JimRN

Spent a bunch of years in the Army. When I was a lowly brand new Private, I had a Sergeant (whom I really disliked) give me a piece of valuable advice. "When you move to a new duty station, keep your eyes open, your head down, your mouth shut, and your mind alert. Do that for a month or two until you know EXACTLY who the players are and how things work. No one cares about the FNG's opinion ( !@#$ing New Guy)" I would follow that advice here. It's further reinforced by Sun Tzu who said “If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.” In essence, you have to figure learn their ways if you're going to change their ways. It requires patience and perseverance. It sounds like you're absolutely right about inefficient charting and a poor understanding of the software. That doesn't mean you're in a good position to change anything yet.

Because they still get paid 1/3 of what a psychiatrist does. At any rate, if you're willing to work nights, you'll find a Psych RN job. At least where I am, there're are plenty of psych RN jobs. Hell, they're offering up to $10K bonuses at times.

That's the answer right there. The level has been consistently low since December. The fluctuations aren't really that dramatic considering the time between them. Focus on good lab draws prior to the first dose of the day and titrate. The best evidence says therapeutic dosages lay around 0.5 mEq/kg/day. Run that figure by the patient's weight and see how it compares to the current dosing. Considering Li has about 8 mEq per 300mg, unless I'm mathing wrong, the dose would be statistically adequate for a 48 kg person. Now, that's not a definitive truth but a decent general guide to consider whether the dose is adequate vs. absorption being a problem. Don't forget to look at renal function too. Just because he's a kid doesn't mean his kidneys can't be insufficient. Ask the doc for GFR, BUN, and Creatinine next time he gets a lithium level.

I worked strictly psych for 7 years, both inpatient and Psych ED. In that time, I can't count the number of times I was hit, kicked, or otherwise assaulted. There's a caveat to all of this, though. Of those times I was "injured" only twice was it serious enough that I needed aid, and I've lost a total of 30ish days of work and probably 30 days on modified assignment due to these injuries. BOTH of those times, the injuries were completely volitional and, frankly, the result of weak management allowing the admission people that were not appropriate for our facility. They were in no way thought disordered or psychotic. Both times, after staff had to be sent to the ED, the Chief of Psychiatry saw fit to have the patients arrested and further, testified against them. I believe he referred to them both as sociopaths. With that out of the way, many time's I've gone hands on with really sick people. I've certainly been scratched, managed to avoid being bitten a few times, kicked once or twice, and definitely pushed. None of those times was I seriously hurt, nor can I remember anyone else being hurt and requiring medical treatment. Sick folks are usually scared or overwhelmed. They don't want to hurt anyone, thus, they're not trying to. They just want to get away from whatever stimulus is setting them off. The key to managing these patients is having a good team and a good plan.

OK, so I thought about reapplying for my well expired board certification. Before we dig into it too deep, I changed my mind in favor of getting a master's degree. At any rate, I'm seeing a lot of very prominent professionals using the credential "PMHRN-BC". Now, before you ask if I'm mistaking it for NP, I looked very closely. I then searched and found a lot of people using this credential, from APNA board members to the president of ANA-Maine and even seen it in published JAPNA papers. In all of my digging, I have yet to find where ANCC approves it or where any other organization is offering this certification. It was always simply RN-BC. Mind you, I don't really care what it's called, I'm just a little confused and seeking some insight. Thoughts?