Psych nursing v. 1 to 1 observation with a psych patient

[justdoiting]

Hi everyone,

I need some advice.

I'm a very new RN (just licensed last week) and I am currently applying for psych positions at the large metropolitan hospital I am currently working at as a nursing attendant.

I feel I have found my niche in psych. I love taking the time to sit down to talk to my patients, to find out exactly what is going on, and working with them to come up with solutions. I also find psych fascinating and truly enjoy studying it and working with the patients (most of the time).

I feel like this may be a silly question to ask, but I feel like I need some advice from some experienced nurses here.

I had a pretty wrenched day at work today on a one to one observation.

I was sitting with a surprisingly strong 90 year old women who was experiencing altered mental status due to a UTI. I could sit and write about all the things that went wrong within that 8 hour shift all night but I will try to keep it brief.

She tried to lock herself in the bathroom multiple times

She punched me in the chest a few times times

She slapped me

She screamed quite a few times (loud enough to make people come running)

She tried to pull her IV out 5-6 times

She kept walking over to the other side of the room to bother her roommate (insisting on tucking her in at one point) . . .

there were quite a few other issues but this is already getting long.

and she calmed that she was doing all this because GOD told her to.

Looking at all this typed up makes it seem like I may be a bit dense for letting her hit me so many times, but I was just trying to do my best to keep her safe (since she refused to sit down for much of the day and was a major fall risk)

Anyway. What I am trying to get at here is that after about 4.5-5 hours of this it all started getting to me. I started getting really annoyed and upset with the situation. I tried redirecting her and a few other techniques to get her to calm down but nothing was working.

I guess I'm just sitting here wondering (after days like today) if I should even be going into the psych field. I like to think my experience with patients will be different as a nurse because you can walk away from a conversation if its not productive, or you or the patient need to cool off and re-group.

So do you guys get frustrated with your psych patients sometimes?

Can you still be a good psych nurse if the patients actions upset/frustrate you sometimes?

Please don't sugar coat this, I would really like to know what you all think.

Thanks for taking the time to read this.

[lasair]

Hey sweety :) you may be a psychiatric nurse and have all the super cool skills but at the end of the day you are still human. Getting annoyed and feeling like you have had enough are normal feelings. If I were you I would try and figure out a way to deal with the feelings, use a bit of reflective practice, you might remind yourself that her actions are not her fault and she isn't doing it on purpose. Also, your feelings and actions are going to be different. You might feel annoyed but your professional knowledge will not let you show this towards the person as you know it is not helpful. You said you are only starting out, this means every experience is a learning one. Also this type of service user may just be the one that you personally find more challenging. Self awareness is important.

Take care xxx

[macfar28]

Sure there are times that a patient might get under my skin but that's when I remind myself the person in most, though not all, cases is ill. In the situation you described I would have asked to switch out. Eight hours is too long with that difficult of a patient. On my unit with a patient like that we switch out every 4 or sometimes even every 2 hours if need be...whatever it takes to stay as therapeutic and patient as possible. Give yourself time. This was hopefully one bad shift but most will not be like this. Good luck.

[SoundRN7]

All nurses, not just psych nurses, get frustrated with patients at times. It's completely normal.

[justdoiting]

Thank you so much for the feedback and advice everyone.

I have recently started journaling about my nursing experience and it does seem to help.

I also frequently remind myself that these people are ill, and that is a great idea about switching out, I think I am going to talk to the charge nurse on whichever unit I am working in (float pool) about that next time this happens.

Thanks again guys, I appreciate it.

[Stephalump]

1:1s with difficult patients are, well...difficult. As has been previously stated, even psych nurses are human. Even nuns are human. All of the above get frustrated and annoyed and have buttons that can be pusher. When I worked as a tech, the unit limited 1:1 to half shifts for that reason. Tech and patient were both better off without seeing the same face for 12 hours straight.

[SheriffLauren]

Ok eight hours with one pt is NUTS, my hospital shedules you for ONE hour, then a change in assignment, at most you have 2 hours back to back. And if you were having such a difficult time the charge RN or other staff would come assist you or switch with you. Sometimes no matter what you do a patient just does not respond to you and its no fault of your own. I dont fault you at all for feeling so ****** after a shift like that. I would have cried all day. I get frustrated frequently, Im only 1 year in and I'm developing my skills, I see an improvment definatley in how i handle these situations but really it will get to you after a point. I try to tell myself, "at the end of the night you go HOME!" and, "try to place yourself in their situation." And I find it helps. Even when it gets really bad (about to burst into tears, so angry Im red in the face and snapping at staff) I tell my charge RN that I need to take 5 to breath and then I can get back to work. Perhaps these things aren't possible at your facility?

[justdoiting]

Thanks again for the feedback guys. I was on one of the med-surg units when this happened and I hate to say it but the staff there just does not care for or support each other. I think I am going to write down stuff like this and once I transition from being a tech to being an RN (already registered, just waiting for a psych position to open up) I am going to bring it to the nursing office and let them know about some of my experiences and I think the switching out every 1 or 2 hours is a great idea, I am definitely going to tell them about that.

[elkpark]

Ok eight hours with one pt is NUTS, my hospital shedules you for ONE hour, then a change in assignment, at most you have 2 hours back to back. And if you were having such a difficult time the charge RN or other staff would come assist you or switch with you.

Different facilities have different procedures. In the psych settings in which I've worked over the years, people took turns doing 2 hrs sitting with someone who needed 1:1 supervision, but, in the medical center in which I currently work (a large academic medical center), in all of the non-psych units, sitters are scheduled on a per-shift basis. The RN and other CNAs relieve you for meal and bathroom breaks (and can assist in particularly difficult situations), but your job for the eight or twelve hours is to be that individual's sitter. It's not "NUTS," it's just a different policy.

[SheriffLauren]

Are sitters specifically hired for just that purpose, or are they regular staff (floor RN or CNA)? At my facility RN and CNA interchange doing 1:1. We change out staff ever 1 to two hours because the patients who need 1:1 or Constant observation are highly psychotic and/or assaultive and it diminishes the chance of staff being targeted and abused/fatigued.

[Whispera, MSN, RN]

I think 1:1 staff should be changed every few hours even if it's not intense. If it's boring, that makes it difficult for the staff person to give his or her best too.

[studentnursemon86]

Boring is exhausting; like watching people sleep. What about 1:2 or 1:3. I don't feel that is very safe but it is done quite often around here due to staffing and increase of patients with SI.