Content That Barnstormin' PMHNP Likes

Content That Barnstormin' PMHNP Likes

Barnstormin' PMHNP 7,636 Views

Joined Mar 8, '12. Posts: 339 (64% Liked) Likes: 867

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  • 5:57 am

    Quote from miamiheatrn
    Thanks you guys have been very helpful
    Short of reading the article to you, yes, we are.

  • 5:56 am

    Quote from miamiheatrn
    Sheesh, I feel bad for your patients lol well I know its a peripheral vasopressor but I'm asking about the caronaries .

    Yes, the article is specifically about the coronaries. Don't feel bad for my patients though, the babies don't usually ask me about that stuff.

  • 5:56 am

    Quote from miamiheatrn
    Sheesh, I feel bad for your patients lol well I know its a peripheral vasopressor but I'm asking about the caronaries .
    I was in a patient's room with 3 doctors in a tricky situation trying to find a solution the other night and the surgeon, who is very well respected and highly regarded piped in and said "have you tried googling it? I do it all the time when I'm stuck".

    The Internet is a plethora of information. Obviously you need to use legitimate sources (such as the AHA source mentioned above) and not just any random website... But don't judge someone for using their resources. The Internet can be your best friend if used appropriately.

    PS: Google led us to a solution.

  • Jul 27

    Well, hurry up so I can put both on my ignore list.

  • Jul 24

    Engineers and Chemists, if truth be told.

    (Grew up surrounded by engineers and chemists)

  • Jul 24

    Quote from bossman
    Really who needs a bigger pat on the back for doing their job? Who posts more about how much they matter and makes a bigger difference? Nurses or teachers?
    Nurses do, from what I've seen ...but I know very few teachers. I have always found dolphins to be very smug, as well. You should have included them in your poll.

  • Jul 23

    Quote from brandy1017
    That is a very sad situation. Why not go back to the NP that was understanding of your mom's need for pain meds and anxiety meds? This is exactly what I feared would happen with the pressure for Dr's not to prescribe narcotics, that people will be left with uncontrolled pain. I see this already with nurse friends who are treated as drug seekers if they need narcotics for an injury or chronic back problem.

    Is there any way you can go back to the NP with her? Otherwise seek out pain management for sure. Sometimes non narcotics can help such as lido patches or a steroid shot, but narcotics should not be withheld from her. Plus she is dealing with anxieity and dementia. The dementia may be increasing the anxiety as she realizes she is forgetting things. I imagine that would be very unsettling.
    During my clinicals, I see pretty often this dynamuc of "the good (cop)/provider" who is "understanding" and "caring" vs. "bad one".

    In my opinion, it is the perfect example of how not to do things. The same story as with a dude who somehow passed NCLEX is glorified as an excellent, caring nurse because she is always chatting happily about life and such while others are effectively doing her job, aka keep her patients alive.

    The NP works under MD license in PA. By "being good" and satisfying patient's wishes, she adds nothing to the quality of treatment and potentially endangers the MD and her own license. BTW, if after TWO years these two put together did not figure out diagnostic workup plan and basically did nothing beyond treating symptoms, I would run for my life outta their practice. 50 y/o female with multiple and increasing neurological symptoms + dementia smells heavily as a systemic problem.

  • Jul 23

    Dear OP,

    while I totally understand your frustration, I must say that your former doctor was very much correct in his tactic, although not in his actions.

    As I get it, your mother is in her early to mid 50th. She has chronic pain and tremor, both of unknown origins, some dementia-like symptoms, personality changes and now new pelvic symptoms. It is a description of a complex patient who was, as far as I get it, never was worked up and has no working diagnosis. It is up to your mother to refuse testing, but it doesn't mean that she should be given meds with high addiction potential for this and that symptom just because she likes how they work on her. Your doc was absolutely right in attempting to transfer care, get specialists on board, etc., Sudden changing meds was not appropriate, but he was correct in refusing to escalate dose without proper diagnosis.

    Regarding pelvic exam, it is up to provider to determine who is more qualified to do which type of assessment in practice setting. Pelvic exam #1 on difficult diagnostic case needs to be done by whoever knows better, not by whom the patient likes more. Unless the NP was specializing in women's health, she might have very limited experience with abnormal pelvic exams.

    Regarding passing info, I can assure you that it is what happens in 100% of cases. No provider in his or her right mind would transfer care without communicating every single detail to accepting care office. Transferring a patient with even traits of "risky behavior" which might affect one's licensing status (even non-compliance, refusing to test, missing appointments, etc) and not telling about it is seen as extremely unprofessional behavior and can kill physician's career.

    I do not say that your mother is addicted, but there were several things in your post pointing on developing of at least tolerance. She absolutely should not be treated in primary care setting, it is not safe for her on the long run and you need to understand it. She should be referred to specialists and get diagnosed before making any changes in her meds. As the very least safe step, she should take the same meds in the same doses, but there should be no increasing doses before we know what is really going on.

    I have to work on regular basis with highly dependent and escalating patients suffering from chronic neurologic diseases from MS to Alzheimer, and it is incredibly painful, in all senses of the word, for everyone involved. I hope you would be able to convince your mother to get diagnosed and find a capable physician for her.

  • Jul 23

    Quote from DelaneyB
    I was reading a post earlier. Normally I love to do that, when I get some downtime I am entertained/educated by posts here and I enjoy it. However I saw something on here that bothered me. It is a recurring theme.

    A user said that since a poster was a nursing student and not a nurse she should change her username. I see that a lot here, other users telling posters to change their name because they are students, or CNAs, etc. Does that really bother you??? It's not like it's that big of a deal. If I was a culinary student I would call myself DelaneyBaker and it would be fine. If I was an engineering student I would call myself DelaneyEngineer. It wouldn't be a big deal. Y'all act as if there aren't millions and millions of nurses in the world and are so prideful. It's not that hard to be a nurse. People from dinky little schools are "nurses". People who did things completely online are "nurses". It isn't a big deal.

    I don't know why this riled me up so much but it did. Sorry for the rant.
    I'm going to excuse your ignorance about what it takes to get through nursing school, pass NCLEX, and work as a nurse. You obviously don't know what you don't know.

    But perhaps you can understand this sentence from the RULES of this message forum:

    8.You agree NOT to use titles that you have not earned. (RN, Dr, LPN, LVN, Nurse, etc)

    So when people tell nursing students to change their screen names, that is because they have violated the terms of service that THEY AGREED TO when they signed up. This is a privately owned web site, and they can make the rules.

    So basically, if this bothers you, TOUGH.

  • Jul 23

    It's both against the terms of service and against the law to present yourself (through name, username, introduction, etc) as having healthcare credentials that you do not have. That's the big deal.

  • Jul 23

    Are you a nursing student? If you are that maybe why you don't understand. It is illegal in most states to call yourself a nurse when you aren't one. Plus I don't want someone who hasn't gone through the rigors of nursing school & passed the NCLEX to carry around the title. Maybe one day when you become a nurse & hear a CNA or med aide refer to themselves as a nurse, you will understand. But until then, no, not everyone can call themselves a nurse.
    While you are in school, do you call yourself a nurse? No! You haven't received the title yet. It's very simple, if you passed the NCLEX you're a nurse. If you haven't, you're not. I'm sure one day you will work with a tech who thinks they are a nurse, acts like a nurse & tries to give you or your patient nursing advice. Then maybe, you might understand.

  • Jul 23

    "It's not hard to be a nurse." Do you even read these forums? Ever go on the student forum and see the threads asking for help? Ever venture into the NCLEX forum and see the "I failed the NCLEX I feel so bad" threads? How about the threads on the general nursing tab that talks about the emotional and physical toll this job has.

    Reading comprehension...not everyone has it.

    If you're not a nurse, don't say you are.

  • Jul 23

    It's a recurring theme because some posters do not know that 'nurse' is a legally protected title and some do not read allnurses terms of service before agreeing to them.

  • Jul 22

    Mental illness is an equal opportunity illness; it affects persons of all races, ages, and income. Mental health nurses take care of patients who suffer from mental illness; they help in the process of recovering the patients’ mental health, to help them live to their fullest potential.

    Mental health nurses work as members of an interdisciplinary treatment team that helps to deliver well-rounded medical care for the whole person. Mental health is an important component of overall health and wellness; mental health nurses help persons of all degrees of disability make changes in their lives for the good.

    There are many paths to becoming a mental health nurse but the first is completing an accredited Registered Nurse program and then obtaining licensure through the National Council Licensure Examination (NCLEX-RN). From this point the path to working as a mental health nurse are wide and varied; some go directly into working in a mental health facility while others may gain experience working in other nursing fields.
    Below is the first hand account of one mental health nurse who has been working in the field for over ten years, we will call her Michelle:

    My path into mental health nursing was not a straight one. Once I had obtained my degree and proper RN licensure I started on night shift in a neuro/trauma intensive care unit (ICU) where the majority of my patients were intubated and required multiple disciplines to keep them alive. Once they were stabilized and able to communicate, they were transferred out. Therefore, the idea of caring for patients who required more of my communication skills than medication never entered my mind.

    So how did transition from this experience to finding myself knee deep in the field of mental health nursing? I realized while working in the ICU that my coworkers often "stuck" me with the complicated families. The doctors often asked me to accompany them when delivering difficult news to patients and families. I often found myself calming a patient who had attempted suicide or been in an accident due to behaviors related to their mental illness. When I had had my fill of the adrenalin rush of the ICU, I found myself wondering where my career should go. I saw an ad for a group home nurse at a community mental health center. I'll be honest; the words Monday through Friday drew me in. But I quickly found that the patients made me stay. And my love affair with mental health began.

    I worked with 40 patients in four group homes for a year when our community mental health center received a grant to start an Assertive Community Treatment (ACT) Team and I was asked to help with the startup of this team. An ACT Team is a service-delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illnesses. However, unlike other community-based programs, ACT is not linked to mental health case-management programs, housing, or rehabilitation agencies or services. It instead provides highly individualized services directly to the patients/person; these services are provided 24/7/365 by members of the ACT Team. These individuals receive the multidisciplinary, round-the-clock staffing of a psychiatric unit; only it is in the comfort of their own home and community. ACT team members are trained in the competencies of psychiatry, social work, nursing, substance abuse, and vocational rehabilitation.

    In just over a year the ACT Program had grown to 50 patients. I worked in this position for seven years before moving into inpatient mental health unit management where I've been for the last five years. I am currently the Nurse Manager of a lock-down inpatient mental health unit at a large regional hospital. I have also during this time taught nursing students and worked with students doing internships, and I have always told them the same thing, “I understand that mental health isn't for everyone. And that's okay. But I ask them to remember they will encounter patients with mental illness regardless of their field. And they always deserve patience, care, and respect.”

  • Jul 21

    Yea she showed you who she is very quickly. MAYBE it won't be as bad as all that, but it sure sounds like it. Update your resume like llg said and start putting feelers out. This could escalate quickly.