one of the more annoyingly high strung nurses on the unit paged me tonight so that i could fill out an incident report. pts are not allowed privileges w/ staff unless they are free of any precautions or special observations. privileges with staff = smoke break. tonight, a pt left with the others though he was on BOTH suicide observation and elopement precautions. this could have turned out badly, but thank God, it didn’t. (no M&M for me)
acc to the rules, all the pts who are allowed privileges w/ staff should be given passes. i knew this already. the reality is that the pts don’t always receive passes from the nurses so the nursing assistants take the patients at their word when they say they have privileges. when certain assistants are on during the week, they become familiar with which patients have been given privileges. to both allay the griping of the patients and the vented frustration of the nurses who don’t like to be interrupted to tell them who is and who isn’t given privileges, the assistants have been bypassing this step and taking whomever outside. this is obviously wrong. no matter what else is going on, the assistants have to realize that they endanger themselves (their jobs and their lives) and the lives of the patients. this is, after all, a monitored, locked down, restricted unit! and for good reasons!
sigh. the assistants say it hasn’t been a problem in the past. the nurse says they need to ask. the patient said he thought after two days he automatically gets privileges. this is a lie. pts get privileges only when the treating team decides. i’m positive that he knew this but decided to play the fool. we hada brief conversation and he walked away, resigned to his lot on the unit.
the situation on the unit is such that neither the nurses nor the tech staff have any education on how to deal with the chaos of psychiatric patients. psych patients are notorious for being annoying, rude, abusive, intrusive and all around maddening. when they clamor so loudly to leave, to be given medication, to get extra food etc; the techs and nurses respond to them by ceding their right and obligation as NON PATIENTS and as STAFF! they respond from the gut instead of from the head. they should be taught how to de-escalate, how to establish behavioral modifications, how to set limits and how to deal with both transference and countertransference. they’re not.
this is a classic example of how people get so accustomed to a certain status quo and so wrapped up in their own doings that they don’t stop to consider how their actions negatively affect others. If anything had happened to the pt while he was down there, the mighty reactionary guillotine of the VAMC would have chopped off many a head. blessedly, nothing did but this won’t end well.
i had to fill out an incident report. i didn’t include the assts role in this matter. i was quite general and pc b/c i’m sure that it will be reported during the shift change and somebody will get in some kind of trouble. i know i don’t need to say anything that would incriminate anyone. in short, i’m slowly learning how to navigate this piranha infested watering hole.