u/banjobeulah

This is just a 100% rant but I work in psychiatric emergency and I hate it. I have no idea why I thought I’d enjoy this job and regret accepting the position. I’ve worked inpatient psych before and did enjoy it, but nothing like this. The city I live in has some pretty pronounced issues with substance use and homelessness and the healthcare system just does not empower us in actually helping anyone in this setting, and I just feel like I’m a part of perpetuating a terrible cycle of trauma and dehumanization half the time. It is so deeply demoralizing and frustrating and upsetting. The culture of the unit I’m on is also incredibly toxic and adversarial toward the patients.

I’m also afraid every day. I was nearly assaulted today and was assaulted last week. Every shift, there is a situation that arises that puts us at imminent risk of assault, if not multiple situations. The patient who threatened me today is on our unit all the time, and this person is a powder keg waiting to explode every time. This person also hates women and especially dislikes me, for no logical reason of course. I don’t want to ever deal with this person again because I do not feel safe at all, but it’s my job. I actively want to quit and don’t know how to go on. I’ve cried after work every day this week.

No point I guess but screaming into the void. Stay safe out there comrades.

Hi folks, I’m a psych RN working in emergency services and starting my MSN in September. I’m trying to understand something and hoping to get perspectives.

So for context, I have been taking alprazolam PRN for 3 years. I use it 1-2 times a week to as infrequently as once every other week, depending on how stressful things are. I get rising anxiety with these sort of intrusive stress thoughts (I’m never gonna get it all done and I’ll fail and etc etc) and usually in the middle of the night. For me, I prefer it this way as opposed to taking something daily. The alprazolam works in a half an hour and I don’t take it unless I need it. I understand that this is not the case for many people, however.

I moved out of state for school and tried to see two different PMHNPs to continue my script, and both were weirdly quite defensive, stating they don’t prescribe benzodiazepines or ADHD meds (which I didn’t ask for and don’t need?). The psychiatrist at my school ended up filling my script.

All this to say, can you give me your perspectives on prescribing these meds? Do you prescribe them or don’t you, and why not? I’d love to know what others think. I understand that they have the potential for misuse, but especially for those with a blanket policy to never prescribe, I’d love to know your rationale? Sincerely hoping to learn from more experienced peers. TIA.

I am likely not unique here, but I SUPER struggle with borderline personality disorder. We have one patient who is admitted to our emergency unit frequently who has the most severe borderline personality disorder I’ve ever seen and also has a lot of ASD traits. She’s incredibly smart and shockingly manipulative and sneaky. She has to possess someone’s attention 100% or she will decompensate almost instantly, and always ends up sedated and in restraints. She always finds ways to grab badges and attempts to elope over and over, many times involving assault of staff. She riles up or antagonizes the other patients and if another patient has an outburst, she will insert herself in that situation and make it worse. Zero boundaries and won’t allow other patients rest or privacy. Will find at least one person in particular to attack relentlessly, usually a patient, and once chosen, she’s nearly impossible to redirect. Every time she comes in, the unit descends into chaos for hours until she escalates to the point of being sedated, and none of the staff know how to properly handle her. We have some nurses on the unit (males, who she prefers) who deal with this patient by playing up to her, and it sets her against the nurses who hold boundaries, and the patient always attempts to leverage that dynamic for special privileges. It’s infuriating.

I find this condition fascinating but I’m also perplexed by it and I find it very triggering every time I encounter it. I have the most struggle with this particular patient presentation. It has made me reconsider emergency psych at times, it has gotten so bad. I wish I understood a better way to interact with a patient like this.

Anyway, is there a particular population or set of diagnostic traits that especially challenges you guys?

What comes to mind? I’m open to all ideas and have no idea what to choose. If you had a white coat ceremony to celebrate your graduation and medical license, what would you choose? The event is in mid-September (New England) and the dress code will be dressy with a big white coat of course!

So are vamp haircuts a thing now? Is it a wig?

I don’t suspend disbelief easily lol.

For those in the US, I just found 3 Henry Rose scents at TJ Maxx! They had Dark is Night, Flora Carnivora, and Queens & Monsters. Small 10 mL bottles but only $16 and they were not in the locked case! My store also had Glossier fragrance mists, which I’ve never seen before. Happy hunting!

I’m just beginning to work in the psych ED and I’ve found a lot of things confronting so far. Some of this is gonna seem probably silly or naive to some but may resonate with others. I probably should be using a throwaway but hey.

The first thing I guess is HOW manipulative people can be and knowing that people may be acting out aggressively just to be sedated, or to be isolated. People also straight up learn and manipulate the system in all kinds of ways, like to get out of being in prison (malingering), to get people to visit and bring drugs, etc. They know where all the cracks are and how to work them.

I guess I’m also seeing how the psych ED can be a part of a larger kind of toxic cycle for patients. Like the frequent fliers. They’ll come in for help with detox when the money runs out and no real change happens for them and it’s cyclic. I guess it just surprised me and it is so sad, to think about how bad it must be to live that way. Also, wow, I cannot even fathom being in one of these units, how sparse and scary and uncomfortable and dehumanizing it all must feel to them. I try to think about that a lot and keep a sense of humanity present.

I guess the thing that has confronted me the most is like, the intersections of mental health and criminality and the limits of my own compassion. We had a pedophile the other day in from the prison for SI and I kept thinking, I can’t blame this person. I can see why this person would feel that way. It was hard for me to see how their life could be expected to reasonably improve or have quality, or how someone could live with or forgive themselves for such a crime against young children. It honestly shocked me to see that I feel this way, and I’ve thought a lot about my own reactions in cases like this, people who have killed children, etc. We had this happen recently, and the things I was also hearing from others on the unit were hard, but also understandable. Made me really think about my role and has kind of haunted me some.

No point but just to ramble and kind of relate/cope I guess. Still figuring out if this is right for me or if these kinds of contemplations are normal I guess. It’s also hard because I went into this field to help and sometimes this feels like inflicting harm, even if I know it’s not.

Anyone else struggle with this kind of stuff?

I’m on day 24 of my second 40 day fast and I’ve been feeling so blissful! This happened last time too! I just feel so calm and unbothered. I can focus so much better. It really makes me realize what the right fuel can do for you. This makes me want to maintain a keto diet after this because I never want to go back to how it was before.

I also have a huge difficult medical licensure exam in a few months and this makes me want to fast for a week or two beforehand so I can have the mental clarity. Anyone ever do that?

I’m slightly obsessed with Merit Retrospect and have ordered a travel size of Commodity Moss to try. I also love Goldfield & Banks Pacific Rock Moss. What are some other mossy scents I should try?

This is honestly getting ridiculous. I had the walk sign both times. First guy made a left and wasn’t even looking and just kept on driving. Second guy was making a right onto Chapel driving A YALE UNIVERSITY LIBRARY TRUCK. And then he cussed me out!! Literally saw me in the middle of the crosswalk and just drove right at me. Both times on Park St!

I’m a Yale medical student. I live downtown and work at the hospital. I do not want to have to resort to driving that short distance just to stay safe. But I’m so over this happening all the time!