I think I love psych nursing because no day is ever "typical". I'm in acute inpatient, and some days I look back on the day and think "wow". My last shift went something like this:
Handover, medications, meet and greet patients, check their environments for safety etc.
I was the ECT nurse for that morning, so up to theatres and into scrubs
to assist with the ECT. Only one patient that morning, a woman with postpartum psychosis who believes with all her heart that she has killed her baby...she hasn't. Return to ward. When she is awake and stable post anasthetic, encourage her to shower, do her hair and sit in the sun for awhile. The seizure was excellent and I managed to get some IV fluids pushed through before she woke, so she is feeling good. Broach the subject of seeing her baby. She is starting to understand that she hasn't killed the baby. She talks about the devestating loss to stillbirth the previous year and we talk about that as a contributing factor to the onset of depression. She is not ready to see the baby yet and I let it rest.
A new admission - a terrified young woman with her first psychotic episode. She believes she is being photographed in the nude and clutches her coat tightly around her. A tearful call from her father and I arrange an family meeting with her, him and me later in the morning.
Followed around unit by man who assaulted me last week but who now thinks he's "in love" with me. Have to playbad cop and be very firm with him. Have been stalked one too many times and know this is what the best approach is. He becomes angry wanting me to say I am his girlfriend - I disengage.
Called to the assessment wing to see an 11 yo boy who I obviously cannot admit, but who I must figure out what to do with. He is in the back of the police wagon and the wagon is rocking..he is throwing himself against the inside walls. 3 cops don't know how to get him out without hurting him. Children's services come and they try to cajole him out. Decide to do the "mother" voice ... commanding... after 10 minutes he is at least listening. Then engage him in conversation throught he glass about his fake tattoo and the ninja on his shirt. He walks to the assessment room and we begin a couple of hours of tantrums etc. He discovers the code black button and learns that if he presses it people come running. Eventually find a unit suitable for him and he is taken there.
Family meeting with father and daughter...some education about psychosis and informing them both that she will need to stay with us for awhile. She begs her father to take her home, she is frightened. He is frightened. Wipe both their tears. Encourage him to sit outside her door while she showers, so she feels safe. She likes this idea.
Do a little DBT with a borderline lady in for a short stay. Go through some distraction techniques...disengaging when she is acting out, doing some planned engagement. Another woman absconds out the front door and heads for the traffic (followed a visitor out). Set off on foot at full speed. Call a code and have some assistance to bring her back to the unit.
Do some bed juggling to make way for new admissions. Attempt to do some reporting. Hear shrieking from afar and go to find out what is happening. There is a fight between two young males that needs breaking up and it is causing nearby females to scream. Quickly settled. Administer a couple of depots, take some bloods, make a few calls to pharmacy, case managers etc. De-louse another headlice victim. Do some obs.
Run to code alarm - a woman who is attempting to rip her arm open with a ballpoint pen. Extract pen, medicate, move to HDU for time out, some more DBT to do. Have a patient accuse me of stealing her underwear..."I can see right through you, I can see you are a liar" she says. Attempt to explain to a pt WHY he can't smoke, chew nicotine gum and wear a nicotine patch at the same time. Get call from chemistry saying a young Clozapine pt has a CK level of 640. Tell them to get a Troponin, check young man for NMS symptoms, then find doctor and ask, "would you like a Troponin"..thankfully she says yes as I've already organised it! lol Do an ECG, find some bundle branch blocking and report it to doc.
Hurridly try to finish some reports, interrupted constantly by requests for cigarettes, leave, someone wanting to look at the contents of their lockers, phone calls, patients coming to the window "just to chat" about various delusions. Reiterate to a young man why he can't ring his mother (she has a restraining order against him) ... he won't let up, perserverating ++. Think, "boy it must be lunchtime"...look at my watch and realise that the shift is almost over in a few minutes.... another day gone! lol
I love psych nursing.