JinnSchlajfertig

I am glad this is being discussed but I can't help but laugh. As I was reading the tips for dealing with doctors it reminded me of wildlife safety tips to help you survive a bear or puma encounter.

I say this as a nurse and someone who will soon be starting my first psych ARNP job who also has a degree in Occupational Health Nursing who us very into employee mental health issues. Ditto what others have said. We have CISM which is a peer-run program, that responds to critical incidents. It is geared towards the correctional officers who are accustomed to accessing that service. But I don't think nurses use it that much, but it's confidential, so who knows. Maybe if a nurse was on the CISM team... Which brings me to the OP comment about nurses getting support from psych after a med error. I would never go to psych for support after a med error. I had a med error, was mortified, and other nurses stepped up to help me frame the experience in a healthy way. Just knowing that other nurses (who I looked up to for being highly competent) had similar experiences helped me to get through it. A psychologist doesn't pass hundreds of meds every day and can't know the pressure that brings and the visceral, gut-churning horror that a med error evokes. So unless the OPs med error recovery program has nursing input, I doubt people will access it. Maybe a better route would be to set up a peer support program. Or training for managers to help staff nurses through common issues like that.

I got my BSN at 35. I guarantee that all the students harbor individual doubts about their ability to get through the program. Some just don't show it because there is this culture of fear around appearing stupid in some educational programs. It can vary by cohort. I was a TA for undergrads and the difference between cohorts can be striking. Some tips: -ask for help! As a TA I saw professors always welcome the opportunity to steer a student to the right path. -print out slides and write on them during lecture if you find that typing notes isn't helpful for retention (rather that typing on emailed slides). It was like night and day for me and I wish I had tried it sooner. -don't be afraid to ask "stupid" questions in class. I guarantee that others have the same question. Also it's congruent with nursing values to ask questions to get the best understanding. It's what keeps patients safe! Your leadership in this area will encourage other students to ask questions and gives the profs a way to guage comprehension. -remember that nursing school is very challenging for everyone and take care of yourself. That includes acknowledging small victories. And knowing when to get help. Good luck. Nursing needs more second-career nurses. We bring a richness to the field.

I was recently working with an RN on Noc shift who had been a critical care nurse for 20+ years, but who switched to corrections due to a terrible spine injury that makes him forever unable to do bedside nursing. He is just the guy you want in a code and I learned so much from him, clinically. But the dude just couldn't talk to the inmates. He was constantly getting sucked into long non-nursing related conversations with them in the continuous observation psych area. If I worked his post the inmates would express disappointment because they could cajole goodies and attention out of him. The attention is important- if you have a guy in an isolated cell, he is more likely to falsely threaten self-harm if he knows it will get him one on one time with a sympathetic nurse. When the RN in question went on vacation, the inmates lost interest in the continuous observation unit and the unit was deserted. Suddenly no one was suicidal because they know they'd get a nurse who followed protocol and wouldn't give them goodies. The RN asked me for coaching (I've worked with similar populations since the 1990s) and we'd run role plays/discuss scenarios during slow times, which improved his interactions a bit. But he is just not the right personality for that place. It is definitely more than clinical skills that make a good fit.

I think personality is extremely important. Nursing is a complex job that demands swift critical thinking, a myriad of clinical skills and the right personality fit. For example, I could think of nothing more horrible and boring than bedside nursing. It's a vital role that provides an invaluable service. But if that role was the only one available to nurses, then I would never have gone into this field of work. Psych/behavioral health, detox and correctional nursing? I'm so down! I don't need the technical clinical skills that is needed in the ICU, but I can set limits while building rapport like no one else. I don't get bothered when patients are non-compliant, lie to me, or get aggressive. It's all part of the job. Most nurses would hate all that and likely be intimidated by the environment in corrections. But correctional nurses have the personality and right skill set to provide great clinical care to this difficult population. We keep vulnerable inmates safe while the system where we works keeps the community safe. I can change up/improve my clinical skills to work in ICU/Med-surg. But nothing will change my personality to make that an attractive option.

It's probably because you are going for an ABSN program. In my ABSN program, the students were just the type of go-getters who wanted to go further in their education. Ditto for BSN students vs RN-program students. There are plenty of of people who want to be/are RNs as a terminal career destination, as you will see in your various clinical sites soon.

As others have noted, it could be the clinical site. I noted the culture of each unit where I was placed in nursing school so I would know which places to avoid in the future. The culture of the units can make your experience as different as night from day! Good for you for noting this and questioning it.

Only way to deal with this is to set clear professional boundaries. If she butts into conversations, end the conversation and walk away. Or say something like, "wow, isn't that funny. I was talking to (original conversation partner) about (original topic) and now we are talking about your cat/shopping/etc. Did you notice that you tend to interrupt conversations and steer them towards the topic of your interest?" Either way, don't reward her behavior with attention. She'll just keep doing it. If you challenge her or fail to refill her narcissistic supply, she'll pick a new target. If she is bossy, grandstanding, pokes into charts or interferes with your duties, especially in front of patients, take her aside and warn her ONCE to back off. Then complaint, in writing, to management. Take notes, keep dates, etc. Encourage others to do the same. They are not likely to respond at first and will think it's a personal conflict that you should work out. But if you document it well, are not alone in your complaints, keep it professional (focusing on how the behavior impacts your ability to perform your duties), then they will hopefully respond. Good luck. You have a full-blown narcissist on your hands. Hopefully she'll move on soon. If not she'll be running the place.

Yes, in Washington State we have a nurse delegate designation. A CNA with extra training and certification can pass certain meds to stable patients in certain scenarios.

Absolutely NOT. There are steps in nursing school before you can do any nursing tasks, even with a licensed RN watching you, like right there in the room. For example you can't, AS A STUDENT take a blood glucose reading until you've done it in lab, mastered the clinical reason behind the actions (book study with testing) AND your clinical instructor AND preceptor think you are ready. This is how it was in my school in Washington State, anyway. But in this case you are NOT a student and don't have all those structures in place to protect you and your patients.

Uh...stuff happens on night shift. Not sure what that has to do with anything except the convenience of the facility who likely can't get night shifts filled. Is there an arrangement with the school? If not I'd assume the facility is just trying to get warm bodies to fill scheduling holes.

The stories by the other nurses break my heart and make my blood boil. That clinical instructor, especially,sounds like a self-serving idiot. I want to shout off the rooftops: EARTH TO MANAGEMENT! PEOPLE ARE VIOLENT! There are tons of people who we care for who are capable of incredible violence. Some may not be in their right mind. But many are just waiting for their opportunity to hurt others. It's just in their nature. We need to stop serving up victims to these cretins on a platter. That's why I'm glad (yep GLAD) I work in a prison. Safety is ALWAYS ALWAYS #1. The custody officers are professional, supportive, skilled and ready to respond to any nonsense. Inmates are infracted for verbally and physically abusive behavior. People coached me on how to position myself to avoid a head-butt or spit attack. Most inmates are fine and not particularly violent. But we use a "universal precautions" approach to keep people safe. Can someone slip by and get a hit in? Sure. But I feel safer by far than when I worked inpt psych or detox with little support, no security personnel and patients wandering all over. I won't work in corrections forever. But I will take the skills I learned with me wherever I go and strongly advocate for staff safety. P.S. I did clinical training in an E.D. If someone was violent the staff responded immediately. We have a sign in the waiting room warning of our no tolerance policy. We are more that happy to restrain a violent who needs urgent treatment and bar those who don't. And we had no problem calling the police. Do not be afraid to make a complaint to OSHA or your state worker safety agency. That's what they are there for.

If there are psych people at your facility they can set up a behavior contract with him. He sounds like he desperately needs it. Also you may want to ask for feedback from trusted colleagues to see if they have any ideas about why he is targeting you. This is absolutely NOT YIUR FAULT. But there may be something you are doing that makes you an easier target than others. If so, then a small change on your part might make a big difference. It may be something you can't control, but if it is, that may be very helpful to know. I mention this because I have learned a lot on the way and rarely get targeted anymore. I see other nurses dealing with obnoxious behavior from various inmates/patients and this doesn't come up for me or other nurses who are experienced at working with difficult people. Good luck

A bully will push as far as you let him/her. I, like many other posters make it clear that I won't take any abuse, am only here to do nursing-related tasks, will limit the time I spend with the person, advocate for a behavioral contract if needed, etc. Things seem to go pretty smooth on my shifts and I work in a men's prison that has more that its share of inappropriate/maladaptive behaviors. Allowing one difficult patient to burn everyone out without providing support to the beleagured nurses is a sign of poor management. As for the comments about dumping the difficult patients on temp/agency nurses-wow. Do any of them stick around? And yeah, I get more an hour as an agency nurse, but I since I not full time (am in grad school), I don't get medical benes, days off or retirement. How does anyone expect to get the bully to chill out if s/he has temp people floating in and out who don't know his/her tricks, don't have rapport, etc. That kind of thinking gives me the impression that this is not a team effort to take care of the patients. Which increases stress and staff turnover.

It's illegal to ask someone to work for free. I would do what a previous poster did and download the relevant labor laws. Also call the state nursing commission. I'm sure they'd have something to say. This is just a way to squeeze just a little more out of their hard-working employees. They're playing upon your insecurities as a new LPN in a very difficult unit. Trying to punish hard-working, conscientious employees is abusive. Obviously they don't have your patients or your own best interest in mind. Do you think you will have their support if something goes awry (which is more likely because you are overworked and have the added stress of a write-up now). I would start looking for a new job.