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.

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