!Ask Ms Anna --- agk's diary 21 May 2023 @ 00:15 UTC --- written on GPD Win 1 on couch, boots off, scrubs still on --- Q: Ms Anna, how many hours are you required to work a week? A: Uh, 40. But when I'm charge nurse I have to work til my admissions, discharges, orders, notes, etc are finished, which was 16 hours one shift this week. When I'm on call and they call me I have to come in. So 70 hours this week. If you think I get a 2-day weekend after this you don't understand what a wreck US hospitals are. Q: Ms Anna, how was your morning? A: There were 3 staff scheduled on the unit due to the large, violent, strong, mad, flat-affect man & 15 other patients. If he went off, he was mine. Otherwise, I was to lead groups, etc. He sat, hulking, preoccupied, withdrawn, back to the corner. I built a little rapport but he was a tough one. One of the 3 staff called in, so there were 2 of us. The other has epilepsy &'d been up 72 hours. She had aura, was labile & crying, pupils dilated. She knew & I knew she'd seize. She asked me not to call 911. After her seizure it was just me. Q: Ms. Anna, what are the rules for the extremely defiant, unredirectable, persistantly homicidal 5-year-old who wants especially to kill the person that just killed her brother, who you got a blessed extra staff order for? A: - Do not program with other children. All fur- niture must be removed from day room where she programs alone. Watch when entering or exiting nursing station, she will run in. - Do not let the patient lay on you, cuddle with you, or physical contact other than high five, fist bump, or similar contact that is not a boundary violation. - If the patient does these anyway, record on a Boundary Violations Report. Have charge nurse sign each violation that occurred their shift. - Do not let the patient have pens, flashlights, watches, or phones in hand. - Do not go into a room with the patient in the shower without a witness, even if attempting to get them dressed. Always grab a witness. - Avoid new movies towards bedtime, as they are stimulating. Safe movies include: Frozen, Cin- derella, Moana, and Encanto. Frozen is prefer- red at bedtime; it's most familiar to patient. - Toys should be picked up and put away at 1900 to allow patient to wind down for bedtime. - Patient's persuaded by games and rewards. She has a squishy toy which can be used to convin- ce her to follow directions. It can take 'time out' in nurses station if patient won't follow directions. - Blankets and pillow must stay in patient's bedroom. Q: Last question, Ms. Anna. What night meds do you give kids? A: In the morning 17 doses of Adderall, Concerta, Ritalin, Focalin, Vyvanse, and everything else you'd expect. At 1930? Uh... 5-year-old: clonidine 0.2mg 11-year-old: melatonin 5mg 7-year-old: Abilify 5mg, guanfacine 0.5mg 10-year-old: risperdone 0.25mg 8-year-old: clonidine 0.15mg, Vistaril 25mg 7-year-old: guanfacine 0.5mg 11-year-old: nothing 10-year-old: risperdone 0.25mg 9-year-old: melatonin 10mg, Vistaril 25mg, guanfacine ER 4mg 7-year-old: melatonin 10mg, risperdone 0.25mg 9-year-old: cetirizine 10mg, melatonin 3mg 6-year-old: Zyprexa 5mg 7-year-old: lamotrigine 100mg, melatonin 7.5mg, risperdone 1.5mg 11-year-old: guanfacine ER 3mg, melatonin 10mg, Remeron 30mg, Paxil 20mg, Sero- quel 25mg 11-year-old: Atarax 50mg, melatonin 10mg, risp- dal 1mg 10-year-old: Celexa 10mg, lamotrigine 50mg, melatonin 10mg, risperdal 0.25mg 6-year-old: melatonin 5mg Go to sleep babies. You should see what I admin- ister to grownups. A more humane, less profit driven, more family- oriented system would look very different. My co- workers wouldn't be burning out, calling in, and falling ill like falling dominoes. Time for sleep. Back to the factory in the morning.