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There were a lot of reasons why I left my job in residential.


Do I regret making the decision to leave?


No. I do not.


It wasn’t an easy choice. Not only was residential my first career path as a nurse, but it truly became like a second home. I enjoyed coming to work and knowing that I was giving all that I could to help these children. I had made amazing friends and had hardworking coworkers who turned into family. I enjoyed walking into the nursing office every morning and seeing people who also genuinely cared about the kids. I had become comfortable working there and maybe that was why I needed to leave.


There were a lot of things about residential that I didn’t like. It wasn’t perfect by any means and I’m sure if you know me, you’ve heard me complain about it one too many times.


However, you’d also know that my heart was always there with those children.


I know I’ve said it many times, but the system is a mess. Child protective services needs more help than they will ever be able to afford. There will never be enough foster families for these children. Residential will not be able to help every child who walks through those doors.


Residential wasn’t perfect, but to me, the impact I felt I was making made up for the things I didn’t like; and that was more than enough for me to stay as long as I did.


After five years, I said my goodbyes to residential and felt good about my decision. I had accepted a position on a pediatric inpatient mental health unit. During my orientation week there, you know, the one where you sit through hours of speakers and try not to fall asleep, was actually pretty informative and uplifting. I was excited about that and when the orientation week was over, I was pumped to go onto the unit and start working.


I had seen so much working in residential; you’ve read some of my most memorable stories from my time there, so you know it wasn’t always easy. Like I said, there were a lot of things about residential that I was not happy with, but I had no idea how much worse other mental health facilities had it until I started to work inpatient.


Being in pediatric mental health for five years, I didn’t think too much of it when I got to the unit to start working without any sort of restraint training or de-escalation therapy. I did have to take one class that was sort of like self-defense, that showed you what to do if you were getting your hair pulled or being bit by a patient. It was pretty informative, especially if you had no experience working in mental health. However, it only taught you how to take care of yourself in these situations, not how to take care of the child. I was mildly surprised by this, but like I said, I had a lot of experience in this already and didn’t think too much of it.

I assumed that at some point there would be at least a trauma-informed care class or something once I got to the unit to actually start working.


There wasn’t.


I had two weeks of orientation, I think. It was nothing out of the ordinary at that point. The patients on that unit at the time were very calm. Med pass was completed then assessments then the rest of the day was spent doing doctors orders: labs, EKGs, urines, etc. Then there were admissions and discharges tossed into the mix. Some days were so busy, even when you had “good patients.”


I know how it works. The chaos in mental health facilities comes in waves. You’ll have a group of patients who are calm and ready to discharge and you enjoy the calm before the storm. When the next bunch of patients start to trickle in and the calm patients trickle out, you prepare for the fights, restraints, and constant hours of therapeutic communication.


Before I say anything else, I want to say this. I am not against using emergency medication in appropriate situations. Appropriate situations in which these medications should be used include severe psychosis, severe agitation in which the patient is a harm to himself or someone else, or when a patient is actively violent.


Working in residential for five years, I had learned that sometimes it takes hours, yes, hours, to de-escalate a child. I had only twice in my career in residential wished that I had emergency medication to administer. The first time was when I had a girl actively hallucinating and was being physically aggressive to staff and herself. The second time was when a seventeen-year-old boy was so severely agitated that he was being restrained on and off for almost two hours because he was being so violent to staff.


That’s it.


Twice in five years had I ever wished I had these emergency injections to control a child.


In my one year of working inpatient, I had seen these medications used so frequently that it was like second nature. I was looked at like almost an annoyance when I wanted to spend the time talking to the kids to de-escalate them instead of rushing to restraints and emergency injections.


In the upcoming weeks, I will talk a lot about my experience working inpatient.


Some days were better than others.


While most days were not great in inpatient, I truly hope the information I provide about my experience there will open the eyes of those who need to see it.


I hope that it will break the stigma.


I hope that it will improve the education and training given to new employees working in mental health.


I hope that those who make the big decisions, the CEOs, etc. will see what is truly happening on these facilities because something has to change.

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