KaffeineFiend

I posted this under Addictions Nursing, I'm posting here as well hoping to get more answers from those who wouldn't go in that sub forum, maybe dual diagnosis units nurses. Mods if this isn't allowed I'm sorry please feel free to take this 1 down. I started at a new facility last week that has a detox unit and a residential treatment unit. Since it is new there's only about 4 clients. My experience is from psych hospitals, including a dual diagnosis unit. However I'm looking for help in how other do things in their own facilities, mainly detox, so that I can suggest ways for us to improve. For med pass: Right now we have a med cart, and med cups. With 4 clients it's easy to just write the initials on the cups. But I don't see this being a good way for when we're up to 30 pts. Im thinking of suggesting a tray for cups with clients names already on the slots? is there another way? for shift report: We have no kardex, no pt binder. Everyone just goes over what they think is important to pass on per client. The problem is I feel things are missed, there's no consistency, and again not a feasible option once there's 30 clients. Ive made a little template for myself that includes the clients name, age, allergies, status, space for history, additional info and last PRNs I requested a pt binder, DON said she'll make one. what do you guys use? What does you kardex consist of? for report do you use a brain sheet? What information do you make sure to pass on? My facility doesn't have any standard policies written out for preferences regarding these matters yet. Nor regarding documentation. Any examples or help will be extremely useful for me to give to my DON so we can run smoothly before more patients are added on. please feel free to DM if you prefer Thank you ahead of time!

I started at a new facility last week that has a detox unit and a residential treatment unit. Since it is new there's only about 4 clients. My experience is from psych hospitals, including a dual diagnosis unit. However I'm looking for help in how other do things in their own facilities, mainly detox, so that I can suggest ways for us to improve. For med pass: Right now we have a med cart, and med cups. With 4 clients it's easy to just write the initials on the cups. But I don't see this being a good way for when we're up to 30 pts. Im thinking of suggesting a tray for cups with clients names already on the slots? is there another way? for shift report: We have no kardex, no pt binder. Everyone just goes over what they think is important to pass on per client. The problem is I feel things are missed, there's no consistency, and again not a feasible option once there's 30 clients. Ive made a little template for myself that includes the clients name, age, allergies, status, space for history, additional info and last PRNs I requested a pt binder, DON said she'll make one. what do you guys use? What does you kardex consist of? for report do you use a brain sheet? What information do you make sure to pass on? My facility doesn't have any standard policies written out for preferences regarding these matters yet. Nor regarding documentation. Any examples or help will be extremely useful for me to give to my DON so we can run smoothly before more patients are added on. please feel free to DM if you prefer Thank you ahead of time!

A PT who has escalated to a point where they are destroying property out of anger NEEDS interventions. Obviously relocation is a big priority. Other patients are at risk of being hurt even if the aggressive action was not meant for them. you can relocate all the patients temporarily until the situation de-escalates, but the pt could still injure staff in their aggressive behavior aimed at property. The appropriate course of action is to intervene before a pt escalates to the point that they've injured themselves or others. Waiting for a pt to direct his aggression at someone else and then act is dangerous, and a disservice to the pt. When staff is attempting to redirect the pt, and all other less restrictive measures have failed, more restrictive measures are appropriate. Why wouldn't you put them in seclusion? They are now safe, as well as others, since they can't cause injury with objects. It's a chance for them to regain control, stimuli is reduced, location is changed etc. They have also been prevented from continuing a course of action that could cause them severe guilt or shame (as many of our PTs do) and potentially set them back. If the pt is so angry that seclusion is just going to cause him to redirect their aggression towards themselves, chemical and/or restraints are appropriate. I just can't see a situation that would allow for a pt to just be allowed to persist with aggressive destruction of property. If a pt isn't a risk to any one nor themselves, then it's not really destructive.

No that's not all there's to it. There are several skills sets needed and the challenges faced range from easy to very complex. It depends on the facility policies, acute or long term care, and population you are caring for. A list of specific things isn't really going to convince anyone unless they have experienced it themselves. However: Those who are in the mental health field because it's a specialty they enjoy, or feel passionate about, will have it EASIER. Those who come into the field for the wrong reasons, don't have a natural knack for it, and have to work harder. Many times they burn out in a job they thought was going to be "easy".

I've been wondering what it meant too, I even looked it up. Now, days later, I realize that they probably meant "to" and "tp" was a typo lol

We do a lot of running when things go down. When it comes to an ETO we call the on call Dr as were pulling the meds. If a nurse from the other units is available she'll run over to help the other staff with the patient while we're in the med room. I've always felt understaffed (I think we often are as nurses) but never realized how bad it is until I started reading posts like these about ratios.

Crisis unit 21 patients = 1 nurse and 2 MHT during the day, at night only 1 MHT and a float between the 3 units

A razor blade hidden under a boob

I work at a private non profit each unit has only 1 RN. We are almost always full. which means: Days and evenings 1:20 RN with 2 techs and a floater Over night 1:20 RN with 1 tech and MAYBE a floater It's really bad, we always feel understaffed. However, reading everyone else's ratios it feels even worse now.

Thanks for replying :) I had had the interview yesterday, it went really well! They were very nice and explained they were looking more for the right attitude rather than the right skills. They feel you can't teach attitude as much as you can teach skills. They did emphasize and asked if I would be willing to study and brush up on growth and development, lab values in different age groups and psych material that highlights certain things not common in adults but common in kids and teenagers. Im definitely willing to, but I would suggestions of any good books, personal experiences or any other resources. Ive already searched previous topics that are similar on here. I hope any answer here will be helpful for others as well:)

Just like the title, what big differences do you see in psych when it comes to kids instead of adults? or vice versa I have an interview later on this week, for a position on a youth unit. The unit is divided between kids under 12 and then 13-17. Besides my clinicals on a youth unit, the rest of my experience is with adults. Im really looking forward to this opportunity. I'm trying to prepare as best as I can. You guys on here are such a great resource, I definitely can use your expertise. Anything you guys can think of would be of great help, even if it's just interview tips:yes: thx!

I respectfully disagree It all depends on how you said it, if you were cocky or rude then you messed up. However, I feel it was appropriate for you to ask if you are being evaluated under the same criteria as the previous nurse. It's a fair question. It seems you're being required something that you cannot achieve. Attempting to meet the time requirement would require extreme rushing to the point of negligence when checking your medications and patients. It would endanger those under your care, and it seems you still wouldn't reach their goal. There was a great suggestion bout changing the med times in order for the nurse to meet the requirement. It seems like the best option, changing the order times will allow you to be compliant with policy. Bring it up to your supervisor along with an explanation of how leaving it up to you to play catch up equals lack of patient safety. If you see they are beyond unreasonable with you, then their real intentions will be more obvious. In that case you can look for another job before being unemployed.

Thanks for your reply So I dk if this is common, or just my facility. But if the techs don't like you, they will not back you up when there is a patient that's getting agitated and aggressive. Obviously it starts with them doing less on their shifts with you and being unhelpful before it gets to that point. But this is a big reason I don't like misunderstandings with my techs. ok so about the patient. Since we're a mental health facility primarily, any client will always have a psych issue for admission. He was Schizophrenic, actively responding to internal stimuli. He was detoxing from opiates and benzos. Dual diagnosis unit had 5 male beds empty, and no admissions that shift either. Sometimes they have beds but were careful not to overwhelm either unit with too many admissions. Thanks for looking at all possible angles lol I needed another pair of eyes on the situation, to make sure I wasn't in the wrong and totally oblivious. I found out eventually, that the nurse on unit 2 that shift was his wife. It explains why this happened, and turns out it's a pattern every Sunday evening. I think I'll be standing up for more patients in the near future. But this experience helped me to trust my gut a bit more. This patient was being shoved into the wrong unit for the convenience of another nurse. Disregarding the actual needs of the patient. I definitely don't regret making a big deal about it now.

I was unable to open it.. Is there any way you could repost it or email it to me? [email protected] thank you so much!

I work at mental health facility. It has 2 units in addition to our Intake unit. We try to keep unit 1 for strictly psych PTs and and 2 for dual diagnosis. Ive worked here since 2009 but took a 4 year break due to a car accident. since I'm "new" some staff try to take advantage of this. I pick my battles though, and rarely make it an issue. However, everytime I get report on unit 1, a common complaint is " this PT is detoxing, dual diagnosis etc, he shouldn't be on this unit" Today I'm working unit 1, dealing with plenty of issues on the unit. When the intake nurse brings me a chart. He gives a very brief hx, but I caught he had substance abuse issues. When I asked why the Pt would be transferred to my unit, the nurse said that's how it's done. I told him, that Id look over the chart and in 30 minutes when my unit comes back from dinner I'd accept the PT. This nurse and I have a good rapport from before so we've always covered what each other's is missing. But this chart was way incomplete. Then within 30 seconds the PT is in my unit! I didn't even have a chance to review his chart. a quick look at his orders showed he was detoxing from various substances. I immediately went to look for the nurse, before the PT settled into the unit. nurse nowhere to be found! finally I found him, asked what happened, we had a deal. Not only was I not ready for the PT but he is really not appropriate for the unit. He got upset took the chart from me and said fine and I'll transfer him elsewhere. Now the techs from intake and unit 2 think this was an issue on my part. That I didn't want the work of accepting a patient. And the unit 2 nurse is also upset. I apologized afterwards for handling rashly (just in case) and explained I'll take any 1 else that's right for the unit. He answered: " don't worry it's fine, I won't report this" report what?? He really believes I'm completely wrong. This is a long enough post, and it's hard to fit all the details. But I thought I was doing what was best for the patient and the unit Whas there a better way to handle this? maybe I'm looking for validation, did I do the right thing? besides an apology and offering to help, how do I fix things with this nurse?

It depends on your complications. I have hypermobility syndrome and on my to being diagnosed with EDS (hypermobile type) I also have Fibromyalgia, chronic migraines and a leg that has had 7 surgeries. Plus other stuff Most of these diagnoses came after being injured in a car accident. so I had already gone to nursing school. I was working already as an RN and then took almost 5 years of rehab and being in a wheelchair most of that time, until I was well enough to go back to work. All this being said because I can understand your position from an unique perspective. To pursue nursing school you would need To have your POTS as stable as possible. And ensure that the treatment plan you are on would stand up to the stress and physical demands of nursing school and clinicals A well set pain management plan. Depending on your EDS symptoms you might need a pain management Doctor. Have braces and splints for subluxing joints, prescribed and well worn before starting clinical rotation. If instead your EDS affects your cardiac system. Then you and your cardiologist need to have a well set plan, again, that would keep you stable despite stress and physical demands. search the schools in your area, or as far as you want to go. But make sure you have your doctors in place wherever you are. Speak with the disabilities office of each school. Depending on your limitations, have a list of accessibility needs and accommodations, permission for extra days off. Is brain fog an issue due to pain? Then you may need extra time for tests. Class notes. ask for their experience with accomodating other students in the same program, or common accommodations for others with same limitations. research disability office services online to get ideas. I did not do school when disabled. But the resources are there. do you know what type of nursing you want to do? probably a regular hospital unit of 12 hours standing, lifting patients. Won't be the best for you or your patients. Ive always worked Psych because I love it. It worked out for me once I became disabled. It's not as physically demanding. But it's challenging in other ways. But I am able to sit a lot, and my shifts are 8 hours. Many told me to go into case management, or work for insurance companies. They hire nurses that do consultations over the phone for their members. Thats wasn't for me but physically it was possible. op if you want this you can definitely do it! It might be more challenging than it would for someone completely able bodiedwith no health issues, but you would obviously bring a unique element by being a patient who is a nurse í ½í¸€ Dont give up

Op at this point you can't take back what you have done, so I would focus on damage control however, if there was more that the other nurse did that you did not mention, maybe you did have a reason to react so drastically. In this case patient negligence, or endangerment that was 1st brought up the nurse herself, then to NM if the issue was dangerous and ongoing. AND then if the 2 of them stuck to the plan despite this, then going over their head would make sense. If what you wrote though, was only what happened, be prepared to humble yourself. Maybe you are new, or your old job had a very different dynamic and structure than usual. But we have all had these co workers, and much worse ones. And unfortunately we will continue to meet them until we retire, and then we will have them when we are patients lol. you cannot react so drastically over minimal things. If and when you are approached about this, you need to take responsibility for overreacting. Maybe it was an extra hard shift and things seemed worse when you wrote the email, but you realize you handled it completely wrong. Assure them you will not be reacting like this again. You are part of a team. A good team member knows when to let things slide or when to have them addressed by supervisors. But it like others said, keep your head down for now. Learn the dynamic of your new team. Just grin and bear it for a bit until things become more smooth. i suggest you learn some conflict resolution skills. and just in case, wether they'll want to get rid of u or you just won't like this job. search for another job just in case!

OP, a situation like this would be frustrating to any of us. however the way your post is written: apparent pressured speech, tangential, possibly paranoid, partially demonstrating delusions of grandeur. You might want to consider that you are in fact in a manic state and seeking help is the best option. it can happen to all of us, and has happened to many already. There's no shame in seeking help. I'd rather have someone tell me that I'm not stable, rather than pretend that I'm ok and let me get worse. Just all around for everyone's safety, yours and your patients, a check up is worth it. I hope things get better soon :)