I suppose I wanted a change from Surgical after a couple of years of nursing...SO....
I transferred to the Psychiatric Unit. There couldn't have been a more radical switch than this. I had really liked my Psych rotation as a student so thought that perhaps this might be a good change.
Interestingly enough, I loved it. For 2 years.
At first, I worked some day shifts and participated in some group therapy, but mostly I just passed out the chemical restraints/mood elevators, did one-on-one therapy - and SOAP charting galore.
What I discovered in those two years, was that the same patients rotated through the place - Revolving Door Syndrome. Drug induced psychosis. Depression. Paranoid Schizophrenia. Bipolar Disorder. Each one with Labels that we apply to a patient from the rapidly expanding DSM.
Did anyone ever get better?
I refused to learn to play pool with my patients because the cue looked too much like a weapon to me. (take note of phone assault story below)
On occasion we were assigned to patients that may have been a potential threat. I can remember taking an agitated paranoid schizophrenic male on a walk once – by myself. Looking back on it later, I shook my head, and promised myself, never again.
I am quite familiar and comfortable with schizophrenia having three relatives with that diagnosis. But a PARANOID schizophrenic is a whole "other ball of wax" (which btw is being dropped as a subtype along with others from the next edition of the DSM).
It was one of these types of patient that was the “person of interest” in a murder that occurred shortly after his release from our unit...his landlord/manager was shot. When he was caught - he admitted to the killing and also voiced delusional justification for his actions.
It was also a diagnosed Paranoid schizophrenic - and former psychiatric patient - that murdered my friend’s brother at a young age – plus 6 others. He is still locked up in a forensic psychiatric institute forty years later.
I am not trying to suggest that all psychiatric patients are dangerous. There is the mundane. And -yes - you can find these types of patients in all areas of the hospital – heaven knows I had more than a few in L&D.
It is just that the emotional/mental status is the main area of concern and the focus of treatment on a psych unit - and what you are dealing with isn’t something that is tangible and is definitely unpredictable.
My girlfriend that I worked with at the time told me about how she lost all of her upper front teeth due a patient grabbing a phone and whacking her across her face with it a few years back. There was no remorse. There was no recourse or accountability put on the patient – even in the court of law. "Nursing is your job - and this is one of the hazards of your occupation" is what the judge told her.
Our Psych Unit was fairly isolated at the time - and this was concerning especially at night when there was only one nurse on shift. There was a rehab unit through 2 sets of double doors – soundproof, unfortunately, due to a lack of foresight - just in case you had to yell for help - no one could hear.
These doors were unlocked, so basically the care that our manager took to lock up our own knives under double lock on the Psych Unit was rendered moot. Not only could a psych patient sneak through those Rehab doors, but he could also slip unnoticed past the nursing station and into the Rehab kitchen where there was a big open drawer with a great assortment of very sharp carvers.
I switched to permanent nights and - when working on the unit by myself one night as per policy back then - an agitated patient rang. He was a young guy and had a history of making physical threats and he was upset that he couldn’t get back to sleep.
I tried to calm him - giving suggestions for relaxation - but he was too agitated to settle easily so I thought that maybe the chemical restraint approach might help him out a little - and offered a repeat prn sedative to him.
The medication room was a very small double locked cubicle, a room within a room, but situated away from the nursing station and the phone. No such thing as cell phones or even cordless phones back then.
When pouring meds, one had to stand back to the patient in an open doorway – no wiggle room.
Fairly unsafe, now I think about it – but that was the layout of the old unit. This particular patient soundlessly crept up behind me and smashed his fist in the glass in the door just inches above my head. I screamed, of course.
But – thanks to the soundproof unit - No one came running to help. No one could hear me. Lucky for me, this time, he didn't have one of Rehab’s knives.....
Shortly after that incident, they determined that one nurse was not adequate staffing and expanded to two nurses on nights. Thankfully it didn’t take a more serious incident to prompt the increase.
Sometimes the patients ran off, and we had to notify the local police of their departure so they could find them and return them. This happened more than once. After all, we were an "Unlocked Unit".
I can remember one young police officer who returned custody of one of our out-of-control patients kicking and screaming. This particular enormous patient had the tendency to strike out - and there was no way any of us could stop him if he felt the urge to run.
The officer stood in the doorway....and said...."you could try and stop these people at least...." to which I replied, "easy for YOU to say – standing there filling up the doorway with a gun on your hip...."
I think it was shortly after this that I pulled the plug and switched back to Surgical.
Wait a minute. No it wasn't.
Posted by A NURSE at 11:22 AM
[comments were salvaged as below]
2 comments:
newnurseinthehood said...
Loved this. It really sums up the simultaneous frustration and fear and heartbreak that comes with working with these patients. I really wanted to work psych, but now that I've actually dealt with some of it, I know I'm not strong enough but I really admire anyone who can, even just for a little while.
Interestingly enough, I loved it. For 2 years.
At first, I worked some day shifts and participated in some group therapy, but mostly I just passed out the chemical restraints/mood elevators, did one-on-one therapy - and SOAP charting galore.
What I discovered in those two years, was that the same patients rotated through the place - Revolving Door Syndrome. Drug induced psychosis. Depression. Paranoid Schizophrenia. Bipolar Disorder. Each one with Labels that we apply to a patient from the rapidly expanding DSM.
Did anyone ever get better?
I refused to learn to play pool with my patients because the cue looked too much like a weapon to me. (take note of phone assault story below)
On occasion we were assigned to patients that may have been a potential threat. I can remember taking an agitated paranoid schizophrenic male on a walk once – by myself. Looking back on it later, I shook my head, and promised myself, never again.
I am quite familiar and comfortable with schizophrenia having three relatives with that diagnosis. But a PARANOID schizophrenic is a whole "other ball of wax" (which btw is being dropped as a subtype along with others from the next edition of the DSM).
It was one of these types of patient that was the “person of interest” in a murder that occurred shortly after his release from our unit...his landlord/manager was shot. When he was caught - he admitted to the killing and also voiced delusional justification for his actions.
It was also a diagnosed Paranoid schizophrenic - and former psychiatric patient - that murdered my friend’s brother at a young age – plus 6 others. He is still locked up in a forensic psychiatric institute forty years later. I am not trying to suggest that all psychiatric patients are dangerous. There is the mundane. And -yes - you can find these types of patients in all areas of the hospital – heaven knows I had more than a few in L&D.
It is just that the emotional/mental status is the main area of concern and the focus of treatment on a psych unit - and what you are dealing with isn’t something that is tangible and is definitely unpredictable.
My girlfriend that I worked with at the time told me about how she lost all of her upper front teeth due a patient grabbing a phone and whacking her across her face with it a few years back. There was no remorse. There was no recourse or accountability put on the patient – even in the court of law. "Nursing is your job - and this is one of the hazards of your occupation" is what the judge told her.
Our Psych Unit was fairly isolated at the time - and this was concerning especially at night when there was only one nurse on shift. There was a rehab unit through 2 sets of double doors – soundproof, unfortunately, due to a lack of foresight - just in case you had to yell for help - no one could hear.
These doors were unlocked, so basically the care that our manager took to lock up our own knives under double lock on the Psych Unit was rendered moot. Not only could a psych patient sneak through those Rehab doors, but he could also slip unnoticed past the nursing station and into the Rehab kitchen where there was a big open drawer with a great assortment of very sharp carvers.
I switched to permanent nights and - when working on the unit by myself one night as per policy back then - an agitated patient rang. He was a young guy and had a history of making physical threats and he was upset that he couldn’t get back to sleep.
I tried to calm him - giving suggestions for relaxation - but he was too agitated to settle easily so I thought that maybe the chemical restraint approach might help him out a little - and offered a repeat prn sedative to him.
The medication room was a very small double locked cubicle, a room within a room, but situated away from the nursing station and the phone. No such thing as cell phones or even cordless phones back then. When pouring meds, one had to stand back to the patient in an open doorway – no wiggle room.
Fairly unsafe, now I think about it – but that was the layout of the old unit. This particular patient soundlessly crept up behind me and smashed his fist in the glass in the door just inches above my head. I screamed, of course.
But – thanks to the soundproof unit - No one came running to help. No one could hear me. Lucky for me, this time, he didn't have one of Rehab’s knives.....
Shortly after that incident, they determined that one nurse was not adequate staffing and expanded to two nurses on nights. Thankfully it didn’t take a more serious incident to prompt the increase.
Sometimes the patients ran off, and we had to notify the local police of their departure so they could find them and return them. This happened more than once. After all, we were an "Unlocked Unit".
I can remember one young police officer who returned custody of one of our out-of-control patients kicking and screaming. This particular enormous patient had the tendency to strike out - and there was no way any of us could stop him if he felt the urge to run.
The officer stood in the doorway....and said...."you could try and stop these people at least...." to which I replied, "easy for YOU to say – standing there filling up the doorway with a gun on your hip...."
We would find the weirdest items in our patients' belongings when we did our "admissions search". One of the strangest - or maybe not so strange come to think of it - was a portable vagina...hair and all. I just couldn't bring myself to handle that one.
I think it was shortly after this that I pulled the plug and switched back to Surgical.
Wait a minute. No it wasn't.
It was during a one-on-one session with a very depressed young woman who just sat around doing NOTHING to help herself, brushing aside all suggestions - all the while complaining about everything going wrong in her life – I told her - "One of these days you are going to snap out of your depression and realize you are an old woman and will have done NOTHING in your life....."
Yes. That is when I realized I needed to get out of there. I don't think I was being therapeutic any longer.
Posted by A NURSE at 11:22 AM
[comments were salvaged as below]
2 comments:
newnurseinthehood said...
Loved this. It really sums up the simultaneous frustration and fear and heartbreak that comes with working with these patients. I really wanted to work psych, but now that I've actually dealt with some of it, I know I'm not strong enough but I really admire anyone who can, even just for a little while.
3 comments:
Oh sweetpea. We've come a long way in many directions. Betters meds. DSM-IV revised 2000 isn't better but I bet you knew that. I have a brother who's unipolar manic and controls his hypomanic by running 7-15 miles a day. It works!!!
Thanks for sharing more stories!! HUGS!
Definitely things have improved. I hear you about the struggle...my dear aunt has suffered with schizophrenia for 50 or more years and even had ECT done - almost killed her. She is a real sweetie, and is doing well in a group home at almost age 80.
Thanks for all your comments and the hug! :) I appreciate it all!
I enjoyed reading your blog and so appreciated your comments. Thanks for the visit. I'll be back ;)
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