The Weekend of... 7-5 to 7-8-19

[Davey Do]

I was charge nurse on the geriatric psych unit last Friday. I had a bad attitude, but it was a busy shift with good coworkers, so all in all, it went well. I successfully dealt with a brittle diabetic, a couple of behaviors, and was graciously complimented by two patients.

Saturday night, my work wife Eleanor acted as charge nurse. There were four other positions on the 11p-7a portion of the shift: working the floor, two 1:1's, and the stupid sentry position of a staff member who acts as a door to the community room so patients won't go in there and hang themselves with a chair. The four positions rotate every two hours.

I worked the floor the first two hours of the rotation, which I truly enjoy because there's always something to do: 15 minute rounds, behaviors, meds, direct patient care, documentation, laundry, etc. The next few hours of the shift are typically slow unless there are behaviors or admissions.

Saturday night there was an admission who was also a behavior problem. The patient was on the floor at the end of my rotation and I dealt with her behaviors basically through direction, limit-setting, behavior mod techniques, and meds. I think I did a pretty darn good job of keeping things in order.

The next part of the two hour rotation had me acting as the "stupid sentry position". I sat at the end of the long partially lighted hallway with the darkened community room at my back. I got to watch Mickey Weird, ex nurse extern, try to deal with the lithe, loud, psychotic new admission. With the dark community room behind me, and the partially lighted hallway, I felt like I was in a theater watching a stage show!

I drew this as I sat with a sleeping 1:1 patient on the next part of my rotation.

There's more to come in sharing my experience, but that's enough for the opening post.

Thank you.

[Davey Do]

Sunday night, I worked with Sharn who took her turn as charge nurse. Again, I was assigned to work the floor for the first two hours of the 11p-7a portion of the shift.

Ranger Rodd use to be a regular ole staff MN nurse on the adult male psych unit for a few years, which is the totality of his nursing experience. Rodd is a decent nurse and we got along well whenever we worked together.

A few months ago, Ranger Rodd became the MN psych house sup a few nights during the week and our relationship changed. I take a portion of the responsibility for the change, for I am a bureaucratic basher. However, Abraham Lincoln said, "If you truly want to test a man's character, give him power" and I believe power has changed Ranger Rodd.

Case in point: In a recent HIPAA forum thread, I noted and openly disagreed with, Ranger Rodd when he said that it is not a HIPAA violation if only the first name of a patient was mentioned in a public place.

Well, Ranger Rodd was untypically assigned to be house sup Sunday night, but we were short of staff, so Rodd had to work geriatric psych. I mean, heaven forbid if we don't have the "stupid sentry position" covered!

So, as I worked the floor, Ranger Rodd sat as the sentry. I was making a round when the bed alarm went off in the room next to where Rodd sat. I went in and assisted the patient in using a urinal and got him squared away.

As I was halfway up the hall, Rander Rodd said, "Dave! The bed alarm's going off again!" I went back into the room, dealt with the situation, and came back out into the hallway. I said to Ranger Rodd, "You know, administration has changed the guidelines of the sentry position. They now say that the sentry can assist with patient care in the area of the door". Ranger Rodd replied, "Well, those guidelines are open to interpretation".

I internally exploded.

I approached Rodd and said in my best Clint Eastwood whisper, "Okay, this will be documented: Patient safety- a bed alarm going off on a high risk fall patient- is more important than some stupid non-door! End of Spiel."

Those were my exact words because I wrote them down in my little pocket journal immediately upon returning to my station in the hallway. Rodd's reply: "Okay."

When I spent my portion of my two hour rotation with the sleeping 1:1 patient, I sketched this, giving the stupid sentry position a worthy title as to appropriately merit its high importance to those in charge:

I meant for the title to be akin to the opera "The Barber of Seville".

Just for poops and giggles, I looked up The Barber of Seville on wikipedia and found something fascinating: The Barber of Seville is also known as "The Useless Precaution"!

https://en.wikipedia.org/wiki/The_Barber_of_Seville

HA!

[Davey Do]

Sunday night, the lithe, loud, psychotic female patient became the third 1:1 and Mickey Weird was sitting with her. I was working the floor.

The patient had received Haldol 5mg/Ativan 1mg IM earlier in the shift without incident but continued to act out. She had Vistaril 25 mg ordered q4hrs PO PRN, so sometime later I approached her and offered her the med. The patient was sitting on the hard plastic box of a bedside table in the dimly lit room and proceeded to urinate as she took the med. You could hear the pee as it spilled onto the floor.

Mickey Weird loudly asked, "Did she pee?" I said yes she did and was immediately called away to deal with another behavior. A male patient, who had punched me in the forehead the week before, as I was placing him in a therapeutic hold, was again acting out.

The lithe, loud, psychotic female patient continued to act out as I later sat with her on the 1:1. The PRN Haldol/Ativan could again be given, so I called to Sharn and asked her to prepare the med for administration.

I wanted to inform the patient of the forthcoming med administration and went to sit on the hard plastic box of a bedside table in the dimly lit room.

From my journal:

[Davey Do]

3 hours ago, Davey Do said:

I successfully dealt with a brittle diabetic

Interesting note: This patient was loud and verbally aggressive when their glucose level was 447. I contacted the NP and got orders for some insulin. After monitoring the patient for a while, I found their level dropped to 40. The patient became docile and was no longer a behavior problem.

With some interventions, their level eventually came back up to 100.

But during the interim, I thought, as I noted in my journal,:

[Davey Do]

In 1979, when I worked at the Anomaly Children's Home I was introduced to the concept of "tiny murders" through a well-seasoned worker: "Tiny murders", he said, "Are those little things with which you have to deal that kill you just a little bit".

Ranger Rodd informed me in the wee hours of Monday morning, "I'm not sure, but I think Roof Elmo (my supervisor) told me she's coming in early to do your yearly evaluation".

A tiny murder.

"Great!", I thought, "Ranger Rodd thinks Roof Elmo's coming in early to do my yearly evaluation after I have worked three 12 hour MN shifts! She could have informed me via email, but nooooooo! She instead tells Ranger Rodd who's not sure! I am going to be a bit prickly!"

Well, alright then.

Never mind.

[Davey Do]

During the mass med pass, a patient compared the geriatric psych unit to the old TV show, "Gilligan's Island".

"Why Gilligan's Island?" I asked.

He replied, "Because I thought this was just going to be a three hour tour!"

Took me back...

[JBMmom, MSN, NP]

It's fortunate that you take a very lighthearted approach to many situations, because some of what you're dealing with could certainly make heads explode! Not that you don't take your job seriously, your patients are lucky to have you there. Especially when you're keeping them from hanging themselves with a chair.

[Davey Do]

13 hours ago, JBMmom said:

It's fortunate that you take a very lighthearted approach to many situations, because some of what you're dealing with could certainly make heads explode! Not that you don't take your job seriously, your patients are lucky to have you there. Especially when you're keeping them from hanging themselves with a chair.

Thank you so very much for your feedback and kind words, JBMmom! If I didn't have my sense of humor I know I wouldn't be on this side of the nurses station!

Adding the line about hanging themselves with a chair made me chuckle!

Nursing is like that though- it can be so difficult and rewarding at the same time. Nursing balances out my life and gives me fodder for my art.

Being able to empathize with others also allows me to see that I'm not in these difficult situations alone. For example, Dr. Banjo was the only psychiatrist for all five psych units, with Dr. Hobbit and Dr. Dadda taking vacation days or whatever this past weekend.

Dr.Banjo can be rather hard-nosed and, while covering for both docs, he d/c'd low dose HS benzos on one extremely nice patient.

23 hours ago, Davey Do said:

I was... graciously complimented by two patients.

I helped this one particular patient who had had his benzos d/c'd get through a rather restless night. When I was saying my goodbyes to the patients Monday morning, this particular patient complimented me and asked for a hug.

The patient and I probably both thought this:

Thanks again, JBMmom!

[Nickc58]

12 hours ago, Davey Do said:

Thank you so very much for your feedback and kind words, JBMmom! If I didn't have my sense of humor I know I wouldn't be on this side of the nurses station!

Adding the line about hanging themselves with a chair made me chuckle!

Nursing is like that though- it can be so difficult and rewarding at the same time. Nursing balances out my life and gives me fodder for my art.

Being able to empathize with others also allows me to see that I'm not in these difficult situations alone. For example, Dr. Banjo was the only psychiatrist for all five psych units, with Dr. Hobbit and Dr. Dadda taking vacation days or whatever this past weekend.

Dr.Banjo can be rather hard-nosed and, while covering for both docs, he d/c'd low dose HS benzos on one extremely nice patient.

I helped this one particular patient who had had his benzos d/c'd get through a rather restless night. When I was saying my goodbyes to the patients Monday morning, this particular patient complimented me and asked for a hug.

The patient and I probably both thought this:

Thanks again, JBMmom!

Davey,

In my few years of being a member on this site I have always enjoyed your posts. BUT THIS.... this meme is unacceptable. No nursing meme should be this dang funny ??. You have truly outdone yourself with this one ?.

[TriciaJ, RN]

On 7/9/2019 at 12:18 PM, Davey Do said:

Interesting note: This patient was loud and verbally aggressive when their glucose level was 447. I contacted the NP and got orders for some insulin. After monitoring the patient for a while, I found their level dropped to 40. The patient became docile and was no longer a behavior problem.

With some interventions, their level eventually came back up to 100.

But during the interim, I thought, as I noted in my journal,:

My mom was a psych nurse before me and actually had to participate in this back in the day. She explained the procedure to me and amazingly they never killed anyone. The conventional ECT procedure was another good story. Those were the days.

[TriciaJ, RN]

For some reason, this thread reminds me of a coworker on one of the psych units I worked. This gentleman was British and very well-spoken, which made him appear brighter than he was. One of the things that made me cringe was when visitors would stop by the nursing station and ask "So how are you guys tonight?" Nurse Genius could be counted on to say: "Oh, this place! It's a wonder we don't go crazy ourselves!" ?

[JBMmom, MSN, NP]

I think a key to working on almost any nursing unit, is a sense of humor to get you through. I have found that , if you can approach work with some ability to laugh at yourself and the things around you (in appropriate situations), patients and families generally respond in kind. Sometimes the darker humor isn't appropriate for patients and families, but is almost as important for coworker bonding and a positive work environment

I had a nonverbal patient for a few nights recently and I felt so good knowing that for a few solid hours he had some laughs (at) with me. It's hard enough being sick, being sick and miserable is too much.