Nursing Voices

Monday, November 26, 2007

A Hard Day's Night

I’ve always thought that the Beatles wrote this song about nurses. We work like dogs to get our money to buy our things, and we sleep like logs after a long grueling shift. Yeah, yeah, yeah. This weekend seemed like an endless hard day's night because we had not one, but three patients on our unit with borderline personality disorder. One patient with a personality disorder is bad enough to handle when you are under staffed, but three patients make a trifecta for a miserable weekend.

Borderlines love to compete with each other, and there is no limit to the mischief they can get into when they aren’t the center of attention. All of my little lovelies were racing to see who could cut themselves the deepest by using their plastic dinnerware. Here’s a picture that gives you an idea of what their arms look like. Yeah, it’s gross. Back in the good old days when we were allowed to use some extreme behavior modification techniques, nurses would never feed in to this type of self-destructive behavior. We would ignore the behavior, give the patients a bandage so they could dress their own wounds, and life went on as usual. No one made a fuss unless there was blood pumping out of an artery. The patients did not receive secondary gain for engaging in self mutilation. They would figure out pretty quickly that their activities weren’t going to ruffle our feathers, so their self-destructive behaviors would stop.

Now, it’s a whole new ballgame on psychiatric units, and the borderline patients know the rules. Patients are now placed on suicide watch if they so much as scratch themselves while they are in the hospital. Borderlines crave attention, and their behavior escalates as they receive more attention for their inappropriate behavior. What really burns my butt is that nurses are getting into trouble if these patients shed one drop of blood while they are in the hospital. That’s why Border Nurse is leaving the country. She’s had it! Her decision has nothing to do with the guy in the brown suit. Doctor Dream Boat is out of luck because the object of his affection is tired of being held responsible for all the crap that happens on her unit. Patients are rewarded for acting out while their nurses get the boot.

I just received a phone call from work while I was writing this post. My boss asked me to come back into work. Fat chance! I’m going to sleep like a log for a few more hours. Good night!


Blogger Emily said...

Enjoy your sleep dear nurse! Sounds like you more than earned it!

1:46 PM  
Blogger Jean-Luc Picard said...

We tend to think 'A Hard Days Night' must apply to us when we have a tough task ahead.

2:44 PM  
Blogger Elaine said...

Correct response to the request - well done!

3:37 AM  
Blogger Cliffie said...

Not trying to be facetious. Just curious. Always wondered about the borderline diagnosis. Those patients seem to have crossed the border. Is there a full-blown personality disorder? I'm not sure I want to know what it might be like.


11:19 AM  
Blogger Gerbil said...

Cliffie: the term "borderline personality disorder" dates from the olden days of psychoanalysis, when patients were classified either as neurotic or psychotic. The "borderlines," however, went back and forth between neurosis and psychosis. So yes, it is a full-blown personality disorder--with a name that is difficult to parse!

12:46 AM  
Blogger Tina said...

My mother-in-law suffered from BPD, thus the whole family suffered. After several years of veiled attempts at suicide, she succeeded to overdose herself while visiting in my home - in front of my children. The ultimate revenge and way to have all attention on herself. I dealt with the mood swings, the love/hate, and "fear of abandonment" for 10 years. Such a sad thing that all of that clouded what otherwise was a caring and passionate person burried down deep. I can only shrudder to imagine what you nurses must go through to take care of multiple BPDs at once! I would think the drama alone would drive you over the border. It nearly did me and I just had one!

11:01 AM  
Blogger Ladyk73 said...

If anyone wants to know the thoughts and feeling and hell of living with bpd just come over to my blog!

I would not wish it on anyone. I don't know...I just think I am bipolar...but whatever.

Try not to "let it out" to the real world. But I am not always successful.

10:12 PM  
Anonymous Anonymous said...

Sounds like fun! I never seem to suffer the same dilemmas as my nursing colleagues do with BPD. I'd have a ward full of them! Honest. But I appreciate the concerns they cause for others and no, I'm not a control freak.

I regard BPD as one of the most challenging presentations in mental health. Invariably they come with a history of abuse and serious life long issues they require careful and extensive unravelling.

My concern however, is the inference you make to hospital 'policy' on their management. They have no such authority! The clinical management of BPD is a matter for the nurse delivering care and it is a well known and researched phenomena. If hospital policy is driven by fear of litigation or secondary risks, then they should ban the admissions altogether - not tie nurses hands during care delivery.
BPD requires nurses to respond to behaviours in the way that suits and, as a psychological behaviour, DSH should not follow a prescriptive course unless it is an evidence based clinical practice guideline.
Personally I would rally my union or other relevant body and insist the hospital withdraw their operational policy for clinical matters - unless they can support it with evidence based clinical research.

10:00 AM  
Blogger David said...

Would you claim that the wounds from another illness were gross as well? or do only borderliners have "gross" injuries. Just because one's injuries are self-inflicted as result of a serious mental illness does not and should not result in a lack of proper care, respect and dignity.

Perhaps, it's a good idea that many patients with borderline are kept on close watch as they're illness can very often result in suicide... including hanging yourself in a closet on a locked ward or committing severe self-harm with borrowed surgical instruments.

It seems as though you think borderliners do all the things they do on purpose, to complicate your and fellow nurse's lives. That couldn't be further from the truth! Some if it has to do with not being in complete control of feelings and actions (hence being sectioned in a ward) and also when you talk to most borderliners who have done time in a ward the only people that they speak fondly of will be the nurses, especially the ones that showed a bit of empathy and respect.

I do understand that BPD can be hard to deal with, but it's a lot harder to live with.

4:23 AM  
Blogger Michelle said...

hi there,
I am BDP and I run a support group for people with mental illness.
I offer an online DBT group...I send the book in PDF format and post the material. We meet in chat weekly.

Just thought you might be interested. If not tell me to Get lost lol

I was just going through DBT stuff and posting on blogs. ☺

I like the name of you blog BTW

Michelle AKA Josie

8:37 PM  

Post a Comment

<< Home