Latest Comments by limandri

limandri 695 Views

Joined: Aug 6, '04; Posts: 11 (0% Liked)

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    You are NOT too old. I've taught many students older than I and, in fact, like teaching those students. They have a stronger base from which to learn, know how to learn from their environment, have good thinking skills, but tend to have demanding families who still want to see them. Please don't let age be an excuse from advancing yourself.

    Quote from peaceful
    Thank you for your post. I found the information helpful and plan to look up recent article you refer to for clarification. I currently work in the psychiatric field with MI DD homeless population. Look forward to going back to grad school for NP (or should i say Advanced Practice PHM). Enjoy hearing your side of being in the field for a number of years and your practice as an APNP and impressed that you have doctorate! Now my only decision is wondering if i am too old, already 48 so trying to decide about school. Hope this psychiatric chat board hears more from you.

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    I'm curious if the patient still needs to continue on medication for depression. In which case it is not just weaning but switching to a different medication. All of the SRIs can cause a withdrawal effect but Paxil is probably the most difficult. I agree that cutting the dose in half for the first decrease is best then slowing down even further. In addition to breaking tablets in half, it is also possible to crush the tablet and mix with a known amount of applesauce, yogurt, peanut butter, pudding, etc then take a proportionate amount. For example, crush a 40 mg tablet and mix with one tablespoon of applesauce. Then take 1/2 tablespoon of the mixture for 20 mg, 1/4 tablespoon for 10 mg, etc. The remaining amount has to be thrown out because it deteriorates even with refrigeration.

    When switching to another SRI, it can be a simple switch with equivalent doses. The longer the half live, the less likely to have withdrawal effects. In fact fluoxetine (Prozac) hardly needs titrating because it has a half life of about 2 weeks. When I am completely discontinuing a SRI with a client, I usually taper down as low as possible (e.g. 2 mg of Paxil) then give them 2-3 tablets/capsules of Prozac to take every other day until gone. If they still have some withdrawal symptoms, I give them one weekly dose of Prozac (90 mg tablet) and let it taper itself out.

    Quote from Jo Anne -OLD
    I have read many ways to wean off the drug.

    What is the common way?. A pt. told me that her doc is starting her on Zoloft at the same time he is weaning off the Paxil.

    What is the correct way?.

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    Don't mean to be a hair splitter but CNS doesn't refer to a degree but to a role and a particular certification. Times are changing and eventually so will the title. The American Psychiatric Nurses Association will soon be certifying advanced practice psych nurses with simply the title of Advanced Practice PMH. The degree is a masters degree in nursing and can even be a doctorate. The American Association of Colleges of Nursing has recently published a white paper proposing the Doctor of Nursing Practice (DNP). I'm not sure I like yet another title but the point is that advanced practice requires advanced degrees.

    Each state has within their Nurse Practice Act what is required for advanced practice and what the title is in that state. Most states have some kind of prescription authority. The best resource is the Journal of the American Psychiatric Nurses Association last issue (Dec 04?) that provides a complete update state-by-state regarding advanced practice.

    I practice in Oregon that tends to be very progressive. As a APRN I prescribe independently and have done so for about 20 yrs. I have both a masters and a doctorate in psych nursing. I love the work that I do and enjoy the autonomy.

    Quote from peaceful
    Many APRN jobs advertised require an APRN with prescription authority. Does receiving an Advanced Practice Psychiatric/Mental Health Nursing Curriculum, CNS degree give the APRN prescription authority once national tests are passed? Would appreciate any information on this degree. Do you have this degree and how is it working out for you? Thanks for your help on this subject. Would appreciate any info you might have.

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    I think it is great that you are interested in psych nursing. There is quite a bit of flexibility and diversity in this specialty and you can get there by many routes. I have my doctorate in psych nursing and I am a psych nurse practitioner. To be a basic nurse in psych you need to get a BSN and work in psych (usually inpatient but not necessarily). To do advanced practice, like I do, you need at least a masters degree in psych nursing. Depending on the state you decide to practice, you might provide psychotherapy and prescribe medications in the advanced practice role. I have to admit that I love what I do and have been doing it for a long time. I advanced my education a little at a time and worked in mental health between and during each return to school.

    In school you do not specialize in a diagnosis. In fact the psychiatric diagnosis has much less relevance to what you do as the client's problems (which isn't the same as the psychiatric diagnosis). Like you, I am very interested and concerned about those who cut on themselves, not because of the cutting but because of the pain they are trying to stop with the cutting. Oftentimes these young (and older) women have experienced traumatizing lives that they need a great deal of well informed therapy and a very patient, compassionate therapist to help them. Think you could do that? I bet you can.

    Keep your sights high and please don't hesitate to ask more questions.

    Quote from wannabepsychnurse
    Hi I just found this website and i am thrilled! I have been wanting to be a psych nurse for quite some time now, and I recently found out that my best friend is a cutter and that has boosted my interest in it even more! I was hoping that someone could help me out with my questions! 1.) Do psych nurses have to got a special nursing school? 2.) How much do they make? 3.) Can you specailize in certain mental illnesses? I would really love to work with teen age cutters!Any ones input is greatly appreciated Thanks!


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    Thanks for your note about the many possibilities with PDAs. It removes the possible error of not being able to read someone's writing and allows immediate notations. If nursing services then have Bluetooth capacity (wireless beaming to printers and networked computers) there could be seamless transfer of information, therefore no transcription errors.

    Quote from marys

    I am a former software project manager of wireless applications that is changing careers to nursing. I am finding that the PDA could become as invaluable as your stethescope.!! I think that there is so many applications that could be placed on PDAs. Like charting at the bedside, looking up info. For students put those care plans on the PDA so that you don't have to spend hrs typing them up and turning them in. I think that the applications are endless. Think about documenting a wound. If you had a camera built in, just like a camera phone, (the new ones are coming out) - you could have that picture in the chart. It is worth a thousand words..


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    Quote from rninformatics
    Babies makes an excellent point about patient health information (PHI) and the Health Insurance Portability and Accountability Act.

    Understanding and complying with this federal mandate affects nursing and nursing informatics practice. Everyone who deals with identifiable patient information needs to be aware of the implications as HIPAA directs how we handle patient information written, verbal and electronic. Everyone who works in healthcare has a responsibility to keep patient information confidential.

    In the case of such PHI stored on a PDA a responsible clinician needs to ask themselves: Is the information protected and secure? If you lose the device will that private pt info (identifiable pt. information includes: the patient's name, diagnosis, lab tests, vital signs, ss #, address, etc.,) be accessible to someone who is not involved in that patient's care and therefore has no right to view such information?

    There are penalties for failure to meet the privacy regulations and for inappropriately disclosing or receiving patient health information. Penalties can be either criminal or civil and can result in monetary fines, imprisonment, or both. Monetary penalties range from $100 to $100,000 depending upon severity. Imprisonment can be for up to 10 years depending on severity. Both institutions and individuals can be held liable for breaches in patient privacy and confidentiality, as the penalties do not just apply to organizations. HIPAA compliance requires the use of appropriate technology, education, changes in previous practice patterns and implementation of organizational policies and procedures.

    3 articles that cover the use of PDAs and HIPAA--
    There are several ways to comply with HIPAA and use the PDA to its fullest potential. One way is to have double password protection, i.e., have a different password to gain entry to the PDA and enter a particular program with pt info. Another is to have a business associate agreement with the software company that may store pt info. I checked with our university counsel and found this was the legal way of doing it. Thirdly, in calendar where you may schedule patients use only initials or some code or first name without any trace back to original data or identifiable info. I'm in psych and that is essential for me. When you dispose of your old PDA or any computer, reformat the hard disk to be sure to remove any identifiable data.

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    I have been a nurse educator for many years and looking to retire in about 5-6 yrs. Have taught mostly BS undergrads and MS psych mental health. Lately I've been excited about teaching web based courses. Like developing them in such a way that they are friendly and human in spite of the technology.

    My question to those who have done web based courses: what do you like and dislike about these courses? I'd like feedback that isn't tied to course evaluations or teacher evaluations, i.e., the stark truth. I'm especially interested in ways to improve this teaching method.

    Thanks for your help.

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    Sorry to read about your distress, ParrotHead. Altho I have never left nursing completely, I have had more than one of those long dry periods. What worked for me was to change positions in nursing, but it sounds like there is so much going on for you that a pet groomer might give you a bigger break. (When I retire dog training and breeding is my choice too.)
    On a more serious note, you have some very serious stressors going on for you and maybe nursing is the only one that you can control right now. I sure home you are seeing someone for therapy and support. You really need it and deserve it. Funny how nurses take better care of others than themselves.

    Quote from ParrotHeadRN
    I have come to the conclusion that at this time in my life, nursing is making me ill. I was recently hospitalized for intractable migraine and really have had headaches almost constantly for several months now. They always get worse either right before I go to work or when I'm at work. I've been getting these terrible feelings of impending doom while at work, always preceding a migraine. I get sweaty and hot and my heart races. And there isn't anything especially terrible happening at work as far as I can tell.

    I am divorcing and my 12 year old son is having difficulty with it and is having behaviour issues. I am too tired and stressed from work to do much about it. It's almost easier to let his father deal w/ it, and I know that's not fair. My house is a mess and I haven't been doing anything about that either.

    Honest to god, I have an interview Tuesday at Petsmart for a dog bather. If I "work out" I can be sent to dog grooming school, which is what I think I'd like to do. I can't even remember anymore why I became a nurse except that it seems to be what my family does.

    I hope to get my good feelings about nursing back someday. I've only been nursing for 3 years and I thought I loved it, but my body is telling me otherwise.

    Have any of you ever been here? Have any of you actually left nursing? It does seem ridiculous, the fact that I am walking away from really good money, but I don't know what else to do.

    Thanks for listening.

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    I am an advanced practice psych nurse with prescriptive authority. I use my Tungsten T3 constantly in my practice. I have a prescribing program that I use to write prescriptions and beam to my printer to be printed out or I can send directly to the pharmacy. Once a week I back up all my data with the company which maintains my patient files on their server in case I have an unfortunate wipe out. I signed a HIPAA statement to include the company as an associate to maintain privacy records.

    I also am a heavy user of Epocrates (free ware) for drug info sufficient for general use as well as important prescribing info (e.g., drug half life, adverse effects, pregnancy rating, etc).

    I also use Psych D and A2ZDrugs. A good resource for PDA software for health care is Skyscape.
    I find my PDA as essential to my practice as any book I would know. Plus if I have a no show I can always play Scrabble!

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    I have been a psych nurse for a long time (both in-patient generalist and out patient advanced practice) and I truely believe a new grad should first get psych experience before going into med-surg. It is much more difficult to develop those interpersonal and supportive skills in med surg and they are so very needed. On the other hand nursing skills in any area that aren't practiced will get rusty. Starting with a year of med-surg doesn't assure that your skills will be current, it just postpones developing psych skills. After a year where ever you are practicing you will find those skills you haven't been practicing get outdated. If you choose to be in psych, start there. I worked in med surg briefly after graduating and can't say it was all that helpful in my career except to affirm my desire and talent was better in psych.

    Personally, I think this one year in med-surg is a myth promulgated by med-surg faculty and hospital employers.

    Quote from EarthChild1130
    I'm sure this has been posted a gazillion times before, and I appreciate in advance any replies!

    Do you guys think that psych nurses need experience in med/surg before going into psych nursing? Why or why not??


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    I'm curious about this as well because I am a PMHNP (psychiatric-mental health nurse practitioner) in Oregon. I have been working as such in both private practice and clinic settings. I'll bet psych nurse generalists don't have much contact with NPs and would love to know what is the experience out there. Also have some self-interest in knowing how NPs are perceived.

    Quote from FutureRNMichael
    Would LOVE to hear replys to this question.