Latest Comments by CASTLEGATES - page 2

CASTLEGATES, ASN, BSN, RN 6,689 Views

Joined Aug 27, '09. Posts: 433 (40% Liked) Likes: 482

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    Mine was 80%+, as well. 96-100 for an A, 90-96 for a B and most were 85 (we dropped to #5 in the state and they changed everything).

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    Their first impression will be when you walk into their office, and it's nursing not HR you need to impress to get hired (unless you're new to the field and can't read people terribly well). Rather than doing all the things suggested by a brand new nurse, change your name on your social media accounts to a nickname. Case closed. No HR at any hospitals Ive worked at have made any hiring decisions based on a FB account. (it was a new nurse that wrote the article, most likely reading articles online versus interviewing the hiring deciders themselves--none of it mentions anything about actual hiring decisions, so I don't see any real valid points).

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    When I completed my initial education, some schools wanted 5yrs to get an MSN (min). Now, some schools are letting nurses with fewer in, but that depends on the applicant numbers (where they can afford to be picky). I know earlier in my career, grades were more difficult to max. The more experience, each time I took a class, they got easier and easier. I'm now doing my MSN DNP and I have no doubts I'll nail it (because I'm old as dirt now) ha, ha! It's OK. I was 23 and looked 15 when I was new, needing at least 5 solid years before I knew what was happening (I was good at my SICU specialty, just not as well rounded as I could have been, especially for advanced stuff, I suppose). Meaning more to do with work experience (but age helped as well). Military considers 1-education 2-experience and 3-age when determining promotions.

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    showbizrn, joysheph, auddit, and 3 others like this.

    Post acute withdrawal syndrome can mimic schizophrenia, bipolar, PTSD, explosive d/o and others. This is why it's not recommended for addictionologists to stamp any new diagnoses on patients until they're finished wit PAWS. It can last anywhere from 2mos to 2yrs. Addiction is a disease, just like cancer. What do we do with a cancer patient who breaks his leg in an accident? We tend to place them in the unit where the most acute need determines where they go. This is the same with addictions at the psychiatric campus where I work. It's not fair to place addicts in a locked ward with people hallucinating, etc. Actually we had to learn this. A patient pursued this the legal route (when we did detox in a locked unit with psych) and the findings were--this was, in fact unreasonable and unjust to lock detox with acute psych (who can get violent), so no more detox patients into the locked units where I am (unless mental illness is the primary need). This is how triage, care, anything works (squeaky diagnosis gets oiled first) ha ha!

    Regarding the previous comments above: "The rest of them I couldn't care less what happens to them. They are generally, from my exp, ungrateful, needy, selfish, and just aholes?" Whoa Nelly! Did I just read an professional RN calling a diagnosis group aholes ???
    If you read no further; three letters E.A.P.!

    I don't feel it's remotely appropriate, or acceptable to name-call any diagnosis group. I had to do a double-take. If a patient is doing something where I feel I'm going to react emotionally, or negatively, I've completely lost my ability to help that person (and I need to move out of that area to a different specialty ASAP). My self actualization, nor does my career depend on patient gratitude (they're not on our units to please US)! My job is focused on saving lives from a continuous, progressive and fatal disease. It's not a moral character disorder where patients are (enter negative name here). Again, it's an AMA AANP ASAM diagnosed disease. Has anyone called diabetics idiots, or aholes because they did xyz to further their illness, became obese, cheated, etc. I take care of them, because they come to me asking (asking) for help. Withdrawals (acute and post-acute) make patients insane. Some are more difficult than others (psychiatry 101 for anger, manipulative redirection, anger management, safe handling, etc). It's my job to come to them armed with all this information, so they understand what's happening to them. I always tell them, "Although you feel like you're completely losing your mind, YOU"RE NOT." When they act manipulative, panic, angry, etc. I calmly let them know "It will get better, trust me, it will."

    In nearly all cases, once in recovery after PAWS, many can decrease or stop psych meds (obviously supervised, but these are the outcomes of recovery). It's nice to see the majority of professionals here taking it upon themselves to learn the most they can, ask legitimate questions and enjoy learning about a rapidly progressing specialty. Wouldn't it be great if we had staff who liked working with the most challenging patients, as well? I love my "druggies and drunks." The more manipulative, the better (because we have something to talk about, and I have an inroad to help them). I don't need any thank you's (my ego isn't fragile, and I already get paid as a thank you; never mind I'd do it for free).

    Last of my soap box chat...patients and other staff see, and react to body language, facial expressions and word choices that exude the feelings one harbors against addiction, races, religion, orientation, etc. People can see, feel and sense that, whereby the practitioner becomes therapeutically ineffective (and creates a toxic environment of the unit, as this behavior can be contagious).

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    tnkrlyn1 likes this.

    I thoroughly agree with the others. I have no references for addiction (pocket sized), since it's more of an "on your feet, using your wit" sort of job. After being manipulated several times, I learn not to allow it to happen again. School of hard knocks (or how many times can they play me)? It's commendable you're motivated. If you're not familiar with the 12-steps, find anything in your life and get thine rear quarters to some meetings . There's a wrench to fit every nut, and I can apply the 12-steps to any stressor in my life. Knowing that will mean you'll speak the same language of most of the patients (since most will have been familiar with it, and it's the track your job will ask you to set them back upon). AA and NA books. Read them back to back. Staying Sober and anything by Terrence Gorsky (he's the relapse ranger). Read all that, and you'll be far ahead of others (depending on where you work). At my hospital, about 1500 nurses and only 1 certified in addictions (none on the addictions , detox or treatment units).

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    Welcome! My two cents would be to focus on the psychological signs and symptoms. I would find a pirated copy of "the brain, hijacked" by Bill Moyers. It explains addiction in the simplest sense. You might be able to get your work to buy a $500 copy, though. I would also attend at least 20 AA or NA meetings, so you understand the lingo, what it is they're facing and what you can do to help. Addicts are not bad, so don't buy into that popular attitude that it's not a diagnosis. It is a diagnosis. They don't throw diabetics into jail for eating a sugar cookie, so addicts who get arrested because of their using is just plain wrong. Our country is decades behind others (who have reduced deaths by as much as 87%)! Keep telling yourself they're sick, not stupid. It's a serious, fatal brain disorder if it's not paused at some point. It's deadly, so work on making a real difference. Don't focus on that one or two pills you can keep from them to "cure" them. It will only anger them and tell them not to return. Real countries treat addiction as a social disorder (and refer appropriately). These are not bad people. Those with the gene will drink or use. That's what they do well. We can only direct them over and over to hit community support meetings with the same fervor they used. Your hospital should have you pretty safe regarding ETOH and benzo withdrawals (stay wayyyy ahead of the CIWA score or you'll lose chasing it). You shouldn't have any DT's if you're doing your job well. Open your senses to all forms of withdrawal and read EROWID for the latest drugs and symptoms for the latest concoctions to hit the streets (in case your area is heavy on the new stuff). It's a good place to read addicts writing about their experiences, deaths of friends and determination to get high. Getting high has been happening since the dawn of man. It's nothing new. Our society doesn't support it, so we have to get them to conform best we can. It's deadly, so make it your business to know everything you can. They are depending on YOU, because the reason patients go to hospitals, is for nursing care.
    Welcome! It's a dream job for many!

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    socoamaretto and Lisa46 like this.

    I agree. If she felt it right to withhold, then that's her professional judgement at the time. Education is another thing; judgement from knowledge-base, where the RN was at the time, with the tools she had at her disposal, is the key (and the quality the hospital expects via training). It's not her fault...I like it when they put the onus on us (personally); it forces me to make it my business to learn my specialty. After all, patients come to hospitals 'cause they need nurses (not MD's). This is our time--things are changing. Not so long ago, there were no specialty certs. Mark my words, APRN's will be doing surgery within the next 20 years or so. Remember when Doctorate's were PhD's, now they're practice DNP's? We're moving into the fast lane, so buckle up! I worked in an ICU that leaned heavily on RN's...We did all Hosp codes w or w/o MD's; tons of things other hospitals (I later learn) wouldn't fathom leaving up to RN's. I do understand places can vary, just like experience.

    Acute withdrawals {which I was assuming they were in--(again assuming also they were in a hospital type setting)} for me, isn't the time to wean. I try to keep 'em there, keep em comfy, so once they're out of acute withdrawal, we can deal with the PAWS and really "talk." It's not easy understanding addiction, what makes a difference (a real difference), and what's just a treatment nuisance. It's hard not buying into the "bad addict" thinking. I stick to acts that will make the difference, allowing meds they want because after all, it is THEY who need to make the decision. I can't force 'em (it will never work, anyway). My one or two petty things won't "fix" an addict. It's deep within, where they change. I try to connect with that part, soon as I can. I love the manipulative one's (especially when I'm suckered) Every once in a while they get me & I've got a big S on my forehead keeps it fun & interesting!

    I can't understand how phenothiazines could be (physically) addictive...I wouldn't know those withdrawal symptoms (or treatment thereof), if I was hit in the face with 'em Anything, including ibuprophen is psychologically addictive, however.

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    I got my guide used from fleaBay. Sometimes you can find good deals there.

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    I would let the counselor know she needs to work on acceptance of what is (versus life as she would like it to be). We make referrals and advise patients what to do in order to promote health. What a catty thing to do by reporting you to your supervisor. I assume that counselor was going through a divorce or her husband just left (something of the sort). Don't stop what you're doing. I'd give the counselor the phone number of your state board, telling her in the future to spend her extra energy on helping patients rather than turning on coworkers.

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    I give meds, then reassess in one hour to determine my plans for the next several hours. Good question; better to ask than wonder ) <--wait a minute-my smiley face turned into some pink circular animal thing?

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    PixieRN1, RestlessHeart, Lisa46, and 7 others like this.

    I give everything and anything TOGETHER for these people who are in the throes of withdrawals. It's only for a few days, 'till their system clears. None of those meds mentioned are addictive, or they would be scheduled meds. It's amazing the stuff people can write and not be questioned. Phenergan is not addictive! Hydroxyzine isn't, either! Please look it up and recheck abuse statistics. Better yet, study and take the CARN exam! Make it your business to UNDERSTAND addiction, not treat it as a moral deficiency.

    I slam them with everything my judgement allows, because after all, they're not my own personal supply of meds (so why act like it)? Why be so stingy with them? We recently had a nurse FIRED for not doling out meds as ordered and requested. It's not my job to try to talk them out of their PRN's. Addictions nursing is a field for the very few who truly understand the disease of addiction. Others should move to straight psych wards. Many get into hot water for not giving meds as prescribed and requested (that's a dangerous game with your license being played). Our nurse who was fired did not give the meds the patients were requesting that the providers were ordering! If they say they're sick, then they're sick. The old saying that addicts are bad goes against the very fact that addiction is a diagnosis, not a moral deficiency (so don't treat them by controlling them; work with them)!

    Imagine throwing someone in jail (who has diabetes) for eating a cookie because they had a craving for one! It's just that simple and these meds are there to reduce cravings, help them sleep or feel more relaxed so they can cope. It's a horrible disease and you want to keep them there so they don't leave AMA and potentially die (relapse is a dangerous time when they may, or may not make it back). The reason they don't add other diagnoses for ANYONE in the throes of withdrawals are because withdrawals can mimic schizophrenia, panic disorders, phobias, bipolar, and explosive disorder. We, as med nurses can't expect to "fix" them by controlling what they take in the moments we interact with them. Why not give Trazodone and a little this and that? Why not give a couple, or a few meds at a time? I throw meds at these guys 'till the cows come mooing home and they appreciate my efforts to helping them feel comfortable. Upon admission, I go through their list of meds with them, discuss what effects each of them have, then we decide on what's most likely to snow them (if they're opiate addicts and it's night time). If an ETOH addict is uncomfortable, I throw benzo's at them to stay ahead of the game, so I'm not chasing withdrawals (I'm more careful with the ETOH and benzo's, though but I always stay ahead).

    The nurse who was fired was investigated by the board and found guilty of playing this dangerous medication withholding game. If it's ordered and the patient requests it and the patient says they're having symptoms (the kind we cannot see), then that's a legal basis for a complaint and a case. Anxiety isn't fun, neither is addiction or withdrawal. If I were uncomfortable, I'd play whatever games I had to, in order to gain some relief! It may turn into a game of getting through the med nurse-barrier between me and the meds my prescriber ordered. If I'm comfortable, then I'm more likely to be precontemplatiive about addiction versus sobriety. That's where I need them to be.

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    I would start off by getting the CARN study guide and CARN core curriculum and passbook (all 3) from the IntNSA website (or if you're really lucky, you can find them used). The psych mental health nursing review they publish is also a huge help in understanding dual diagnosis stuff. All four of these were useful for the course to pass

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    It usually goes up when they drink the hand sanitizer (if you've got that); otherwise I would check the instruments and search the room.

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    bluesnurse likes this.

    My advice? Don't sweat it, the shyness goes away with any nursing job but you cannot escape interaction and being sought for your knowledge at any level. We're resource people, so they hunt our shy selves down!

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    YouSmellLikeCDiff likes this.

    Just basic employment stuff. Whether or not you have what you need, you have a Dr. who can attest to the fact you're on it legally. You, therefore, have nothing to worry about. At least you didn't spend your summer smoking a bong and having to wait 3 months to clear before job searching, so don't worry! If you're meant to have the job, you'll have it. If you review old posts, they're all of a similar thread as yours. The internet is a wealth full of information and answers. Tens of thousands of nurses had the same issue as you before. You're not alone (legit or illegit drugs, questions run the gammut).


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