burnay76

I've decided to tender my resignation. I really suspect they are trying to build a case to show I somehow lack competence in order to implicate me in the patients death. They can't implicate me directly, but a civil court only needs to show that it is more likely than not (51%) that my action or lack of action contributed. The worse they make me look in the meantime... the better chance they have of making a case. It's a tough one... this patient was not expected to live into adolescence due to cardiac issues, yet lived well into her 30's (ultimately the cause of death was related to this cardiac condition). The facility insist nothing could have been done to save the patient. They can't touch my license though.... like i said, they have nothing to implicate me at all. Time to get out before something else happens and they CAN implicate me! I've allowed myself to be set up for failure too many times, and have been lucky nothing has happened.

Did I mean that the way it sounded? Not sure what you mean. What I mean is that I am generally given an LPN to assist in nursing functions. Management has and plans to continue to staff me on occasion without the LPN and no replacement..... potentially increasing my workload beyond what is reasonable. Realize this is emergency psych..... patients walk in the front door all night long just like an ER often in such numbers that they cannot be triaged for hours (which in my mind is unacceptable). At the same time we are running an extended observation unit (pretty much an inpatient unit except there are not enough beds and people literally sleep on the floor). I can assign the LPN to work the extended obs unit and check in on her from time to time. When she is not there I literally must be in two places at once! Wow... I make it sound really terrible..... perhaps it is and I've become denesitized.

Am I naive in believing they don't want to "hang me out to dry"? I think they will if it comes down to it, but I don't think they will seek to do so if they can ultimately sweep the whole thing under the rug. This is a Magnet facility....fairly decent to work for.... but very tight with money when it comes to psychiatry, thus staffing suffers. Their priorities are well meaning, but misguided. For example... you'll never get turned down for a time off request, but that may leave next to nobody left to work. Fortunately I have maintained documentation of my repeated insistence that staffing is inadequate. I'd hate to have to move on to another job..... I really like the environment and there is nothing like it for 60 miles. However, it might be nice to just go to school and not work at all (I started my Psych NP studies this week).

What baffles me is that these occurrences are completely unrelated to the death of the patient! The paranoid part of me suspect they are attempting to establish a pattern of negligent behavior in case this ever comes to court. They can find no staff at fault in the client death, but perhaps claiming poor nursing can mislead a judge or jury to believe that staff, not hospital practice, was at fault. The bottom line is that I think the death may have been preventable had there been adequate level RN staffing (not LPN, or counselor, or other support staff)..... I don't want to get into it in case this post ever comes to light.

I work in an emergency psych program that recently suffered the death of a patient (first death on site in over a decade....so it is a BIG deal). In the aftermath I received a written warning citing me for not assigning rounds to the counselor (there is only one counselor who is fully aware that rounding is their job and customarily takes responsibility each and every night), not ensuring a bathroom door was locked (again a counselor duty), not monitoring a counselor's behavior who essentially dumped all her work on an orienting patient care tech, and not assisting a patient care tech in a patient search (again a function generally performed by a counselor). None of these incidents were related or contributed to the death of the patient (management explicitly admits this). The whole scenario smacks of making someone "pay" rather than addressing the root cause and responsibility which in my opinion is....... you guessed it, staffing! This environment is generally staffed (on nights....and remember this is an emergency environment) with two counselors, 1 RN and a LPN. Census may range from 5 patients to 30 with zero to 10 new intakes on any given night....and staffing is NEVER adjusted up regardless of acuity. As the RN I am asked to take responsibility for care of all triage/intakes and care for new intakes while supervising the counselor and LPN who care for those admitted for extended observation. We essentially run an Emergency department and an inpatient unit. Now at times I am asked to work without an LPN, which in my mind is downright UNSAFE! On the flip side, some night i do jack squat. The manager likes to cite these kind of nights for the reason the staffing is as it is. Sure... the average hours of work each night might be 6 or so.... but that's an average, and you have to staff for those times when there are 12 hours of work to get done in 8 hours. This particular night i was moderately busy. I proceeded no different than any other night nor different than any other nurse there would have. My manager more or less minimizes the write up and it seems he needed to do this so that something was done....essentially someone had to "pay". However, I am concerned that I will be "witch hunted" in the future. For Pete's sake they couldn't even come up with something related to the death but had to review video tapes and come up with unrelated infractions.... done not by myself, but by subordinates. I have accepted responsibility for poor performance of my subordinates. I am not convinced that I could have known about their lack of performance unless I had directly supervised their every move (obviously unrealistic). However, I am an old military man and you protect the troops. How would you approach this whole situation?

This is a tough one. The current trend towards customer service can conflict with "conventional wisdom". I would be concerned about liability issues. If the patient became ill on soup brought from the nurses home (or it could be construed the soup had any negative role) - that nurse is toast. Arranging for the dietary service to provide it - not a problem, even if the nurse helps in obtaining it (i.e. obtains it from the store and has dietary prepare it). It would become even less of an issue if the nurse was reimbursed by the hospital for the cost. Of course this should not be done blatantly so it appears to other patients that the nurse is favoring this one. There is nothing wrong with going out of your way for a patient when you can. Like I said.... this is a tough issue. The easy answer - what does hospital policy say?

I'm looking at applying to the MS in nursing (Family Mental Health/Psychiatric Nurse practitioner) program at SUNY Upstate. They have an established FNP program and are planning to start the psych NP program next year. I was wondering is anybody is currently attending or has attended there for their advanced practice education? I am wondering how competitive admission really is there. I am an ADN with a BA is philosophy. Because I have a BA, they have a program where I can take several excelsior exams in order to essentially opt out of doing a BSN by proving comparable knowledge. I graduated my BA studies 7 years ago with a 2.51 (did some additional graduate course work and maintained a 3.8), graduated my ADN studies 2 years ago with a 3.01. I have a little over a year as a psych nurse (as well as my initial med-surg time) and 5 years paraprofessional experience in psych, and 8 years of service as a medical specialist in the Army Reserves. My skills in psychiatric nursing are strong and I am knowledgeable beyond what my grades reflect as I struggled to work full time while attending studies throughout my academic career... thus my less than stellar grades. I'm wondering if any one has knowledge or experience of this program, or perhaps with another program, and can comment on whether I am setting myself up for disappointment or if my academic/work history might give me a shot at advanced practice studies.

tough.... I just took the community focused nursing exam today and got a "C". I read both texts cover to cover (1500 pages in all). It's a pass, but I'll need to do much better on the others to downplay this one.

Wow, we are way off topic but....... The link you have isn't the correct one. The program is not the RN-MSN. With a Bachelors in another field and an RN one may go directly into the MS program. See these two links: http://www.upstate.edu/con/rn_with_degree.php http://www.upstate.edu/con/ms/apn_msn_coursesframe.php One actually skips many usual requirements of the BSN. I was skeptical at first as well until speaking with them.

No, I'm actually saying the program I am looking at does not require the completion of BSN classes. You need to take the excelsior BSN level tests for nursing management, nursing research, and community focused nursing. That's significantly less than what comprises any BSN I've heard of. Apparently they feel its enough to demonstrate BSN level knowledge. they spell out the program requirements on the web site. Now excelsior themselves will let a person enter their MSN program without a BSN or any BSN tests/courses so long as you have an ADN and a bachelors in another field. They attempted to recruit me into it but it really didn't seem like a good idea. It's not a clinical masters program (i.e. you can't become an NP or clinical nurse specialist) so it's really just a masters degree for the sake of having a masters degree.... no route to advanced practice of any kind. (I don't mean to offend anyone.... just saying Excelsior's MSN isn't in line with my career goals)

The school I am applying to is SUNY Upstate Medical University (http://www.upstate.edu) they have a program for RN's with Bachelor degrees in another field. It might be a pretty unique program.

I think everyone is right... bottom line you won't get any better a nursing job with a BS in anything but nursing. However, there are numerous options for an RN with a Bachelors degree in another field. For example, I am applying to get into an MS Nurse Practitioner (Psych) program with an RN (Associate degree) and a BA in philosophy. I can skip the BSN because I already have a bachelors.... I just need to pass a few Excelsior exams to demonstrate I have knowledge at the BSN level. I'm not sure how many programs there are like this. I too can't really stand floor nursing (especially med-surg) and quickly moved to psych nursing (as a floor nurse, but it is much more tolerable). Within six months of moving into psych nursing I got a job working in the admissions office doing intakes and screenings which is much better. My BA didn't help me in landing that job, previous experience in admissions and intakes as a paraprofessional did. Nursing just placed little value on anything but nursing.... it's unfortunate.

What are the requirements in your state to move into an ER Nurse position? I am in new york and they require that you have one year acute care experience (ICU/CCU is usually preferred) or are in an approved year long ER Nurse training program. I know this varies state by state. I have 6mo. Med-surg/tele and 6 mo acute psych (charge) experience and I am looking to relocate somewhere (anywhere is US) where I can get into some kind of ER training program. I am working with a recruitment company for direct hire and am wondering what areas might be an option. Any information about your states regulations would be appreciated. Thanks! (I know some folks will think I am nuts and don't have enough background but I have an extensive background in emergency medicine as an Army Medic which involved doing a lot of what ER Nurses do in the civilian world. Also I spent 4 years in an ER assisting in medical clearance of psych patients. This won't make up for lack of experience but will give me an edge. I don't pretend to know what I need to know which is why I am specifically seeking a position where I will be given an extensive training period.)

I worked in the private sector in a psych facility for four years prior to my currect position in a state psych facility in NY State. In the private hospital the use of seclusion was always preferrable to use of mechanical restraints (although brief hands on manual restraint was often neccessary to move the patient into seclusion (seclusion is a misnomer as there is always a staff present on 1:1 during any such event). In the state facility use of seclusion is an option of last resort and mechanically restraining the patient is preferred if the use of a manual hands-on restraint is not effective or not appropriate. Anecdotally, In those four years I never once was hit by a patient (and 2 and a half of those years was in a crisis center where they are most acute). I have been at the state facility 2 months and had a patient hit me today after stopping her from self abusing (it was a minor thing and didn't hurt me in the least - I wouldn't have approved a restraint at this point but the nurse Administrator was present and gave the order). For those of you working psych or who have experience in the field, what are your thoughts regarding the use of restraint versus seclusion. Seclusion seems less restrictive to me and, in my experience, removes the patient from whatever is going on and gives them the opportunity to regroup in a safe environment. I'd rather get a "time out" that a "tie down" Also - if you know of any scholarly writings supporting the use of one over the other that would be great. I have been unable to get the restraint committee to give me information that indicates our policy is evidence based. for those who may not remember or use different terms: manual restraint = hands on restraint mechanical restraint= use of restraining gear (4 point leathers in this facility) Seclusion= placement in a bare room with a plexiglass window and somewhat padded walls and floor. Thanks! Scott

Hi, I'm a relatively new nurse myself and I have certainly been a pain in the rear I am sure. I am a strong proponent of evidenced based practice and this leads me to a lot of "why" questions. I know experienced nurses become really frustrated with this. It is unfortunate, like some have said, that the input of newer nurses is often dismissed or discouraged. I do not know it all...... not even close. I am quite well read on recent innovation and most current standard practice (doesn't mean I can always do it though). I try to encourage discourse on methods so that I and those helping me can critically think about what we are doing. Unfortunately this is too often seen as challenging. I cannot be content, however, to just do it because I am told (especially if it doesn't seem to make sense) Other fields are better at recognizing that fresh blood brings a wealth of useful knowledge and "old" blood bring a wealth of experience and wisdom. Knowledge, wisdom, and experience are pretty much useless (and even dangerous in nursing) when they stand alone. They all depend on each other to form a coherent and effective practice. That said - there are also those newbies out there who just need to be slapped silly (maybe even me sometimes) :trout: