January 26, 2010

Recent highlights from work

  • Patients--of both sexes--on the high-functioning unit were coming onto me left and right. Something must have been in the water supply.

  • I had a patient throw some underwear at me.  Fortunately, they didn't hit me.  I do hope they were clean...they looked it, but I wasn't investigating them up close and personally, though.

  • I made a medication error.  Fortunately, it was the same family of medications so no harm, no foul to the patient...and in the tradition of "it worked out for the better" med errors, it did work out for the better for the patient.  Still no excuse though.

  • One sexually inappropriate patient on the intensive care unit got attached to me for some reason. I offered him 1mg Ativan. It didn’t even take the edge off. I had to call the doctor to get him 2 mgs of it plus a haloperidol chaser. That worked for the first day. Next time I see him, he follows me on the unit and says he wants to smell me. I’m not working on that particular unit at that time, so I can’t give him any meds. But I can damn well set boundaries.

  • I arrive on the unit one day and walk right into a code:  a  patient is cutting themselves.  Fun.  Secure patient, start paperwork.

  • I had a patient bitch all evening about how their foot hurts. I call the medical doctor and get the order to send the patient to the ER. Patient starts to bitch about having to go to the ER. I tell patient that they have been whining all day about how nothing was done for their foot and now they have the chance to get it looked at, so do they want to go or not because I have other things I need to be doing.  Patient opted to go...good thing too based on what they found.

  • For the first time, I got to see a patient being restrained.  I do understand that it is in the best interest of the patient, in order to prevent them from hurting themselves and others.  At the same time, to have to order someone to be strapped down--or to just even witness it--is very unsettling.

  • The patients fought over the television. I informed them that the prior shift had laid down the law about it and unless ALL parties could amicably come to their own terms, I was enforcing last shift's law. Everyone who came by the nurses station bitched to me about either not being allowed to watch their program, or having to deal with the others bitching about them because they wanted (and got) to watch something else. One threatened to check out AMA but backed down when I told them if that's what they wanted, I'll get the process started.

January 24, 2010


My workplace is actively recruiting again, particulary for more core staff.  Of course, I'm getting edgy again over whether I (as PRN staff) will get enough hours.  This happens every time my workplace starts advertising...and every time so far I've had no reduction in hours.  If anything, I keep getting called to do extra.  And I have to keep reminding myself that I can only work the shifts that I put in for, and I can't work any and every shift because my life precludes that.  Then I calm down for a while.

I am relaxing about it more.  This month I hit 5 months' in towards the infamous "first year."  After 6 months' working, I think I have enough leverage to compete against new grads, as well as some of the necessary experience to compete against experienced nurses, should I decide to look elsewhere.  I'd rather not leave here though...while it's not the ideal workplace, it's flexibility is suiting my needs perfectly.  Also, I still have a lot to learn about psych nursing and I'd like to keep developing my skills.

I received a complement from one of the senior nurses.  I was on the intensive care unit when one of the female patients lost it and started threatening a male patient who she perceived was harassing her.  She stalked off to her room, the other nurse and I followed because we were hoping to get her to take a PRN.   Other nurse asks her what's wrong and the patient screams "I'm going to scratch his eyes out!".   Other nurse says nothing to this and we're all standing there, so after a bit I say, "tell me what he's done that you want to hurt him."  I get her talking for a minute or two...I can't say I entirely defused her because at one point she suddenly jumped up from bed and started towards the door so purposefully (she did have a history of aggressive behavior) that other nurse and I scampered back.   But she was calmer, and I told her that she should avoid him and we'll keep him away from her, and not to pop anyone but see us first.  The other nurse said that I used my therapeutic communication very well.

Bipolar to form, the patient was happy and smiling and talking to the object of her wrath a few minutes later.   A couple hours later into the shift she got riled up over him and started down the hallway towards him cursing and screaming when she saw me, stopped, said "I'm going to go to my room" and did just that.  

"Good idea," I told her.   Granted, I was holding a syringe in my hand at the time of this exchange...it wasn't for her--it was a scheduled medication for another patient.  But I guess she drew her own conclusions.

Therapeutic communication isn't exactly like the book says it is...especially in detox.  Detox patients sometimes need to be asked "why" and to hear things from your own experience.  Of course, my experience isn't from the addict point of view, but from the family member of an addict one.  But there are several staff that are former users and when a patient complains "you don't understand", can honestly reply "I do" and relate their own experiences.  Detox patients also can't stand to hear things reflected back at them because many perceive it as your being condescending or mocking to them.  Instead, you have to find a way to help direct their reflections towards the truth, and then tell them what they need to hear...which isn't necessarily what they want to hear.

Though truth be told, I have not been up on detox lately.  This is aggravating some of the other nurses there because they want me up with them--I'm pretty good on detox protocols and know the territory.  I don't know why...my guess is that some of the core staff who normally work up there are complaining about being floated elsewhere, so they're working to accomodate them.  This means that as PRN, I get floated more.  But it's all good--I don't mind the change in scenery because it keeps me from being bored as well as gets me more exposure to psychotic patients.  And to be honest...the workload on other units is usually a lot lighter than it is on detox, so sometimes being floated elsewhere feels to me like it's a day off with pay.

January 19, 2010

A new perspective

I've been working on the resumé and updating my application at the local hospitals.  No, I'm not planning to leave my current place of employment...I just thought it'd be nice to have my resumé kept current for when I need it.   And I figured that I'd freshen up my hospital applications just in case they're actively recruiting for eager psychiatric nurses.   I have to say I felt a rush when I was updating the applications, because I can now put down real acute care RN experience (in addition to my volunteer) experience,  as well as put down the RN-BSN program.   I'm still technically a new grad until August though...but I'm getting there.  And hey, if they want to get in on the ground floor with me, here's their chance.

When I was updating, I did see that Number 1 hospital did have an opening in psych that would be up my alley and I wouldn't have to quit my current job...but I didn't apply for it.  I thought about it, and decided that I wanted to get at least 6 months' experience in before I go and start looking for anything else, even a per diem job:  I want to have a stronger knowledge base and more developed skills before I go interviewing, so I don't look like a new grad deer caught in the headlights.  And besides, there will be other opportunities there, I'm sure:  they just don't have a psych unit, they have an entire facility for it.

It's nice to be able to look at the hospital websites and the job listings without this pressing feeling of urgency or the "I need to find a job, I MUST find a job" attitude.  Nor do I look at the websites and feel a sense of rejection because they won't even look at my application because I was a new grad.  Nor is there the "I've applied for this a month ago and was turned down, and yet you're still advertising it--was I truly that atrocious in your eyes?" feeling.   Instead it's "let's see about working here in the future" or "wonder what they would offer me next year when I do have that experience" or "they're still advertising it, perhaps now I have a shot."

I opened up the paper the other day and was reading an article about someone who died.  The name didn't ring a bell...right away.  It wasn't until talking to someone at work that I realized that the deceased was once a patient there, that I worked with him when I was on his unit that day, and that there's speculation that the death may not have been of natural causes.   It was saddening.

January 13, 2010

Let's play "Name that Psychaitric Drug!"

I'm getting a handle on the drugs...I know most of the detox ones (wonder why?), the benzos (again, wonder why?)and several of the common psychosis ones, and I can usually see the generic/brand name and know what the other one is...but I don't have the drugs down as cold as I'd like to.  I really want to know exactly what they are used for and why.  Also, I know nearly nothing about the ADHD/stimulant or other medications. 

So I decided to go "back to school" a bit and do some self-study.  I will take one drug a day (OK, every few days) and take 10-15 minutes to review it.  Basically, I want to be able to know off the top of my head generic/brand name, uses, general dosing range, how to give it, when to/not to give it, side effects and what type of cheese it would go best with.  After all, I don't want to be giving the right med with the wrong Cheddar.  Maybe I'll really go back to school and make up a flash card for it.

Meanwhile, statistics promises to be interesting.  I have to write a paper (!) for it.  On what in God's green earth am I going to have to write a paper about for a math class?!?

January 8, 2010


I don't particularly feel like going into work today:  the weather's blah and I feel blah.  But go in I must.

Once I get my exact school schedule for this semester, I may have to change my work schedule around so I can accomodate it.  Right now at work, I'm set through the end of January.  The first class starts Monday (online) so hopefully there won't be anything that requires me to show up in person this month; then once I get my class schedule, I'll shift my work schedule to accomodate test/quiz/in-person dates.  I started thumbing through a Statistics for Dummies book to get a jump on things.  I also received my graphing calculator yesterday, and cried a little because it looks so damn complicated to use.  But I'm sure I'll figure it out...I hope.

I also admit that I'm thinking about scaling back my work schedule a day every other week or so.  Don't get me wrong:  I still enjoy my job very much...but the excitement of "I'm finally a nurse, I want to be working!" is wearing off, and I'm beginning to miss the downtime I guess I took for granted while I was in school the first time around. 

But we shall see.  I also think that a lot of my blah-ness is due to getting back into my usual schedule after a few weeks of decreased hours and holiday revelry.  After a couple of weeks, I'll be back to my usual eager-to-work self.

Lately I've been feeling some med-surg twinges again.  I realized that of all of our class and of most of my nursing school friends/contacts, only a few of us didn't do med-surg after graduation.  Two went to dialysis, one to LTC, one to home health (she kept the LPN job; the HH job is strictly for her to get her year's RN experience), and two (one being me) are in psych.  But everyone keeps posting about their med-surg experiences...and it makes me wonder if I am indeed missing anything by not being there.  

I get to do a lot more with the patients in psych than I can in med-surg:  they're all walkie-talkies, so I can focus on their mental issues and not whether their chux needs changing.  So I know what I'm not missing from med-surg:  the blood, guts, poop, grunt work, essentially being a skivvy...which unfortunately is a good part of med-surg.  I accept that.  But I know there's more to med-surg than that--nurses do a whole damn lot of procedures in med-surg. 

Anyhow, if I really want to enter into med-surg, I could get a PRN job somewhere, or wait until I finish my BSN and jump in then.  I think these twinges will pass...though something tells me that taking out my NCLEX review book and textbook and just brushing up on med-surg things is a good idea right now. 


January 4, 2010

New year, and back to the books

I do like the promise of a new beginning that New Year's offers, but I don't really make New Year's resolutions.  Well, I kind of do, but I don't list them out and say "This year, I will..."  I tried that once last year:  on a journaling website, I had joined a group where we all made a list of 101 things to do in 1001 days.  I made my list, and before the month was out promptly forgot all about it as well as my poor journal.  Now, I know that I've done some of the things on that list...definitely not all 101 though.  But it just confirmed to me that I'm not a New Year's Resolutions List person.

Instead, I go into the new year with general ideas of what I'd like to achieve.  I do better that way...no, I'm not 100% there either, but at least I don't put pressure on myself to try to tick off items on some written list.  Or even to come up with a list in the first place.

One thing that I've had to be firm on myself with though is my yarn crafts.  I have far too much yarn:  over 50 miles' worth.  Yes, I tallied it.  So I had to put down in print that I was not buying any new yarn until I made substantial inroads into knitting or hooking up what I have.  At least a few miles or so.

It's funny:  I've graduated, and here I am back in school.  I went to my local CC to pick up my textbook for a class and the woman asked me if I needed to get a student ID.   That reminded me to look for it...and fortunately, I found it in my glove compartment.  I haven't changed much...my hair is darker now than it was in the picture, but that was because I stepped up a shade level in the hair dye. 

I also saw that it still had my student nurse name tag attached to it, which was promptly removed.  I'll keep the name tag as a memento.

I've lined up the next few classes towards the pursuit of the BSN.  I have Stats and Patho for this spring.  More Patho and Assessment are for the summer, possibly with Public Speaking (if necessary, I'll roll Public Speaking over to spring 2011).  Diversity, Information and World History are for the Fall. 

I'll worry about 2011 later.  If all goes well, by Spring 2012 I've got my second nursing degree. 

Then, who knows?  No more school for a while after that, though--I'm certain about that.   Otherwise...maybe I'll stay in psych.  Maybe I'll go to med-surg for a while.  Maybe I'll land in another specialty.  Maybe I'll do all of the above.

Though I have to admit...I kind of like being a student.  It's fun to be able to learn.

Work is taking some readjusting, as it always does after prolonged time off.  I had nearly another week off for the holidays, so to get back into the routine is always difficult the first couple of days.  Fortunately, they've seen fit to leave me on detox...which I always enjoy despite the workload.  Lately, there's been enough medical issues going on to keep things interesting.

January 3, 2010

Hello, 2010

Happy New Year to you too. 

Work tried to call me in, but I resisted.  Granted, double-time would have been a nice perk...but I wanted the time with the family.   The extended family is gone now--they left this morning--and it's nice to have the house back to ourselves.  Back to the usual routine starting tonight.