Adventures in Psychiatric nursing-

  1. The psychiatric nurse role is sometimes perceived as a easy specialty. I would like to invite psychiatric nurses to give examples of the types of cases
    that we see in our outpatient clinic, emergency services office,
    and inpatient units ...........

    My specialty was Emergency services...

    >18 year old male known to crisis center calling on a pay station (no cell phones then) to report he was going to jump off the bridge into the cove.
    The payphone was located at a gas station before bridge. Call traced while client engaged.
    Police responded, transported client to our center. Involuntary hospitalization carrying a knife,
    stating he will kill pregnant women, then himself. Off all anti psychotic meds
    >83 year old female brought to Emergency services. Staff observed deputy sheriff and unknown male
    unloading an easy chair from a truck. Elder female now sitting on the chair on the sidewalk.
    Staff out of crisis center to introduce ourselves, we received no call. Unknown male is court appointed attorney.
    His client is now homeless due to being evicted for non payment of rent. Numerous health issues, no hx of
    psychiatric issues. No family or friends in area. Uses walker short distances. Time of arrival to our center,
    4pm. Admission to hospital overnight, while social service obtains placement.
    >7 year old male with suicidal ideation and specific plan and intent. Lives with grandmother, who does not
    drive. Grandmother has serious health issues. Seen by psychiatric nurse and Child psychiatrist.
    Admit via involuntary commitment. Hospital is in another county,must have state police transport.
    No health insurance---state bed. FYI- Father is deceased, mothers whereabouts are unknown.
    Per our social worker, this client stayed at the inpatient unit for 5 months due to his dangerous ideation.

    >25 year old male calling upset "thinks he killed his girlfriend". Afraid to call police alone, our center
    called police per his request. States he now "knows she is dead". His address ironically located a few doors down from our location. He denies having a gun, or other weapons "except the knife".

    Came out on his porch outside to wait for police. Police updated continuously, and police arrive within moments of appearance on the front steps .Caller is unknown to our emergency services.
    Taken into custody without incident.

    >Unknown male caller, angry on the phone with emergency services, going to even things up.
    Gives details of why he is upset. Specific and immediate threat to present to our doorstep with numerous weapons.
    Police advised, they are enroute to our center. Caller known to
    police and court system. Outstanding warrant pending. SWAT team engaged by police.
    Caller never showed up to our center..police continued to investigate. Will advise us if he is taken into custody.

    Very lucky for us, these cases did not present in the same day...
    Last edit by jahra on Dec 4, '11
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    About jahra

    Joined: Jun '06; Posts: 1,102; Likes: 965


  3. by   ImThatGuy
    Maybe because I've done (and still do) the police side of what you're talking about in your examples and becauseI have seen similar instances of all of those stories that it still doesn't seem like a drama-filled, difficult day, lol. I want to be a psych NP.
  4. by   jahra
    Hats off to professionals like you ImThatGuy, that made our
    days easier by your response.
    And presenting in stressful, unique situations and navigating our way to a peaceful outcome.
    Psych service will be looking forward to having you on board soon...

    Best wishes with your psych NP studies!
    Last edit by jahra on Dec 6, '11
  5. by   Hygiene Queen
    I had to put slip-on heel protectors on my lower arms to keep a pt from biting through my skin. She had rotten jagged teeth. Yes, she repeatedly bit the protectors and even had a second staff holding her head to attempt to prevent her from doing serious damage.

    I had an old man take an unexpected full-on swing to the side of my head. Knocked the crap out of me and my ear hurt like heck. It was a forceful direct hit.

    I had another big old ex-marine fling me around as me and my partner tried to keep this guy from attacking his room mate. Thought he was going to toss me and break my back.

    We had a woman who required the 1:1 supervision of 2 staff at all times. We kept her in her room and staff was separated from her by a table blocking the doorway to the room. Say what you want, but if you had dealt with her, you'd know why we had to do it.
    She bit, hit, scratched, hair-pulled, strangled and head-slammed multiple staff. When I say "head-slammed", I don't mean she slammed her head. I mean she grabbed a nurse and slammed her head on the floor.

    We had a highly trained athlete who was extremely strong and agile. He was so out of control and dangerous, we called for police back-up. He got tasered.

    Did you know old people aren't weak and frail? Not when they are confused and scared. They pump adrenalin like anyone else would. Add some mental illness to it... and you have an ungodly beast on your hands.

    One of out nurses walked into a room and was strangled. Thank God for a passing staff member. She's okay, but she needed some counseling.

    And my favorite: the old lady that attacked me with a comb. She was going to comb me to death. lol

    These are just a few.

    Yes, the work isn't "hard"... but when the **** hits the fan, it's drop dead dangerous.
  6. by   Hygiene Queen
    Quote from ImThatGuy
    Maybe because I've done (and still do) the police side of what you're talking about in your examples and becauseI have seen similar instances of all of those stories that it still doesn't seem like a drama-filled, difficult day, lol. I want to be a psych NP.
    You know you share our joy!
    What you don't keep, you send to us.
  7. by   hanasea
    I think you will be a great psych NP!

    My father worked as a policeman over 30 years. I shall respect you too
  8. by   pitapita
    I always love it when people think psych nurses have it easy...we get a lot of nursing students at our facility, and a lot of them walk through the door thinking it's going to be their easiest rotation. Those same nursing students can usually be found huddled in our locked nursing office when one of our 300 lb pts starts trying to kick the door down because they are delusional and think we are keeping their kids locked in there. Or you have a head-banger who likes to whack their head against the CORNER OF THE DOORWAY so that it splits down to the bone every time. That one kept being sent out to be sutured, and then would come back, tear the stitches out, and then use their hands to rip the wound open even further. The best part about patients like that is, we have to keep them until they learn how to control their behavior. Which took months. Can you imagine having to come into a sitation like that every shift for months? This is how people get burnt out from psych. I just let everyone think what they'd like about my job - honestly, a person has no idea what that job is like until they're the only nurse on and they have to try to talk down a patient who is repeatedly threatening to stab them because they look like the parent who abused them when they were a kid. Fun times!! These stories are not few and far between either...LOL. Anyway, food for thought, I guess.

    - Pita

    Last edit by tnbutterfly on Jan 8, '12 : Reason: Please do not post link to off-site personal blog
  9. by   Whispera
    While I share your need to write about things I've been through, it comes to mind that anyone can read things here, and it's possible someone reading could be or know a patient I would write about. That keeps me from writing things I'd love to share. Please consider this when you write about someone with enough details to have his or her story be identifiable.

    The remarks from some that psych nursing isn't easy or isn't real nursing definitely make me at LEAST a bit irritable. Walk a mile in our shoes, I say!
  10. by   pitapita
    I absolutely LOVE being a psych nurse. It's definitely NOT an easy job - I really don't know why people would think that...

    - Pita
    Last edit by tnbutterfly on Jan 10, '12
  11. by   RN58186
    Hats off to the psych nurses - I couldn't do it! I have been admitted to psych units and have seen what the nurses have to deal with and I could not do it. (And yes, I have been one of those pts who needed their extra special skills a time or two....) Absolutely could not. I would never say psych was an easy job or that psych nurses aren't real nurses. (But I did sort of chuckle when on one admission the nurses would bring me the glucometer and say "I understand you know how to use this.... Because I sure don't.") To me psych nurses are a very special breed and I am glad they are there for those of us who really need them.