know he's okay..... I'm picking him up on my satellite" I calmly said "ok, anything else?" He said "he loves you"...my dad died 5 years ago, and his name is bill.... I told a coworker who later asked him "who is Bill that you were talking to?" The patient who is black (my dad white) said "he's my brother.....Well, (pointing to his skin) not my brother, brother. My Catholic brother". Again he was on point. We are Catholic. Anyone else have stories like these?? I find it fascinating!!!!

Good for you!! I sometimes think too many people take things too far, and its such a slippery slope! I want to try to maintain my integrity and not act of desperation or emotion....it can be a challenge and not always popular.

We don't allow patients to wear a bra with an underwire because we had a patient remove hers and use it to cut.

I would love to be a fly on the wall the first time you interact and try to manage a patient with borderline personality disorder or attempt to set limits with a patient with antisocial personality disorder...They would love you!!! I can tell you one thing you are definitely capable of... Disproving the old saying, "there's no such thing as a dumb question". I don't want to be harsh, but you aren't helping the common stereorype of ICU nurses being arrogant and looking down on other specialities! ...good luck.

Well said. I felt like the hospital supervisor and I were the only ones arguing the fact that it seemed like punishment/consequence and that is NOT the indication for PRN Ativan and Haldol! ... It was so frustrating. At one point during the debacle, a psych tech threatened the pt with 4-points!! All the patient was doing was swearing and slamming doors!

I wish I could fix my typos and spelling! Lol I can't edit it...

Very good point about four-points! ...he was in a physical restraint, and before any meds, IM or PO, prepared he was released for the hold.

Thanks, I agree with everything you said!! The code was called in the middle of shift report. I was receiving report, and the evening shift charge nurse was giving report to all of night shift staff. Typically it is more organized, but we had a lot of seasoned nurses leave recently. Literally all of evening shift that day is relatively new to the facility and psych (less than 1 year!). The night shift supervisor was the one who took the lead and made the decision. She has many years of experience, and new the patient well and had good rapport. I think it took so long because someone not sure who called the code over the radio to have security and anyone available in the hospital assist. He was restrained so quickly and without warning no one had time to prepare meds or a plan. The charge nurse usually directs the situation but she learned of the code as it was announced. She entered the scene once he was already restrained. She then want out to the nurses station and stayed there for the entire code. It was so unorganized! My biggest complaint is, the next day she went and complained to management about the supervisor, and she was the only one willing to take the lead. Also, he was just banging doors and swearing loudly, which his plan does say that warrants a code....had he been posturing toward someone, or violent, I'm sure he would have had the IM without question by the supervisor.

I work on an acute adult inpatient unit. We have an extremely aggressive patient who is involuntarily committed. He is child like and becomes aggressive when he is told no or doesn't get his way. Otherwise, he is actually pretty likable. He has a behavioral plan in place that says to offer his meds PRN meds PO twice when he is in need, and if he refuses force an IM. this is after trying other options to de-escalate. I understand and agree with this, but the other night staff disagreed while he was being held down and waiting for the nurse to draw up his meds... His meds were taking a while to be prepared, about 5-7 minutes, which seemed like a while since he was in a physical restraint. The hospital supervisor and security were able to verbally de-escalate him during the time. He was no longer being restrained and had calmed down. He said he would take the meds PO. He began crying and saying "I'm sorry". The director of nursing and the treatment team were the ones who impressed upon staff that the behavioral plan must be followed by everyone. This incident occurred on a weekend and they were not present to clarify the plan at the time. The charge nurse said "no, it's too late. He's getting the IMs". The charge nurse was in the nursing office during all of this and the supervisor was with the patient. The supervisor disagreed and gave them PO without incident. We had no problems with him after that. Her rational was "...he is agreeable. Not only would it be unethical, but it risks him escalating and disturbing the mileu again". This caused staff to turn on each other, and everyone was interpreting the behavioral plan differently. We have not heard anything from the DON or treatment team regarding this. Both sides of the argument emailed their perception of the incident to the DON. My question is: If a patient becomes agreeable to take PRN meds PO, after originally refusing, can they be forced with an IM? Is that ethical and following least restrictive/invasive treatment?

Thanks! I got my quick results....I passed!!

I've been freaking out the past day and half. I took my boards, and I can't stop obsessing and analyzing everything. I had 75 questions, 18 of them were select all. Many of my classmates got their results the next day. Mine are not available yet!! I heard so many conflicting things about the Pearson vue trick so I decided I wasn't going to try it.... Well I caved and tried it. I entered my credit card info (I used an old visa gift card just in case it actually charged me. I hit submit. I didn't get a pop up, but it was more of an alert at the top of the page. It had a triangle with an exclamation point in it and the message read :"our records indicate that you have recently scheduled this exam. Another registration cannot be made at this time. Is is that what I'm supposed to see? I did it from my iPhone so, I'm hoping that's why it was not like the pop up block I hear described. Anyone have experience with this?? I'm going crazy!!