In October 2017, I was worked with a patient who would have left me intimidated and uncertain during my first year out of nursing school. After abruptly leaving the meeting with the doctor, he made an intense and profane phone call before slamming down the receiver. Shortly later I met him in his room. He was upset that he was here on a involuntary basis and was not going to be getting klonopin. Still loud and animated, he told me he was leaving the hospital "today" even if it meant "leaving in [hand] cuffs." I recognized he was in the "release phase" of his agitation, so I gave him the opportunity to vent his frustrations to me as I listened with interest and concern. Knowing he was likely in a form of withdrawal, I understood the high potential for agitation and frustration. Because I had personally counted the sizable discrepancy in the number of controlled pills in his pharmacy bottle from home, I felt confident to bring up the team's concern for abuse. I also explained that though he felt klonopin was "the only thing that worked" it was not a viable long term solution for him, especially since he would need to continue increasing his dose to get the same therapeutic response. I told him I would contact the doctor to ask for an alternative med to get him through his current anxiety while his scheduled dose was being titrated. By first establishing a relationship, then working on a plan of action, he was able to calm himself down without any additional support from other staff members. Before the end of the shift he thanked me, shook my hand, and told me, "There's a reason you do what you do."
In December 2017, I worked with a middle-aged male patient who had been admitted to the Aspen Unit only a few hours earlier. He requested to access his cell phone, which was locked in his storage locker. The phone was brought to him at the nurses station and I explained that he could only transcribe numbers from his phone before it was returned to his locker. Without any verbal acknowledgement he took the phone and placed it in his pants pocket. Becoming more confrontational and defiant, he told the staff it was “my phone.” Despite multiple explanations of the unit policies, he gave no indication of complying with the staff request to return it. Being very early in his admission, I knew he was angry to be hospitalized. Beyond that, his level of confusion would be even greater if this was first admission to psychiatric hospital. His anger and confusion made it difficult to comply with a rule he did not agree with, working with staff members he did not trust. Considering all of these factors, I told him, “I think we can work together.” Though his protests continued a minute or two longer, I came back to that same phrase: I think we can work together. Despite multiple staff members later telling me they thought there was “no way” he would give it up, he handed me the phone. By attempting to establish a partnership, a physical interaction was avoided and a level of trust began to form.