On June 13, 2022 I started my first real new job as a registered nurse. I no longer work for the department of corrections and now work for the department of health and human services. I'm still in orientation, and will probably still be in orientation for another couple weeks at least, but I think I've been there long enough to open up and talk about it now.
I need to clear up some things as I get my head around them. First, I may occasionally talk about the 'prison' I work at. That's pure habit and muscle memory. I do not work at a prison any longer. I work at a state mental health hospital. BUT... those two things do get kind of blurred. Let's go over the 'prison' part first.
A prison is a place for incarcerated individuals. Prisoners or parole violators. They've been convicted of a crime and as a punishment, their freedom has been taken away. They are obviously told where they are to live (in the prison) but they're told where to be (in their cell, in the yard, in the chow hall...) they're told what do do (sleep, eat, go to class, go to work...), they're told what to wear (with very little choices), and of course how to act. Their medical care is NOT one of their freedoms taken away from them. They can refuse medication and/or treatment. The only exceptions are when a judge orders someone into mental health treatment as otherwise they'd be a danger to themselves or to others. Even in our residential treatment program for severally mentally ill prisoners, only a handful had such orders. That's prison.
There are several varieties of mental health hospitals. I work at one that's a high security level and works with the criminal justice system. Say that there is a guy brought in by the police for a supposed crime but he's so mentally unstable that he can't work with a lawyer to properly defend himself or even be part of his own defense. He's sent to my hospital to receive treatment and improve him enough so that he can either defend himself or at least be a part of his defense. Or say there's a guy who is supposedly not guilty because he's been declared insane. He's sent to my hospital to receive treatment toward that insanity. If his treatment goes well he can either return for his trial or he will stay and receive treatment until he's not a danger to himself or to others.
There are also less secure hospitals that have patients requiring more secure treatment (they become violent). Those patients are sent to us until they can be treated at a lesser secure level and then they're sent back (or to another mental health hospital). I've been told that the average 'stay' at our hospital is 15 months. At the same time there are patients that have been there for decades. No patient there is free to leave on their own accord, meaning that they are a danger to themselves or to others. Other mental health hospitals may have some in that same category, but we're the only one where its true of all residents.
Now, another thing that I have to get right in my head... and probably have to explain to you too... is the word 'hospital'. At the prison we ran what was called an 'Ambulatory Clinic'. In other words, it was a healthcare setting where you could walk up to and present yourself for treatment. If it required supportive care like you'd receive in a hospital, we'd have to move you to another setting. This mental health hospital has everything you'd need for mental health.... and that's about it. We do NOT perform much in the way of physical healthcare. Sure, we can provide first aid but we can't even start an IV. Anything more than simple wound care would be sent to a 'real' hospital for care.
So... prison was where inmates lived, were convicted felons, and could accept or refuse almost all medical care. The mental health hospital is where patients live but cannot refuse mental health treatment (and refusing medical treatment would probably be looked upon as a bad sign, mental health wise), and have NOT been convicted of a crime, but still can't leave.
Clear as mud right?
That freedom is a BIG difference though. We are not supposed to take their freedom away unless they are a danger to themselves or another. And by 'take their freedom away' I mean anything from locking them in a room, standing in front of the doorway to a room they're in, to putting a hand on their shouder as I guide them to a corner to talk. That would all be removing freedom and would need a LOT of paperwork.
Now, I've mentioned I'm a nurse manager there. I'm in orientation with a nurse, two security agents, and a member of the housekeeping team. I guess I should talk about the organization... geez this is very different from what I'm used to.
Okay, so there are two wings at the facility. Each wing is split up into four units. In each unit there is a security supervisor, five security agents, and one RN. There are psychologists, social workers, psychiatrists, and medical doctors assigned to all the patients as well but they're not assigned to a particular wing or unit. Before I was hired there was one nurse manager per wing. BUT they're making the transition between security supervisors and nurse managers. Eventually there will be a nurse manager on each unit instead of a security supervisor. So I'm learning not only my nurse role, the nurse manager role, but also the security supervisor role which entails the security agent role.
Okay, so back to orientation class. The housekeeper only had to be in the classroom portion for about three days. The security agents have to be there for two weeks. The nurse, two and a half weeks. And me? Its looking like three whole weeks. As I said before, I had my vacation in the middle of the first and second week. When I came back, however, they didn't send me back to class. Instead I shadowed one of the nurse managers as she ran a wing and a specific unit. And I have to be honest.... it was boring. She said she was very busy but... man, there wasn't much to do.
I imagine there's still more for me to learn as I have about another week of class, but I can't imagine it filling up a day.
I did find out that staffing always includes the security supervisor and a nurse manager. That means I'll work some weekends and holidays. How many I work depends on staffing. Right now it looks like I'll work about half of the major holidays and every third weekend. To be honest, working the weekends will be a nice changeup as it will also including having the preceding Thursday and post Tuesday off. That means regular week days off.
The drive isn't horrible. It IS over a major highway where my previous commute was on a country highway. I get to work faster, but traffic is such a bigger variable. Yesterday, the Friday before the holiday weekend, was jam packed when I left and instead of it taking 45 minutes it took an hour and 15 minutes. That's a 30 minute delta!!
Right now, to be honest, the most difficult thing is the hours. All the orientation classes and the shadowing so far have been on the 'day shift'. I have to be at the classroom at 0700. As I'm a little less than an hour away that means leaving at 0600. I have had my alarm set for 0400 the past few weeks. Now that will get better once I move to afternoon shift. That's 1430 to 2300. 2:30 PM to 11:00 PM. I won't really have to set up an alarm as I'll likely get up on my own with plenty of time to spare.
Oh, and I should talk about the uniform. Or lack thereof. Seriously, they don't require the nurses to even wear scrubs. I've seen them show up in jeans and t-shirts. I can't wear ties as they don't want anything that's "grabbable", so my dress shirts are out (they look kind of silly without ties). I've moved to my casual shirts and they seem to go over well enough with my older work slacks on. I also purchased a lab coat (in khaki as I just don't do white!) that will help separate me from other non medical staff and give me pockets (my casual shirts don't have pockets!). It feels REALLY strange walking around in khaki slacks and a bowling shirt and being looked up at as 'dressed up'.
I'm sure I'll share more once I get into the groove of actually working.
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