The Weekend of... 7-12 to 7-15-19

[Davey Do]

It was another eventful weekend on my three 12 hour MN shifts at WRMC (Wrongway Regional Medical Center) and I plan to give you some highlights in story and song as this thread progresses.

Being assigned to act as a door for two hours periods gives a body a lot of time to think. Oh- for those just tuning in, you may want to get some background on "being assigned to act as a door" and check out this thread:

As I sat in the dim light acting more like a doorstop than a door, since all the patients were sleeping, I began reviewing specific situations that made me want to become a nurse:

As a kid, I liked to catch and cut up frogs, but I think that really only exposed me to A&P, and was not the reason I would eventually want to become a nurse.

I enjoyed grabbing onto my little sister's wrist, dragging her over to the electric fence and giving her shock treatments, but I think that was more of a reason why I became a psych nurse. I enjoyed studying her behavior- you know, the stimulus/reaction sort of thing?

The fact that my high school sweetie's Dad was a doctor may have influenced me a bit, as I truly enjoyed hearing his tales of medical adventures.

But I came to the conclusion that it was my destiny to become due to the result of a situation which occurred in 1976 when I was 19 years old:

Yeah- I think that situation inspired me to take a first aid course in 1977, become certified in CPR in 1978, an EMT-B in '79, NREMT-A 1981, then eventually become a nurse- an LPN in 1983 and an RN in 1990.

[Davey Do]

Another thing that happened as I was acting as a door was that a male patient made a vague threat of harm while complaining about his new room mate. I immediately (in a sense) gave him a little reality orientation and let him know he would have to deal with the ramifications of his actions.

The patient had the wherewithal to apologize for what he said and committed to safety. I told him that I appreciated his quick turnaround, insight, and apology.

A portion of the conversation (sort of) went like this:

[JKL33]

Such a therapeutic door you are!

[Davey Do]

12 hours ago, JKL33 said:

Such a therapeutic door you are!

Why, thank you, JKL!

As I have oft said, "It's a bore to be a door!"

Last weekend, a "lithe, loud, psychotic" patient was admitted and became a 1:1 due to her behavior. This patient has been put on a forced med of Zyprexa 20 mg BID and has regularly received doses of Haldol 5/Ativan 2 mg q6 hour PRN along with Trazodone and Doxepin at HS, which has done little to slow her down and curb her behavior.

Attempts by staff to enforce guidelines or advisements of appropriate behavior have resulted in things like the trashing of her room and name loud, defiant, profane name-calling.

On the MN shift, this patient will sleep only for intervals of about 15 minutes, wake for a bit, and again wreak havoc.

I sat with this patient for a two hour interval in the wee hours of Monday morning. She had just taken the PRN Haldol/Ativan PO about a half an hour before I sat with her. I enforced guidelines, kept the lights low, and initially did not respond to her profane insults.

As the patient intermittently slept, I made some notes and sketches in my journal. I wrote down the words "oppositional personality" and drew a sketch of a cartoon Jesus saying, "Compliment those who berate you".

The next time the patient woke up and began her inappropriate behavior, I found something positive in what she said or did.

When the patient awoke and began grunting, I said, "Hark! Is that the sound of an angel awakening from her beauty rest that I hear?"

She got up and stood by the window, looking out of it, saying nothing. In a low tone I said, "She stands by the window, appearing pensive". In a few minutes, the patient returned to her bed and slept again for about 15 minutes. I repeated the positive approach thing each time and had no inappropriate behavior from her.

My conclusion: The patient was displaying inappropriate behavior in order to get a response or attention. It has been said that "Bad attention is better than no attention". If she was not acting out, it seemed others gave her no attention. When she acted out, staff gave her attention.

By giving her positive attention before she displayed a behavior, I was feeding her monkey, so she did not act out.

When my two hour interval was up, I informed my relief of my findings. The patient was standing nearby and I said, "Look at her. She's listening to us, attentively; focused. A marvel of meditation!" The patient looked at me and smiled. She may have even chuckled.

"You mean I should patronize her?" my relief asked.

"Yeah, well..."

[Davey Do]

Continuity, consistency, and knowing what to expect all give us a sense of security and helps to prevent cognitive dissonance. However, continuity, consistency, and met expectations are on short supply when it comes to staffing at WRMC.

Even though my pre-work mantra is "Expect the unexpected", I did not expect to be pulled to the women's psych unit Sunday night. I had worked the past two nights on geriatric psych, I knew the patients, and in my recollection, I have not once been pulled from geriatric psych on a Sunday night. I get pulled on Friday nights about once a month, but never on Sunday nights.

A nurse must have had to have worked extra in order for me to be pulled, I have seniority, geriatric psych is my home unit, so "Why was I pulled?" I asked Mandy, the MN house sup. "I don't know", she replied, "It doesn't make any sense. I'll find out and get back to you". So, with a passable good attitude, I clocked in and went to the women's psych unit.

Two nurses, an RN and an LPN, who usually work the women's psych unit, were also scheduled for the 12 hour MN shift. After report, when the charge RN asked me what I wanted to do, I replied, "As little as possible". "Okay", she said, "You can take the day room"( which has doors).

Taking the day room duty is basically where a staff member sits with a clipboard of patient precaution sheets on their lap and fills them out while a loud TV blares programs and commercials and patients sit around and stare at each other.

I stared off my sojourn with a public announcement of who I was ("Hello ladies, I'm Dave- I'm a nurse.") and then went around and chatted with each of about 15 patients.

After my meet & greet, I stood there and watched the patients stare at each other. I remembered the complaint of a particular patient years ago, "We never do anything on the weekends- get any therapy- we sit around and watch TV!"

So I asked if I could turn off the TV and if anybody wanted to have a group. It was pretty much unanimous: "Sure. Why not?"

We introduced ourselves and said one thing we liked about ourselves. Or passed. We talked about such things as meds acting as catalysts or inhibitors. We talked about the sympathetic and parasympathetic nervous systems. We talked about all emotions stemming from the two basic ones: Love and fear. We talked about the difference between logic and emotions. We talked about things you shouldn't talk about:

The group held the majority's attention for about an hour and fifteen minutes when it trickled down to about four patients who I sat down and continued chatting with, mostly about meds.

I had a good time on the women's psych unit but was pulled back to my home unit of geriatric psych at 2300.

[Davey Do]

I learned how to mix colors while working in a paint store some 42 years ago. The elderly lady who taught me how to mix colors told me, "Don't let anything distract you while you're mixing colors. If you are distracted, you may make a mistake".

I learned a truism here on all nurses which goes, "All bleeding stops eventually".

As I set up the patients' HS meds last Friday, with the phone ringing in the nurses station that is adjacent to the med room, I thought of both of these situations from which I've learned:

[Davey Do]

Rooty Payne is a psych tech who is worthy of respect, for he is a good coworker, gets along with just about everybody, and is very good with the patients. When Rooty works the floor, I never have a concern about the patients' safety and care.

However, Rooty is mischievous. On three different occasions, that I am aware of, nurses have inadvertently left their work keys in areas accessible to patients. When Rooty has found the misplaced keys, he secures them, but does not return them to their owner until the end of the shift.

The nurses who misplaced their keys have loudly proclaimed so and have frantically turned units upside down in search of their lost keys. They have gone as for as, but not limited to, doing room searches and digging through trash and dirty laundry.

Rooty believes that staff who leave their work keys in areas that are accessible to patients need to be taught a lesson, for this is a grave compromise of patient and staff safety.

It is worthy to note that staff who have inadvertently left their work keys in areas accessible to patients have never repeated the act after they have gone through Rooty's Aversion Therapy.

3 hours ago, Davey Do said:

I had a good time on the women's psych unit but was pulled back to my home unit of geriatric psych at 2300.

On my way to the geriatric psych unit, I stopped to use the restroom just off the main hospital entrance. There, on the urinal, sat some security guard's work keys.

I thought:

But I didn't. I secured them and informed Mandy, the house sup.

I'm a real light weight.

[Davey Do]

I was working the floor, providing direct patient care Saturday night and Eleanor, my work wife, was finishing up an admission. As I passed by the nurses station, Eleanor said, "Mandy called and said she wants you to call her back".

Always thinking the worst, I asked, "What did she want?"

"I don't know", Eleanor replied, "I didn't ask".

"The least you could do is ask 'Can I tell him why?' or something like that!" I scolded her.

"It's none of my business, and besides I am not your secretary!" she retorted.

"Oh Jeez", I whined, "I'm probably going to get fired!"

I called Mandy and she asked me, "Can you pee?"

"I can pee in Morse Code", I said.

"I'll meet you down at the lab", she instructed.

Mandy was waiting for me outside of the lab when I got there. I thought of Lloyd Bridges' character in the movie "Airplane!" and said to her:

[RNNPICU, BSN, RN]

Wellll... Where is the update. WRMC making you pee in code? DId it have to do with the keys?

[Daisy4RN]

35 minutes ago, RNNPICU said:

Wellll... Where is the update. WRMC making you pee in code? DId it have to do with the keys?

I bet Mandy knows that DaveyDo is also mischievous and could have possibly used the keys to sneak in somewhere he didnt belong, therefore just covering the bases lol

[Davey Do]

23 hours ago, RNNPICU said:

WRMC making you pee in code?

When I was young, I use to pee like streaming music.

Now that I'm old, I pee in Morse Code: In dots and dashes.

[Davey Do]

2 minutes ago, Daisy4RN said:

I bet Mandy knows that DaveyDo is also mischievous and could have possibly used the keys to sneak in somewhere he didnt belong

When I was younger (and unmarried), I used to snake... a... er... "sneak" into places for stolen moments.

Alas. Now that I'm old, I'm not focused on stolen moments. I'm more focused on bowel movements.