the idea for this post came to me while elucidating someone in another post...
since i've worked in the psych field 6 staff have commit suicide since i've been employed here, several fired for intimate relations with clientele, a few fired for showing up drunk to work, at least two for stealing meds....
I've found this to be more prevalent in the psych field... have any of you found this type of stuff to happen in other areas of nursing as it does in the psych field?? and what does this suggest about the psych field to any of you that have shared the same type of experiences?
i see your point and frustration, but if we generalize the clientele and look for them to be 'fixed' or see that they're 'still broken,' we become cynical. I've seen this happen to people. I counter the attitude all the time, and I think it just becomes a way of coping that detracts from our effectiveness as nurses. Some people really don't like to hear it though, but i've learned if you're advocating for a client and your efforts follow that principle, you can almost do no wrong, even if it upsets people in the process. However, there is something to be said about tact.
We must look for the client's victories and accomplishments on their level of functioning, and if you don't see a lot of change, that's ok. It's really boils down to it (improvement or complianct) being their responsiblity, not ours.
What becomes a real challenge is when you have to do this (accommodate levels of functioning) with the staff. This is where we have some type of expectation, at least we'd hope, but sometimes we are really disappointed when we try to pigeon-hole people into our expectations. e.g. we'd expect nurses not to be: 'getting into personal squabbles with the clients, mistreating the clients like you were saying, or other boundary issues.' Hard lesson to learn sometimes, when our expectations get shattered though.
I feel it's easy with the clientele though, because in those terms, the fields are wide open and the only expectations are simple unit rules and you provide the boundaries necessary. Furthermore, you'll probably see one client that accels and they make it all the more worth it sometimes.
just something to consider....
you make a lot of good points. In my year of volunteering in psych, I learned a lot, felt a lot of compassion for people, but I don't think I could have gone on with it day after day. After all, I was only there once a week and when patients did talk with me I felt fairly comfortable. But when they would sometimes talk about the terrible abuses in their life, I did not feel comfortable and was at a loss to say anything of comfort to them. I did attend on my own some of the classes or support groups for the patients and their families and could understand their distress. But I found that you can run into every type of diagnosis or problem possible, and on and on they go and keep returning to the hospital.
You know like you said about the ones that do excel, you are thrilled because I would see a patient that was really out of control one week and come back the next week and see a different person because their meds worked or they had ECT. But what I have learned, these patients are chronic and I guess I like to see "cures." I guess I just don't have that kind of patience seeing a lot the patients that just don't change. Most of my work has been in the acute med/surg work and I think that is still strong in me. I know a lot of the medical illnesses are chronic but I have discharged a lot of patients that don't come back as often and I guess it is just a different type of "detective work" with assessments and I just keep falling back to that. The nurses I worked with were just so outstanding, I felt that I would probably never reach their level. I guess that old med/surg is still pretty ingrained in me. But I did find your post very interesting as I did in the time I volunteered there. It was not a loss to me, but an adjunct to learning about a whole different set of illnesses and giving me a different viewpoint about mental illness which wll indeed be a help to me.
Specializes in Med-Surg, Geriatric, Behavioral Health.
Interesting thread. I want to include a post here that I did some time back that relates to this thread. I too used to be a mental health professional, for 10 years to be exact. Had it rough as a kid...but it was NOT an issue UNTIL later in my life when I had kids of my own AND stress crumbled me to my knees. Hey, I was pretty together and successful prior to my fall from grace. My credentials at the time were: RN,CNS, LPCC, BSN, MSN, MSEd. I've worked in outpatient therapy (individual and group), partial hosp, detox, inpt mental health, research, and community speaking. I was in grad school twice in two very rigorous programs...one in counseling. But, when it hit, it hit hard....what?... PTSD and Depression. I've since left the field...for my own peace of mind.
Below is my story of that fall from grace.
To add my 2 cents in. I first began having symptoms in 1998 when my two children became the same age that I was when I had it very rough as a kid. The nightmares and images about my own childhood began during this time. Looking at my children flashed images of when I was that young, my old memories flooding me. When this happened, I would cry and hide myself out of shame. At night, I'd wake up crying or in panic from the dreams I had, many I remembered, some I did not. My wife got used to me after awhile bolting straight out of bed or not going to bed at all. Some times, she'd tell me in the morning that I cried in my sleep. Many times, I was afraid to go to bed, because of the nightmares. I was diagnosed with PTSD in 2001, but not until I sought help for myself; my wife was against my seeking help because she didn't want a diagnosis on our insurance, for anyone to know, and just found it unnecessary...like, I was just making bad choices or something of that nature. However, I began seeing a counselor, then was referred to a psychiatrist who placed me on meds. In 2001, after getting help, my symptoms escalated because events in my life that I had no control over, such as: my sister getting beaten up by her then husband, a good friend ( in his late twenties and an RN) keeling over from a massive MI, another friend almost died from a brain aneurysm, a patient who successfully suicided by hanging and my attempts to save him to no avail and trying to hold together my young coworker who was falling apart afterward, my wife and two kids in a major car crash with my wife injured and my 5 year old with a severe spinal injury, helping my daughter get through that experience during the ER, life flight and prep for surgery, and living with a caustic mother-in-law who lived with us (wife and mother had codependency issues) who took great effort to split my wife and I up since I couldn't function like "a man" anymore...men don't have emotional issues (their standard). All these stressors occured within a one year time frame on top of my PTSD that I already began developing and which I kept hidden out of shame. The resultant and concurrent depression took all the little reserves I had left. In a year's time, the theme and threat of death and people suffering was all too much for me. I crashed. I burned afterward. In 2002, the PTSD and the resulting depression left me almost unable to function. I was hospitaized, much to everyone's shame. At the time, I was too numbed out to care anymore. In the hospital, I met a surgeon who was being hospitalized for his major depression, in a way, validating that it can happen to us too. Had to take two leave of absences from work. As far as my wife and her family were concerned, I had no more to contribute to them. Mental or emotional illness was such a filthy word in that family. My then lawyer brother-in-law who was going through a bout of his own depression and on Zoloft could not tell anyone about his own condition then because of the shame it would have caused regarding his own mother...he had to stay the apple in her eye. Yes, another high achiever and miserable. My own family lived about 200 miles away. I left psych as a field because I didn't want any more triggers, no more saddness. I also felt that if I could not help myself, how could I help others. So, I left the field. Actually, I'm kind of proud of that. I've also seen my fair share of impaired mental health professionals in my 10 year hitch in the field who mix their own issues with that of the patient, which I always felt was wrong. I thought it was my ethical duty to remove myself. I was on meds for 2 years when my symptoms finally began diminishing to a point where I could function on my own. All my adult life prior to all this, I was an achiever, grabbing any goal I set my sights on. High achiever in the military, grad school, and career. Lived in an up and rising neighborhood development, with most of my peers being docs, lawyers, accountants, and businessmen. But, the PTSD made in all insignificant. The PTSD and depression took much away from me. I lost my wife because I stopped being that high achiever she needed as a partner. We divorced under good terms, but the experience of PTSD made me see my wife under a new light. If I got no support through this, what support could I expect if I had an MI or became significantly injured or got cancer? The kick in the pants was that my wife was a counselor (LPCC), marriage and family to be exact. Both my then counselor and doc both shook their heads when they met her, both saying to me in private "and she's a counselor?" much to their disbelieve and dismay. My wife only came to a couple sessions to appease my counselor and doc, because it was my problem, not hers. She didn't seem to care that it was tearing us apart. Like I said, I worked in psych for 10 years, but after going thru this, I just couldn't do it any more, at least not for a long time. So, I left it in 2003. I didn't want any triggers or any further relapse. I let my counselor license (LPCC) lapse and placed my Clinical Nurse Specialist (CNS) license on inactive. Moved out on my own, giving just about everything to my ex-wife. Much of why I did this was because I loved my kids so much...their lives shouldn't change because of everything. I detest dead beat dads. I sure wasn't going to start being one. In fact, through just about all of this, my kids were pretty well sheltered away from this whole thing, the one thing my wife and I whole heartedly agreed upon through the whole ordeal. In this sense, my wife and I worked together as a team. I see my kids every day off. I see little of my ex-wife, mostly by my choice. I've been med free, counselor free and doc free for 2 years and plan to do what ever I need to do to stay that way if I can. My symptoms now, consist of occasional nightmares and images, but not to the severity, intensity or frequency that they once were. As an ex-counselor, any surfacing symptoms become my cues to improve my coping and support. Had a suicide one year ago on our med surg floor, just got past his anniversary. Had some increased symptoms for a little while, but now they have diminished greatly since the anniversary passed. I just told my first live person at work (in private/off duty) some of my experience. The first time in 2 years. I did this because he (an LPN) had a recent episode a depression and a bout of suicidal ideation, checking himself inpt. He told me in private. After the coorifice of a couple weeks, I shared some of my story. He's young, about 26, lots of angst in his life. He desires to make some positive changes in his life, although it causes great frustration to him. I told him about myself because I truely care for the guy and don't want him to see himself as being the only one around that has struggled. However, he is young, and his motivation may wax and wane. I respect him highly, even if he is 17 years my junior. I really believe he has great potential and will make an excellent man later in his life. So, I risked it. So, I told him, but I fear that I may have lost him as a friend as a result. I try not to psychoanalyze anyone, but as an ex-counselor myself, I could feel it in my gut, and it sort of saddens me. However, like anyone who tries to move forward, one can only move onward. I'll try to give him the space he needs. I try to understand. But, in closing, there are alot of nurses and doctors who have mental and emotional illnesses who still practice and practice their art and science well. We are only human. And as humans, we can hurt and we can suffer and we can also move forward. The last of my 2 cents.
In my 10 year stint in that field, I have met (emphasis) many folks, professional and nonprofessional, who worked in the field who have ongoing mental , emotional, and/or CD issues. It runs the gamut from Docs, RNs, LPNs, Social Workers, Counselors, Psychologists, and Mental Health Aides. The sad state of affairs IS that the stigma is STILL so very great, even amongst mental health professionals ...no one "comes out" until he/she crashes and burns. Sad, very sad. (Be mindful, health professionals "in general" tend to weigh heavy in mental, emotional, and cd illnesses, not just in psych) The more education one has in mental health field, the better off one is...I totally agree. But, the stigma is ever so present and lack of support for professionals with these issues to come out and get help can be very lacking...many crash and burn. What is needed is "mandatory" counseling for all exposed, front line staff in psych... helping staff who may have them already and to help "prevent" the development of mental, emotional, and cd illnesses during the course of their work for those at risk. I'm not talking just a little referral to EAP. I'm not talking inservices. but counseling for all. But, this will never happen. Too much denial, too much stigma, too much cost. Again, it is sad. Folks in most need of help may never get it or get it adequately in my opinion. I know, we hear the war stories about the Borderline Nurse or the Bipolar/Alcoholic Doc. But, what about the nurse who suffers from an eating disorder? The Doc who is depressed and entertaining the thoughts of suicide because the stress of the practice, but keeps it to oneself? How about the paramedic who is having PTSD from accumulated incidents of trauma in the field and can't shake it? It is more common than what you realize.
Thank you for starting a very interesting thread. I wonder if this perception is valid, though, the things you mention happen in many areas of nursing and in other professions (corrections and law enforcement are 2 examples that immediately come to mind).
I agree w/the other poster who wrote that management needs to be adressing these issues, the percentage is too high, psych. unit or not. How well are applicants screened? Was there any counseling or debriefing offered afterward? I guess I am fortunate because I work in a facility that does make an effort to address such issues.
And it's not just the poorly educated that need to be closely monitored. One of the rare times this sort of thing happened at our facility, a Social Woker w/a Master's Degree left her husband and children to run off w/a male client w/severe mental health issues (he was a handsome guy, but really, what was she thinking?). Our management then initiated a mandatory inservice on boundary issues.
We have had our share of (for lack of a better word)squirrels come to work w/us, but they don't usually stay long. I do have co-workers that are on anti-depressant medication. In light of percentages in the general population in this country, I don't find that too surprising, and for the most part, these people are competent, at times outstanding, in their job performance.
To tell you the gut-honest truth, I would rather work w/someone who has first hand experience of mental illness than someone who simply does not understand that these are real neurochemical-based disorders and, no, they can't be cured by simply suggesting to a pt. that they "straighten up and fly right", in so many words.
I DO NOT believe that this sort of thing is more prevalant in the psych. field and this is coming from >10 yrs experience. And no, you can't judge a person's ability to perform their duties by looking at their current life situation. I work w/a PCT who has suffered divorce, "weird relationships", and yes has a maladjusted child or 2. She has a compassionate and therapeutic demeanor and pts are better off when they have been in her care. On the other hand, I used to work w/a CHARGE RN who had a stable marriage, functional children and a seeminglly idyllic life. This lady was out to save the world and frequently went well beyond her scope of practice to intervene in pt's lives, not always to their good. Rumor has it she would make calls to former clients if we had too many empty beds, "just to see how they were doing"
I guess my point is, we live in a diverse culture and it truly does take "all kinds of people to make a world". If you truly believe that aberrant behavior is more prevalant in the psych field, back it up w/repeatable research and numbers. By the way how do you "elucidate" someone. Sorry about the length of the post.
Very well said. Thank you for your post. You are absolutely correct in all that you said. I don't think the problems and issues being listed are only seen in psychiatric nurses, but in all nurses. I also don't believe that a true desire to help others is anything to be wary of. Nurses are supposed to be compassionate and caring. That's what we do, isn't it? When I stop wanting to help other people, I should stop being a nurse. Whether I work in OB, OR, Med Surg, Peds, or Psych; it's going to feel better at the end of the day to know I did the best I could to help someone get better than to think I put in eight or twelve hours not caring what happened to them.
Your story was so touching! As for the guy at work, if you lose his friendship at least you can be sure you made a difference in his life. You've had to endure so much pain in your life and to turn all that experience into a way to help others is, in my opinion, one of the bravest things a person can do. :kiss
ZZTopRN, BSN, RN
483 Posts
you make a lot of good points. In my year of volunteering in psych, I learned a lot, felt a lot of compassion for people, but I don't think I could have gone on with it day after day. After all, I was only there once a week and when patients did talk with me I felt fairly comfortable. But when they would sometimes talk about the terrible abuses in their life, I did not feel comfortable and was at a loss to say anything of comfort to them. I did attend on my own some of the classes or support groups for the patients and their families and could understand their distress. But I found that you can run into every type of diagnosis or problem possible, and on and on they go and keep returning to the hospital.
You know like you said about the ones that do excel, you are thrilled because I would see a patient that was really out of control one week and come back the next week and see a different person because their meds worked or they had ECT. But what I have learned, these patients are chronic and I guess I like to see "cures." I guess I just don't have that kind of patience seeing a lot the patients that just don't change. Most of my work has been in the acute med/surg work and I think that is still strong in me. I know a lot of the medical illnesses are chronic but I have discharged a lot of patients that don't come back as often and I guess it is just a different type of "detective work" with assessments and I just keep falling back to that. The nurses I worked with were just so outstanding, I felt that I would probably never reach their level. I guess that old med/surg is still pretty ingrained in me. But I did find your post very interesting as I did in the time I volunteered there. It was not a loss to me, but an adjunct to learning about a whole different set of illnesses and giving me a different viewpoint about mental illness which wll indeed be a help to me.