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Is crying a form of manipulation? Need input! [Dec. 29th, 2006|06:47 am]
Psychiatric Nursing

Hi, I'm a charge nurse in a state psychiatric institution. As you may be able to infer, I work in a situation where we do hands-on restraints, mechanical restraints and seclusions.

We are now a free-standing hospital, part of the most innovative movement in mental health care in the country, but previously we had been on a campus with a security hospital and a sex offenders program and our unit (now a free-standing hospital) has always been the most dangerous unit to work on the entire campus and it is now even MORE so because we are no longer part of the campus and do not have security counselors to come to our aide when we have a violent situation to control. (We are all trained in how to physically restrain patients and how to protect ourselves, but it's definitely strange knowing we don't have a hundred security counselors waiting to jump run down to our unit with a simple phone call if need be!)

Anyway, with that knowledge about my work environment, I'll try to make this as brief as possible: Six mos ago an LPN was hired to work on our team. She has had SERIOUS boundary issues with patients, all of which I documented and turned in to my supervisors, she had been blatantly insubordinate with me (one instance was when she was out on the floor with one of the patients she was inappropriate with and she was challenging him and taking steps TOWARD him, her arms crossed, her eyes narrowed, all pissed off at him b/c, well, apparently because he was in acute psychosis and that pissed her off. I called her name twice and motioned for her to get back in the nurses station and she pointed at me and snapped, "NO! Stop!" Then later told me I was "making" her "look bad in front of so-and-so." (Warning sign, anyone?)

She continues to do unsafe things. She should have been fired b/c of the things that occurred with the one male patient, but she wasn't, which is very upsetting to all of us who have to work with her. I can't even explain how upsetting it is to us.

Recently she has begun "tattling" on every member or the nights team on what appears to be a daily basis. She has made up absolute lies about things and then, when we confront her about them she lies some more or plays the crying card.

I spoke to my DON at length about the problems still continuing, the fact that people are considering bidding out to the old campus hospital because of the situation and I got lukewarm support at best.

I decided to have a meeting of my own where we get all the cards out on the table and say, "After tonight, I don't want to hear anything about 'well she said this about me yesterday or a week ago or two months ago," that if you have a problem with someone you go right to the source, etc.

Here's my question: We already had a mini-meeting like this with her on one of our shifts and any time we would call her on anything (and it was all being done VERY tactfully) she would start up crying.

I talked to my clinical lead who said, "That's a dead giveaway right there. When someone starts up the crying in a team building session it's just because they are trying to turn the focus away from the facts and onto how pitiful they are for crying."

So, I am facilitating a meeting with our team tonight and my question is this: I think there is definite merit to what my clinical lead said. I think the woman is using tears to gain sympathy and it WORKS. I mean, I felt AWFUL sitting there the other night watching her cry. She even got me to hug her and I loathe the woman. She's lied about me to the point that my DON has threatened to put something in my personnel file about it and it's absolutely untrue, she defies my decisions, she talks in my ear when I'm talking to MDs on the phone and reading back orders....the list goes on.

Do YOU think it's a form of manipulation and, if so, what do I do about it tonight when she starts it up again?

I already have written down as a ground rule for the meeting that we are all to conduct ourselves in a professional manner.

I am a VERY emotional person. I mean, VERY emotional, but when people give me constructive criticism, I don't cry. I mean, MUSIC makes me cry; seeing birds fly makes me cry. Heck, I've gotten into it with other staff members and fellow charge RNs at work and I haven't cried.

Advice and thoughts, please. Thank you!
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Psych Caroling [Dec. 12th, 2006|05:03 pm]
Psychiatric Nursing
[mood |gigglygiggly]

Christmas carols for the mentally ill:

1. Schizophrenia --- Do You Hear What I Hear?

2. Multiple Personality Disorder --- We Three Kings Disoriented Are

3. Dementia --- I Think I'll be Home for Christmas

4. Narcissistic --- Hark the Herald Angels Sing About Me

5. Manic --- Deck the Halls and Walls and House and Lawn and Streets
and Stores and Office and Town and Cars and Buses and Trucks and
Trees and.....

6. Paranoid --- Santa Claus is Coming to Town to Get Me

7. Borderline Personality Disorder --- Thoughts of Roasting on an
Open Fire

8. Histrionic Disorder --- You Better Watch Out, I'm Gonna Cry, I'm
Gonna Pout, Maybe I'll Tell You Why

9. Attention Deficit Disorder --- Silent night, Holy oooh look at the
froggy - can I have a chocolate, why is France so far away?

10. Obsessive Compulsive Disorder -- Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle
Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells,
Jingle Bells, Jingle Bells.
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Hi I'm new [Dec. 6th, 2006|07:14 pm]
Psychiatric Nursing
[mood |curiouscurious]

I graduate in May of next year and I wasn't really thrilled with any of my rotations until I got to my psych one. I was very excited about that rotation and was not disappointed. The only experience I had before was basically all types of med-surg stuff and all in hospital settings. I don't want to be in a regular settings. ICU scares the hell out of me and my biggest attraction to nursing is the people, not the meds or tubes or machines. I also have had a fair amount of psych stuff to deal with in my own life so I like to joke that I feel right at home with the psych patients. LOL! I think a big reason why so many nurses are scared of it is because they are afraid of being attacked by a patient. Most psych patients are not violent. Most are depressed or disorganized, delusional or just not all in this reality. I find them fascinating in all cases and funny in others. I, of course, don't laugh at them behind their backs but laugh with them when appropriate. Most know that they are different and are just glad that someone can talk to them without ridiculing them or blowing them off. I have a knack for getting people to talk to me and in some cases I truly understand where they are coming from. I won't judge a person for being suicidal or freak out about it. We're all just people and we have a hard time with different things, some being socially acceptable and some not so much. I could care less about social norms anyway. I've even considered doing nursing at a local prison. They say they've never had a nurse get hurt and the prisoners are extra nice to nurses because they are the only people that care about them feeling okay. I also think it's an alternative way of getting one's own therapy or different perspective and is a way to grow on the inside. I'm thinking about psych and also hospice care. I have personal experiences with hospice and think they are the most wonderful people.

So I have a question for all of you. Do you feel like if you do psych then you will lose a lot of your skills you were taught in school and be unable to work anywhere but psych?
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Neims16, may be esp. interestng for you: Eating D/O [Dec. 6th, 2006|06:48 pm]
Psychiatric Nursing

This came up in someone else's journal and I felt the need to copy it over here because it's important. It's my writing from my experience treating eating disorders.
You mention what appears to be a DSM-IV criteria for diagnosis of Anorexia Nervosa, saying that a BMI below 18 "can get you the diagnosis of anorexia [nervosa]."

What you don't mention is that being skinny is a minute part of the diagnosis of Anorexia Nervosa. Hell, the way you make it sound, I could get diangosed with Anorexia Nerosa since my BMI is 17, so I hardly meet the 85% of the expected weight for my age and height, but there's a lot more to it. (Hopefully for me, however, my BMI will get back up to 18 once I get over being sick.)

Here are the four critera from the DSM-IV TR:

A: Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight

C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of suriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive mensrual cycles. (A woman is considered to have ammenorrhea if her periods occur only following hormone, e.t., estrogen administration.)

Then a type must be specified:

Restricting type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behaving (i.e. self-induced vomiting or the misuse of laxitives, diurectices, or enemas)

Simply being skinny or underweight does not mean you have Anorexia Nervosa and most women who suffer Bulimia Nervosa are average weight or overweight.

Both these diseases are devastating beyond words. I am a psychiatric nurse and contrary to what I thought I was going to do with my advanced practice RN degree, I am 99% certain I will be a nurse practitioner in psychiatry. Working in a state institution, I see the most ill of our nation's people.

The most ill patient I ever treated had Anorexia Nervosa. She was 22 years old and had the mentality of a 13 year old because that's how old she was when her disease set in. She never grew up because her entire growing up had been consumed by this disease. I had to watch her take showers, pee and crap, all to make sure she wasn't drinking water to get her weight up or purging. I had to sit in her doorway at night while she slept to make sure she wasn't vomiting into her blankets, which she did.

She had been found in a coma in her apt. once by a friend with a blood sugar level of 16. She should have been dead. She didn't care. She was 5'6" and barely weiged 80 pounds when she arrived with us. She kept telling us she wouldn't die because she hadn't died when she was 62 pounds, so why would she die at 80#?

She had to be restrained in 8 point restraints and have a tube put down her throat every day for weeks in order to keep her from dying.

Every time I opened her door on rounds I was terrified I would find her dead. We all were. There she was, dying before our eyes. We'd all had people attempt suicide while we worked and all knew patients who took their lives after leaving our care, but here was this potentially pretty, very bright young woman killing herself right before our eyes and the sound of that scale clattering was a the cocking of the gun aimed right at her heart as it gave out day by day and she couldn't even hear it.

Why tell any of this? Because it's important. People with this disease are no more in control of what they do than are alcoholics unless they recover successfully.

Listen to what your friends, your sisters, mothers, daughters, brothers, wives, sons are saying. Watch what they're doing. Intervene before it's too late.

If you have the opportunity to see the HBO documentay "Thin," as someone who works with patients with eating disorders, I urge you to watch it.

And, please don't be quick to judge someone as having an eating disorder because they happen to be thin or "skinny." Believe it or not, being told repeatedly that you need to put more meat on your bones can hurt, or at the very least, grow tiressome. When's the last time you walked up to the overweight person in your office and said, "Hey, Noelle, you're fat. You need to really work on dropping some weight." Or "Gosh, Noelle! Have you gained MORE weight?"
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Problems with Posting? [Dec. 6th, 2006|06:40 pm]
Psychiatric Nursing

Is anyone having trouble posting here?

In order to post, you MUST be a member, so, make sure you joing the community first before trying to post.

Other than that, I received a message that someone was unable to post here.

If you are having such a problem, please let me know via dropping me a line in a comment at my personal lj noellechristine and I'll get it sorted out ASAP.

Thanks so much for all the new interest and welcome all!

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Since everyone is introducing themselves... [Dec. 6th, 2006|07:09 pm]
Psychiatric Nursing

Hi. I'm Emily. I'm a first year student in a graduate entry program at Ohio State and just finished my first quarter. It's an accelerated master's program for people with a bachelor's degree in a field other than nursing - we get our RN along the way. My specialty track is psych - I will be a Psych NP when finished. My bachelor's is in psych and I have a master's degree in experimental psych. Right now, I'm thinking that I want to work with...

-eating disorders
-drug/alcohol abuse
-sexuality and sexual identity.

Not really sure at this point. Hopefully I will get a chance to explore all of those areas and more during my specialty work.

Looking forward to reading the posts in this community!
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(no subject) [Dec. 6th, 2006|02:33 pm]
Psychiatric Nursing

Hi group. I'm a nursing student in an ADN program and barring any disaster, I'll graduate in May. I'd been struggling with whether nursing was something I "really wanted to do." I didn't dislike it or anything, but I had yet to find a field I really liked. I'd begin each clinical day thinking "ugh, I don't really want to go in - I'd really rather just stay at home." I work at a nursing home too, which wasn't bad work but even after a few weeks I could see how people burned out so quickly.
I had my psych rotation in October. I absolutely loved it. I felt much more that I'd made a difference. I no longer whined about going to clinical, even at 6am.
So, I'd very much like to work in psych once I graduate.
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(no subject) [Dec. 6th, 2006|01:39 pm]
Psychiatric Nursing

My name is Jenna. Although I'm only in my pre-req classes before nursing school, I'm planning on what 
field to go into. Reason being, I want to take classes that will help me in my field in the long run. For awhile
now, I've been planning on psychiatric nursing. If anyone on here already does this, could you let me know
what the job entails? And what degree is required for this job? 

Thank you in advance.
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(no subject) [Dec. 6th, 2006|11:09 am]
Psychiatric Nursing

I'm Noelle. I'm an RN who began, as far as I know, the first comm here for nursing students student_nurses It's a fantastic resource and a great bunch of men and women. If you are a student or just want to be a mentor and aren't a member and are interested, come check us out.

I created and maintain a couple other communities including this one.

Welcome to all who have joined or who are stopping by.

I work as a charge nurse in a state psychiatric facility and I love it. I love it so much that I have decided not to do what I went into nursing school to do, which was become a certified nurse-midwife, but instead am going to become a NP in psychiatry.

I feel psych nurses serve the most misunderstood, underserved, and often unloved people in my country and I want to serve them the way they deserve to be served with all the humanity and decency any other human being deserves.

I work with people with severe mental illnesses who are prone to violence (NO! This is NOT the norm for those with mental illness,) but it is the sad truth for some.

I learn something and find value in my work every day even though I have been called names I didn't even know existed and heard the C-word hurled at me more times than I knew was possible.

It's not a job for just anybody. You've got to have more compassion in your heart than you knew you had and sometimes I have cried on my drive home because of the tragedies I see. But knowing I am trying to help and being an advocate for the voiceless makes it worthwhile and I figure, there will never be an end to women who want to deliver babies. It takes a very special person to speak calmly to a person through the window of a seclusion room at three in the morning.

Any questions about my job for newcomers to psych, let me know.

Also, for any students, please know that I work with the people with the most severe mental illnesses. Don't be scared away. I wasn't, after all. :-)
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Intro. [Dec. 6th, 2006|11:03 am]
Psychiatric Nursing

Hello all. I hope this community can become more active -- it would be awesome to have a forum for psych nurses to interact with each other.
I am making the transition from pediatric neurobehavioral studies to adult psych. I say I am still "transitioning" although I've been at my current job (state psychiatric hospital) for about 3 months just because it's so different than everything I'd done before.
My unit is an acute stepdown pre-discharge unit. Or that's what it's supposed to be. Lately it's unpredictable and unstable, mostly because we've been getting patients from the acute forensic unit that aren't quite ready for discharge or to be interactive in the milieu. I'm a permanent charge nurse there.
Ideally I'd like to move to one of the chronic units (I far prefer the chronic population to the acute) but that's probably far off in the future.
Anyway, I look forward to a lot of good psych nursing discussion!
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