Vent about psych admit of 12 yo boy

[elizabeth8503RN]

***VENT*** ***Kind of long***

I work in an equivilant to a pysch ER, we do assessments, then reccommend the patient to the correct level of care (therapist, psyciatrist, in-patient, ect...)

Anyways.... I did an assessment on a 12 yr old boy, accompanied by his bio mom and her boyfriend. The boy was making threats to hurt himself, cut his throat, ect. Very defiant, rude, obnoxious, continued to deny that he was ever suicidal, not very cooperative.

After the assessment I called our on call doctor (per protocal) and it was reccommended that this boy go to either day program (if parents felt safe taking him home), or in-patient on our unit.

I go back to the assessment room to inform the boy and his mother of the decision. I basically say "Ok...I talked with our doctor on call, and we have two options. 1. (talking to the boy) You can go to day hospital, or 2, you can go in-patient."

The immediate response from the boy was "My mom has a third option. She can just take me home. I am not ever coming back here. I don't have to!"

I inform mom that yes, that is an option, but we also have a fourth option, mom and mom's bf could file for commitment. The three of them begin to discuss this, and it became heated. I opted to leave the room so that the three of them could discuss the options.

While I was waiting, I noticed the boy attemting to leave the premisis, with mom yelling at him to come back. Luckily he did go back to the room, and our security guard had to stand by to help monitor him. I go back to the room and mom tells me that she wants me to start filing for court committal.

I go back to the nurses station to page our doctor yet again. Not five minutes pass, and I am called back into the room, yet again. Mom has decided that she will take him home, AMA. I let her know that before we can go that route, the doctor must be informed.

Get a hold of the doctor, and the doctor reluctantly agrees to do this. Go back to the room, have them sign AMA. They leave.

NEXT DAY

I get a frantic call from the same mom about the same boy. He went to school and made threats that he wanted to die. She was headed over to the school to pick him up and bring him there. I inform her that if she wants to bring him in, and he was unwilling to come voluentarily, that they (mom and mom's bf) needed to go to the clerk of courts office and have him committed.

Few hours later they stroll in with the court committment papers... and he is promptly admitted (be me).

The entire time the boy is abrasive, rude, and continues to deny any suicidal ideations, he claims that what he said at school was "This (who knows what "this" means) is what makes me feel like killing myself."

Anyways, he is admitted to the unit, and mom still isn't sure that she wants him there. (AFTER obtaning the court order)

Some days I just don't understand people.

[xtxrn, ASN, RN]

Of course your just curious xtxrn, because you would like say that I can't possibly have a valid opinion on this situation unless I have been a nurse for 2 yrs or more, right?

Actually, I have been a vet tech for over 10 years, and although you may not agree that it has anything to do with nursing and people, I would argue to the contrary. As a matter of fact, as a vet tech I spend more time working with the clients, aka parents, in getting them to do the necessary care for their pets, whether it be vaccines, emergency care, elective surgery, etc. If I can't get to my clients then I can't help my patients, which is my number one goal.

My team always knew that I was the person to go to for any difficult clients who were not interested in doing what was most important for their pet, mainly because they are all animal people and could care what the person thought, they just wanted to care for the pet. But you have to get through the people first. My specialty was the "I got the darn dog for free, why would I pay hundreds for you to fix his shattered pelvis (after he fell out of the back of my pick-up truck, duh) when a bullet only costs ten cent", as the dog is laying there on the floor with his bone sticking out of his leg gasping in pain, a dog who happens to have a not so great temper even when he isn't in pain.

Most people aren't bad, they just aren't exactly smart, lol, they need someone to stop what they are doing, look at them and really see them, see what they need and who they are and not see them as some burden, some thing to be checked off their to-do list. The qualities I learned as a vet tech are going to make me an awesome nurse and I have complete confidence in that. Is nursing and being a vet tech exactly the same, NO, so don't try to skip around the topic at hand by going into a vet tech vs nursing rant becaue I dont care. I have treated ANIMALS better than many of you treat your PATIENTS and that's the darn truth. And I didn't treat them so well because I am some "weird" person who thinks animals are better than people, no, it's because they were my PATIENTS. I would come in early, leave late, work 12 PLUS hr shifts more than 3 days in a row, I got paid less than HALF what most new grad nurses do, no benefits, no health insurance, got bit, scratched, yelled at, looked down at by patients cause I am "not the vet", dealt with inner office politics and backstabbing, got pooped and peed on, been treated like an idiot by vets and I could go on and on, every rant you have had about nursing I can match, but NONE of that mattered, because nursing is WHO I AM, IT'S WHAT I LOVE.

When I am getting ready to leave at the end of the day, an hour or more after my 12 hr shift ended, my uniform stained with various fluids, exhausted, feet and knees aching, my vet, clients or co-workers not having patted me on the back, I go over to my patient, resting quietly, comfortably, with no more pain, I lay my hand in his fur, silently checking his vitals, his IV placement and fluids and urinary catheter/urine flow, he barely opens his eyes, exhausted, as I pull his cover over him before I go, no growls, no snapping, because throughout my care I showed him gently, firm, compassion, I didn't expect him to care, I expected to still get bit, snapped at, growled at, get my double meaing here?, but my reward, is occasionally, occasionally and unexpectedly, I get a silent thank you. Because I cared, because I tried, because I took extra time at continuing education seminars on how best to communicate with patients and how to deal with aggressive pets, because I made it my priority, because something else mattered to me than myself, I put myself out there and I made a difference in the existance of a living thing and that's my karma.

What I am sick to death of is being surrounded on a daily basis by self-involved, spoiled, mean spirited people who don't know what they don't know and aren't willing to try and learn. It's not just nurses, vet tech's are the exact same way, you just want to sit on your pedestal

I find peace by surving a purpose higher than myself, and no I am not talking god, I am talking about (semi) self-less compassion and mercy, giving of myself without expecting something in return, to my family and to my patients. It's not easy, by any means, I am only human, but it's so much better than worshipping at the almighty pedastal of ME, ME, ME.

I know this may sound harsh, but no one will learn when they do less than what they are fully capable and instead of learning, they are patted on the back for mediocre and then are never able to grow. When I grippe at the OP it's because I know she can do more, and I am not just going to pat her on the head and say "good girl" and hold her back.

"I'm only one person and I can't do everything. But I can do something. I will not let the fact that I can't do everything prevent me from doing what I can." ~Helen Keller

I repeat this to myself on a daily basis, it's not just a random quote placed here to show off how smart I think I am.

(I apologize for any misspellings)

Actually, I was interested . I didn't expect the huge chip. Not everybody is against you, what you do, or what you have to say.... and I agree- you have a lot of interaction with people, and nasty aspects to the job. So, please don't make me fit some stereotype you seem to have. I could have just blasted you- instead I asked. I didn't have to bother.

I agree that getting a Bozo button for merely showing up is pathetic- and an insult to the kid who works his butt off- and is royally screwing up a generation who doesn't understand that work is a verb- not a destination. :)

The compassion isn't coming through - dealing with people who don't know what they don't know is a major PITA... I totally get that.

BUT, a suicidal brat (serious or not) and a dysfunctional family aren't the same as pets (and I love mine more than any human on the planet). Opinoin is one thing- not having that experience is something esle- sorta like saying to you, "just put the mean cat in a cage and blow it off- -it bites".... can't do that if the cat needs something. Then have the owner bail out without having the cat checked out for whatever is bothering it. It stinks- why bother if they don't want help....

ER nurses and psych nurses have a different type of acute stress (and everybody has stress- don't think I don't understand that)... it is very difficult to deal with wishy-washy parents (who probably got Bozo buttons for showing up and are ineffective humans AND parents) who come for help, then opt for non-compliance. The OP didn't say what else was going on in the middle of that mayhem.. not always easy to get all the stuff in- especially when nobody is making a decision.....that's all :)

I'm sorry you're having so many annoying people to work with....I wish I could say that nursing will be better. I have yet to see a patient curl up and purr - on a good day they might say thanks....RARELY, they made a positive impression...that goes for patients and other nurses.

:hug: I had no "ill will" towards you with the simple question I asked.

[xtxrn, ASN, RN]

I probably spent more time on psych units as an adolescent than off of them. I had an unstable home life but most of my issues weren't really environmental. (I'm one of ten kids and none of my other siblings had the same issues that I did.)

From the perspective of a former patient, I think I would interpret the boy's "this" statement as both a lack of control and a lack of those in power correctly interpreting whatever is going on in his head/thought patterns/etc. And, yes, the third option means that he has half a brain. I said the same stuff all the time.

For what it's worth, I spent a lot of time IP but my mom absolutely refused to let me go residential. As a foster parent, she "knew what kind of kids went to those sorts of places" and, in hindsight, probably didn't want to let go of whatever authority she had over me. At one point, I was a 70 lb anorexic whose self-injury issues were landing her in the ER 2-3x a week. I desperately needed long-term treatment but my mom continued to refuse.

I turned out okay, I guess. So it does happen. But I'm pretty sure that most of my treatment providers would have had the same questions about my mom that you do about the boy's family.

I'm sorry you didn't get the residential that was recommended. Many are really good- and the first stability many kids ever had. The kids I worked with on adolescent IP psych BEGGED to go to the place nearby- they kept kids for years back then = and the staff was great to work with (I worked both places - the residential place for a brief time).

But it sounds like you have a lot of insight :)

Best of luck to you :hug:

[elizabeth8503RN, MSN, EMT-B, NP]

My vent was very abbreviated to what actually happened. To those of you concerned about me not speaking to the boy by himself....let me assure you that I did in fact spend time speaking to him one on one. To those of you that believe that I did just as the mother asked only because she asked is also not true. I did what was best for both the mom and the child.

Just a few facts that I may not have mentioned earlier.

1. Mom's boyfriend has been in the boy's life much much more than the father ever has been, and from the way the boy talked about the mom's bf...he actually liked the mom's boyfriend.

2. I spent time speaking to the three of them, spent time talking to just mom, and I spent time talking to just the boy.

3. The boy denied ANY type of abuse while I was interviewing him by HIMSELF... and there were no indications to make me believe otherwise.

4. I did as my policy stated, the doctor was aware of everything that was going on. Every person coming in to our facility (whether or not they want a therapist or in patient) gets assessed by a clinician (RN or social worker), and once the assessment is done the recommendation is done. If the doctor needs to be notified, then that is done. The facility has done this since it has opened its doors many moons ago, and will continue to function in the way that is has in the past. (Which works extremely well, both according to our staff and the numerous patients we see)

5. I did notify the doctor as to what was going on, in fact I spoke to the on call doctor several times in regards to this child, both on the day the him and his parents left AMA and the day he was admitted. The doctor was well informed in regards to his behaviors, the mother's behaviors, ect.

6. I don't know if it's the state or the hospital or a combination of both that require the signature of the minor child, but it is our policy, and I have to abide by it.

7. To those of you concerned/upset/mad about my saying: "It's parents like these that show me how NOT to parent my children (whenver they come along)... I am sorry that I offended you in some way. Yes, it is true that I do not have children yet, but there are some things the some of these parents makes me wonder IF the parent at all. To those of you that say, I will eat my words when I become a parent.... You are probably right,

I am sure that I haven't answered all the questions in regards to this, and in fact may have provoked more questions than answers. For that I do apologize.

As to PetsToPeople:

I don't know exactly what your beef with me is about. In case it has not been mentioned before, this was a RANT...a VENT... somewhere that I hoped to get something of my chest, WITHOUT being torn apart my someone who does not have the full story.

To all: I work with a bunch of people (most of which have been in nursing more years that I have been alive), and each and every one of them believe I did the best that I could do in the situation, as did the doctor on call. I asked more questions during that case then I probably have in entire week, Each one of them would have done what I did.

[hiddencatRN, BSN, RN]

Of course your just curious xtxrn, because you would like say that I can't possibly have a valid opinion on this situation unless I have been a nurse for 2 yrs or more, right?

Actually, I have been a vet tech for over 10 years, and although you may not agree that it has anything to do with nursing and people, I would argue to the contrary. As a matter of fact, as a vet tech I spend more time working with the clients, aka parents, in getting them to do the necessary care for their pets, whether it be vaccines, emergency care, elective surgery, etc. If I can't get to my clients then I can't help my patients, which is my number one goal.

My team always knew that I was the person to go to for any difficult clients who were not interested in doing what was most important for their pet, mainly because they are all animal people and could care what the person thought, they just wanted to care for the pet. But you have to get through the people first. My specialty was the "I got the darn dog for free, why would I pay hundreds for you to fix his shattered pelvis (after he fell out of the back of my pick-up truck, duh) when a bullet only costs ten cent", as the dog is laying there on the floor with his bone sticking out of his leg gasping in pain, a dog who happens to have a not so great temper even when he isn't in pain.

Most people aren't bad, they just aren't exactly smart, lol, they need someone to stop what they are doing, look at them and really see them, see what they need and who they are and not see them as some burden, some thing to be checked off their to-do list. The qualities I learned as a vet tech are going to make me an awesome nurse and I have complete confidence in that. Is nursing and being a vet tech exactly the same, NO, so don't try to skip around the topic at hand by going into a vet tech vs nursing rant becaue I dont care. I have treated ANIMALS better than many of you treat your PATIENTS and that's the darn truth. And I didn't treat them so well because I am some "weird" person who thinks animals are better than people, no, it's because they were my PATIENTS. I would come in early, leave late, work 12 PLUS hr shifts more than 3 days in a row, I got paid less than HALF what most new grad nurses do, no benefits, no health insurance, got bit, scratched, yelled at, looked down at by patients cause I am "not the vet", dealt with inner office politics and backstabbing, got pooped and peed on, been treated like an idiot by vets and I could go on and on, every rant you have had about nursing I can match, but NONE of that mattered, because nursing is WHO I AM, IT'S WHAT I LOVE.

When I am getting ready to leave at the end of the day, an hour or more after my 12 hr shift ended, my uniform stained with various fluids, exhausted, feet and knees aching, my vet, clients or co-workers not having patted me on the back, I go over to my patient, resting quietly, comfortably, with no more pain, I lay my hand in his fur, silently checking his vitals, his IV placement and fluids and urinary catheter/urine flow, he barely opens his eyes, exhausted, as I pull his cover over him before I go, no growls, no snapping, because throughout my care I showed him gently, firm, compassion, I didn't expect him to care, I expected to still get bit, snapped at, growled at, get my double meaing here?, but my reward, is occasionally, occasionally and unexpectedly, I get a silent thank you. Because I cared, because I tried, because I took extra time at continuing education seminars on how best to communicate with patients and how to deal with aggressive pets, because I made it my priority, because something else mattered to me than myself, I put myself out there and I made a difference in the existance of a living thing and that's my karma.

What I am sick to death of is being surrounded on a daily basis by self-involved, spoiled, mean spirited people who don't know what they don't know and aren't willing to try and learn. It's not just nurses, vet tech's are the exact same way, you just want to sit on your pedestal

I find peace by surving a purpose higher than myself, and no I am not talking god, I am talking about (semi) self-less compassion and mercy, giving of myself without expecting something in return, to my family and to my patients. It's not easy, by any means, I am only human, but it's so much better than worshipping at the almighty pedastal of ME, ME, ME.

I know this may sound harsh, but no one will learn when they do less than what they are fully capable and instead of learning, they are patted on the back for mediocre and then are never able to grow. When I grippe at the OP it's because I know she can do more, and I am not just going to pat her on the head and say "good girl" and hold her back.

"I'm only one person and I can't do everything. But I can do something. I will not let the fact that I can't do everything prevent me from doing what I can." ~Helen Keller

I repeat this to myself on a daily basis, it's not just a random quote placed here to show off how smart I think I am.

(I apologize for any misspellings)

So, to recap, you have no experience in psych, but are happy to nastily point out all the things the OP did wrong and then get even nastier when asked what basis you have to critique the OP's actions. Got it.

Of course you're entitled to your opinions, but we're also entitled to judge the weight we give your opinions based on your experience with the subject matter. If you're finding people regularly questioning you on your experience in coming to your opinions here in this forum, perhaps you could consider that a. your behavior is turning people off and/or b. some aspects of nursing might really BE different than being a vet tech.

[Rob72, ASN, RN]

To all: I work with a bunch of people (most of which have been in nursing more years that I have been alive), and each and every one of them believe I did the best that I could do in the situation, as did the doctor on call. I asked more questions during that case then I probably have in entire week, Each one of them would have done what I did.

And it sounds like you did fine. Some observations:

It is very common for single-mothers to, "parent by committee". In general, they have not had stable, supportive relationships with men, of any sort, in their lives. Because women are (again, in general) more relational than men, these single parents are terrified of losing the relationship with their child through retaliation/rebellion, if the parent sets firm limits on behavior. Again, I am generalizing based on widely demonstrable sociallay stereotypical behaviors- there are in fact single-fathers who exhibit the same issues...so nobody get all constipated, here.

Ideally, Lil' Johnny will identify strongly with/respect mom's boyfriend. Even more ideally, BF will marry mom, showing Lil' Johnny that love & all is wonderful, but commitment is what carrys you through episodes, "Like we had when you were 12..." If that happens, and if Lil' Johnny has some counselling that helps in instilling a more firm grasp of personal responsibility (vs., "...its okay to act on what you feel. Your feelings should be your guide..."), Lil' Johnny may develop a sense that women are more than talking, needy weiner-warmers. Not trying to shock/be crude/whatever, but socially, if we continue to accept "B" as a synonym for "woman", the predominant perception that women really aren't people will continue to grow.

And, ultimately, that is Lil' johnny's conflict- mom "couldn't keep" a decent male role model around for him(MAJOR issue for boys); mom can't limit his behavior, either by reason or force(undefined boundaries leave children insecure, with a long-term oppositional pattern as they try to 1) find boundaries and 2) determine why those boundaries exist).

Well-adjusted people have a balance(of some sort) between logic and emotion (empathy). Men and women as parents(in general) have complementary behavioral models- one will be "reasonable", the other "sensitive". Obviously, individuals vary, but men tend to be more logical(left brain), women more empathetic(right brain).

[leslie :-D]

To what blatant misinformation would you be refering? We could get to the point more quickly if you would actually back up your claim.

oh, get off your high horse!

(:lol2:)

sorry...had to throw in some sort of animal joke.

seriously, i admire your passion, but the condescenscion needs to go.

leslie

[Rob72, ASN, RN]

I am sorry that you weren't able to get that child in a seperate room guarded by an officer so you can get the parents out of panic mode and sit down with them and ask them what was going on, when did this start, etc and help them to make the best decision for themselves. Rediculous, sometimes I can't believe the stuff I read on here. I know that as a nurse you can't help everyone, but it sound to me like you didn't even try.

I'm going to assume this is the "misinformation" to which DHG was referring. I don't know that I would have used the term, "misinformation", so much as saying that it is lacking insight.

Your post was defensive, and demonstrated a certain amount of insecurity. Caregiving, in any arena is highly transferrable, and I know that your experiences will stand you in good stead as an nurse. However, being able to identify what you don't know is also one of the most important aspects of learning behavior(i.e., "Do you know what you don't know?").

You state that people are the most frustrating segment of your current job. The fundamental difference between animal care and human care is that at least half, if not the majority, of human holistic crises are caused by self-determinant action, frequently wilfully, and most commonly in gratification-seeking behavior. These individuals have little to no interest, and less motivation to change, the behaviors. Your current patient population lacks the ability to manipulate. This is a key difference in the care-relationship.

In context, this family unit is most likely unprepared to identify or resolve core issues in a meaningful manner, nor is this something likely to be done in a pre-admission setting. The child also has little motivation to change, as he has found a coping mechanism that gives him a feeling (though not practical, functional) of control. This a whole-family counselling problem.

Without second-guessing the OP, and without "going beyond the scope of practice", what we would "hope to see" is someone talking to the BF and mother, encouraging and supporting a more reciprocational relationship between them, with clear guidelines for acceptable/unacceptable behavior for the child that both parents agree to and will enforce. Separation in the ED, contextually, is likely to heighten the mother's distress, exacerbate the child's need for control, and (unless he is incredibly intelligent anf strog-willed) alienate the BF by imposing an elevated conflict of competeing needs.

[canoehead, BSN, RN]

I am so tired of posters reducing the conversation to sniping at each other. Usually there are misunderstandings or assumptions on BOTH sides. And always BOTH sides have information they generously want to offer.

So the vet tech might have a viewpoint that shows us a different way. And if someone tells him/her their reply is useless (not a helpful statement anyway) why would he/she even respond to such dribble.

If you think a vet tech doesn't have anything to offer don't reply, and they go away faster. If you pick a fight, it lasts for frigging ever, and bums out the whole thread.

We all look like a bunch of snipping old ladies, and allnurses suffers.

[dirtyhippiegirl, BSN, RN]

I'm sorry you didn't get the residential that was recommended. Many are really good- and the first stability many kids ever had. The kids I worked with on adolescent IP psych BEGGED to go to the place nearby- they kept kids for years back then = and the staff was great to work with (I worked both places - the residential place for a brief time).

But it sounds like you have a lot of insight :)

Best of luck to you :hug:

Awww, thanks! :) With a solid decade of continuous therapy, I'd better have some insight.

I recently learned that they converted the child/adolescent psych unit that I spent the most time on into a second adult unit. I think they were the last hospital in the area to have an acute under-18 unit. (Twelve years ago, you had probably 4-5 places to choose from.) I guess kids either get shipped to the residential centers or placed with the company that contracts to do all the state stuff these days. Shame what our mental health system is like.

/end thread hijack

[emtb2rn, BSN, RN, EMT-B]

OP, I think you did a good job given the circumstances. So you are the primary screener with input from the psychiatrist? Interesting.

[Spidey's mom, ADN, BSN, RN]

As an aside, I thought of this thread last night when watching a 20/20 with Diane Sawyer about the over-medication with psych meds that is happening to kids in Foster Care.

I wasn't shocked - I know this is happening. But it was sad nonetheless.

There is some Congressional movement on this issue. She also interviewed someone from the FDA who came off as kind of flippant and disrespectful.

The kids in the show were awesome!

[leslie :-D]

As an aside, I thought of this thread last night when watching a 20/20 with Diane Sawyer about the over-medication with psych meds that is happening to kids in Foster Care.

I wasn't shocked - I know this is happening. But it was sad nonetheless.

There is some Congressional movement on this issue. She also interviewed someone from the FDA who came off as kind of flippant and disrespectful.

The kids in the show were awesome!

i watched that show, too, and it/info/kids were all awesome.

thank goodness for loving, concerned foster parents.

leslie