Tag: Mental Health Nurse

One night shift in a mental health rehabilitation ward

Here’s what happens on a night shift in a mental health rehabilitation ward; or at least within the Trust I worked for.

I was working a bank shift which means I am on the Trust’s bank of staff who are available to cover shifts on the various wards if they don’t have enough staff. Because I was a student I could only work as a nursing assistant (N/A).

In comes Ayo with her big bag and her big blanket, tutting as always before slumping down into a chair, moaning, “Oh Lord, I don’t need this, I worked an early bank shift on Jasmin (ward).”

Working a night shift and then a late shift is not standard practice. Long hours, fatigue, and lack of rest breaks or time to recuperate between shifts are associated with an increased risk of errors. However, it’s very difficult for Ward Managers to keep track of, if staff members do extra bank shifts on another ward, which many of them do. Is it any wonder they’re tired and burnt out when they’re working three to four bank shifts a week elsewhere?

What happens in a mental health rehabilitation unit during handover

Lisa arrived just in time, as Clare was about to start the handover at nine pm. “Mandy’s not coping with the titration of her Diazepam and continues to scream at medication time. Sasha remains bright in mood and went out with her nurse to buy new underwear today. She asked when Nancy was working next……..” and this made me smile as I’d taken a shine to her too.

“Elsa messed herself today — again, and her clothes were found on the shower floor.” Clare briefly covered all patients on the unit and said her goodbyes. That left Lisa, Ayo, and me working as a support worker.

Ayo was coordinating this shift but before she could even allocate patients and any tasks Mandy was banging on the office door. “I need my medication. I need my medication……” and as I went to speak to her Ayo cried out “No. Let her wait. Everyone have to wait.”

“Ayo, I just want to let her know that she will get her medication soon. It’s not nice that she’s crying and upset. I ………..”

“No!” thundered Ayo and she kissed her teeth, after which she allocated four patients to me, including Mandy and Elsa. As much as I loved working with all the patients, cos they each brought their own joys with them, I noted how I was always given the more difficult patients to work with. Unfortunately, lots of staff on various wards did this but, by rights, being qualified they ought to have taken these patients.

Lisa would be doing medication this night and I was to prepare supper of toast and hot chocolate; no coffee or tea because patients weren’t allowed caffeine before bedtime.

Supper time on this rehab ward

Mandy was given medication first before tottering through to the kitchen, wringing her hands and muttering to herself. “Hello, Nancy. It’s nice to see you again. I’ve had my medication but they’ve cut it down and I can’t cope Nancy. Honest, I can’t. Can I have three slices of toast nurse and will you cut it into quarters for me?” before shuffling over to the large table. I took her hot chocolate over as she was trembling and I could see her ending up with half a cup if she was to carry it.

Edward was next at the counter and he too shuffled away happily with his toast and jam and cup of chocolate. At only forty years old Edward could have passed for fifty-plus as he was always unshaven, his face was weatherbeaten and his grey hair had receded.

Edward had a diagnosis of schizophrenia and since he was seventeen he heard many voices and saw people who were not visible to others. Unless you saw him at mealtimes, you wouldn’t know he was there; he was so quiet. I had to seek him out each week for games night and he came along willingly, as he was actually really good at Scrabble and we both enjoyed the challenge.

What happens at Bedtime

With medication and supper over I went to check on my four allocated patients. All bar Edward were in their rooms and in various states of undress. Mandy wore a long floral flannelette nightgown and ancient slippers and I watched as she carefully folded the clothes she’s just taken off into neat piles. Her room was spotless if not a little cluttered as she collected china teapots of all sizes. and colours. “Night, night nurse. Will you close my door for me?”

Sasha was in bed and snoring lightly. Elsa was struggling with her bra straps so I offered to help. “Fuck off me, you. I don’t need you.” she spat and turned her back on me. “Go on, fuck off.” Then she gave me another of her toothless grins. I think she just liked to test the nurses’ responses. She always made me smile and I told her I’d be back in five to see she was okay.

I did go back because if you say you will, then you must. So many patients are left waiting when nurses tell them they’ll come back and don’t. I think it’s cruel. That just left Edward. He was watching a film in the shared living room, chuckling away to himself. I wasn’t sure if he was laughing at the television or the voices he heard but he looked happy enough.

Staff lacking common sense

Just when I was going to join Edward for a while, Ayo called “Bedtime Edward.” and switched the lights out. I said “He’s watching this film, let him see the end. It’s over in twenty minutes.”

“It’s eleven o’clock and it time for bed. Come, Edward. Come now.” Totally ignoring me, she watched as Edward struggled to get out of the chair and shuffle over to the door.

Once everyone was in bed Lisa checked all the downstairs doors and windows then returned to the office. I asked why Ayo wouldn’t let Edward finish watching the film. “Eleven o’clock lights out,” she mumbled, and at least had the good grace to look a little embarrassed.

Unbelievable. We all have very different body clocks and bedtimes, and had Edward been at home, he would have watched the end of his film before going to bed. I was going to make sure that I documented this in Edwards’s notes and flag it up at the next team meeting.

Staff bedtime too

It was eerily quiet, pitch black, and unnerving as I went to the kitchen to get drinks for myself and Lisa. On my way back to the office, all I could see in the living area was a pair of eyes peering out at me from underneath a blanket.

I whispered “Hello,” but got no response. I crept forward so as not to startle what I thought was a patient but Ayo shrieked “My Lord. Girl, what you doing? You frightened the life out of me.” There she was, feet up with her slippers lying on the floor, curled up on the sofa. “I havin’ my break. Go. Foolish girl,” and she kissed her teeth.

Off I went with the drinks, shaking my head, stunned. I asked Lisa whether this was normal practice, for staff to sleep while on duty and was told that we each get two hours break but Ayo just sleeps all night. “So that would leave one of us on the floor?” I inquired. If both Ayo and Lisa were on a break that would leave me, an N/A, to be responsible for the unit. “Yes, that’s what we do. It’s okay, Ayo always sleeps” she smiled.

“I’m sorry Lisa but I don’t feel comfortable with that. I’m working as an N/A and I’m not qualified if there’s any emergency.”

Staff ignoring poor practice

“Nancy, she’s done it for years. Even our manager knows,” said Lisa sighing and shrugging her shoulders. However, that night neither she nor I had a sleeping break. We both sat in the office, Lisa looking at holidays online and me reading through my patients’ notes. I really enjoyed finding out more about the patients and while it was quiet I could help update their care plans, number the pages in their files, and generally complete paperwork that’s often difficult to do during a busy shift.

The time went quickly and I was so immersed I didn’t hear Ayo coming into the office. However, I heard her loud yawning and watched as she stretched upwards before dropping herself into the spare chair next to me. I caught a whiff of her stale morning breath and body odour! Offering to make us drinks allowed me to make a swift exit and by the time I’d returned, Ayo had wheeled her chair to another desk.

Six fifty-five and the morning staff were starting to arrive. “Nancy, Lisa, you go on the floor, I do handover.” Which is normal for the coordinating nurse to stay in the office to give the handover, while the rest were outside attending to patients. However, I couldn’t help but wonder how a nurse who’d slept all night and hadn’t asked her colleagues about the shift’s events could possibly give an adequate handover. Again, I asked Lisa who tutted and said “Nancy, you’re just a student. It really won’t do you any good to keep questioning your colleagues’ practices now. They won’t thank you and you’ll fall out.”

Nurses ignoring health & safety

“I don’t want to fall out with them but as I’m a student, working as a nursing assistant surely I have an opinion? And I don’t think it’s safe for patients or staff if others are not doing their job.”

“Nancy, it’s just how it is, how it’s been for years and you can’t change it.”

The Nursing & Midwifery Council’s (NMC) Code of Conduct 2015, sets out professional standards of practice and behaviour for nurses, midwives, and nursing associates. Point 3.4 states: act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care. Both Ayo and Lisa had completely ignored all the rules!

Would you be able to highlight where they’d gone wrong? Would you have reported them?

I would later talk this through with the unit Manager.

Note to self: “Folks who never do any more than they get paid for, never get paid for any more than they do”― Elbert Hubbard

Have you ever felt anxiety while you were studying?

The feeling of anxiety is often in response to stress, like anxiety while studying hard for end of year exams. A recent conversation with a good friend, who’s struggling with anxiety during her final nursing exams, made me reflect and repost this old article.

Many people have these anxious feelings during their lives and fortunately, these feelings normally pass once the pressure has subsided.. However, having an anxiety disorder is more than feeling anxious or stressed. It’s when the anxious feelings don’t pass, they occur frequently and stop you doing what you want to do. Moreover, people with an anxiety disorder often find it very difficult to manage their symptoms.

I felt stuck in the vicious circle that was anxiety and my life. And it was getting worse. Some days (and nights) of constant anxiety left me feeling drained, fatigued, and unable to focus or concentrate. Struggling with what felt like a scrambled brain, I couldn’t take in or retain the information I needed to study.

My anxiety was crippling while I was studying

I just wasn’t getting this studying and revising lark. And how foolish was I? I thought I’d be learning about mental health nursing. So I couldn’t understand why we had so many lectures about all the oligies i.e. sociology, biology, physiology and psychology.

These lectures were normally trotted out by bored lecturers using big words, which was a major bugbear of mine. By the time I’d figured out how to spell sternocleidomastoid* the lecturer had moved on. And my notes then had more holes than Swiss cheese.

Another bugbear was how many communication and interpersonal skills classes we had to attend each week. I mean, everyone has these skills. Right? Doh! I should’ve realised that the shoving and pushing brigade, together with the teeth clicker and tutters, didn’t. Not forgetting the newspaper rattlers and chair scrapers, the talkers and the snorers, along with the class disruptors.

While it wasn’t anyone’s fault I was plagued with anxiety, it was certainly my classmates’ lack of consideration that made it go through the roof. I think I spent the first half hour of each class wound up like a coiled spring. Just waiting for all the commotion to die down so the lecturer could begin.

There’s no such thing as a stupid question, or so it’s been said. Well, I beg to differ, because some students really did ask stupid questions. And with disturbing regularity. Just kill me already! “It says here to write my name in black ink, does that mean I can’t use a blue pen?” or “We’ve been told we had to arrive on time for classes. Does that mean we can’t be 5-10 minutes late?”

And these same students managed to interrupt and disrupt lessons with their stupid questions, so much so, that the topics were cut short. This meant we had to go through the whole bloody lesson all over again the following week.

I wish I’d known how to reduce my anxiety while studying

Three months in and just before Christmas, we were given an essay to complete over the festive period. It was something like ‘How my life is different since starting Uni.’ Okay. Sounded simple enough. Until I got it home and read how I had to write in an ‘academic’ manner? Using references and to use ‘reflection in and on action.’ I’d only passed a few low-grade GSCSs some twenty years previously, for crying out loud. And, as far as I can remember, we didn’t use referencing, and no one ever mentioned ‘reflection’ or ‘academic writing’.

Let me tell you, pre-computers, I re-wrote this essay so many times, wanting to sound clever and knowledgeable. That didn’t work. It just left me feeling even more stupid than I’d first thought, and my anxiety was sky high. The more anxious I got , the less I could concentrate on my essay, and the deadline was looming. What, with this and the class disruptors, boredom, big words and stupid people, I wondered if uni was for me.

However, what example would I have set for my sons had I not completed the essay and got a whopping seventy eight per cent as a result?

Before you go any further, stop!

A little tip for you. Let out that big breath you’re probably holding in right now. That’s right — let it out with a big huff. Let your shoulders drop down from your ears. Unclench your teeth and jaw, go on, give it a little wiggle and let your whole face relax. Now drop your shoulders, unclench your fist (s) and lay them (or one of them if you’re on your mobile now) flat on the table or your lap. Uncurl/uncross your legs, give your toes a wiggle and let me explain quickly.

Your body physically can not be tense and relaxed at the same time. So — if you’re hunched up, fists in tight balls, jaws clenched — you’re effectively telling your brain you’re on alert, tensed and ready to fight or flee. The brain is constantly receiving signals from the body, registering what is going on inside of us. So it makes sense, if you follow the tips above, your relaxed body is telling your brain you’re calm and relaxed.

Now you might try this and think “Huh, that didn’t work,” and you might be right, the first time. But if you practice it enough — waiting for the bus, sitting on the train, in the lift, in the shower or standing in that always slow queue at the Post Office where the person in front is paying all their bills with pennies.

Practice, practice, practice. And just when you do need to relax quickly ie before an interview, exam etc, you’ll have practised so often, you can do it immediately, with ease.

What is an anxiety disorder?

Anxiety is your body’s natural response to stress. It’s a feeling of fear or apprehension about what’s to come. But if your feelings of anxiety are extreme, last for longer than six months, and are interfering with your life, you may have an anxiety disorder and you should contact your GP, access counselling, seek professional help.

Some symptoms of anxiety

• Tense muscles
• Irritation
• Excessive worrying
• Restlessness, pacing, fidgeting
• Agitation, quick to anger
• Snappy
• Fatigued – changes to previous sleep pattern
• Changes to previous eating pattern
• Changes in libido

Repeat the technique as above — breathe, relax your jaw…….. Go back up the page, remind yourself of the technique and practice, practise, practise.

Now take a look at this model for anxiety. Then read about coping skills to relieve anxiety, panic attacks and stress.

Anxiety can be debilitating, so it’s important to seek professional help if your symptoms are severe. If you feel anxious on the majority of days and experience one or more of the symptoms listed above for at least six months, it may be a sign of an anxiety disorder.

Regardless of how long you have been experiencing symptoms if you ever feel like your emotions are interfering with your life, work or relationships you should seek professional help.

Although anxiety is a medical condition in its own right, there can sometimes be a physical reason for your symptoms – and treating it can bring the anxious feelings to an end. See your GP to rule out any other causes and do not self-diagnose.

Are you still practicing unclenching your teeth and jaw? If not, go back up the page and remind yourself of the techniques.

Over to you

So you have anxiety? I hope you’ve found this post useful and if not, I’m happy to answer any questions and accept any suggestions. Let us know your tips to control your anxiety, and I look forward to your comments.

*Sternocleidomastoid — One of two thick muscles running from the sternum and clavicle to the mastoid and occipital bone; turns head obliquely to the opposite side; when acting together they flex the neck and extend the head