Wednesday, June 1, 2011

Back To Basics - A Uniform and Group Therapy Mandate

          Starting June 1st, our hospital has mandated the mental health unit staff to start wearing nursing garb, i.e. scrubs. We’ve always had to option to wear those instead of the civvies that has been standard wear for psych units for decades. One of the reasons why out administration decided to do this was because they wanted to eliminate the wearing of hoodie sweatshirts. I guess they finally got a clue that people wear hoodies so that the cameras that surround the hospital hallways cannot identify them. As I post this, I would have been wearing my uniform the previous night.
Another thing our bosses wanted us to do was group therapy on the night shift. That would be difficult to squeeze in between the time we report to work at 7 p.m. and 10 p.m. when the patients go to bed. I commented facetiously during a staff meeting that maybe I could conduct group therapy while passing snacks at 8 p.m. Pass the patient a snack and ask him/her how the day went and if he/she met her goals for the day. If not, what he/she could have done better to achieve those goals. In the meantime, the rest of the hungry masses (and they are always hungry) wait in line for their turn. Then a group riot ensues… Just stating the worst case scenario.
In reality, this is how the night shift schedule works out: at 7 p.m. we report for duty and until 7:30, we listen to report from the day shift. At 7:30, we do our rounds, check on how our assigned patients are doing (first we have to make sure that they haven’t run away, and are still alive). The mental health workers do this while the RN’s talk to their patients. It is also in this span of time that patients get visits from family and friends until 8 p.m. The LVN’s on the other hand are getting the medications ready for the evening. At 8 p.m. we serve snacks to all the patients. They line up in the dining room and we pass out whatever the dietary department left for snacks: sandwiches, or fruit cups, or yogurt, plus juice and milk. This can be quite chaotic since everyone wants their share plus more. Some patients want a second helping even when the others haven’t had their first helping yet. Also at 8 o’clock, we offer free phone calls on the hospital phone and there is another queue in the hallway for that. Some patients do their phone calls first, then come to the dining room to get their snack or vice versa. Did I mention that we also check the patient’s vital signs at that time? There is another line in the hallway for that and we have to do orthostatic blood pressures and pulses which take time especially that we almost always have 30 to 36 patients. This takes about an hour and a half to finish.
So there is a constant flow between the hallway and the dining room. How are you supposed to conduct group therapy that way? By 8:30, the medication nurses are ready to pass medications and that requires a separate line in the dayroom area where the medication room window is. So there are actually 4 activities going on at the span of time between 8 to 9 p.m. After that, at 9:15, we conduct the last smoke break of the day, which lasts till 9:30, and finish off the remaining vital signs. Most of the patients go to bed after that and a lingering few watch TV until 10 p.m. after which we close the TV room so that the housekeepers can clean it up before they leave for the night. As you can see by now, the schedule is tightly packed between 7 and 10 p.m. and squeezing a group therapy session in there would be an exercise in futility. Of course the bosses who told us we should do group therapy has never worked the night shift or even observed what goes on in the evenings. Go figure.

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