barnstormin', BSN, RN 7,030 Views
Joined Mar 8, '12.
Posts: 318 (66% Liked)
I gave you facts.
I even said so in my posting. "In fact....."
As nursing faculty/an educator, I have concerns that your approach brings to light. (That is an opinion).
Actually in my field of nursing (aeromedical) we have a strict weight policy, BMI cannot be >30. This is done because of the helicopter's weight and balance requirements as well as the mechanics of working in tight quarters. Most do not like it but it's the price we pay for safety. This stupid six pack though makes my stomach look like a washboard
" i did a placement in school on a PTSD unit." That is not psych nursing experience. We all had a psych rotation during nursing school.
Op is wise to listen to listen to her husband.
The likelihood of injury really depends on how a unit is managed, what is the staff culture. On a well-managed unit, staff are not easily manipulated, they don't throw each other under the bus and they step up to help each other. They remain alert to any subtle changes in the milieu and in individual patients' affect and behaviour and intervene before situations escalate.
On poorly-run units, staff slack off, try to win popularity contests, allow situations to escalate until someone gets hurt. Good management will weed out staff members who don't perform to high standards. Poor managers will worry more if their staff like them.
When applying for a job on a psych unit, it might be helpful to request one or two "shadow" shifts. It will allow you to talk to staff and see first hand what kind of a unit it is.
Of course there are individuals who have been assaulted and injured on psychiatric units, and I am in no way diminishing or discounting those experiences. But those are not common experiences, and they are not unique to psychiatric nursing. Nurses get assaulted and injured in all sorts of healthcare settings. And many of us have worked in psychiatric nursing for many years (in my case, >30 yrs) without being seriously injured.
I precept. I don't like to precept first semester clinical students because they don't have enough internal medicine knowledge to make the leap to geriatrics. What I find is that I get NP students coming through who have the book knowledge the school gives them about prescribing, labs, etc, but that previous preceptors many times don't let them practice working with any of it. Physical exam skills tend to be good, but the actual "exam, then do" is lacking. When my students are there I make them sit with labs and med lists and diagnoses and tell them to "figure it out". Generally that starts with them talking through it with me and as the rotation goes on it's them coming to me with assessments and plans, including meds, future labs, and reasons why. I won't take "it's the guideline". Ok, nice, but why??? I also let them practice writing prescriptions for everything from PT/OT (I work in LTC) to actually writing the controlled substance scripts. Since the facility still uses paper, they have to think and can't rely on an EMR to populate meds. This means they have to know how to look up dosing guidelines. This is from a school that does weed out people (I've had students set up to come to clinical and then be told they're not coming because they failed a mock physical exam with SOAP note, failed a written exam, etc).
I agree that there are too many schools that are fluffy NP programs. I also think that it's a mistake to let students go straight through from RN to MSN without having worked for at least 6 - 12 months before starting an NP program. They haven't gotten the basic RN experience they need. And don't get me started on RNs who think they don't have to wipe a butt or pass meds in LTC because "that's the LPNs and CNAs jobs".
It's not just the schools that can be problems. I don't mind not getting paid to precept. I do it because I love it and because I had some amazing preceptors and I want other students to feel like they have had a good grounding in geriatrics. I do think, though, that schools need to screen their preceptors better rather than just saying, "Well, it's a warm body." There are preceptors that do it strictly for the recertification. Others do it because they love to teach one on one. Some, well, no clue why they precept. I've had student tell me that they've had entire rotations where they don't get any hands on, just watch. I've had other tell me they've never seen a preceptor write orders. Others have never worked with labs in clinical. And so on. So yes, the schools are a problem, but so are the preceptors.
And no, I don't hesitate to fail someone if they need to be failed. I don't do it often. Usually by the time a student leaves they're dealing well with how to handle basic geriatric issues and they know where to go to get help (including me--all of my students get my personal line and they can text or call or email when they start practicing if they get stuck). If they're not, they fail. And I tell them why. I also touch base with them at the end of every clinical day to discuss questions they have, how they did, and any concerns either of us have. But I know a lot of preceptors don't do that. It's a mistake. Oh, and there are some schools I refuse to take students from...Just saying those are the programs I rejected when I applied to NP programs.
lol all those big words they tend to dodge in any nursing curriculum. I talked to one of my friends who is in an online np program. she states they don't have tests.... ever.
They write papers and do discussion posts.
Let me repeat that
they write papers and do discussion posts
one more time
they write papers and do discussion posts
ok, you get my drift. np education is too lax and not formulated correctly at most institutions.
Being a good NP necessitates being autodidactic. Reread physiology and pathology, review assessments, learn what your assessments including labs and rads are actually picking up, and start learning the ins and outs of common complaints. Pick a couple meds for each indication that you like and run with it.
To give you my path in psychiatry, NP training mostly made me an APA expert. So then I had to actually learn enough about physiology, neurobiology, neuroscience (are these distinct fields to anyone else), pharmacology particularly -kinetics and -dynamics, psychopharmacology, psychopathology, memorizing a good chunk of the DSM, and becoming generally better acquainted with neurology (neurocog, PD, HA, Sz.), endocrinology (mostly thy, adren, and DM) and sleep medicine. I do try to be somewhat abreast of primary care mostly because I think all of us should be aware of the interplay of life's sicknesses and injuries with our respective populations.
Some things I still am grossly uninformed about are CT and MRI interpretation, although I never see any images, and EEGs.
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My goodness, people are salty today. She said "so" twice?
OP, I get where you're coming from. I'm 6 weeks into a new position, and I knew going into the position that there are a lot of changes that need to be made. But you cannot make changes until you gain their trust, and that will take a few months. Even if you were hired as a manager to a new facility, one cannot expect to swoop in and make changes off the bat without some fear and distrust from the staff.
Give it some time, and as others said, for now just model the changes you want to see.
Nope. One of my classmates is an awesome ER nurse. I'm happy for her but it wouldn't suit me at all. I work rehab and palliative care. Just be yourself. This is your journey and no one else's. They are not better people because of the job they do.
It took me 3-6 months to get the hang of it. To find my rhythm. Looking back, I think one of the obstacles was I was still in "student" mode of thinking during the first few months of my job. So what I did was every day after work, I'd still study and go over patient cases until things become easier. No one ever stops learning as an NP. I think a lot of new NPs assume that since they pass the boards, they don't have to study anymore more so since they recently passed it. No NP program is perfect. Studying never ends IMO.
What program did you attend? I think everybody should know how to at least diagnose a UTI before graduation. I am not knocking you but it sounds like whatever program you attended did not prepare you well.
It would probably be best to go home and read the material, its hard to absorb stuff reading wise at work unless it is applicable to the current situation. Uptodate is good but its so so in depth and not really needed for simple stuff. Epocrates is pretty good, 5 minute clinical consult online is good. If your program (which it doesn't sound like it did) didn't prepare you well I would probably pick up a copy of robins and cochran pathologic basis of disease. give ita read and understand all of its material.
I know it takes some getting used to but most people I know were able to handle most primary care issues by graduation, but we can fix that no worry. There are plenty of resources and in order to protect yourself from getting sued I would do some self study at home and run scenarios through your head.
I hated being a nursing student. I don't mind when other people are though. Unless they try to take my computer that I was charting at.
But seriously, my impression of them is that during clinicals they often dont know what to do with themselves. Not that its their fault. Looking back to my clinical experiences, there wasn't much guidance beyond "look for opportunities to learn but all you are allowed to do is help get vitals". I wish clinical time had been a better learning experience for me.
I love to teach them when I can, and I wish nursing education gave them more hands on time to get comfortable in the clinical setting. And allowed them to DO more during clinicals rather than just "observe" without much direction. Looking back, I would have totally traded a nursing theory class for more quality clinical time when I was in school.
I'll nurse some students.
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