After working a stretch on the psych-medical unit, it was a nice break to be floated to psych stepdown. I spent the last several shifts wrestling with IV machines, suction and oxygen tubing. Sometimes all with the same patient. And all the call bells that go off when the bed alarms are triggered! When there's a restless patient, it seems like their bell never stops ringing no matter how low we set the sensors to.
I have remembered that I dislike suctioning. Phlegm is my kryptonite.
In an attempt to accelerate my getting up to med-surg snuff, I got a couple of med-surg reference books for my Kindle. While I will always be a fan of paper books, the Kindle makes it possible for me to have all of my reference books with me while at work. Plus I love the fact that I can order it and have it delivered within minutes.
I've also started looking at a few med-surg and LTAC CEUs. I have to accumulate 150 of them by 2021 to renew my certification, and only 51% need to be in psych; the rest can be in whatever I choose. So I'm going to kill two birds with one stone there.
Anyhow, back to stepdown.
Loads of manic patients. The mania is very strong in the air as of late.
I generally tend to get along with patients in mania, though just watching and listening to them wears me out. The rapid hyperverbal speech, the hyperactivity, the flight of ideas as they jump from topic to topic, the delusions of grandeur…it really is exhausting to keep up with them. Still, it's a nice change from answering call bells.
It’s frustrating when PRNs don’t slow them down at all, especially when it’s the middle of the night and they’re waking other patients up. I tell them repeatedly that as long as they can keep it quiet they don't have to return to bed (some of my peers do not agree with this strategy. I am of the mindset that as long as they are behaving or not in danger of being hurt, I don't have the right to force them into their room). The problem is that they’ll be calmer and quieter for a minute or two. Then the voice and energy level naturally starts escalating again.
At one of my previous jobs, we would utilize that energy for good and have manic patients fold towels or tidy up the common area. Depending on the patient, they might get a broom and dustpan and be put on sweeping patrol. Of course, this is if the patient is willing, which they usually were since they had all this energy to burn.
But it’s harder to manage at night. During the evening, when everyone else is awake and active, having a manic patient or three is one thing. At night, when the goal is to have all the patients sleeping…well, that’s another. Sometimes the PRNs need to be “strongly” encouraged. While I hate pressuring patients into taking medications, it's better doing that than to have them wake the psychotic patients who would pose an even bigger problem if THEY were awake.
For all the exhaustion working with manic patients can provide, one of my favorite things is to listen to two manic patients have a conversation. They will be discussing two entirely different things at high speed and yet still understand each other perfectly. It's amazing to watch.
But the manic patients are asleep tonight...for now, anyway. It's the religiously preoccupied and delusional that are awake and roaming. I've been lectured once already on how I'm going to hell, which is a nice change from just being told that I'm going to hell: at least now I'm having the why-I'm-going-to-hell explained to me. I'm apparently holding another patient hostage. But at least the patients are being so polite and friendly about it with me.
