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Psychiatric Nursing

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New here [Jul. 20th, 2007|02:27 am]
Psychiatric Nursing
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Hey - new to the community, but not new to nursing or psych. I've probably been doing this for about 20 years too long.

I'm actually at work right now, and I'm frustrated as hell. We have patients who manipulate, and attempt to staff split - and I'm working with a relatively new nurse who allegedly was in counseling (like conducting some sort of talk therapy group) in psych prior to becoming an RN.

She's actually a very bright person, but she just does not understand the concept of limit setting. She gives me the hairy eyeball every time I tell a patient "no - and this is why". It isn't like I arbitrarily make things up, or that I'm "punishing" people. I'm just following the treatment plan, and not allowing manipulation to waste the time our patients are "inpatient", you know?

I've talked to her gently about this. And I've been more blunt/direct. I've given her resources. And still, with the evil looks when I follow the behavioral plans and stick to the unit rules like glue. I hate to go to the boss. I mean, I really hate to go to the boss. I like being able to tell her that we have problem solved and worked through our stuff and made things work. At this point, I'm not sure what else I could do. Anyone else deal with this sort of thing? Am I missing the glaringly obvious solution to the problem (other than letting the boss deal with it)?

[User Picture]From: thought_ribbons
2007-07-20 04:42 pm (UTC)
I'm a studnet nurse who is going to be starting psych rotation this fall, I think that you are giving the right approach by trying to talk with her first. (As someone new to nursing i;d rather someone go HEY you're dong it wrong (or what ever) than running right to the boss)I think you should try to talk to her again, but let her know if the issue doesn't resolve then you're going to have to go to the boss. Then (if) you have t go to the boss then exaplin all of your efforts soi far to get you to that siduation. Or if there is another collague that you can talk to with this/talk to her about it then maybe having two people tell her somthing will help her understand!

Take care ansd I hope it goes well for you!

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[User Picture]From: ratherbewater
2007-07-20 05:40 pm (UTC)
I'm a nursing student, but previously worked in many psych settings. Maybe she doesn't realize how damaging the patient's manipulative behavior can be. I'd try just telling her that you are not being mean and that what you are doing is necessary for the treatment of the patient. Also let her know that what you are doing is necessary for the safety of the patient as well as the staff that work there.
I know it can be hard for new people in her position to see that what you are doing is what's best for the patient.
If this doesn't, or hasn't already, worked, then go to your boss. You cannot allow her leniency to be detrimental to the patient's treatment and safety.
Good luck. I know that's a difficult position to be in.
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[User Picture]From: evilcresyluna
2007-07-20 08:15 pm (UTC)
Are you telling her about why you're acting the way you do (ie, what the treatment plan is, what the rules are, etc) or saying directly "I feel that every time I enforce the rules with this patient, you're giving me evil looks and you disagree. Tell me what is going on." Honestly, it might be subconsciously, it might be that she is following the rules but doesn't think they're "fair" or whatever, but does it really matter as long as she follows the rules? I say this because I'm one of those people with easily readable faces, but it doesn't mean I wouldn't follow the rules or whatever.

Or, alternatively, if she's not following the rules and won't discuss it with you, add in "I think I'll need to go to our manager about this, because I don't think we can provide good care if we're acting differently with this patient." Then she can decide to work it out with you or go to the manager.
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From: (Anonymous)
2007-08-13 05:48 am (UTC)

time for a transfer or retirement?

Maybe she's not pre-judging her "inpatients" like you are. Sounds like you have been jaded by your job. It's unfortunate because if that is the case, you could serious cause harm to the people your caring for.

I was pre-judged as a visible minority who didn't care for themselves and was treated sub-human. I had been brought in under false pretenses. A week later I returned to introduce who I actually was. A pure white business woman with a great tan who owned their own home, car, etc. A woman who received merit awards from the city, someone who was at the top of their profession and a role model in the community.

I made sure to volunteer each week as a reminder of what happened.
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From: alearose
2007-09-25 02:53 pm (UTC)

Re: time for a transfer or retirement?

I realize you won't get this since you didn't post with a user identification (anonymous), but I do not prejudge my patients. I'm very good at what I do. I just don't fall for manipulation from patients. Believe me, I have cared for a number of patients who didn't "belong" in psych, but rather needed a good divorce lawyer or to discard some so-called "friends". But the majority (99%) who come to us are in crisis and need help, which does many times, include setting limits and using behavior management plans.

There is a reason they have been admitted involuntarily, and I am not doing my job if I don't follow the treatment plan (which btw, is not arbitrarily made by a single person - it is written by a team of dedicated professionals from all disciplines who are committed to doing the most they can to help people in a very limited amount of time).
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[User Picture]From: psynurse
2007-09-25 02:39 pm (UTC)
Did things get better?
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From: alearose
2007-09-25 02:47 pm (UTC)
Well, yes and no. I think part of the problem was that she was really unhappy and physically miserable working night shift. So she switched to days. Now she thinks that I'm very nice because people always know what to expect. WYSIWYG, you know? There is a reason that consistency works, especially in psych.

The no part is that this nurse really isn't happy in nursing in general. She's not sure this is what she really wants to do. That always makes people hyper-critical of what is happening around them. She worked med-tele before coming to us, and in our hospital, it is the toughest floor there is for chewing up new grads and spitting them out. People assume that psych is a good place for nurses who "can't cut it in the real world". I hate that kind of ignorance.

I'd really like to see this woman succeed in nursing and find a place that makes her feel like she's doing some good. I'm not sure it'll happen, if she isn't interested in finding it. That's another story though - I have a tendency to see potential in others that they don't want to develop.

Anyway, thanks for asking. Things are fine between us. I had another talk with her before she left nights and really tried to explain that work is work. Our patients are our jobs, not our friends. We do them zero good if we aren't consistent with the treatment plan. After she went to days, she said the chat we had helped, because she was having more contact with patients than before and could really see the benefit of keeping professional distance and following behavior plans.
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