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luv2yoga (3,910 Views)

Joined Nov 26, '03 - from 'TX'. He has '7' year(s) of experience and specializes in 'Psych'. Posts: 241 (7% Liked) Likes: 29

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  • Jun 11 '10

    I know I'm late on this topic, but I as an ED patient (now in recovery after 4 long years) turned nursing student, a few things I would have liked the nursing staff to know on the psych unit I was hospitalized on multiple times:

    1. As stated by other posters, I am a very intelligent person whose illness forces me to manipulate you to prevent me from eating. I don't enjoy this any more than you do, but still, NEVER let your guard down around me.

    2. In a secret part of me I may never tell you about, I am grateful someone has taken over my life which, though I may swear otherwise, is completely out of control.

    3. You may not understand my complex need to not eat. That's totally fine. What goes a long way is attempting to understand, with active listening. Being ignored and hushing up my feelings contributed greatly to me getting sick in the first place. When my symptoms flare up, I am trying to communicate what I can't say in words. Don't ask me, "Why won't you eat?" Instead, ask, "What do you want to say to me right now?"

    4. Again, you may not see it right away. But being in the hospital may be the first real support I've gotten in a long, long time. People finally "get" me, and I don't have to constantly keep up this facade of being fine while my mental, physical, social, and spiritual health slowly but surely degrade. It was, and still is, the best thing that could have been done for me, though I appeared to fight and kick the whole time.

    Thanks to the psych nurses who cared for me until I could get well enough to help others like me .

  • May 13 '09

    I'm in the Alternate Entry MSN program at UT-Austin... I know this thread's dead, but just FYI, UT is in the process of creating a PMHNP program. 2 of my classmates and I are the first members/guinea pigs in the track.

    There's no info on the website or anything because they haven't even created all the courses and whatnot yet, but keep your eyes peeled!

  • Jan 2 '09

    I'm worried about clinicals as well. In my city, many of the outpatient state agencies mental health providers are NPs. The agencies will be the first I contact.

  • Dec 26 '08

    Hello everyone. I am a psychiatric/mental health nurse practitioner who graduated in 2007. I currently contract with a privately owned mental health center and with a physician, so essentially I am considered a independent practitioner.

    This year has been dominated by filling out various applications for credentialing. It has been a very frustrating waiting game. Just getting a medicare number, which is required for all the other credentialing applications, took no less than four months!

    As far as what I do all day, I do medication management more than anything else. I really like that aspect of my job, but you must realize that when you are seeing a patient every 15 minutes, there is no time to actually do therapy with them. While in school, I spent 45 minutes to an hour with each patient and did both med management and therapy, so this was an adjustment for me.

    Working with the physician is wonderful. He and his staff are so supportive! Unfortunately, this is not the case at the mental health center. The owner of the mental health center and the therapists who work there seem to think that I am at their beck and call 24 hours a day seven days a week. There is very little support from the office staff, and I end up doing alot of clerical jobs that should be taken care of by the support staff. Lesson learned from this: if you go this route, make sure everything is spelled out explicitly in your contract!

    As far as salary goes, I really can't give you an accurate estimation yet. I have worked most of this year for essentially nothing due to the time it takes to get all the credentialing in place. At both practice locations, I pay the facility a percentage. Much of the time, I am waiting for insurance payments to come in. This is getting better, but if you choose to work as an independent contractor, realize that you probably are not going to see very much money for the first year. I really wish I had known this in advance!

    In the area where I live, there are very few P/MH NP's. I really wish I had known someone to ask questions of and who could have given me advice regarding contracting and the credentialing process. I think this would have made the process alot easier. If you have any questions, I will gladly try to answer them.

  • Sep 30 '08

    I was re-reading this thread today, and it does sound very depressing and hopeless. And Catcoon, you are an example of why pedi-pysch nurses go to work everyday, because we all know (and pray) that there are those kids that make it out of the system and lead "normal" lives (whatever that is). BUT, what is being said loud and clear here, is that we all seem to be seeing a change in our society, where younger and younger kids are being hospitalized, with very very serious mental health issues and I think we all sort of scratch our heads and think "what can I do to as a nurse AND as a member of society to make a positive impact?". The anger and frustration is directed towards our system that only allows someone to drive a car after they have practiced, learned and passed a test vs. allowing anyone to bring a life into this world with the only requirement being an available egg and sperm. I like the tax break idea medsurgrnco brings up.
    1st we have to identify that there is a problem- think that's what this thread is doing. 2nd: identify the cause, and I hear several here, prenatal insult via maternal drug use; late adoption such as the kids coming from Russia that have lived in an orphanage for their 1st 1-7 years vs. the Asian adoptions which tend to happen closer to birth. etc etc.
    3rd: identify early interventions that give each kid a fighting chance. For example in New Haven there is a mentoring program for identified high risk parents (such as a 16 yr old, or an addicted mom), who are offered a stable adult mentor for at least the 1st year if not longer, and they usually start working together during the pregnancy. There are now residential programs for addicted moms (I'm telling you crack and meth are REALLY bad for a developing brain!!).
    I would also point out that most of us in this field hold on dearly to the knowledge of cases that we know are doing OK! I had just such an expierence 2 weeks ago....ran into a woman I had worked with as a teenager, had tried to kill herself several times (and I'm not talking scratches to her wrist here). She is a nurse and mom now! She is doing well! Bumps in the road, of course, but she is leading a "productive life". And Catcoon, you have stepped up and reminded us, "there are successes, and I'm one of them", and for that I thank you.
    I know this will sound very corny, but I have to say, everyday I'm at work I pray that I can do ONE thing to make a patients day a little better, give someone a milligram of hope during their darkest hours, offer an iota of dignity to the guy that just lost his med hearing and is about to have a needle stuck in his butt. I go ahead and help the acute manic fit the sheet properly for the "toga party" he thinks he's going to at 3 am.
    So back to the original post "how do you guys do it?" We develop a healthy sense of humor, we respect that little bit of insanity that lives in all of us, and we keep a mental log of those who do well!
    opps, gotta go, my soapbox is tipping.....over....

  • Sep 26 '08

    awe, Edison, I so feel for ya!! Been there done that! However....I'm still in psych 30 years later. But REALLY, I remember I felt that way when I left my first job after 2 years (private hospital, long term by today's standards) with young adults age 18-30. One patient tried to kill me (or herself) at least once a week. I ended up working at a state hospital for a few months (it was a total piece of cake job), out of the field for 6 months, then back at a university hospital, where I'm back to working currently.
    Here's what helped me survive
    1). Use your vacation time. We earn a lot of it in acute care for a reason. Take at least one week off every 4 months, NO EXCEPTIONS! We need to re-charge our batteries and get perspective.
    2). I, personally have never been able to work with kids (age 4-13), because of the parent factor. It's a family system problem, with the weakest suffering.
    3). Look into residential level of care. You actually get to help folks make progress, as they are there with you for a longer stay, less acute. Look into a company like CRC or Aspen Ed. They are money sucking profit companies, but you can have job satisfaction for a year or 2.
    4). Think about taking a breather from nursing. It's better to take a break from something you were "called to", than walk away feeling like a failure. Try something like bartending. You laugh? It's the same thing on another level...you give people mind altering substances and listen to them whine about their lives. And they TIP you!!
    5). If you are going to work with borderlines, read everything Linahan has written. With the Big B, knowledge of development is everything. I have always loved working with them (I know, how masocistic is that!?), but as I understand how they view the world (totally skewed), I am a far more effective nurse, and I take my ego home at the end of 8-16 hours, intact and all LOL!
    6). All aspects of nursing have a psych conponent, ED, oncology, CCU...all people would love a nurse who understands their is a human behind the diagnosis, with all the stress that comes with illness, maybe that's your calling??
    That's my 2 cents, I wish you the best of luck.....in what ever you choose to do!

  • Sep 26 '08

    awe, Edison, I so feel for ya!! Been there done that! However....I'm still in psych 30 years later. But REALLY, I remember I felt that way when I left my first job after 2 years (private hospital, long term by today's standards) with young adults age 18-30. One patient tried to kill me (or herself) at least once a week. I ended up working at a state hospital for a few months (it was a total piece of cake job), out of the field for 6 months, then back at a university hospital, where I'm back to working currently.
    Here's what helped me survive
    1). Use your vacation time. We earn a lot of it in acute care for a reason. Take at least one week off every 4 months, NO EXCEPTIONS! We need to re-charge our batteries and get perspective.
    2). I, personally have never been able to work with kids (age 4-13), because of the parent factor. It's a family system problem, with the weakest suffering.
    3). Look into residential level of care. You actually get to help folks make progress, as they are there with you for a longer stay, less acute. Look into a company like CRC or Aspen Ed. They are money sucking profit companies, but you can have job satisfaction for a year or 2.
    4). Think about taking a breather from nursing. It's better to take a break from something you were "called to", than walk away feeling like a failure. Try something like bartending. You laugh? It's the same thing on another level...you give people mind altering substances and listen to them whine about their lives. And they TIP you!!
    5). If you are going to work with borderlines, read everything Linahan has written. With the Big B, knowledge of development is everything. I have always loved working with them (I know, how masocistic is that!?), but as I understand how they view the world (totally skewed), I am a far more effective nurse, and I take my ego home at the end of 8-16 hours, intact and all LOL!
    6). All aspects of nursing have a psych conponent, ED, oncology, CCU...all people would love a nurse who understands their is a human behind the diagnosis, with all the stress that comes with illness, maybe that's your calling??
    That's my 2 cents, I wish you the best of luck.....in what ever you choose to do!

  • Sep 18 '08

    The amount of blood passing thorugh the superior vena cava (where the tip of the PICC should be) is over 2 liters per minute. There is no "mixing" due to the large volume of blood flowing in this area. As long as it is a double or triple lumen, and the patient's heart can handle both rates of fluid simultaneously, blood and TPN can be given together. Usually the rate of the TPN is decreased during the infusion.

  • Jun 7 '08

    I have been waiting for a post like this for a while. I have been at my hosp. for almost 1 year. And I have up and down nights. I am no longer the new girl on night shift.

    I was given all of the WORST pt. assignemnts, to the point I felt like quitting. My girlfriend who started 2 months before me also had the same problem until I came along.

    Now I see them doing it to the new girl on my floor. She graduated last year, same as I, but worked in a pain management clinic untill she was hired at my hosp.

    She finished orientation about 1.5 weeks ago. So she is on her own on night shift with me. I see the assignments the day shift charge nurse gives her for the night, so when she starts her shift at night, the day charge is already gone and the night time charge won't change it, It's AWFUL I had the same problem. I still get the AWFUL assignemnts when ever she isn;t there and my girlfriend gets the AWFUL assignments when ever I am not there, but we learned how to deal and manage, which takes time.

    I ALWAYS reach out to the new girl on my floor and ask if she needs help. I say to her, "I know how this feels, I will help you with what ever you need." She always say she's fine. But I see her running round like crazy,like I still do.

    I pulled her aside and said, "What can I do to make some of this madness better for you." She always says to me, "I don;t know how you do it." I said, "It took a very long time, and I still have problems, but when ever, which is rare on this floor, someone offers me help I take it, as long as I can reciprocate it in the long run for someone else, it just makes team work possible."

    She gets all of the critical pt's. on top of admissions. I get the same load, but when ever she is working I see how the nurses treat her. Not offering help, or just giving a little bit of advice, ignoring her ect..I went through the same EXACT THING and it still happens to me.

    I can;t let the RN's I work with at night with make her as crazy as they made me. It's in my nature to help her out. She's younger then me by 4 years and I am already starting to see how much she is hating our floor. I always offer to switch pt.s with her so maybe i can take a load off of her back. I try to give her tips and tricks, tips how to handle the other nurses, and how to deal with some of the crazy situations on our floor. I always do her admission orders, if i can. I show her what to do, b/c on my floor orientaion is a joke.

    I also told her if she is overwhelmed speak up. It took me months to learn how to do this. Mostly b/c I was the new nurse on night shift, so I didn;t want to be a pain to anyone or "that nurse", but I realized when I have WAY TOO much going on I need to speak up.

    I also told her that it takes a while to get to know the different personalities on the floor. Being new it takes a while to find out who will help you when you need it and ACTUALLY help you, who will say they will help you but when you ask they have every excuse in the book not to help you, and there are the ones that just ignore you and don;t want anything to do with you.

    I also said get to know the CNA's, they are my bestfriends and I love both of the 11p-7a CNA's. If you are nice and say please and thank you, it goes a long way, and if you can help them out when they need it, they remember that, don't bark orders at them and make them feel like they are beneath you.

    My CNA's told me that there are 3 nurses that they have respect for that work night shift and I am one of them. Reason being, I never talk down to them, I always say I will help and I always say please and thank you for what a great job they did before they go home in the morning.

    Believe me there have been manytimes I have been in a bind at 7am right before shift change and everything goes to poop literally. One example my 2 CNA's were ready to leave, bag in hands and walking out the door and saw me trying to ask the 7a-3p, CNA to help me with a pt. with an exploding ostomy bag that needed to be cleaned, it was everywhere. The 7-3 CNA told me she was busy and Ignored me. My Night CNA's dropped their bags, said "Ang, we are here to help you, not a problem." We had the whole mess cleaned up in 10 minuites. I gave them both a hug and said, "you have no Idea how much this means to me." They have even stayed late to help me take pt's for stat scans b/c the pt. went south at 6:45AM and knew I would have no help at all. I thank these ladies every night I work with them.

    I also remember their birthdays b/c no one ever does, and just the fact that I said, "Happy Birthday" or got them a card goes a LONG way!!

    I can't say it will get better, but from all of the BS we deal with as new nurses, we learn how to manage our time eventually, I am almost at my 1 year mark and still have problems.

    I do know from getting the worst of the worst pt's I can identify things and handle situations alot better and with more skill then I was able to a fwe months ago. I am able to tell the MD's get up here NOW and evaluate this pt., and don;t tell me I will get there in a little bit. I see the new girl call the MD's at night and they ignore her or don't show up, like they used to do to me. I said you have to get aggressive, not witchy but aggressive. I have gained alot of MD's respect by being aggressive as to comming to evaluate a pt., ot just follow through with orders.

    I also said to her, DO NOT let the day shift RN's give you a bad report, or just leave things out, b/c they will do it and leave you with a mess to clean up. Do a through chart check while getting report. She has the same problem I had. She was on Day Shift for 8 weeks and and since she is Night Shift now, she dosen;t want to point out things that should have been done during the day shift b/c she is afriad of what they will think. Worst of all the day shift RN's know how to push over the new night shift RN's, and it is awful. I told her don't let them do it to you b/c when you go to give report in the morning and are bombarded with 1 million questions, you end up scrambling to find the answers. I just got over that fear a few weeks ago and I am almost 1 year into my 1st year of nuring.

    I gave her the new report sheet I use, which works like a charm. I made it out of frustration, b/c I was always left with a crap report at the start of my shift. I also said don;t let the day shift RN's that also graduated with us in 2007, give you crap, she said ,"I noticed they act like thy are better than me." I said it has to do with the fact they have been working on the floor longer. Just tell them if they have a problem with you, to tell you, and it usually diffuses the situation. I also said if the day shift nurse is short, ask them if they are ok, or if they got enough sleep, this always seems to do the trick, and the attitude usually goes away or at least you understand why they are being short with you.

    Hope this helps, sorry it was so long but I had to get it out b/c I know EXACTLY how you feel. First year nurses, it's tough and you may hate every minuite, but you learn how to deal with situations, and manage people and problems from the experience you are getting. It took a long time for me and I still have problems.

    But all I know, if my pt.s say to me at the end of my shift, thank you so much for everything you did for me, or I love when they ask If I will be back tonight, or they only ask for me to be their nurse tonight b/c I am the only one who actually took care of them, I know I did my job the RIGHT way.

    Remember, we are here for the pt.'s, and I KNOW it's hard to remember that when we get the most horrible pt. assignments on a regular basis, deal with all the chaos and confusion, questioning why we became a nurse, or worse feeling like handing your badge in and quitting (which I have wanted to do more times than I can count) , I also remember it makes us grow into becomming excellent nurses, and giving our pt's the time and care they need.

    When I feel like I want to just quit right then and there, I ALWAYS have one pt. that seems to remind me why I became a nurse, even if they didn't say it. It's a smile or just a thank you for all I did for them. That no matter how much I whine on the phone on my drive home to my mom, about how horrible my night was. About an hour after I get home I always remember that I got through the night, no matter how much I hated it, and I was able to provide the best care I possibly could for mt pt's. And if i made an impact on at least one of the 6 pt's I had that night, it seems that I am meant to be the RN I worked my but off trying to become.

    REMEMEBR HANG IN THERE, AND WE ARE HERE FOR YOU!!! This is what this website is for!!!! I have been using it from my first day as an RN and every morning when I get home from work since. I have had more advice and support on this website, being a new RN, then from anyone I work with. Conrats for becomming an RN, you worked your butt off to be at this point if your life, I know I did!!! Have a drink, or just 5 min. to relax and think why you became an RN.
    *wine:beercuphe

  • Feb 1 '08

    Hmmm. I am currently enrolled in Chamberlain's RN to BSN program and have few to no complaints. My experience as an adult learner continuing my education would be different than that of someone new to the field attempting to acheive their RN through an online program. The latter appears to be the people with issues. I can remember being in a traditional nursing school and the stress involved, so I can only imagine what attempting such a task online would entail. I have no boards to pass upon the end of my studies. Yes, it is expensive, but all course materials, including books, are included in the cost. You will find that most online schools are costly. They offered me great transfer credits and I really like the fact that I will complete in a short amount of time. The advisors have been quite helpful. The online classes have been well organized and my grades have been posted in a very timely fashion. This has been true for both the Devry gen ed classes as well as the Chamberlain nursing courses. This past semester I had a group project with a gal from another state, farther in the program than myself and we talked at great length about the program, she has yet to experience troubles as well. It's important to look around at various programs and decide what works for you. I can tell you that I have friends and coworkers in other programs discussed on this board, some happy wit their choices, some not. There are pros and cons to all.

  • Jan 19 '08

    The Aiken study from JAMA in 2002 is worth a look... She addresses nurse-patient ratios.

    Managed care and the way our health care system works today isn't doing nurses or patients any favors as far as staffing.

  • Jan 19 '08

    The Aiken study from JAMA in 2002 is worth a look... She addresses nurse-patient ratios.

    Managed care and the way our health care system works today isn't doing nurses or patients any favors as far as staffing.

  • Jan 19 '08

    ok, when floated (I don't do this regularly(((disclaimer))), when I give 'em a quick I'm so and so... I'll be in shortly I ask them if they need anything. I write it down on my assignment sheet I make. I check vs. pull my meds and grap the requests.. pain meds, snacks.. look up labs.

    So I then hit each room with the vs known, do the assessment, pass the meds.. a bit of teaching as I fluff and puff being friendly but always moving.. checking IV dates, tubbing dates, dressings....talk, teach and do all at once. BEFORE I leave the room, I explain I'm moving on to the other patients and ask what else I can do to make them comfortable.

    (seems crazy when you're busy... have 6 more to see.. but I swear... settle them in now why you're there and get it done so you can move on and be interrupted as little as possible).

    family grabs you in the hall during med pass. Smile and let them know that you will be busy for a bit providing meds and treatments and want to give their concerns you full attention AFTER your meds have been passed. (Yep some are angry and have been put off all day... here you can try for a few moments and then say... let me bring my charge nurse in to help address your complaints. Now I will finish my med pass and then check back in to make sure your needs have been addressed.

    yeah I know, ideal... but when it works 60% or more with these problem people... usually more... you're back on track... family is at least listened to. Usually family just needs TIME with SOMEONE as the docs stop in so briefly.

    lastly... take that deep breath in and out before you enter each room and pass meds. The patient needs you to be calm, not in hurry and needs their meds correctly... even though you want to scream "shut up I have to go to the next room"... exude... calm.... it's catchy.

    Not meant to be preachy at all, just a few suggestions that may help at least some of the time.

    thats a LOT of patients. I swear, if you slow down you will be more efficient. best of luck... it will get easier, promise.

  • Jan 19 '08

    ok, when floated (I don't do this regularly(((disclaimer))), when I give 'em a quick I'm so and so... I'll be in shortly I ask them if they need anything. I write it down on my assignment sheet I make. I check vs. pull my meds and grap the requests.. pain meds, snacks.. look up labs.

    So I then hit each room with the vs known, do the assessment, pass the meds.. a bit of teaching as I fluff and puff being friendly but always moving.. checking IV dates, tubbing dates, dressings....talk, teach and do all at once. BEFORE I leave the room, I explain I'm moving on to the other patients and ask what else I can do to make them comfortable.

    (seems crazy when you're busy... have 6 more to see.. but I swear... settle them in now why you're there and get it done so you can move on and be interrupted as little as possible).

    family grabs you in the hall during med pass. Smile and let them know that you will be busy for a bit providing meds and treatments and want to give their concerns you full attention AFTER your meds have been passed. (Yep some are angry and have been put off all day... here you can try for a few moments and then say... let me bring my charge nurse in to help address your complaints. Now I will finish my med pass and then check back in to make sure your needs have been addressed.

    yeah I know, ideal... but when it works 60% or more with these problem people... usually more... you're back on track... family is at least listened to. Usually family just needs TIME with SOMEONE as the docs stop in so briefly.

    lastly... take that deep breath in and out before you enter each room and pass meds. The patient needs you to be calm, not in hurry and needs their meds correctly... even though you want to scream "shut up I have to go to the next room"... exude... calm.... it's catchy.

    Not meant to be preachy at all, just a few suggestions that may help at least some of the time.

    thats a LOT of patients. I swear, if you slow down you will be more efficient. best of luck... it will get easier, promise.

  • Jan 19 '08

    Gosh 7 patients is a lot of patients. The way to get through is to priortise your care and document as you go through. Decide what needs to be done immediatly and what can wait. Try not to allow the patients to manipulate you, be firm but kind.
    Focus in on certain 'tasks' ie.
    Get organised with pain meds I find if you have a pt who is frequently medicated, medicate them it takes so little time-but if they are constantly using the call light it becomes stressful for you and you will lose focus.
    Ask for help should you need it, a more experienced nurse may well have a little time to help, just because they dont offer doesnt mean they wont help, sometimes nurses dont want to step on each other's toes.

    Remember just practice safely and a smile will get you a 10 min reprive from a lot of pts.


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