Jump to content

Topics About 'Mental Health'.

These are topics that staff believe are closely related. If you want to search all posts for a phrase or term please use the Search feature.

Found 12 results

  1. W. Barding

    Take Note of the Small Stuff

    “Don’t Sweat The Small Stuff”. We have all probably heard this and would most likely agree. However, let's take a moment to look at this from a different perspective. We have all been quarantined, separated and isolated from loved ones and friends for months and let's face it, our mental health has clearly been affected. We get up on the wrong side of the bed and everyone else pays the price. We take it out on the fast food worker because our order is slow or the greeter at the grocery store because they look at us wrong. According to an article in Frontiers in Psychology social isolation has been linked to anxiety and depression (Pietrabissa & Simpson, 2020). This should not be taken lightly; we need to take steps to help prevent the downward spiral of our emotional health. Time for a Challenge Time to expand our outlook! Take that driver that is tailgating you, let’s be honest your first instinct is to get angry and say a few choice words. It is then we must take a deep breath and try for a minute to look from their perspective. Maybe they are having a bad day or maybe there is an emergency they are trying to get to. The reason I am suggesting this approach is more for your emotional health than for their benefit. If all we get out of that experience is anger, then we pay it forward to the next poor soul that steps into our path, and the trend continues. I have actually tried this myself and it did make a difference in my thought process. I let go of the anger that really only hurt me and pretty sure my blood pressure dropped about 20 points. It is a terribly heavy burden to carry that anger around all day. It takes energy to hang on to when we could use that energy somewhere else to make a positive impact. Now, do I do this every time I run into this situation? No! But I know when I do it changes me, little by little. Pre Op Testing You know all the testing you have to do before a procedure such as labs, x-rays, and EKG’s. This information tells the physician whether it is safe for the patient to undergo the procedure, in this sense it prepares the physician to proceed or not. How can we prepare ourselves to endure those negative impacts we encounter throughout the day? Let's explore a few outlets to let go of the negative energy and bring in the positive. Downward dog, Warrior II, jumping grasshopper, yes you guessed it, yoga has been a long time activity known to reduce stress and help center your thoughts. According to a Mayo Clinic Article “Yoga brings together physical and mental disciplines that may help you achieve peacefulness of body and mind. This can help you relax and manage stress and anxiety.” (Mayo Clinic Staff, 2020). Let’s not forget the great physical benefits as well! If this is a good fit for you then I would encourage you to consider this outlet. Another avenue for consideration is meditation. This can be done just by picking a quiet place in your home sitting for a few minutes in silence and clearing your mind. Some people play soft soothing music, while others play a mediation app that walks them through soothing relaxation techniques. WebMd has an article that states daily relaxation in the form of meditation helps reduce stress, enhance our mood and even lower our blood pressure (WebMd Staff, 2020). This is simple enough anyone can do it. It does not require any physical effort but does give physical benefits. My personal way of centering myself and seeking a positive outlook is through prayer and devotional reading. It helps me take the focus off of myself and gives me a sense of peace that I carry throughout my day. It gives you a sense that I am not carrying these burdens by myself. They say that people of faith are generally happier and less prone to depression (Vann, MPH, 2015). These are just three ways that we can prepare ourselves for the day's events and have a more positive impact on all around us, including ourselves. Attitude of Gratitude Now that we have adjusted our attitude, done the jumping grasshopper and taken time for prayer and devotion let's take actual note of the small stuff. What do I mean by that? Have you ever noticed the little things that people do for you? A few days ago I had decided to look for all the ways that people did something kind for me. I was driving to work when I passed a semi and when I was far enough ahead he flashed his lights to let me know it was OK to get back over. I got to work and a coworker held the door open for me. Multiple times throughout my workday coworkers offered to help me with my task. When I got home my husband had made a delicious dinner. My husband made me ad delicious. LOL These gestures make me feel good and I want to return the kindness. Always look for opportunities to fill your heart, open a door, pick something up that someone drops or write a note to a coworker and tell them how much you appreciate them. Take advantage of small chances to make someone's day a little brighter and perhaps let them know we are all not quite as isolated as we feel. The last several months have been a challenge, to say the least. Our mental health has taken a beating and it shows. Yoga, meditation and prayer can help center your soul relieve some of the stress. So cling to the small acts of kindness in your day, pay it forward, for this may help us learn a little more about ourselves and those around us. Bibliography Mayo Clinic Staff. (2020, December 29). Yoga: Fight stress and find serenity. Healthy Lifestyle Stress Management. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/yoga/art-20044733 Pietrabissa, G., & Simpson, S. G. (2020, September 9). Psychological Consequences of Social Isolation During COVID-19 Outbreak. Frontiers in Psychology. https://www.frontiersin.org/articles/10.3389/fpsyg.2020.02201/full Vann, MPH, M. R. (2015, December 7). How Prayer Strengthens Your Emotional Health. Everyday Health. https://www.everydayhealth.com/emotional-health/power-of-prayer.aspx WebMd Staff. (2020, July 28). Meditation, Stress, and Your Health. WebMD. https://www.webmd.com/balance/guide/meditation-natural-remedy-for-insomnia#1 Take Note of the small stuff(1).pdf
  2. Brian Short, founder of allnurses.com, aka allnurses®, along with his wife and 3 teenage children, died in a tragic murder-suicide in 2015 due to a quick onset and fast-spreading serious mental illness. I met Brian once during his lifetime, but I actually got to know him after his death. This is my story, from my point of reference. You will read my opinion, based on my understanding, of what is, and what could have been… this is my personal point of view. What Would I Find? During the first few months as the new business operations manager at allnurses®, I expected to find skeletons in every closet. I expected to see signs of financial trouble and cover-up. I expected to learn about hidden debt problems. I expected to uncover and discover financial areas of small business distress. I expected to hear stories of despair, stories of shame and secrets to keep the business afloat. Given the unspeakable nature of Brian’s death, local and national news stories, reports of a defamation lawsuit, and his uncharacteristic, horrendous actions just prior to his death, I expected to be walking into an unpredictable, messy, challenging situation. In fact, the financial business story that was slowly unfolding was contrary to what I initially expected. There was nothing out of the ordinary here. What I was looking at were the records of what seemed to be a healthy, debt-free, and rather remarkable small business. A business with a substantial operational checking account balance. A business that had built a solid team of dedicated employees that were traumatized by what had just happened to their leader and his family. A business that was thoughtfully managed with passion and a giving-back attitude. allnurses® was not only consistently operating profitably from month to month, I found a recently established non-profit under the name “allnurses® Foundation”, which was in the process of setting up a Board of Directors. The foundation was well on its way to becoming a fully operational do-good Charity. OK I’m thinking, this makes sense, the business checking account was holding an unusually high balance, a reserve, which I now figured was earmarked for this newly formed do-good Charity. I learned the intention was to fund the do-good Charity with a portion of allnurses® operational profits and provide benefits to the underprivileged. It was becoming clear to me that the founder of this company was a visionary that deeply cared about giving back to his community. Brian Short was hoping to do good things with his business by putting profits into a charity that would help others. Helping Others Perhaps Brian set up the do-good Charity because he knew the challenge of growing up without privilege. He once told a friend (Randy Cassingham’s in “Two Good Friends”) “We were very poor growing up, I lived in the ghetto on the north side of Milwaukee. This humble beginning was a great source of passion to want more and do something better with my life.” His best friend’s mom was a nurse, and that’s what led him to the profession. Along with giving back to his community, Brian developed a passion early for using the internet to help the nursing profession. Brian became a critical care nurse to help people, but during that process he also started allnurses® because he wanted to help his fellow students. Brian was a nursing student in the 1990’s when he started a helpful-link-page on the internet. He couldn’t find enough information about the nursing profession, so he set up the page so his fellow students would have a quick resource. allnurses® grew from a page of helpful links to a discussion forum to allow nursing students and nurses to ask questions of their peers, seek career advice and share first hand experiences. From early on, it was clear to Brian, that in order to maintain a safe, secure and privacy-compliant discussion platform, it was important to protect each users’ anonymity. From the beginning of allnurses®, the core values were in place to make the site a welcome discussion area where all users could state their opinions and safely carry on conversations. Greater Cause As I got to know the team at allnurses®, I could see that Brian treated his employees very well. He had built a dedicated and passionate staff under his leadership. These loyal employees were now willingly working alongside me, as the newcomer, and were ready to buckle down and work hard through this transition to meet challenges head-on for the sake of his legacy. I came to allnurses® to help manage operations after Brian’s untimely death. I was confident that my passion and past experience counseling small business owners through difficult situations as the Director of our local SBA Women’s Business Center would be valuable for allnurses®. Assisting this business would be rewarding. After spending 30 years successfully growing my own family business, and turning operations over to the 2nd generation of owners/managers, the timing was right. I was up for the challenge. There was another basic underlying draw for me to this job. It was very clear to me that Brian died at the hands of a severe mental illness. This hit a raw nerve in me. In my 2nd year of college, my uncle, only 3 years my senior, committed suicide. He was my mom’s youngest brother, a neighbor, my childhood best friend, he was like my big brother. I was devastated. I couldn’t stop thinking about what I could have done to prevent his death. Why would he do this to our family? My poor Grandma. My poor Mother. I became angry at myself. What did I miss? What is wrong with me that he couldn’t talk to me about his feelings? I felt so helpless. Other than consoling words, loving hugs, and keeping in touch while I was back in college, I felt like there was so little I could do to help. Joining the team at allnurses® would not only allow me to help the business through a difficult situation, but it would also be humbling, and perhaps healing, to be a part of a much greater cause. Brian’s goal for allnurses® was to fund a do-good Charity - perhaps nursing scholarships for the underprivileged. After Brian's death, the family would likely prefer to channel their grief toward another do-good cause - mental health awareness and suicide prevention. That was a comforting thought and might help me close the wound from my uncle's suicide many years before. Facing Adversity But first we had a big hurdle to get over. A sprawling 17-count-civil lawsuit. (Docket Number: 2:15-cv-03202) My initial opinion after reading the lawsuit was that the allegations were a mixture of false claims and baseless exaggerated presumptions. This was clearly a meritless case that should quickly be dismissed and hopefully put behind us. Believe it or not, our legal system allows any party to file a civil lawsuit against another party if they feel wronged. The defending party then has no choice except to settle with the suing party or hire an attorney to fight every charge and let the courts decide the outcome. Early on, before I joined the team, allnurses® attempted to settle the lawsuit, but they would not agree. Their lawsuit was looking for monetary damages and asking for the case to be brought before a jury. Brian knew his site users had a right to their opinion and allnurses® was innocent of any wrongdoing, but at this point, he realized this was going to drag on and on. Could this depressing realization been the trigger to his declining mental health? As the months turned into years, my original hope for a quick resolution to the crazy lawsuit slowly faded. The suing party amended the charges, then a year later amended them again. In the end they amended the charges 3 times. THREE TIMES. The legal costs were piling up faster and faster and the charity reserves set aside for the do-good Charity …. was eventually spent. Finally, 3 years into the battle, the case was dismissed ---- but wait ----- the suing party was not done yet. They decided to appeal. allnurses® had no choice, now we had to pay to go through an appeals process, and this took another 2 years. Did We Win? On August 19, 2020, we heard from the appeals court and the case was dismissed, again. I guess we won. We were victors. Or victims? The costs and pain cut deep. This lawsuit has been proven to have absolutely no merit. allnurses® and its members did nothing wrong. Hailed the victors, yet felt like victims. Think about the family, fans, classmates, neighbors, friends, siblings, parents, employees who lost dearly. They are the victims. They lost their loved ones, brother, sister, cousin, son, respected founder and family to a serious mental illness that spiraled downward at the onset of the lawsuit. The business drained its charity reserve, originally designated for good causes by the founder, to defend this massive exaggerated meritless lawsuit to a tune of over a half a million dollars. I don't think the suing party set out to cause allnurses® all this emotional pain. But I did originally underestimate the ruthlessness of their greed and how far they would reach to get what they want. Looking at it now, it seems they just saw this as an opportunity to make money. Perhaps they felt the more they piled into the allegations, the more likely allnurses® would give in and offer a monetary settlement. We didn’t give in. We fought until we won. The key is WE won - which means Brian won. They did not win. Should Defending Party Pay For Case Dismissed? We have big problems in our judicial system when a civil case can be brought against a company, found to be meritless by the courts and dismissed, appealed and found again to be meritless and dismissed again in a higher court, and the suing party does not become automatically responsible for the monetary costs incurred by the completely innocent defending party. Things need to change. In every state, including Minnesota, a clear message needs to be sent. Hey if you are suing out of greed or to get a hopeful insurance settlement, you better have a valid claim, or you will be required to reimburse the defending party for ALL costs associated when your case is found to be meritless and dismissed. As I have stated, this didn’t happen here and the fallout and pain to allnurses® ... enormous. But what was actually lost was even more. What Could Have Been I frequently reflect on what charitable work and benefits that could have been funded over the last 5 years with the charity reserves that Brian had set aside. All the underprivileged nursing students that could have but did not receive scholarships. Perhaps we could have used the funds to support men’s mental health awareness causes. A cause that is close to the hearts of all employees, fans, siblings and family of the allnurses® team. Maybe we could have prevented two or three other families from having to go through this devastating pain. Overcoming Adversity Leads To Strength Greed’s ugly head might have put Brian’s charitable intentions on hold while allnurses® fought it off, but now we are ready to wash our hands, move on and over this hurdle. As a team, allnurses® has renewed energy to carry on Brian’s wishes. Our mission is to empower, unite and advance our members by providing a secure and safe online community where nurses, educators, students and professionals could voice opinions freely and anonymously. Now we are able to offer an even stronger nursing career and support environment for the nursing community. We are proud that our members have trusted us since 1997 and represent more than 60 professional nursing specialties from around the globe. Thanks for keeping the momentum going, and I'm glad to be a part of the journey. Welcome to Brian's Legacy. Grow and succeed with us. Please note: In order to properly perform my duties, I had access to every private and business email, record, password, file ... everything. There was absolutely nothing of indiscretion to be found, even after 5 years. It is important to me that readers understand Brian’s character as I have came to understand him. Links and Information regarding suicide prevention: National Suicide Prevention Lifeline American Foundation for Suicide Prevention Crisis Text Line Veterans Crisis Line Suicide Prevention Resource Center
  3. Falcon RN

    Employee Health During Covid

    So I am finishing up a paper for my last term of my BSN and it's about how confidential employee mental health services should be available 24/7 for medical staff. I was just curious if anyone has mental health wellness services available (especially for the night shifters)? If so, what form does it take? If you could make a change to your organization in this regard, what would you like to see? Please feel free to comment on anything related to protecting the mental health of nurses during this crisis. Thank you in advance! I really believe this is something that should be addressed across the nation.
  4. Katniss88

    Mental health during the pandemic

    I was diagnosed with depression at the end of 2017 after seeking counseling for the first time. I didn't start an antidepressant till probably the next year, then I would take them on and off, kept telling myself that I wasn't depressed and didn't need the medication. Then in mid 2019, I had an embarrassing experience which provoked me to seek out counseling again. I found the right therapist and have been taking an antidepressant since. Nursing can be stressful at times, but I was doing fine with my depression and doing well until March. I worked on a COVID unit for the first time on a Friday, then the next day "bam" here are feelings of anxiety, sadness, and crying. I worked on a non critical COVID unit for a while and even volunteered because I wanted to help and wasn't afraid( I was afraid the very first time I worked on the unit). I forced myself to stop watching the news, even though I wanted to watch, because it increased my anxiety levels. We have been working overtime hours every other week since this pandemic started. Then recently the hospital is requiring us to work OT every week. That's asking too much. I am a nurse who RARLEY will pick up OT. I have worked 3 straight weeks of overtime. What makes it worse is having sicker patients than usual on my med/surg unit, these are not even COVID patients. I cannot devote the right amount of attention to a really sick patient who might turn critical when I have 5 others pts. The increased hours on top of taking care of really sick patient's has been wearing me thin. I like where I work, but I feel like I am becoming burned out.
  5. simba and mufasa

    Mental Health: A RACE I HAVE TO RUN!

    When I graduated, my first instincts were to work in a MHU, but did not. Over the years, I have gone to many specialties, but still feel as if something is missing. Before COVID-19, I was contemplating on obtaining a post-masters certificate in MH, but was not sure, but thanks to COVID-19, its the green light for me to pursue this dream! DNP/ NP /CRNA, Informatics, Education? Is PhD worth investing in? Midlife crises?, Mental Health NP here I come You are a Pill Pusher Mental Health: Job suitable for retirement Working with the crazy, not my cup of tea You are going to end up like them MHNPs do not work; all they do is write prescriptions! Introduction "There's this stigma or attitude when it comes to the topic of mental health that we aren't supposed to talk about it. We're supposed to ignore "(Grant,2016). According to the World Health Organization, WHO (2008), mental health and substance abuse, both contribute to the second largest cause of disability and disease burden worldwide. Mental health commodities have adverse health outcomes and increased costs for the individual as well as the broader population (2012). Stigma results in adverse health outcomes, furthermore tragic events such as mass shootings, natural disasters, racism, other acts of violence and last but not least, the COVID-19 pandemic, highlight the need to address the stigma associated with mental illness and substance abuse disorders to improve our public mental health system (Mathers, Fat, Boerma, 2008). Background in Mental Health Mental health is a taboo topic in Africa. Growing up in southern Africa, people whispered behind closed doors so that they could not be heard. There was talk of people being mentally unbalanced or being weird in their behavior. After the liberation war, when soldiers came back, they were not the same. Many were withdrawn, abused alcohol and others committed suicide. Suicides were never discussed, they were hushed up and families suffered in silence. In retrospect, people with depression, anxiety, maniac disorders, post-traumatic stress disorder PTSD as the returning soldiers were never treated nor did they get the counseling necessary for their well-being and these were mental health issues that needed treatment and counseling. Near Miss When I graduated nursing many years ago my first choice was to work in a mental health unit, MHU. During my psychiatry rotations, I was inspired and motivated by the nurses’ work ethics and caring attitude. I fell in love with many aspects of mental health. The hospital I wanted to work at that time was in the news, a mental health technician was killed by a patient, as a result, my family was up in arms with this decision, so eventually went to the Medical-Surgical unit instead. Through the years, I have worked in the Intensive Care Unit, Telemetry, adjunct clinical instructor, and lecturer. As I have rotated through these units, I never felt accomplished. I always felt as if there was something missing. I struggled for self-identity as a professional. The thought of being a mental health provider always lingered in my thoughts and I always wondered what it would be like to become one. COVID-19 and Mental Health In March 2020, the world health Organization declared COVID-19 a pandemic(WHO). Since the pandemic many people have lost their jobs and the resulting downturn of the economy has negatively affected many people’s mental health and resulted in new limitations for people with prior history mental illness and substance use disorders (Panchal et. al., 2020). As the virus keep moving to different states, factors such as school closures, social distancing and isolation and financial distress will increase mental health issues such as anxiety. Social isolation and loneliness result in poor mental health and households with older adults and adolescents are at risk for depression and suicidal ideation (Panchal et. al., 2020). Job loss is correlated with increased depression, anxiety, distress, low self-esteem and may result in higher rates of substance use disorder and suicide (Panchal et. al., 2020). Deaths due to drug overdose have increased more than threefold over the past 19 years. Stress, Burnout and Fatigue, PTSD in Healthcare Workers As a healthcare worker on the frontline in New York state, I was stressed and fearful for my life as we did not have enough PPE. I was afraid of bringing the virus to my loved ones. As a nurse in the ICU, the nurse-patient ratio changed from three or four at times. These patients were critically ill and taking care of them was emotionally draining. I have never seen so many deaths at once. Codes and rapid responses were called over the intercom every five minutes, I felt like I was living and playing in a horror movie. I have been having dreams of some of the patients and am sure am suffering from PTSD. Insomnia has set in as well. Most of my fellow nurses have turned to beer or wine to rewind. We have not been given any resources to utilize for coping once the pandemic slowed down. Burnout can eventually lead to mental health issues such as depression and substance use. Choosing Mental Health People newly affected, will likely require mental health and substance use services. Those with prior history will continue using the services but there is a shortage of mental health providers (Panchal et. al., 2020). I chose to be a mental health practitioner, MHNP, so that I can help bridge the gap and provide much needed services as existing ones are overwhelmed due to the pandemic. I also would like to educate my fellow Africans that mental health is a disease that needs attention and that there is nothing to be embarrassed about. I chose to be a MHNP so that I can help frontline employee’s suffering from the effects of COVID-19. I chose mental health so that I can help different people in all age groups. Working at a group home with teenagers with mental issues reinforced my will to be a MHNP. As a nurse, I would take the teenagers for their psychiatric evaluations, we would spend the whole day waiting because there were other people who also had appointments with the same psychiatrist who served many group homes and served the whole county. I would watch the psychiatrist write script after script without properly assessing the patients. As a MHNP, I will take the time to talk to my patients, evaluate the effectiveness of medications before loading them with more pills. Jails have inmates with numerous mental health issues. When released the inmates need proper care, so it is my intention to work with the underprivileged of society and give back as America has allowed me to go beyond my imaginations professionally and improve patient outcomes. The COVID-19 pandemic gave me the green light to pursue what has been in the back of my mind for so long. Sometimes in life, you need a sign to pursue a dream, and I think the pandemic made me open my ears to listen to that inner voice. I plan to use my education to inform and teach people about mental health. I also plan to continue being an educator specializing in mental health. Nursing students’ curriculum includes mental health but there is a shortage of nursing faculty. I will be a great resource when I become a MHNP and as a result, will become proficient in managing mental health improving patient outcomes.
  6. spotangel

    Saving Frank!

    This article was written and initially submitted in December 2017 and at that time I asked for it not to be published yet. With what just happened in the last few weeks, I feel now is the time. Ironically enough my initial title was, “I can’t breathe!” I had changed the title as I did not want to evoke or trigger emotions. Now that same title is a hashtag! It is out there now. Trevor Noah called it and gave us all a perspective of how the shoe feels on the other foot. Frank In the last two weeks, we have seen blatant discrimination captured on camera in NYC and Minneapolis. As a human being, it was extremely hard to watch George Floyd die. As a professional, my mind was screaming to let up on the knee pressure, start CPR on the field and right a wrong. I imagined the other end of it as the ER staff now received a patient who was clearly dead and desperately tried to save him. It took me back to 2008 when my ED team and I were in a similar situation. Frank was brought into my ED when a Group Home staff's good intentions backfired. Here is what happened. Saving Frank in Today’s World “Not again lord!” my brain screamed as my hand reached for the red phone calling with an emergency. This was our 5th code in the space of 2 hours that EMS was bringing in on a Saturday. A 25-year-old black male without a pulse and CPR in progress. ETA (Estimated Time of Arrival) 5 minutes. I marshalled my weary troops again and set up for the code. We had plenty of time as they took around 20 minutes to arrive. We took over once they rolled in. Behind the ambulance around 6 squad cars pulled up. As I went in and out of the resuscitation room, my eyes lingered around 20 police officers by the entrance of the ED. “Something is cooking!” I thought to myself. The Story of What Happened The patient, Frank, was DOA (Dead on Arrival) and had been coded in the field for over 40 minutes. We worked on him for over an hour without a rhythm. He was finally pronounced. The EMS gave us the story. Frank was a schizophrenic and lived in a group home. He had no family. He was agitated and pacing and so one of the staff got worried. They asked him to go to the ER and he refused. They called 911 after consulting their manager and EMS arrived as so did the cops. When Frank refused again, the cops called for reinforcements and struggled to contain him. He struggled violently. They then put him in an Emotionally Disturbed Person (EDP) body bag also known as a "burrito". Every time he raised his head up and screamed, they held him down. Soon he stopped struggling. The EMS team got him on the stretcher to put him in the ambulance. One of the EMS workers noticed that he was not breathing and had no pulse. They called for reinforcement and started CPR. The ALS team arrived to help and intubated him on the scene, continued CPR, and brought him to our ER. I saw the ED Tech take his belongings and clothes after the code, label the bag with his name, date of birth, Medical Record number and the date, then put it in our utility room. The weary staff moved on to the next emergency disheartened that we could not save him. Police Arrive I saw two more unmarked police black SUVs park at the ambulance bay and a few suits come in. They wanted to speak to the ED attending that ran the code. I pointed him out to them and they thanked me. They were from the police IID (Internal Investigation Division) as a call had gone out to them. They were also directed to Medical Records as they wanted copies of the ED course and copy of the medical chart as part of their investigation. Medical Records would direct them on our hospital protocol to obtain records. Frank's Group Home Contacted A phone call was made to the group home and the phone number obtained for the manager. She was not informed of his death but asked to come to the ED. She came with the assistant manager and the doctor and I took them to our family room. Sitting around a small table we informed them gently of his death. Rose, the manager, began shaking and crying. “I should not have asked them to send him to the ER. I should have come in and calmed him down. He would have been alive!” Sara, the assistant manager, raised a trembling hand and put it on Rose’s shoulder to comfort her. “I can’t believe it! Poor Frank. Dear God! What did we do! We only wanted to help him.” Both women sat crying. The doctor walked out after hearing an overhead page for him leaving me with both of them. Swallowing my tears, I asked them if they wanted to view Frank’s body. Hesitantly, still in shock, they agreed. I walked them into the resuscitation room and pulled 2 chairs for them to sit by Frank. They sat silently, tears rolling down and dripping, shoulders shaking, Sara covering her face while Rose stared at Frank’s face, her eyes anguished. I silently offered them a box of tissues and murmured that I would be back in a few minutes. Frank's Belongings I walked into the utility room and put on gloves and took out the bag of Frank’s belongings and the belongings list clipped to it. Silently, I opened the bag and checked all the items against the list. A watch with a cracked dial, shoes and socks, a tee-shirt still wet with his sweat and sweat pants and underwear soaked in urine, a wallet with a $2 Lotto ticket, and a train monthly pass. Eyes smarting, I put all the belongings back imagining his last struggle at life as with every ounce of his strength he struggled to live. I Wish ... I wish he had got a second chance in life. I wish he had been with staff that knew how to handle his pacing and increased agitation. I wish it had been a weekday with full access to a psychologist and other trained personal that could have handled his issue in a safe manner. I wished that the EMS and cops that had come in contact with him had dealt with him differently given a second chance. None of the wishing would change the outcome. Wiping my tears away, sick to my stomach, I walked slowly back into the room and gave them his belongings. They left and Frank was sent to the morgue as he had no family. The police group and the IID also left. De-escalation I went home feeling drained, wondering what we as nurses can do to educate others in handling psych patients. Many times as situations can quickly change, chances of violence and harm are high, triggering the choice to use force to subdue a patient. De-escalation is a learned art. How much training and mock practices on de-escalation are our first responders getting? What kind of training should health teams get to help patients, keeping ourselves safe at the same time? What is the aftermath of the ones left behind and the ones that worsened the situation while meaning to help? Which professional schools teach these techniques in mainstream classes as anyone at any time can be affected as one goes about their daily life? I have seen videos of how to deal with an active shooter scenario but very few on psych outbursts and de-escalation techniques. How Can We Help Save the Franks of the World? For starters, the focus should be on primary care. Many times, these situations escalate during off-hours and weekends when there is minimum help available. Primary care health providers including Nurses, Home Health Aides, Med Techs, Community Health Workers, and all who touch the patient in clinic or at home (family members) should be taught mental health awareness, de-escalation techniques and how to recognize early signs of agitation and mental health changes. The training should include: Scenarios Role-playing Drills on a yearly basis Safety for both staff members and patients is critical. Always be near a door Be fully aware of your escape route Have a backup plan in your head Watch for nonverbal cues of increased agitation from the patient Always listen to your instincts as they will guide you to be safe This could be done as a public health funded program where training is offered in a primary care setting. The next group that could potentially touch the patient are EMS, police, and firefighters. There should be yearly mandatory training. The response team should preferably include those who excel at de-escalation especially when responding to an Emotionally Disturbed Person (EDP). Once they arrive, they should collaborate with someone who works well with the patient as much as possible. NYC police (NYPD) presently have a dozen crisis de-escalation teams that collaborate with Health professionals and are on call for street calls. The Receiving Emergency Department The ER that the patient is brought to should preferably be a psych ER. Since this is not always feasible, the ER should follow the protocol for EDP to keep both staff and patient safe. It is amazing is to see how certain doctors and nurses excel in dealing with these patients, so they would be your first resource when available for a smooth transition. I was heartened to read a recent article about a collaboration of a healthcare system with emergency services to provide ongoing training for first responders in New Mexico. The University of New Mexico’s Department of Psychiatry and Behavioral Sciences has an ongoing collaboration with Albuquerque Police Department to improve patient outcomes, including 24/7 contact with officers and continued education for both police officers and physicians. This would be a model of care of collaboration within a community and would be more proactive than reactive in nature and help save lives. Yet another article talked about mentoring youth that are touched by violence (Youth Alive, a California based nonprofit organization that work with hospitals to instill leadership traits in adolescents and prevent further violence). Increased Mental Health Issues During the Pandemic The reality of our lives is that these cases are becoming more the norm than the exception. The COVID-19 pandemic has increased mental health issues among Frontline Workers along with the general public! It is important for us nurses as frontline staff to be aware of how to deal with volatile situations and have a few plans in place both as individuals and as teams. Staff at a supervisory level should have safety as a top agenda and mandate trainings and drills. In primary care, people coming in for doctor’s appointments should get screening questionnaires that trigger referrals to appropriate services that support their mental health and teach caretakers how to deal with exacerbations or flare ups of a patient’s mental state. Another collaboration would be a group home supervisor reaching out to the local police precinct and building a relationship with their clients and the cops so that there is a connection when the call comes in. Our call to action as nurses is to get in touch with our local government and be their resource and expert when needed. This requires time and commitment but think of the lives you can save with your actions! The ripple effect can go far and wide! I have worked in a group home setting in the past and learned to build a trust base with all clients. What I learned to foster de-escalation was to use activities that calmed the patient at the beginning stages of agitation and not to ignore the behavior. For one, it was walking to the store and getting a cup of coffee (fresh air therapy as I call it). For another, it was putting on his favorite show or music in a quiet space. For yet another, it was tearing down white paper methodically and piling them up (sorry trees). Each of these activities helped the individual get to a safe space within themselves and made the situation more manageable. An approach that worked with Frank might have kept him alive instead of being in a body bag at the Medical Examiner’s office. It is easier for us to point and blame than recognize the underlying problem and come up with ways to fix it and thus save the Franks of the world. This Year, Let Us Mark Mental Health As One of Our Priorities Let us not forget our mental health and the mental health of others entrusted in our care. Be kind to one another! Use your professional expertise to advocate for others that cannot advocate for themselves! I do not know if Frank ever got justice and what was the outcome of the investigation. In the case of George Floyd there was no known mental issue but a suggestion of “awfully drunk” on the initial 911 call that needs to be verified by toxicology report. It still does not justify in any shape or form the overuse of restraint techniques used by the policemen. I hope and pray for swift justice for George Floyd, his family, an end to innocent people being harmed and for us to heal as a community. Every life is precious and every day is a chance to be a better person! As we cry out against injustice, let us persist for justice to prevail and be there for one another. In this time of unrest, I pray that let there be peace on earth and let it begin with me!
  7. I’ve changed many details to protect the identity of the nurse I interviewed. I offered to pay her for her time, but she refused, so I made a donation to the American Nurses Foundation Coronavirus Response Fund in her honor. The Coronavirus Response Fund for Nurses focuses on: Providing direct financial assistance to nurses Supporting the mental health of nurses – today and in the future Ensuring nurses everywhere have access to the latest science-based information to protect themselves, prevent infection, and care for those in need Driving the national advocacy focused on nurses and patients Mental Health RN I interviewed Frannie, a mental health nurse who specializes in addiction medicine. She is a Registered Nurse who works at an outpatient opioid treatment center. I was surprised when she told me that some people wouldn’t describe patients on methadone as being in “recovery” because methadone is still an opioid. Frannie said, “If their story is that they are recovered, then they are.” I have no experience with this type of nursing, so I was fascinated to learn that about 30% of the patients at the clinic will likely be on methadone for life. “These are stable patients with jobs, families, work. They are highly functional.” I asked about access – do you have to get referred? Frannie said, “Anyone can walk in off the street. We have an NP there every day and a doctor 2x week.” For those struggling with addiction to opioids, methadone is prescribed at a low dose. Many start out at 30 mg daily, but some are now at the daily maximum dose. Their tolerance level is extremely high. If they have been doing fentanyl, they need a lot more. You have to not judge a 90 lb. woman who needs 200 mg to function.” Frannie told me many of her patients have been coming to the clinic for 5 years or more. Many of them are at 80 – 120 mg daily. I asked how a maintenance dose could max out. I wondered about tolerance. Frannie said, “A lot of it is psychological. If they miss a dose they feel like they have the flu. Most of them come in once a month or every 2 weeks for their supply. They take it the way they are supposed to and then come back for more.” What about the other 70% of your patients? “At the bottom of the ladder are the people who are unstable with comorbidities. People with higher levels of care do come in and we are trying to keep them off the street. These are the borderline stability folks. 15-20% of them are never going to get to take home doses. They have to come in every day. They are often also still using methamphetamines, cocaine. We test them once a month randomly, but even if they test positive, we still treat them. We keep an eye on their dose. Urine tests get sent to a lab. Sometimes we can’t dose them because there are too many other drugs on board. There’s a small percentage of patients who are freaking out, like they are coming in wearing three masks, but most of them seem to be hanging in there. They’ve already been through some rough S%$#. Even though they are addicts they have some resiliency.” Unique challenges to those with addiction According to the National Institute on Drug Abuse, the pandemic presents some unique challenges for people with substance use disorders and those who are in recovery. I read an interview with Dr. Nora Volkow, the director of the NIDA that focused on the collision of the Covid-19 pandemic and another very real public health crisis – substance use disorder. It really hit home when Dr. Volkow said, “We had not yet been able to contain the epidemic of opioid fatalities, and then we were hit by this tsunami of COVID.” Issues that are exacerbated by Covid-19 The healthcare system is not prepared to care for those with addiction Social distancing makes these folks even more vulnerable by interfering with the support systems that help them to recover The drugs themselves negatively impact human physiology, making those with addiction at higher risk for getting Covid-19. According to Volkow, it’s harder for patients to get access to treatment. Some clinics are decreasing the number of patients, the healthcare system is less able to initiate people on buprenorphine. If you are socially isolated and you overdose, it is much less likely that you will be rescued with naloxone. There are no statistics yet on how Covid-19 is influencing fatalities from drug overdoses. Research into the NIH’s $900 million Helping to End Addiction Long-term (HEAL) initiative came to a halt. Research into bringing medication-assisted treatments to prison inmates has stopped. Some IRBs are closing, making recruitment for research impossible. Dr. Volkow spoke of the need to be creative with virtual technologies to advance the goals of NIDA and the NIH. How have things changed at Frannie’s clinic since Covid-19? “For the patient it’s unsettling. They come here every day and it’s different. They are more stressed. They are constantly asking – are you going to close? They are so worried the clinic will close. It’s their life-line. We’re behind glass. Before we always had half the window open, now we keep it closed. There’s no paperwork due to pen sharing. We are doing it all on the computer. They used to get their own water from a pitcher, now we pour the water for them.” What about infection prevention? “People who in the past didn’t get take home doses are now getting them." I thought that would be a bonus for folks to not have to come in as often, but Frannie said, “People like coming into the clinic, though it’s hard to be responsible for all the medications. If they don’t live in a home, 14 bottles is hard to keep track of. You can’t get more take out if you can’t be responsible for your medicine. I’ve been surprised though that most of the ones who have gotten the extra doses to take home have been bringing back all their empty bottles, which is required if they want more doses. Another change is that we have to call them every other day on the phone to assess how they’re doing. I’m pleasantly surprised. It’s been interesting to call my patients every day. I thought maybe they wouldn’t answer their phones, but they are sober and kind and happy for the check-in. It’s increased my trust in my patients. I have to wear a mask and gloves all day and the patients also have to wear them. We keep their masks in plastic bag with name. It’s now the security officer’s job to let in ten people in at a time. He hands out the masks.” Frannie said previously there were between 20-30 people in the room, “being social and seeing each other, they miss the interaction." I wondered if the patient masks dry out in those baggies. Frannie said, “I have no idea. That’s the policy – it’s what we have to do. I am getting some skin breakdown from the mask. I switch between my homemade and my surgical mask. There are four of us nurses in the pharmacy and our desks are not 6 feet apart. No one is changing their masks. Despite that, I think we’re doing a pretty good job. I think we don’t give them enough credit. We talk about how vulnerable they are, but they are doing okay. They have surprised the crap out of me.” Future interviews I’ve written up interviews with two other nurses, so if you enjoyed this one, check them out: At the Bedside with Covid-19 - Stories from the Frontlines At the Bedside with Covid-19 Part 2: John I hope to continue to interview nurses in various roles. Please let me know if you would like to be interviewed, or if you have any requests! Next up is an interview with an ER nurse.
  8. EDwyer

    Healthcare workers study

    Researchers at the National Institute of Mental Health (NIMH) are conducting an online research study to learn about how stressors related to the COVID-19 pandemic affect the mental health of healthcare workers over time to better understand the experiences of healthcare workers during this difficult time. Participation involves completing online questionnaires every 1-3 months for 12 months. The questionnaires take about 30 minutes to complete. You must be at least 18 years old to participate. Please go to: https://covidhcwstudy.ctss.nih.gov/ to participate.
  9. Nurse Beth

    Laura Hears Voices

    Laura’s Story Laura (name changed) was a 27 yr old successful make-up artist in Los Angeles. She was in demand on movie sets and worked for several well-known clients when she was diagnosed with schizoaffective disorder. In the years leading to her complete mental break and suicide attempt, there had been some signs- she was obsessed with numerology and even moved apartments twice in order to live in places with a more favorable number address. Later she would confess to her mother she heard voices since high school. One night the voices told her to get rid of all her jewelry, as it was evil, and she threw her great-grandmother’s 1.5-carat mine-cut vintage diamond ring set with emeralds and sapphires into the middle of the street, never to be found. The night she had her break, she drove herself to an outpatient crisis center. Despite being disorganized, paranoid and anxious, she was discharged. An hour later, she threw herself in front of a police car to get attention and help. She was hospitalized with several injuries and when her mother went to her apartment to pick up some of her things, she found a 50 lb open bag of dog food in the living room for her 2 large Great Pyrenees dogs to eat out of. The kitchen sink and countertops were strewn with mail, dirty dishes, and articles of clothing. There were wads of uncashed checks from clients. Most disturbing to her mother was the small bedroom closet. On the floor was a pile of blankets indented in the middle. It looked like a small nest. She’d been sleeping on the floor in her closet to feel safe at night. After her hospitalization, Laura was an outpatient in the “mental health system”. She was lucky in that she qualified for Medicare and Medicaid. Laura and her family quickly learned some hard realities about the mental health system. Laura was in and out of the hospital several times the first 2 years for medication adjustments but learned that she had to say she was actively suicidal in order to get admitted and receive treatment because of the shortage of behavioral health beds. If she simply checked into a crisis center and said the voices were threatening her and she was terrified, or hadn’t slept in 3 days, she would be told she had to wait 3-6 weeks to see her psychiatrist and released, often without seeing a doctor. Laura also learned that her psychiatrist would change every few months because county doctors were doing their residencies and quickly moved on. Luckily for Laura, her family educated themselves about mental illness and supported her completely. Her mother accompanied her to doctor visits and often wondered what happened to young adults in the system who had no one to advocate for them. Then she looked out of the window of her car and wondered if Laura would be one of the homeless people wandering around downtown, without her family. Many adults with mental health issues live on the streets, estranged from family. The mental health system has few resources to help them. The Numbers Recently in the news, Henry (name changed), a 15 yr old boy with autism, waited 15 days in the emergency department of Baltimore Washington Medical Center after having a crisis at school. The shortage of behavioral health services and the increase in the need for services have created a mental health crisis. Elias Shaya, MD, a director at Medstar Health's Behavioral Health Services in Maryland, and past president of the Maryland Psychiatric Society says "The trend is nationwide and it is a crisis nationwide," According to a 2017 government report, persons with mental disorders or substance abuse disorders, or both (dual diagnosis), presenting to the ED and requiring admission have increased more than 30% from 2006-2014. Millions of people are affected by mental illness every year. Up to 19% of all adults will experience some form of mental illness and the prevalence is much higher in minority groups such as those who report as mixed/multiracials and lesbian, gay, and bisexual adults (National Alliance for Mental Illness (NAMI). Nationwide Behavioral Bed Shortage There is a national psychiatric bed shortage. According to a widely-cited report, currently, there are approximately 11.7 beds per 100,000 people. While there is no universal agreement on the number of recommended beds per capita, the most commonly cited target is about 50 beds per 100,000. Over 5 of those 11.7 beds are occupied by patients who are being investigated for a crime. Jails and prisons have become de facto mental health facilities since mental health facilities were shut down in the 1980s with the 1980’s deinstitutionalization of the mentally ill social initiative. Lack of Insurance Parity There’s also a lack of parity in insurance coverage for mental illness coverage. Mental health insurance parity means that insurance should provide equal benefits for mental health and substance abuse disorders as for medical disorders. What is the solution to this growing problem? Is it time to look at what other countries are doing to help their mentally ill? At the very least, we can help to raise awareness about the lack of parity. Each of us can do our part to combat stigmatism. What are your thoughts, and how can we do more?
  10. traumaRUs

    Youth at Risk - Suicide and Self-Harm

    Suicidal and suicide attempt survivors require special care. This is even truer in a pediatric ICU (PICU). Feri Kiani, MSN, PHN, CCRN, RRT, NPS and Sandra Lee, MSN, RN, CCRN recently presented the topic: Youth at risk for Self-Harm and Suicide. Tools for the Bedside Nurse allnurses.com’s Content and Community Director, Mary Watts, BSN, RN interviewed the two presenters. She asked what was the impetus for this presentation? They answered that this was initiated by bedside nurses concerned about their suicidal and suicide attempt patients. This was the first project the education dept wanted them to tackle. Of course, medical needs need to be met first, but once they are met, patients need to have further psychiatric care. However, there was often a delay with transferring them. The goal was to give the bedside nurse tools to deal with the post-acute suicide attempt patient. They looked at numbers and suicide is the second leading cause of death for children. The goal was to provide a therapeutic environment for these children post-suicide attempt while they await placement. Risk Factors They identified some risk factors for youth suicide attempts: Previous suicide attempts Previous mental health issues Family history of suicide Stressful family situations Knowledge of close friends, family or classmates that have attempted suicide Access to weapons Peer pressure Protective Measures And they also identified protective measures that fight against risk for suicide: Involved in school Good coping skills Connected with school/community Feel valued in their environment Engaged in activities Family engagement was also very important, they stated and said that the families can refocus and emphasize the positives in the patient’s life. In pediatric nursing, the family is also cared for and is an extension of the patient. Staff Education Another issue they discussed was the staff nurses perception of these patients and how to provide education to deal with these situations? Some of the solutions included role-playing, suggestions for therapeutic communication and tools for dealing with these patients. They integrated this education into the annual competencies. Role-playing occurred in the skills fair which is held once/year. The unit psychiatrist and social workers facilitated this station. The number of patients that fall into the self-harm or suicide attempt diagnoses is fortunately rare but very stressful for the PICU staff. The nurses felt awkward and were fearful they would say the wrong thing and further stress the patient. However, the skills fair role-playing provided a safe outlet to verbalize and practice these communication skills. There was also a survey and found that nurses can be judgemental and unfortunately their behavior can reflect this. However, once they learn more, they develop more compassion and better-coping skills to deal with this patient subset. This is a topic that needs to be addressed and discussed. Here is the complete interview.
  11. xwill327

    Interview with the Psych Nurse

    It’s great when a psych nurse can be empathetic to their patients from the education they received in nursing school combined with previous patients they have cared for. I believe they can give even better care when they had experienced it first hand. Countless times patients have yelled at me, “you have no idea what I am going through.” My one colleague has experienced being admitted to an inpatient psychiatric unit. I wanted to understand her experiences and how it impacted her career as a Registered Nurse in Psychiatry. We worked together and I was immediately drawn to her passion for the field of psych nursing and just her as a person. We became close and were able to share stories about work and eventually our life struggles. We disclosed personal experiences with each other. Not only was she a runway model (super cool), but she also struggled with an eating disorder and mental illness. To my surprise, she had been admitted to an inpatient psych unit. I had always wondered what it would be like to be the patient. Here are some views of the psych nurse as the patient: Has anything on the job ever triggered you from personal experiences? My first week on the floor, I was called to a behavioral health crisis on the medical floor: essentially meaning a medical admission lost their mind… I was called in to help restrain an anorexic patient who was refusing treatment. She was not a danger to herself or others and restraining her would go against my ethics, as well as, and more importantly, it was against the law. I did nothing though! I just stood there, watching her be tied down so they could enforce the treatment that she had refused. All I could think of was, “what if I had been restrained for my anorexia turning my hospital stays.” It would have been nothing less than scarring. That thought repeated in my mind as I remembered back to a time when I still denied my emotional disturbances, just as that girl was as she screamed she was fine. Since then I have learned to be an ally to ED (emotionally disturbed) patients, as I know the world of medicine as a whole for the most part avoids them like the plague! How do you feel when you know you helped someone who had a similar issue as you? I will always think back to this one patient in particular who I will refer to as K. If I can think back to someone I feel I helped, it would be her. I was placed on a one-to-one with her following her attempt to hurl herself through the glass window in her room. She was placed on a suicide watch one-to-one which meant one person watching K. Usually this job is given to a PCA (patient care assistant) or a Behavioral Health Tech. However, we were short staffed that evening so as charge nurse I took the role. I had to be within arm distance of her at all times. To say the least, K. was not having me when I entered the room. My close proximity only bothered her more. Despite her attempts to avoid even eye contact I continued my attempts to make conversation. After my relentless conversation prompts, she began to engage with me. We began to joke and she laughed with me. I stayed with her for nearly three hours that evening. The next day K. approached me and said, “I think I get what you were talking about with good things still having a bad side and bad things having a good, like last night, bad-I tried to jump out a window, good- we got to talk and have fun.” My heart sunk and it remains the largest thank you of my career. I am not out to save the world; that would only be a disappointing pursuit. But, if I can help a suicidal patient laugh for a couple hours, I cannot go home with my head hanging down. What is your take on the inpatient experience? Is it beneficial? How would you change it? I don't know if you meant my personal stay in the psych ward or my time working in them. Seeing that I have now experienced both I can say that after my 4th stay I stopped attempting to make light and accepted I would do anything for them never to have happened. Despite this speaking in terms of my work they each had enormous importance. My first stay at 18yrs I learned how to relate to the fear that comes with admission and of its great unknown. My second, I learned the shame that comes along with it and the anger when you have to be admitted against your will. My third stay was due to a head trauma, not psych symptoms, I was placed in the ward purely because of my history. There, as I came back to reality from the two cracks in my skull, I found out what is was like to lose your voice to your overshadowing past. My fourth stay I went in attempting to get ECT, which I was denied. Already a psych nurse at the time, I had far more insight into the world of outpatient but not inpatient. I learned about the frustration in delaying the discharge process. Only because of my further protest did my 72 hour letter not continue to stretch in time. Most patients don't know their rights: such as a 72hr letter to demand discharge. Are you open with your coworkers on your background or remain private? I remain more than private. I was having vicious side effects causing me to shake and tremor constantly. I looked like a wreck as well. To explain this I would blame my other and more acceptable meds treating for my epilepsy. At times, I went as far as to claim having other disorders to explain my symptoms away. My anorexic appearance I denoted to marathon training despite not having worked out in a year for fear of increased hunger. I wish I could be more honest with my coworkers but the way they talk about these disorders and how they talk about the patients afflicted… I just cannot imagine them thinking of me that way. How do you strive to break the stigma of mental illness? How can others in your opinion? I strive by simply getting up everyday. I have a fortune I carry in my wallet that has the quote, “Heroism is the endurance for one more moment more,” which is far easier said than done. It was only recently that I have admitted to myself I am in fact disabled by my disorders. Despite being crippled by them my unwillingness to let them win as well as at times pure denial of them… has allowed me to achieve both personal and professional success even when it seemed everyone else assumed I would fail. How others can break the stigma is to talk about it. If there were simply more numbers of people talking about their disorders, I truly believe even more would come forward and the rest of the world might not be so uncomfortable. Thank you to my colleague and cheers all!
  12. Working in psychiatry as a nurse is a challenge, to say the least. As a travel nurse, it is possible to take a new contract every 2-3 months which means 4 new employee orientations a year. Yikes! Being THE new nurse is not easy. How To Make Teamwork a Priority Teamwork is of the utmost importance to maintain safety. A safe unit means the day will be a good one in psych nursing . We get accustomed to our coworkers and their ways, as in any job. The goal is making your day go as smoothly as possible for you and your coworkers. You are spending forty hours a week together so this is crucial. You build a bond and a routine together. Then a new travel, temporary nurse comes in. This can be a challenging for the staff. You can also be replacing someone they enjoyed who was unfortunately fired or is even ill. This can make for a difficult transition. Even if you are just filling in because the unit is short staffed: still a challenge. You are filling gaps in the schedule but must prove yourself worthy! How much experience? Travel nurses are required to have 1-2 years experience in their specialty. When you arrive to this new facility, you are pretty much determined to be competent enough to function with basic training of policies and their EMR system. There’s an unspoken competitive edge due to this. You have to enter the position with the attitude of: I can handle anything you throw at me! You are firstly asked, “Where have you worked before?”, once you walk into your unit. I believe this is the staff sizing up your experience. They want to know if you are up to par with the expectations of their unit. Can you keep up with the workflow? Will you know what to do during a crisis? How to Please Both Staff and Patients? The second step, despite being in a new place with a new process, can you still provide patient care, with knowledge combined with compassionately? This is one of the biggest challenges. The duality of pleasing the staff and the patient seems to be a tough one. You do not want to step on the toes of the nurses you have just met. You will have to work with them for at least three months. A shaky start will not be helpful. In situations I am involved in during the first week or two I remain laid-back. I will offer advice if a situation is unfolding in front of me. Sometimes the nurse proctoring me may be unsure of what to do But I’ll still tread lightly. No one likes a know it all. Once you overcome this short period of conflict with-in, you feel more at home. You can then voice your opinions about plans of action, within crisis and even discharge plans. Crisis? Now this leads to managing a crisis. I remember intervening my first day of a new contract. A staff member was getting punched by a patient and luckily I was able to safely intervene and diffuse the situation. I immediately proved myself to the staff and they were happy to have me. That’s not always the case. Once you are comfortable, and one of your patients are in crisis, your skill set should really come to play at this moment. It will show the staff that you are more than just a fill in, but someone who is a skilled nurse and there to work hard. The ones who just fade into the background during a crisis because they are a travel nurse make a bad name for travelers. Don’t be that person. Most importantly, providing the best patient care daily stands out the most in any unit. Putting the patients needs first will always help avoid a crisis. Let’s not forget that also. A jovial, warm approach succeeds all when doing psych travel nursing! Cheers. What do you do as a psych travel nurse to make the transition smoother?