Tuesday, July 18, 2006

I Gotta Blog This

Summertime fun and a new dog have taken me away from the computer for the past few days, but I've got one of those special stories to tell so I'll let you all in on the Good Times while the BBQ is heating up.

I've been oriented to do charge when the regular charge nurse is off. I had two days of shadowing the charge, and then there would be two days of her shadowing me. No problem, right?

I'm plugging along on my first day of doing the job myself with the regular charge shadowing me, and anyone who asks her a question is told "HK is charge today". I'm feeling like I got this handled. At least until noon rolls around.

Carlos (not his real name) was a big guy. Upon admit he had given us some trouble by becoming extremely threatening/violent/agitated and ended up in seclusion a few times in as many days. I think I've mentioned that we're a facility that only uses seclusion or restraint as a last resort, so you can believe he was really out of control. I was aware that he might act out again and was keeping an eye on him. He was really focused on getting out to get a smoke break, but you've got to maintain a certain level of behavior to go out. I told him at the start of shift that I hoped he would try his best to maintain control, take PRNs if they were offered, and if he did well we would try to get the lunchtime smoke break. At that time it would be more than 24 hours since his trouble. Rules, you know.

He couldn't do it. I was hoping not to have any trouble, but he got angry with staff and started yelling. I tried to redirect and gave PRNs, but then he yelled at Psych Doc shortly afterward. There's no way I can let him go out and smoke when he's screaming and cussing.

When I told him (as diplomatically as possible, trying to avoid a fight) that he wasn't going to get to smoke, he slammed his fist against the window of the nurse's station then ran full speed and planted his shoulder into the elevator door. As he ran down the hallway, we called for staff. He knocked over the linen cart when we followed him. At the end of the hall he slammed his elbow into the plexiglass cover of the fire extinguisher and removed it. Now he had a weapon which he brandished as if he'd like to crack someone's head open. Probably mine.

There were only four of us, and I knew well enough that even without a weapon we would have to wait for the staff who were still running toward us to catch up. We couldn't do anything but wait for them with him at the end of the hall. The he pulled the pin and sprayed clouds of nasty yellow fire extinguisher powder at us. But wait - there's more.

The billowing extinguisher powder did something to the fire alarms, which went off. The patient room doors around us which were magnetized open slammed shut. Screeching alarm sirens blasted. Patients came out of their rooms and we directed them into the other hallway where staff lined them up in a fire drill line. Carlos sat on the floor in the corner with the empty extinguisher while we emptied patients from the hallway full of the awful powder-fog. By then staff from the other floor arrived. When they restrained him and took the extinguisher, he didn't fight. I heard the sirens of the fire trucks arriving. I exhausted my supply of bad words and began inventing new ones.

Carlos went into seclusion in 4-points (I wanted to give him some extra-credit points, but didn't know how) as firefighters poured into the hallway from the stairwells. I noted the nurse managers were there also. The 30 or so other patients were taken down on an impromptu smoke break because the fumes were spreading down both halls.

Once the firefighters got the alarms off and gave us an all clear, doors were opened and a large fan brought in. Housekeeping was called. We aired out the unit, said goodbye to the fireguys, mopped up the floor, and brought the patients back up.

I sat down to fill out the paperwork, my shirt and hair still full of nasty powder.

So much for day one. :P
Posted by HypnoKitten at 7:41 PM

Blogger hoosier student nurse, at 6:46 AM  

Boy, talk about trial by fire! No one can say nursing is boring. Maybe at times really stressful, but never boring. Good for you for maintaining your calm when you were in charge!

Blogger The Platypus, at 7:24 AM  

You could get hurt wrestling with somebody. I'm glad I work at a place where I can just page for armed security cops and then stand back and watch.

So, when will Carlos' insurance run out and I can expect to see him in the ER?

Blogger HypnoKitten, at 11:59 AM  

I feel pretty confident in our restraint techniques - if we've got enough people to do it I've never seen anyone get hurt by the pt. It may be similar to what your security is trained in, but at least in our case the patients have already been searched and we're sure they have no weapons on them.

Carlos is actually doing MUCH better now and is pleasant and friendly. I'm noticing that it takes about a week to get back on meds and feeling better for some people. By the second week the hallucinations and paranoia weaken to the point where we can make plans to discharge safely back to wherever they were living before. SO MANY of our patients are there only because they went off meds and decompensated.

We don't send people out when the insurance runs out. At that point the county pays for their bed, because they are an involuntary admission by the courts. If they DO get released before they're ready to go, it is because of the courts letting them off on some sort of technicality on the initial detention. Then you'll get them, guaranteed. :)

Blogger Austin of Sundrip Journals, at 3:10 PM  

Let me just say, it can only get better from here.!!

What a vivid description...and funny I might add. I've been IP in a psych ward too many times to count and I know that at any moment things can change. I've seen you guys handle things professionally and then there are some that i thought might need a dose of meds themselves just to get through the shift.

Bravo for getting through that day and for using skill and coping skills (new invention of curse words could be considered a coping skill).

Blogger HypnoKitten, at 11:12 PM  

I guess curse words could be a coping skill :)

One of our awesome discharge planners told me that "Chocolate is a coping skill - it isn't a healthy one, but it is a coping skill..."

And yeah, after this I did feel like I could use a PRN myself. I instead went down and got a cold Dr. Pepper from the machine (to wash the extinguisher taste from my mouth, also!) Lately I've been drinking Dr. Pepper, I'm not sure why.

Post a Comment

Links to this post:

Create a Link