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why does something have to happen first?

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i am an lpn who has worked primarily my entire 7yr carrer in some form of locked psych setting...what do you do when your new nurse mgr. doesnt want to address your longterm psych pts decompensated states? when his mgr. dosent want to address the issue? when you only see a psychiatrist q 3-4 wks? when your nurse mgr hires all new rns w/o any psych experience and who are fearful of psych pts, thus giving into demands, threats of violence & not medicating for behavioral reasons? when the nurse mgr tells to ignore all you have learned r/t mental hygiene law: elopments, 2pc, court commitment, vol. & invol. admittance "it doesent apply to our new "Geropsych" unit, but the law still applies....doesnt it??? how do constantly report/doument a pts decompensated state for months & document that it is having an adverse impact on his decison making process r/t to denying medical tx and now we are to the point of going to bio-ethics to force medical tx on him, when all along (based on extensive past hx) this pt. when psychiatrically stable will allow tx. if not treated this pt will face an amputation!!!! but he also has an extensive hx of serious suicide attempts 2ndary to command hallucinations & yet since may of this yr he masturbates almost constantly affecting his adl's, is constantly responding to internal/external stim., saves his own urine in his rm in juice cups to conduct his own u/a "i'm a surgeon!", cannot handle off ward priv. d/t bizarre, inappropriate beh & on & on......and not one MED change or eval! all of this is doucmented daily!!! pt/pt pt/staff assaults have increased 10 fold, as have falls. the pt i have spoke of is not the only one being overlooked, and i am not the only staff person who feels this way???? what do i do, aside from leave, to help this situation???

I'm sorry, I'm probably not going to offer you anything new or constructive... I mean I could go on about reporting the situation to the relevant state authorities, but to be honest the first priority has to be your own wellbeing. Clearly you are suffering with the stress of wanting to provide a service to your clients and being prevented from doing so.. this is a recipe for a personal disaster.

Despite feelings of loyalty to your clients, and wanting to advocate on their behalf, your not going to help them if you drive yourself into the bed next door. I would document everything you have highlighted, hand in your resignation and then send your concerns to state authorities... why.. well its clear your (apparantly legitimate) concerns are not being responded to, if you threaten or actually do report the situation to authorities while employed there you could be victimised and/or scapegoated to appear to be in some way responsible for the situation. Finally, what pleasure are you getting out of work, we spend more time in work than at home, if your not happy and the potential for happiness is limited its probably time to move on.

yours regretfully StuPer

i am an lpn who has worked primarily my entire 7yr carrer in some form of locked psych setting...what do you do when your new nurse mgr. doesnt want to address your longterm psych pts decompensated states? when his mgr. dosent want to address the issue? when you only see a psychiatrist q 3-4 wks? when your nurse mgr hires all new rns w/o any psych experience and who are fearful of psych pts, thus giving into demands, threats of violence & not medicating for behavioral reasons? when the nurse mgr tells to ignore all you have learned r/t mental hygiene law: elopments, 2pc, court commitment, vol. & invol. admittance "it doesent apply to our new "Geropsych" unit, but the law still applies....doesnt it??? how do constantly report/doument a pts decompensated state for months & document that it is having an adverse impact on his decison making process r/t to denying medical tx and now we are to the point of going to bio-ethics to force medical tx on him, when all along (based on extensive past hx) this pt. when psychiatrically stable will allow tx. if not treated this pt will face an amputation!!!! but he also has an extensive hx of serious suicide attempts 2ndary to command hallucinations & yet since may of this yr he masturbates almost constantly affecting his adl's, is constantly responding to internal/external stim., saves his own urine in his rm in juice cups to conduct his own u/a "i'm a surgeon!", cannot handle off ward priv. d/t bizarre, inappropriate beh & on & on......and not one MED change or eval! all of this is doucmented daily!!! pt/pt pt/staff assaults have increased 10 fold, as have falls. the pt i have spoke of is not the only one being overlooked, and i am not the only staff person who feels this way???? what do i do, aside from leave, to help this situation???

Hi there. I have been a psych nurse since 1973. I worked in many a in-patient unit (now in out patient).

continue to chart. bring this up in team meeting where the patient MD. is there. Have the other staff that feel this way go to the staff/team meetings with u to give their support.

don't quit yet until its resolved and u can leave knowing u made a difference.

and by the way, go for your RN.

thanks for responding....i have thought of leaving, saving myself so to speak, but i'm one of those who feels like one person can change the world!!! i just havent figured out how!!! the bio-ethics team met in re: to that pt today & ruled that it would be unethical to force medical tx on this pt, when there is a longstanding hx. of medical compliance w/this person when they are psychiatrically stabil....a bittersweet victory in my book...now, just to get him psych tx.,before he loses his foot! i went to work last night & again pulled up the mental hygiene law for our state, highlighting all that applies to each different law that is implicated w/different pts and the hospital policy that corresponds w/the laws, giving it to my night supervisor. she is going to have a mtg. w/the chiefs of the hosp. and bring it up w/them. she was'nt aware that this was going on....i guess my concern is not only for my pts, but also the new rn's that are unaware of the law....i think that we have all been in a situation where we learn that "poop rolls down hill" and i would hate to see someone in a potential situation where they could have legal charges pressed or loss of job, or even worse....lose their license, just because they arent trained and a new nurse mgr.dosent want to recognize the potential legal, ethical ramifications of not having done so. i know i wont let someone who is 2pc'd, high elopement risk, out on unescorted privleges...and i know why i shouldnt, why i cant!, but it goes on all day long!!! the potential for pt/staff disaster is very high...the pt advocate is going to be getting a call in the morning re: all of my other issues (i stopped by the outpt clinic & spoke w/my mentor when i first started working...a rn w/34yrs in acute psych, and she told me to go to the pt advocate, that i would not have to divulge my name...we have computerized charting, so i could tell her where to look in the records and never have to see her and she would be very interested in what i have to show her!) i guess when i get home every morning i might be frazled/frustrated, but i really do feel like i have a purpose and i can make a difference! when i dont feel that way anymore....i guess i could always convert to being a band-aid bunny! (what we affectionately call the medical nurses in our facillity) i will always be a nurse!

Glad to see your getting some results, even if there maybe a long journey. In light of what you've said, it maybe there are enough supports and concerned individuals in the organisation that there could be change.

I re-iterate though, don't set yourself up to be a martyr, if there are supports in place fine, but if your going to have to fight on your own then your mental state could be affected. We as nurses do get the Florence Nightingale bug occeasionally and feel we have to sacrific ourselves for the good of the patients, however through bitter experience some have learn't that it only created another patient.

Good luck in your campaign, and I hope your patients benefit... your a credit to the profession.

regards StuPer

Sounds like you work where I do, sad but true. First of all allow me to say that I certainly can relate to you. Happens quite a bit here I work. Myself I think denying the patient the medication that will stabalize them is abusive. Allowing a psychotic patient to continue to refuse medication & steadily decompensate is abusive. This is time lost from their lives locked away in a facillity in a state of psychosis when they could be stabalized & perhaps living in the community hving an increased quality of life. Now then the argument is that we can't force them to ake medication this would be abusive. Most facillities have in place policy on medication administration agaist a patient's wishes. If no such policy exists then medication administration can be court ordered. If the patient is so psychotic & is in a dangerous medical state which requires treatment but the patient will not consent then the patient is in actuality a danger to himself & thus committable or at least could be deamed incompetient. Mind for all of this one requires the cooperation of the ward physician & members of the treatment team. In my experience the best I can do at times is to document the facts of the situation. Ex; working nights I come in to only find that yet another day has passed & the MD has ordered no PRN medication for a psychotic patient who is steadily decompensating, nor have they increased the medication at all they may have even decreased it. The patient is of course awake & carring on. I call the MD on call & force them to come to the unit & see the patient. I insist on increase in the medication & or PRN medication so the patient may actually get some relief. I document in the record how I had to call the MD on calll as the ward physician had ordered NO PRN medication at all for this actutely psychotic patient. I go on to describe the patients symptoms & behavior. I go into detail about the patient & offer that this condition has been steadily decompensating & has been repeatedly reported to the ward physician. (gotta make sure you can prove that ne but if you see the situation cming you an begin to set it up so you have the proof in several days worth of notes in the record). You know I REALLY hate to be so difficult in harting this way however I just CAN'T STAND to sit & watch a patient suffer all b/c the MD is lazy or incompetent or just doesn't care.

The patient advocate was a nice touch, I too would remain annonymous in this regard. If you choose to remain employeed where you are & they know anything came from you, I would definately fear they would retaliate, no matter that you were right. Many times administration does not care to know the real problems as then they might actually have to address them.

In any event I wish you the vey best of luck in your situation & believe me when I say I do UNDERSTAND exactly how you feel.

On an aside forgive all the missing letters in my reply. I have one of those cordless keyboards & the dang things ALWAYS drops letters when I get to typing fast, as I do with long replies.

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