re: something to consider...

Movingalong,

I totally understand your post. I've seen the quality of care decline at my psych facility. It's mostly DNA copying error at our place - we've have tremendous turnover and each successive generation of new staff gets a poorer and poorer orientation because they're learning from people who have been there less and less time. The folks who have been there forever are burned out on teaching new staff and feel loathe to invest time and energy in people they see not staying.

I'm not so much in a problem solving mood tonight as a griping mood, so I'm a little at a loss as to what to do about it. And since I am merely a PRN person there, and the fulltimers don't care enough to do anything, it's a difficult hurdle.

You are so right about the full time people not caring enough to do anything about it. I finally resigned my volunteer position (I am seriously seeking work now). It came to a head the last night I was there. There has been a cna that has been there for I don't know how long who regularly verbally abuses the patients and gets right in the nurses faces. The nurses have stopped complaining to the Lead Nurse. Anyway, my last night there, my favorite NM had 2 admissions and I didn't see her for most of the evening but the Lead nurse, after she was through with her charting, socialized, took long smoke breaks, party time with other staff members coming in and would you believe when I asked the cna to help me with a patient because there was no one on the floor except me, a volunteer, an unlicensed person, trying to keep order with the patient's in a group watching an educational video, I got no help after asking for help putting a confused patient to bed (not my duty, but no one else was watching out for the patients.) I asked the cna for help who was socializing with the Lead nurse if she could help me and she said "I'm going on break." So when I started going to another unit to ask for help, the Lead nurse ran out of the nurses station and said "John" will be back from break to take care of him." Not the slightest concern about this patient or any of the others. Do not apologize for "griping." I haven't been that angry in I don't know when. I guess this is my way of venting from this.

Oh, by the way, what is DNA copying error?" I think I have a bit of a clue but if you don't mind, enlighten me further.

Wishing you words of comfort.

It's technically the theory on why we age - cells replicate and replicate, and each new one is a little less perfect than the last. Alternately, when you use a xerox machine, if you make a copy, then make a copy of that copy, and so on, each one is a little messier than the last.

Each new orientee is trained by someone who is less experienced than her predecessor.

I'm in a better frame of mind today. I'm on at the facility this weekend. This will be my first official weekend on a different psych unit. We'll see how it goes :).

i LOVE that! :rotfl:

I have worked about 20 yrs in psych and another ten in med surge and emergency nursing.

I have found my psych coworkers to be generally saner than those who worked with me in med surg and the ER. Mostly this is due to careful screening by the personnel dept and a serious committment to self support and supervision by the clinical staff. Unfortunately that committment to self healing is time and energy consuming. The bean counters often don't see the need for it and put pressure on clinical staff to spend their time on things that make money.

The best single thing to be done to prevent patient suicide, is increased staff. This means that the patients are watched more closely and get more staff contact.

I have to agree with the comment that ingeneral people with problems do think they might gain insight by working in psych. These are the ones that the careful screening should be screening out. Not just for the sake of the institution either, one of the nastiest meltdowns I have ever witnessed was when a nurse with childhood sexual abuse issues was working on a women's specialty unit with women who had histories of profound childhood abuse. Eventually she heard something from a patient that she could not handle.

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?

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.

Interesting discussion and some well made points, I suppose In my experience I did get involved in mental health for personal reasons, but rather than personal problems it was an interest in philosophy, psychology and wondering about my own reactions to different social issues that led me down the path to mental health (well that and being tired of welding....:-D).

I've worked in many non-mental health clinical areas though, and I have to say that while yes some psych nurses have no business talking to bricks let alone patients, the majority have been more settled, stable, and relaxed with who they are then most non-mental health nurses I've met. The backstabbing between shifts and various nurses on general wards would make Lucrecia Borgia blush.

One last point, perhaps the reason we're having this discussion at all is that nurses who work in mental health tend to be more introspective and analyse the way they react and behave with others more than non-mental health clinicians. After all the old saying goes (and boy do I tell many a patient this) you can't learn to love (and care for) anyone else, until you learn to love (and care for) yourself.

regards StuPer

i had a psych instructor who said that you cannot offer counsiling help to someone else unless you have been through some yourself. i think this is true with any aspect. i think you have better insight and empathy for the person you are helping.

i think there has to be a line though. i wonder about those who have committed suicide. i wonder if they showed signs to any co workers. hind sight but i just wonder. we often are shocked that a co worker would do something extreme. did we see signs and just chalk them up to stress? or did we just ignore them and think, "no, not them...." just a thought.

I agree, therapy is generally part of a counseling program.

Now that you mention it, I don't think I really want to work psych now. You post is very well taken. I had been volunteering on an adult locked unit for over a year. My NM talked me into renewing my RN license and go to work there. I had been in that hospital once for 3-4 days for depression and just thought it was the nicest place, hence my ending up as a volunteer....

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....

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.......

I'm glad you like the post, and boundaries are a huge issue.

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.