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Not just Psych

When working in residential, it was a sort of running joke (that wasn’t funny at all) between the kids, that we weren’t “real nurses.”


“Nurses work at hospitals.”


“Nurses do IV’s.”


“Nurses wear scrubs.”


Some of the older kids, especially those with oppositional defiant disorder and conduct disorder, would often refuse to listen to anything we had to say. They would refuse blood draws and meds, and visits with the doctor.


“You have no idea what you’re doing. You just take care of crazy kids,” I had a boy tell me during a restraint. He was screaming that he was feeling lightheaded as I tried to assess him during the restraint to determine the next step. I told the staff doing the restraint to let him go and had the boy sit down on the floor, up against a wall. He started to calm down as I assessed him. He was feeling lightheaded because he started having a panic attack during the restraint. I sat down beside him as we did breathing exercises together and I monitored his oxygen saturation and pulse rate. His respiratory rate went back to normal. He looked down at the ground and said he was sorry.


“For what?” I asked him.


“You’re probably the nicest nurse I’ve ever met,” he replied, still looking down at the ground.


I just smiled and told him thank you and that it was okay.


I never took offense when the kids said things like that because I know their words have nothing to actually do with me. I know we have talked about that a little bit before.


So after I made sure he was okay, I left him with the staff and went back to the nursing office to do what all nurses do: documentation.


Working in mental health is hard. I’ll be honest, when I went to nursing school I didn’t realize how much would be involved. I hate math. Literally HATE math. I told myself that working in psych, I at least wouldn’t have to worry about calculating for IV’s, or anything else that involved numbers.


Wrong. Totally wrong.


Especially when I got to the inpatient unit. More on that next week so stay tuned!


So not only do psych nurses have to, you know, do the psych part, but we have to be able to do everything else, too. It’s overwhelming and while I totally believe that every nurse has their special calling, for many reasons, psych is mine.


I always said that I never in a million years could work with dying patients and my heart is so grateful for the nurses who do.


I didn’t really think that working in mental health, however, I would have to have patients who had not only mental health diagnoses but also medical conditions. I was clearly naive to this fact. It just isn’t fair to see a child struggling with a medical condition and a psych condition.


And it is by far one of the most difficult patient populations to take care of as a psych nurse.


The first two diabetic patients I had while working in residential is a great example of howdifficult this can be.


One was eleven and one was thirteen. We will start with the eleven-year-old girl.


She was very, very defiant. She had a multitude of diagnoses and was often very difficult to regulate.


Working in residential is a lot different than working inpatient. There are more regulations and polices that have to be followed and a lot of things that we aren’t allowed to do that you can do on an inpatient unit; one of which is restraining a child to administer medications.


This girl refused her insulin all of the time, at least five times a week. Since we weren’t allowed to restrain her to give the insulin, we often had to call the EMTs who would have to take her to the hospital just to be restrained for an insulin shot. It was always such a disaster of a process and one of the many reasons I wish that residential had some of the same allowances as inpatient. SOME. Definitely not all.


After she had been in residential for quite some time, she was finally warming up to me and I was able to get her to comply, most of the time. We had come up with a reward system and she seemed very motivated by it, most of the time. If she took her insulin shots willingly for three days, on the fourth day she would be allowed to eat lunch with me in the nursing office. She enjoyed this and it was working…again, most of the time.

One day she was having an awful day. Nothing that we did calmed her down and she was dysregulated for hours. I knew that it was not going to be a pretty situation after dinner when it was time to give her insulin shot.


I was right.


She walked into the nursing office and slammed the door behind her. I opened the door so that her staff could come inside as well. She was not happy with that either and started to throw all of the papers off the table. I sat down at the table and watched her do it. The staff that was with her wanted to intervene, but I said to hold off as we watched her throw papers all over the nursing office. After about three minutes, she sat down at the table across from me.


“Are you ready now?” I asked her. I wanted her to have a chance to calm down and if throwing papers around, which was hurting no one at all, was what she needed to do, then that was fine with me.


Unfortunately, that wasn’t enough. She wasn’t calm enough yet and quickly grabbed the insulin pen that was already ready with the needle attached. She started to chase me around the nursing station, attempting to inject me with the insulin. What was even worse for this situation was the fact that the staff that was with her was terrified of needles and refused to come into the office to help me. She finally called for another staff who wasn’t afraid of needles, and helped me to restrain the girl and retrieve the insulin pen.


Needless to say, the squad was called and another trip was made to the ER for the insulin injection.


The second girl, let’s call her Katy, was so depressed. It was a very different situation than with the first girl who seemed to refuse her insulin just because she could. Katy would refuse it because she wanted to die. She would say that she just didn’t care anymore and sometimes it would take over an hour to convince her to comply with the insulin. Thankfully, while in residential, she eventually ended up taking the insulin shots.


I was fearful for Katy because I knew that she had a very unstable home life and most likely wouldn’t comply with treatment once she discharged from residential. She was such a sweet, caring girl who so badly just needed to be loved.


I remember one day, when it was close to her discharge date, she was in the nursing office calculating her insulin dose with me. She gave herself the injection as she often did when she was in a good mood. She then looked at me and said, “I hope you know I’m not going to do this when I leave here. I’m going to die no matter what.” I can honestly still see the look in her eyes. She was so sad and empty. It was a moment where I was at a loss for words, because I believed her.


She was right.


Shortly after she discharged, she was admitted to the hospital. She had been noncompliant for so long with her diabetes treatment. She was in a coma for a few weeks before she passed away. My heart shattered when I found out.


I’ve also had many patients with epilepsy, hoshimoto’s encephalitis, pregnant and postpartum teenagers, just to name a few of the medical aspects I’ve provided care for.


Just like in the stories of the two girls with diabetes, it’s extremely scary when medical and psychological diagnoses mix. The outcome for the patient often doesn’t seem positive if they are not motivated in same way to take care of both their mental and physical health. This is why I constantly am saying to take care of your brain. If you aren’t taking care of your brain, it is extremely difficult to take care of anything else.


Aside from this post being a rant about psych nurses actually doing more than just psych, because we obviously do, I honestly just wanted to reiterate one fact that hopefully I’ve embedded into your brain a million times by now. You truly never know what someone is going through. Mental, physical; it’s all important and playing a role in that person’s life. So please, take the time to be kind to everyone you meet. You never know how hard they are fighting to keep themselves alive. Sometimes, putting one foot in front of the other just to walk to the bathroom can be a challenge for some. The last thing people need is someone else making their life more difficult than it may already be.


So, as always, take the time to know someone before you form an opinion; psych nurses are medical too; and please, take care of your brain!

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