AussieRN36

Don't let it bother you, OP. Some people genuinely froth on the power imbalance/ego self-stroking. If you show that it bothers you - you'll keep reinforcing their childish, challenging behaviour. Those kind of personality traits are in abundance in the crit care areas. Just keep learning and advancing your skills and make every effort not to turn into that kind of nurse.

Wow. In Australia Grad RNs go to level 1.1 salary, then the following year it's 1.2 salary, then the salary goes up in increments to level 1.8. Then there's level 2.0 and beyond that can be applied for when suitably experienced. The pay situation sounds pretty rough in US! You guys should come and work here lol. Nobody bats an eyelid over pay here.

There is a doctor in Perth, Australia who gives naltrexone implants to methamphetamine addicts. It supposedly reduces the cravings. Personally, I think this is ******** because so many ex-opiate addicts get stuck into methamphetamine when they've got naltrexone implants. Side note is that the naltrexone implants aren't approved for human use, they've been a research drug since back before 2000. Dodgy dodgy. All subjective responses here, by the way! I don't understand how naltrexone even works for alcoholics or methamphetamine addicts. Ex-opiate addicts can still get drunk and high on meth while on naltrexone. What makes alcoholics and methamphetamine addicts different to the effects of naltrexone? As for opiate withdrawals, the best drugs to use are clonidine (for the extreme discomfort/RLS symptoms), promethazine (to calm and as a non-addictive sleep aid) - IMI if necessary cause it works. 200mcg buprenorphine tablets speed up the withdrawal process and can make a heroin/methadone withdrawal much more comfortable over 7 days, but nobody seems to do that anymore, they just jump for once daily dosing of subutex/suboxone (which puts the person into withdrawal, hurr, go figure).

Think of heroin like xanax and methadone like diazepam. Drugs with short half lives are excruciating to get off and that's why we need to use long-acting drugs to help with the main issues - which is the horrendous withdrawal which is typically why people keep using heroin. Heroin addicts need to use at least 2-3 times a day just to stave off withdrawals and function normally. Methadone maintenance provides them with an opportunity to take one dose per day at a fraction of the cost. In my neck of the woods, a seasoned heroin addict would need to spend $100 on a hit just to feel something. Methadone costs around $4-$6 per day - depending on the pharmacy dispensing fee. Taking methadone allows the individual to alleviate the physical symptoms of withdrawal - this in turn enables them to relearn how to live life without constant intrusive thoughts about using heroin, enables individuals to have a better social/family life and look after their children better, enables people to return to education and the workforce when they're ready (it's hard to do this after years of addiction, so it takes time for preparation/readiness). Ohh and the ability to sleep! When in heroin withdrawal, one cannot sleep for days if not weeks, one cannot enjoy the comfort of being able to sit/lay comfortably without restless legs symptoms - with the feeling like there are electric spiders crawling inside your bones and across every nerve in your body, the feeling of not being able to have a comfortable temperature - imagine feeling cold to the core but sweating profusely, and being hypersensitive to the touch of another, or even something as simple as feeling a cool breeze - instant gooseflesh, but not normal gooseflesh like you or I experience, it's a horrible, uncomfortable torturous sensation and it just gets worse. I understand that detox regimes are structured around the theory that withdrawals peak at day 3-4, but they get worse beyond that and can last up to 2 weeks. Methadone also enables people to keep items of value and keep money for more important things in life (food, rent, etc). Imagine living a life where you took everything to cash converters to loan/sell because the withdrawals literally drive you insane. A drug like heroin that will call to you and put ideas in your head of ways you can make cash/get cash and make those god awful withdrawals go away. People will do anything to make them go away - even crime and prostitution. Yeah, methadone doesn't do that to a person. I understand that some people continue to use when they're on methadone, but they use a heck of lot less. If a person uses once a week or once a fortnight on their pay day - it's progress because seasoned heroin addicts will use every day of the week and the cost of doing so is financially, socially, and psychologically devastating.

I think the mental health clinicians should be trained in addiction & recovery. There seems to be such a lack of understanding coming from the staff, and it results in this transference and counter-transference feedback cycle. It's unhelpful because it puts everybody on the defensive. My work place treats both and there isn't any more issues coming from the addiction patients than there is the psych patients. I detect a lot of stigma and to be frank I'm sick of hearing the subjective handovers coming from staff in relation to the addiction patients.

People don't respond well to statements that begin with "you". Try to reframe the statement and lose the "you", focus on making statements that begin with "I"... Being "you"d at makes a person defensive. By using 'I' it is you that takes responsibility for the situation. Most people recover quite quickly from their melt downs if you deal with the challenging behaviour appropriately. A favourite of mine if I'm stuck is, "Well that escalated quickly?!? What can I do to help right now?" Then whatever they mutter back, I just calmly smile and say, "I know how that must feel.... I am sooo sorry about that, let's get everything sorted out". That avoids the person becoming defensive and usually prevents them arguing with you b2b taking up too much of your time. Validate.... validate.... validate. If they think you've been neglecting them, that feeling is real for them and the sooner they get over it the better for you and everybody else on your team. Before you leave ask them, "Is there anything else I can do before I go"... will save the call bell from going off in five mins time, cause you can group the tasks together and save yourself some time. Bit trickier with dementia and CALD confused patients... need to use less words to communicate the same thing or it'll go way over their head.

Okay I have a few thoughts to add to this thread. First of all, we're nurses and we don't diagnose medical conditions; Doctors do. Secondly, sundowning at 0600 seems a bit odd.. have a think about why this is lol. Thirdly, it's completely normal to feel like telling a person to cut the crap sometimes; but it's not what the OP did. Not sure why people are getting on their high horse over it. Nurses are supposed to reflect on their feelings (yes, nurses do have feelings) and let it guide their reactions to future situations at work. I'd be calling delirium if the woman was seeing dancing monkeys and her AMT dropped from 4/4 to 2/4 or less. Irritable, brittle mood is a symptom of many different mental health conditions and personality traits. Especially first thing in the morning; Some people are horrendous when they wake up and that's just normal for them. The majority of general nurses know very little about psychiatry. It's why challenging behaviours can be so hard for you to deal with in the first place. No point trying to act like you're Florence Nightingale every time you handle a patient who is being a tit. It is frustrating but how we deal with situations vs how we think don't have to be synonymous.

I haven't smoked any weed since I was 21 years of age. However, when I retire I'm going to smoke weed everyday. At this stage of my life, I'm happy with my morning coffee & 5mg fluoxetine. :)

Sorry but your patient is staff splitting. She is manipulating you for attention. You need to set firm limits because it sounds like she has cluster B traits. You can still validate a person's feelings without crossing boundaries. :)