Friday, August 03, 2007

All over the place

Where to begin...? I'm having flight of ideas!
Today, two families presented with our new admissions, and both parties agreed that "This unit isn't what we thought it would be."
Today, two families and the patients themselves complained that the degree of dementia our other patients were suffering was making them (the new admits) actually feel WORSE and they wanted to leave. The doctor replied with a terse "You need to be here" and told us they could sign their 72-hour notice(s) if they really wanted to, but otherwise they would be leaving AMA, which of course means no meds or follow-up.
Today, one husband said he would be contacting his lawyer.
And, today, three of our staff nurses have penned letters to the nurse manager and director of the unit regarding the (in)appropriateness of our current clientele.
It's what we have been saying all along.
We are not intended to be a dementia unit.
It's not that we don't enjoy the Alzheimer patients. Being that we are a geriatric psychiatry unit, one would expect to find a certain degree of cognitive decline and behavioral issues that are associated with dementia... along with the accompanying psych issues that we are intended to treat. But! But...
We also are supposed to care for patients who have a major depressive or anxiety disorder, schizo-affective disorder, schizophrenia, bipolar, and post-traumatic stress disorder (to name a few). None of these are an ideal mix with the wandering, yelling, confused patients who drive them to the absolute brink of violent madness. The depressed patients become more withdrawn and isolative, helpless, hopeless, needy, and at times, even suicidal. (If I'm going to end up like that one day, there's no point in going on...). The anxious patients become even more anxious, to the point of hypomania if not full-on manic. The psychotic patients become nearly unmanageable because their thought process is already disordered, and this new distraction is too much to handle.
We are asking that some consideration be given to the psych patients that need our services. The ones that can benefit from group therapy, activities, medication management, and a safe environment with caring staff who are attentive to their needs. Instead, our time is spent changing diapers and feeding patients who have regressed to the point that a meaningful conversation is out of the question. We have no gripe with providing ADL support and the usual nursing care that any patient might need at any given time, I promise you that. However, the purpose of this unit is to treat psychiatric disorders, not provide a holding bed until a nursing home is chosen.
At our last unit meeting, fingers were wagged because there haven't been afternoon/evening groups held for quite some time. When we do manage to get one logged on paper, it reads "nutrition" or "hygiene" because all we can get done is feeding and showering.
The patients we have had recently include a 79 year old completely with-it woman who has been bipolar for 40+ years. She is severely depressed and very worrisome. She sensed a worsening of her symptoms and requested to be admitted before she goes "over the edge".
Today, she said she couldn't take it here anymore and did sign her 72. She said she'd rather lay in her own bed all day than listen to patients X, Y, and Z one more minute. Then there's the 70-something patient with worsening DM, hemodialysis, and a BKA. She's pissed at life, herself, and her doctors. She wants to die. SHE needs help with her ADLs, of course. But she belongs here. We can work with her, try to improve her mood, her outlook, her hope. Sadly, she gets to wait in line because patient Y just pooped himself and is crawling out of bed again.
A 50-something patient with history of severe depression and SI, who is also a cutter, wanted to be admitted to our unit. She had been here a few years ago, and we had helped her. She has been seeing a therapist who helped her uncover some demons, and she knew she needed a safe haven to protect her from herself. Most of us got to see her once or twice a shift.
Yes, there are some serious safety issues at play. We get 'spoken to' when a patient maneuvers their way out of the w/c with alarm, seatbelt, pummel cushion, and lapbuddy, and still manages to fall; yet when we try to afford the treatable patient with the appropriate therapeutic milieu, we should have been somewhere else, like babysitting.
We had a 64yo woman with newly diagnosed CRF who receives peritoneal dialysis. Her depression over her health issues was overshadowed by complete irritation at the demented ones. She said she had hoped we could help her with coping skills and positivity as she adjusted to her new medications and lifestyle. Instead, she attended one group that centered on "some memory-trivia game for the old folks" and colored some pictures. We have been offering one-on-one sessions for therapy as appropriate. The rest of the time, these folks are bored! The social worker, COTA, mental health technicians and nurses all agree that holding "groups" for two or three patients who would benefit, is all but impossible, when all available staff is needed to monitor the wanderers and fall-risks out there. And, when the day shift office people are gone, you can bet we use geri-chairs with.the.trays.up. Just don't tell anyone, mkay?
I have been considering a move to the adult psych unit. Or back to med-surg. I really don't *want* to, but if I gotta, I will go.
That's what sucks about the geropsych situation.
As a rule, I do like my job.
But I see two possible scenarios.
One, we limit the admission of dementia patients who can be managed at their current facilities. Or,
Two, we make some serious structural changes to our unit to accommodate the needs of those patients; invest in adaptive equipment; and add some more staff, for Pete's sake! Then, they can divide up the dementia pts from the regular psych pts, and everyone is warm and fuzzy.
In other news, as the fall semester looms on the horizon, I have yet to get my three 12's, as promised. They're working on it, I am told. I even offered to work the goofy 3P-3A to help out the evening/night crew (which I currently work on, anyway). Waiting.
And, I joined a committee to placate my NM and fluff up the ol' resume'. Why is it, all committee meetings tend to be a boring rehash of the previous meeting's minutes and intense planning of what to accomplish at the next meeting (and so little tends to get done!)? Then there are those action words we all love to hear: utilize, implement, exercise, augment, accomplish, enhance, enrich, efficient, proficient, fiscally sound. Bah! ::vomit, hurl:: Now I know why my bandage scissors have the nub at the end of the blade... Julie doesn't need to handle sharp pointy objects.
Ahhh. Well now that's off my chest... I have little else to offer right now.

Here's to a wonderful end to a sensational summer season! Cheers!


Blogger Sudiegirl said...

Wow - I very rarely read something like this...psych care from a nurse's point of view.

It does sound like your department is quite overloaded with the wrong things.

I wish you the best...I'm a bipolar disorder patient and I know how bad it can be when treatment options are all over the map. I'll be back.

03 August, 2007 09:57  
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16 December, 2008 06:40  
Anonymous Medical Scrubs said...

It sounds like you're in a really hard position at work. I'm so sorry, and I hope everything clears up!

14 June, 2012 15:09  

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