Do all things without grumbling...

I have my current favorite bible verse referenced on my bathroom mirror as a daily reminder to do everything without complaint (no one wants to hear it anyway) or as I like to put it, suck it up buttercup.  I try very hard to not complain about whatever goes on in my day and to just grin and bear it, however, one thing that tests me time and time again is getting an admission from our own ED at shift change.

As any nurse will tell you, most days have a certain routine.  Medications need to be passed, procedures need to be done, rounds with the doctors happen, etc.  If you are lucky, this will occur without incident and you are able to pass on report and be on your merry way shortly after shift change and report are over. As a day shift nurse on a psych unit, my goals for the day consist of many things, but in the end, keeping everyone safe has top priority.  For many of my patients, transition is a HUGE trigger.  Transitioning from the playground, from quiet time, from group time, etc. can be hard on the kids.  Transitioning from staff, especially at shift change can be time for mutiny on a psych unit.  Hence my frustration with admissions at change of shift.

I am proud of the team I work with and the fact that we have a plan for shift change and how we can make things easier on "our kids."  We know that many of these kids cannot trust adults and will test boundaries to the limit when a new adult is present.  Our team tries (very, very, very hard) to create a consistent routine, to plan ahead, and to plan with the child what will happen next, in order to maintain calm on the unit.  As a day nurse, I work hard to keep the calm at shift change so I can set up the incoming night crew with a good shift since I will likely be seeing them the next morning.  This is where my plea to the ED comes in.  If I know that your patient is coming to me at 1729, please be prompt and send this patient to me ASAP.  Please do not put in the admit order at 1749 and then send the patient at 1915. We are now in report with the night crew and trying to maintain that thin shred of calm on the unit that we have worked hard to maintain and the patient you have sent me is crying, screaming and has nine relatives in tow, who are all on their cell phones tweeting/facebooking/snap chatting, wanting to take pictures of the patient on the psych unit no less, all while demanding water and a "safe" place to put their very expensive handbag.  I understand that the ED is not fond of working with "my" kids, but please do not hold "my" kids until 1915 and tell me they need to move now so night shift assignments in the ED can be made. We made assignments as well, and this admit may change how we would have staffed.  My unit is different than most.  Parents do not stay.  Kids are not confined to bed.  All are triggered by the smallest upset/noise/change in routine.  Although I may grumble when this happens, I will always stay to help the next shift in whatever way I can, I just wish other areas would understand how huge and unsettling shift change is for psych patients.

Bah Humbug!

  One of the things I thoroughly enjoy about working in psych is the never ending questions.  We are always trying to discover the root of the problem, to understand the cause and the why to the behaviors.  The dangers of being in psych is that you take this questioning and longing for answers and begin applying it to not just your patients, but to others in your life and even yourself.

  For the past few years, I have started dreading the holidays.  The days and month up to the holidays I enjoy - making lists for gifts, decorating the house, making meal menus.  Then as the days get closer to the big day, I start becoming angry and bitter.  I am(self) tasked with many things such as making the entire meal, purchasing the gifts, wrapping the gifts, pleading with family members to attend at least one mass out of the year with me, and driving my mother to and from my home.  All without an offer of help from other family members.  I then find myself stewing over my being deprived out of an ideal family gathering where family members share in the tasks of making meals and opening their homes to one another, and staring at just another item on my list (nurses love to make lists, even adding little check boxes to make the items official) that I cannot wait to check off and call it a day.  Obviously not a festive or mentally healthy way to spend what is called the "most wonderful time of the year."

  So, what do I do?  I need to re-frame my thinking, much in the same way I try to teach my kids at work.  Look for the trigger.  Examine how it makes me feel.  What is my behavior.  The trigger is the holidays and my belief that there is an ideal family holiday that I am not able to enjoy, which in turn makes me angry (not sad or depressed, but very angry) which makes me irritable and honestly not really nice to my family.  Here's the hard part.  I need to change my thinking, and I know that I need to do this in order to stop this cycle, and it is going to take a lot of conscious effort on my part.  Yes, it is the holiday and I only have my family of four, my mom and my father-in-law to celebrate with, not the Norman Rockwell painting I envision for a large gathering.  Although I am tasked with the cooking and baking, realistically, I am the only one able to prepare the meal.  What I need to look at is delegating tasks to others and being o.k with those tasks being done by someone else.  Ironically, I am feeling better already.  As cliche as it may sound, I (and I am telling myself this) need to be grateful that I have family around to celebrate with.  Although it may not be the celebration I envisioned long ago, it is still a celebration and needs to be viewed as such, not an occasion to be bitter and angry.