Kids These Days

The good news about my psych nursing rotation is that we are being treated like actual nurses with actual responsibilities. On Day One, we were doing vital signs before breakfast and this week we had our own patients (which included doing 1:1 therapy with them), did our own charting and were responsible for reporting to the next shift.

The bad news about my psych nursing rotation is that we are being treated like actual nurses with actual responsibilities. Whatever work we are given we are expected to complete without passing it along to a “real” staff member if we run out of time. Lunch breaks have lasted 15 and 20 minutes, respectively, because there is a very narrow gap between when we finish morning activities and begin afternoon process group. And it takes us forever to do anything because we’re not familiar with the vocabulary of psychiatry yet – how many times did I hear the term “labile” before figuring out what it means?! Look it up.

But the good news outweighs the bad. I feel challenged and exhilarated by the work, despite the absolute exhaustion when I get home at the end of the day. I’m still trying to figure out a decompression strategy to protect myself from bringing everything home with me – we hear and see some heavy sh*t.

In some ways, these kids are just like any other mopey, manipulative teenager you might encounter. “Pukey adolescents,” as my dear dad called them. C’mon, we’ve ALL been there! But these are pukey adolescents with a twist. Be it a history of abuse, a dysfunctional family relationship, a genetic predisposition to mental illness or an actual psychosis (or perhaps some or all of the above), each shift brings forth intense revelations that are really hard to hear and even harder to process. To end up on a locked inpatient psych unit, you have to be determined a danger to self or others. So … yeah.

Unfortunately, I’m also extremely frustrated by the way the system works. These kids come to us in crisis and our job is to assess them in as little time as possible, determine that they are safe and send them on their merry way because insurance companies won’t cover them if they aren’t in crisis anymore. Many of them are “repeaters” to the unit. Some have left here and subsequently committed suicide. A number have told me they don’t want to leave because this is the safest they have ever felt. The staff works really hard to help the patients develop coping skills and take advantage of therapeutic opportunities, but there’s not enough time to really do the work these kids need.

So talk to me… How do I advocate for my patients in a system that is designed to fail them? And how do I take care of myself so that I don’t agonize over that very question?

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