arbasham3363

I have just graduated with an MSN in Nursing Education. I'm updating my resume and email signatures and I wondered if anyone can tell me the difference (if there is one) between just the MSN and the MSN-Ed credential. Thanks

We do pick our battles every day. Most things aren't worth fighting and arguing about. But when a patient is clearly getting other patients upset and you have a potentially dangerous situation on your hands, something has to be done. Also when the patient has "friends" on the outside who call nurses and threaten them because the patient didn't get what she wanted, there has to be boundaries. I believe that saying no and setting boundaries is essential because that's what "real life" is all about. If they can't handle being told no, they can't have their Oxy early and have a behavior then that is on them and they should have a natural consequence for their actions. Our Docs are pretty good about putting PRN IMs out there for nurses to use at their discretion. Nurses here make the decision to give IMs or put patients in restrains/seclusion then notify the Doc after it's done.

That sounds like an excellent tool for my unit. Those are all things I have talked to my regular staff about. How would you deal with the staff being inconsistent with following plans or straight out ignoring what you tell them? I go to my supervisor and she just shakes her head.

I'm not clear on what suggestions have been made here. I have no control over the legality of what happened. We are not allowed to press charges on patients.

Are these behavior support plans something that are in addition to treatment plans? Our treatment plans have "problem", "goal" and "intervention" sections to them. They describe the problem, what the patient's goal is from treatment for that particular problem and the intervention needed to assist them with that goal. All staff have to read and sign off on treatment plans and I do regular trainings on these. Staff still seem to have difficulty following them however. Perhaps if they were involved with coming up with a behavior support plan they may be more apt to engage.

I've worked in a state psych hospital for 2 years. I've been slapped, kicked, punched in the face (resulting in a concussion), spit on, bit twice, hair pulled, pinched, scratched and had body fluids thrown at me. I also have a high acuity female unit with 1/4 of the patients having a personality disorder diagnosis. It's not for everyone. This doesn't happen every day but when it does it can be bad. Especially when you don't have experienced staff to back you up.

Meriwhen, I agree with you 100%. The bad thing is I have absolutely no control over what staff I get. The two women's units have the worst reputation in the facility and no one wants to work there. So we get all the new hires until spots open on other units and they can transfer. On my unit we have one RN (me), one LPN (sometimes) and 3-5 psychiatric attendants. I have weekly staff meetings to address issues that come up and I use that time to do training on personality disorders as well as other diagnoses. I myself have a lot of experience (15 years) with intellectually challenged patients but not nearly enough with patients with mental illness and especially personality disorders (about 2 years). I am constantly looking for guidance from the nursing supervisors but they seem to be as lost as I am. That's why I was hoping more experienced nurses on here might be able to give me some advice or support that would help me.

I absolutely agree that the boundaries are out of control on my unit. It seems to be an issue with the system. I have educated and trained my staff ad nauseam on personality disorders and appropriate boundaries. One problem is that 4 out of the 5 staff are very young (2 aren't even old enough to drink) and have absolutely no experience in healthcare. Another problem is that I have little support from administration as far as disciplinary actions for staff or even plans of improvement for that matter. In fact, when this incident happened there were two staff standing outside the door watching me get hit. A 65 year old nurse had to push past them to try to help me. No one received any additional training or discipline for doing that. Am I fighting a losing battle because that's how I feel. It also doesn't help that the unit physician gives in to the patient because he feels like he's being too hard on her. She is dangerous to others as well as to herself (she recently broke a fluorescent light bulb in her room and cut her leg and wrist in three places almost down to the bone). I'm pretty much at my wits end not knowing what to do.

I am a Charge Nurse at a state inpatient psychiatric hospital. I work on an all female unit. We have 5 out of 15 patients that have a personality disorder diagnosis. One patient has narcissistic personality disorder. We recently had an LPN that had very loose boundaries with this patient and both began to target me. The LPN was eventually removed from the unit. The patient caught me off guard one day and punched me in the face as well as multiple times in the head. This patient has a behavior treatment plan for milieu disruptive behavior. I feel like her disruptive behavior escalates her and others into physically dangerous situations. I guess I have an idea of what milieu disruption is but this patient's behavior is sometimes very subtle. Can anyone give me examples of milieu disruptive behavior that you have experienced? I want to avoid another situation like this in the future not only for myself but for my staff.