greg in mass

Yes it does get frustrating and many staff get burned-out from the "personality disorder" clients. All clients need help, and you should not focus more energy on one client or type of client than another. The Personality disorder client (i.e. Borderline client) will demand all of your energy and the rest of the staff's energy to give them all attention, whether it be positive or negative. The reason it gets frustrating is that these clients do have an understanding on what they are doing, but like you said, they refuse to take "personal responsibility" for their actions. Other clients may not be able to express their needs to staff as well as other clients. This can be hard to determine which client needs more priority over another client during your shift. Gaining the experience comes within time. Try to ask other nurses, the treatment team, and the other staff at your facility for more insight on how to handle personality disorder clients better. You can also read up on this type of client in the DSM, the internet, other books, etc.

What types of qualifications and/or education does one need to get a position in QI, UR, or Risk Management? :)

DBT is used in my facility, but only a few people are trained in. The downfall with this therapy is that it is designed for clients in a out-patient setting. My facility uses it in an in-patient setting and from my opinion it is not that useful. From my understanding of a Borderline Personality Disorder client, it is better to discharge them as quickly as you can out of a in-patient setting. If not, then this type of client tends to become dependant on the system and will do anything....including hurt themselves very violently....to stay in an in-patient setting. Trust me, I've seen many Borderline clients over a 8 year span. Many of these clients that do leave tend to become repeat clients that come back to the in-patient setting. What also gets to be difficult is dealing with 5 or more on a unit....while you also have 20 other clients as well. Borderline clients burn out your staff and they all want so much attention....positive or negative....it does not matter. When you have more than 1 client on your unit, they tend to be buddies often, and they also compete against one another for staff's attention. If one gets more attention than the other, then you will often see the other act out purposely to harm themselves to attain attention....and this competion continues. These type of clients tend to be on close observation often. Treatment teams try and devise special plans for these clients, which only works temporarily. These clients are well aware of what they are doing, because remember it is a personality disorder they have. They tend to split staff often and tend to lie often about staff. Sometimes their lies get staff in trouble, and they have no remorse for their actions. They cannot stand being alone....and will converse with anyone...whether they like them or not just so they can have company....and will try and do anything to get on 1:1. Many other characteristics also occur, but I could go on and on. Hopefully this gives you some insight to help. ------------------

I've seen alot of interesting things working in psyche.... As far as something similar to your posting..... Well I have seen clients intentionally consume their own fecal matter and buy urine from other clients for consumation as well. Sometimes you have to learn a good way to detach yourself from your natural reactions to be able to tolerate the psyche field, because you tend to see alot of strange things. ------------------

Learning ASL is useful, but it depends on what you plan to use it for. If you want to be a nurse with ASL fluency and be able to use these skills, then you would have to work in a facility that specializes in deaf clients. I do not know what is out in your area, but I'm sure you can ask around. After you become fluent in ASL, you can also do freelance work as an ASL interpreter, which is in high demand....because not too many people know the language. If you did do freelance work, you can do work in hospitals and clinics around your area and assist deaf people in doctor's office, etc., where you could also utilize your medical nursing knowledge as well. There are many options on where you can be an interpreter, but doing work in the medical setting allows you to also utilize your medical knowledge. ------------------

Thanks for answering me. As for me, I am interested in the legal field. I am not quite sure the best approach at going into this field while utilizing my nursing degree as well. I have read other emails and posts from several other people related to these type of questions. I have to say that everyone is giving me more ideas than I realized. Actually a friend told me to post my questions on a forum to get some ideas related to my such questions. I never knew what a forum was. I then came across this nursing forum, and I am very happy to utilize this as resource without even leaving my home or work. ------------------

I do not know what the law is to this. However, where I work the MD has to sign every page.

Can someone answer any of my questions??? I have worked as an RN for 2 years and in the direct nursing field for 8 years. I have an interest in becoming a Nurse Paralegal, but I do not know the best way to go about this. I work in Massachusetts and saw a Legal Nurse Consulting Program at Northeastern University, which is an intense 12 week program costing around $2500. Interested in becoming a Nurse Paralegal, I contacted an attorney who hires Nurse Paralegals. He told me that from his experience, the Northeastern University program is a waste of time. He also said that I should get hands on experience working in a law firm reviewing cases. I have no legal experience and I do not know if a lawyer would be interested in training me in this field. 1)How do I get experience in this field? 2)What types of experience do I need? 3)Am I too inexperienced in the nursing field? 4)Will an attorney allow me to work with them and review cases so that I can get legal experience? ...... 5)If so, which type of attorney should I focus my time in contacting? 6)Upon contacting this attorney, what can I do at present experience level to help his law firm and still get Nurse Paralegal experience as well? 7)What college course should I also focus on learning (I currently have not studied any law course yet, but would like to...and I'm not sure which course to start focusing in on first)? 8)How much do Nurse Paralegals make per/hour on average, or is it per/case?