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MedicalIamA Mental Health Nurse, working that night shift...AMA!

Jul 26th 2017 by Happybrain101 • 19 Questions • 669 Points

Hi there, I'm a mental health nurse, I've worked across many different units from psychiatric emergency, schizophrenia, mood disorders, concurrent disorders and tonight I'm working on forensics! Feel free to ask away

http://imgur.com/2xnI1aX

EDIT: Wow, I woke up from night shift and can't believe all the great questions and kind words! So sweet of all of you. If you are suffering from a mental illness and are seeking help, please find a local crisis line and get the proper help you deserve. If you or someone close to you is in imminent danger, please call 9-1-1 or your local emergency line. Another thing, I apologize if I did not make sense, I kind of jumped out of bed after a few hours of sleep so excited to answer questions, I don't think my brain turned on yet!

Q:

Did you choose mental heath or did you just happen to end up there? Thanks for what you do.

A:

I'd say I chose it, I initially wanted to major in psychology but was scared of not finding a career once graduating so I decided to do nursing. On my first mental health rotation it kind of just clicked that this was where I was supposed to be, never left it since!

Edit: I truly appreciate the thank you, it means a lot!


Q:

Do you ever see signs of mental illness in your family and friends?

A:

Yes I do, I always joke around about diagnosing them with a personality disorder, but I have had the time where I realized they are suffering from what appears to be a psychotic or mood disorder. I have talked to them and provided them some guidance in how to find treatment if they are willing.


Q:

I always joke around about diagnosing them with a personality disorder

TBF, there's tons of people with borderline structures (not to be confused with fulfilling the criteria for DSM's BPD). Not everyone needs to be an always-suicidal, drug using, can't-hold-a-job patient in order to suffer from some of the common and very distressing phenomena that lie at the core of BPD.

A:

Oh for sure, and some of my friends and family do exhibit traits of certain personality disorder including narcissistic and borderline.


Q:

First of all thank you for everything you do!!! Now my question is, what do you find the most challenging about the job?

A:

Why thank you!! I would have to say how mentally draining it is, the verbal and physical assaults are quite common but it's just constantly reminding yourself you are working with a mentally ill population who don't always have judgement and insight into what they do. Reminding yourself not to take things personally can be quite challenging!


Q:

I screamed at a psychiatric resident once and I still feel incredibly guilty about it. I'm sure most patients regret abusing their nurses once they get better.

A:

They do! I had a patient who threw a table at me, every time I see him now he makes sure to say sorry..again.


Q:

What do you do for stress relief?

A:

I spend time with my dog, take him for walks or to the beach. He listens very well!


Q:

What kind of puppy? Do you have a picture of him we can see?

A:

It's a shitzu-poodle mix! He's blind but the sweetest gem!

http://imgur.com/a/cJG2A


Q:

First, I want to thank you for doing this AMA, now for my question; Have you ever encountered or experienced weird/spooky stuff during your shift?

A:

Thank you for the kind words. Last year we had a completed suicide on one of the units, during the night shift the patient who was staying in the room, and completely unaware of what had happened in the room months prior, woke up and kept asking who was screaming in her room, we told her it was no one and she was safe in hospital, she asked so switch to another hallway. We switched her the next day and moved a gentleman into the room, the next morning he walked out of the room, looked tired as hell and asked who was screaming all night...


Q:

That is some creepy stuff alright. Thanks for responding so fast!

A:

No worries, it's been a slow night thankfully!


Q:

How did the patient succeed in suicide in the hospital?

A:

Unfortunately a question I get asked too often, I'm not really sure if there is a right answer to this, he was deemed stable at the time and between the 15 minutes clinical monitoring he was able to successfully complete a suicide. He had planned this out very carefully.

But to add to this, I always am so interested how we try to destigmatize mental health but when a suicide occurs in hospital it is easy to point the fingers at the front line workers, I've never seen a nurse in cardiology be blamed for a heart attack. We have to understand that 2/3 of these patient have some risk of suicidal behaviours, and most of these people are here against their will, under a mental health act. The amount of people I have talked down and physically cut down from attempted suicide is tremendous, but unfortunately some people are very certain of this decision, and no amount of help will change this.

Sorry just my little rant, nothing against you just a point I like to share.


Q:

What advice would you give to a student Mental Health Nurse?

A:

It will be scary, you will see things that will scare you, it will become easier and you will become tougher.

Remember just to listen and validate, a patient really does know if you are listening or just sitting there getting your notes so you can chart on it. They know the difference when you are being genuine or not.


Q:

How often in emergency do you feel you get 'time wasters' (people who don't need to be in emergency psychiatric care)?

Do you think the increase in knowledge about mental illness these days mean you have more people presenting at the ED when really they just need someone to talk to?

Reason I ask is I was in an emergency ward for 36 hours a few years back and the registrar basically told me I was wasting their time. It was very traumatic considering I was so depressed I had conspiracy theories (not quite psychotic but almost) yet she wouldn't discharge me until I admitted was wasting their time and wasn't suicidal.

A:

Yes, unfortunately we have our "regulars" in psychiatric emergency, sometimes they want a dry place to sleep, sometimes a sandwich and other times someone to talk to. However, we also complete a full assessment on every patient that comes through. I have never seen anyone have to wait more than 6 hours or be turned away at the door.

I think it is becoming more common to come through emergency and know you can get mental health help. If not an admission, it is very helpful to connect people to the right resources and give them that 30 minutes just to talk to someone.

I am really sorry to hear about your experience, I really hope this was a one time thing and you can feel comfortable to go to a hospital or mental health facility if you are ever feeling the need to again.


Q:

Hi there! How are suicidal patients dealt with? (And thank you so much for doing this AMA)

A:

You're welcome, good question!

It all depends if this person is actively suicidal. If they are actively attempting they are usually put into 4-7 point pinel restraints. A nurse is sitting with them through this whole experience. I know it sounds cruel, but the reality is this is the only way to physically stop someone from harming themselves it to have them strapped to a bed.

If someone is passively suicidal with no plan or intent, we keep close clinical monitoring and at times to distant 1:1 where we always have our eye on them.

Either way they are kept safe on the unit, they are provided with support during the day through their nurse and programs on the unit. They are however, on the same unit as psychotic patients, but did you know that 10-15% of schizophrenia patients have historically completed suicide. They are a population we monitor very closely.


Q:

What is the most rewarding part of your job?

A:

Of course the corny line comes out...seeing them get better.

Seeing the psychotic patient who was smearing shit all over the room, barely making sense and stating there are bugs crawling all around the room, making their first trip to Walmart with the recreational group.

Or when the forensics patient has finally received community living and finally gets to be discharged. Seeing them hug their family and friends after 10+ years of incarceration in the mental health system is quite a feeling. Seeing these people become working members of society again is so great!

One time I had a extremely paranoid patient, refusing to eat and extremely agitated. We had him on a IV running for fluids that we could barely keep on him. He was losing weight at an alarming rate. His mom would come in everyday, try to feed him but nothing. The one day, him and I had a long talk, he agreed to start intaking sealed liquids, we moved onto solid food and by the end of the week he was eating full meals again and the IV was out. His mom came up to me and said "You gave me my son back, I don't know how to thank you"


Q:

Hey there fellow mental health nurse! I work in Australia and love our job. I'm just wondering how restrictive the mental health legislation is where you are from? For example, what kind of restraints are you allowed to use, and when can you detain a patient against their will?

Kudos to you buddy. We both know how ridiculous and draining this job can be at times. Feel free to chat to me any time if you ever need support.

A:

Hi there! That's awesome, I have actually considered working in Australia!

Here we are allowed to use a few different type restraints, this includes mechanical (pinel restraints and seclusion) or chemical restraints (injectable medications). We can detain a patient against their will, and able to restrain when they are under a mental health form which is issued by a psychiatrist.

If they not under a mental health form, we are unable to do any restraints.

How about in Australia? Would love to hear the similarities and differences!


Q:

My mom used to be a nurse for the psychiatric floor and she talked a lot about how many of her patients were homeless because of their illness. Have you seen the same trend?

A:

Yes, a large part of our population includes homeless patients who have been kicked out of group homes due to aggressive or bizarre behaviour. Our social workers, work hard to integrate them back into the community once they are stabilized!


Q:

When I attempted suicide when I was 16 (ik edgy right) one thing I remember is the nurses always shining lights into our rooms. So my question is do you hate doing that?

A:

I absolutely hate doing this, sleep is so vital in recovery and I feel like an annoying pest constantly opening door and shining lights, but its for patient safety and that comes first!


Q:

I know you’re not a doctor but still a professional.

My wife is undiagnosed but strongly suspected to be borderline or manic depressive.

She recently told me she wants to kill herself but simply doesn’t know how to. She said she was reading about it online and it said to tell someone she trusts, so she told me.

What can I do?

A:

Hi there,

Please find a crisis line if there any in your area, these are extremely helping in linking you to proper resources. If the risk is more imminent, call 9-1-1. Even if she does not want you to do this, it will help her.


Q:

What is the saddest thing you’ve ever heard or experienced at your job?

A:

We found a patient unresponsive in a room, during the code blue and when CPR was initiated, his phone started to ring on his night stand. I looked at it, and it was his mom was calling at 5 in the morning. Still gives me chills. He did not make it.