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  1. Hi all , I worked in psych case management for a while and usually we would meet our members in the community , at shelters , and sometimes at their homes . I later went on to work in an inpatient unit . I had thought about travel contracts in psych but I'm also seeing more and more job listings for psych nurse home health . Sometimes the HH also has a hospice department . Is this basically case management ? Many jobs post a pay for visit rate . Is it possible to only pick up per diem visits ? And taking it a step further , is it possible to cross train to work hospice per diem ?
  2. thekid

    Psychiatric Nurse Moving to Arizona

    Ratios will vary amongst facilities (and last minute staff call off), per diem is about $35/hr with a ratio of 6 to 9 (just an average). Fortunately, there are many psych nurse jobs available in Arizona.
  3. Hi all, are there any RN to MSN (psychiatric nurse practitioner) online programs that will allow a very motivated, excellent self learner to accelerate rather quickly through the requirements? I understand that requesting to test out of certain classes will be up to the school, I'm trying to get a reasonable estimate on how a full time student with previous RN experience may be able to focus solely on school and finish at a much faster pace. Any thoughts ?
  4. Boy do I feel old! I graduated from MCC with the two year and I remember recruiters from hospitals meeting with us, offering us jobs in pretty much any department, with sign on bonuses. I wanted out of Phoenix so I applied and got a job at the hospital in Flagstaff, but due to a few family circumstances, ended up declining the offer, moved to Colorado and very quickly got a job in hospice care. Sorry to see so many nurses struggle.. hang in there !
  5. thekid

    Do Antidepressants Work? Maybe Not.

    If you really want to dive in to a can of worms, look up Dr. Peter Breggin's work. Or MAD in America. It's at the very least an interesting topic. I have observed antidepressants cause more harm than good to patients, and I have also observed antidepressants serving as a temporary rescue action to help jump start a patient again . What bothers me the most is observing the prescribing provider switch a few medications at the same time and not follow up for six weeks. IMO, unless a patient is having severe adverse reactions necessitating a "wash out" , one med should be altered at a time and evaluated. I've witnessed way too much polypharmacy in psych . And any change in medication should be closely monitored, at the very least by phone contact, between provider and patient. A patient can slide downhill quick . When I worked in psy case management, I would create a simple daily log for my members, each day they had to write a brief summary , listing medications and dosages, times, diet, sleep and amount of stress, and any symptoms. It gave them a sense of involvement (and perspective) into their own medication management. And it was a great tool to present to the provider when it was time to follow up.
  6. thekid

    LTC's are a joke

    I can't believe after all this time that for pts requiring crushed meds, that docs have not ordered liquids instead.
  7. Thank you for your encouragement :) I am glad that is is apparent from my post that I take the decision seriously and do enjoy being challenged, and yes, I have many obstacles. We have a general family NP program in Hawaii, I wonder how many nurses have gone this route then specialized in psych later (if that is possible). Not that I agree with it but I know of a lot of general practitioners who prescribe psychiatric medications . Unfortunately I do not have any mentors and my previous psych case management experience did not leave me with many contacts/references because we worked independently . Admittedly we had a high turnover rate , the social workers would stick around but the RN's left within six months, not just because of the pay but because of the management. Surely other RN's have left positions due to poor management, but it's not the best thing to list on a resume . Although psych nursing is my top interest, most of my clinical experience has been in long term care. I may try to pick up a few assignments in state so I can build references again. Once I'm out there in a job, I am excellent at networking and dropping a business card on the desk of medical directors, DON's , etc. I enjoy the entire management of care, from initial assessment to complete/ongoing follow up, referral to community resources, etc. In that aspect I enjoyed case management but unfortunately our caseload was too high, the acuity was determined by the insurance company (and did not reflect accuracy at all, I often spent more time helping the "once a month" pts because many of them knew how to work us and work the system, then complain and switch case managers, or agencies. Of 40 people, I had two that I was fortunate enough to assist and get them stabilized on medications, get them to visit their GP to follow up on other health concerns, and enter the work force again. I was very happy. Many of the patients were in the CM program as a requirement to receive other state benefits, so they were noncompliant or missing in action. I had one guy who would show up once a month, collect his SS check, then disappear. I understand programs have imperfections, but I suggested to the company and the insurance company to consider hiring an intern or student at a lower wage to process the non-stop housing applications and to update the large stack of paper files in the office that were outdated by a few years. It was a big mess and I made many suggestions to the companies during IDT meetings, that is where I excel.. once I understand some of the process , I can see what needs to be fixed and have possible solutions . I have been looking into online programs too, as I would be happy to take a few classes while I continued to work as an RN . I'm just not sure if online MSN/NP programs are reputable or considered satisfactory so that when it came time to look for a job, an employer would not consider a candidate who attended a brick and mortar school. I learn very well on my own, I have the discipline to study and research on my own and I would even try to challenge a few classes and see if I could test out of them, or at least receive credit for my field experience. That standard "two years of recent experience" is the real bummer. I understand why the standard is there, but I'm able to pick up on things rather quickly, and despite the fact that most of my hands on clinical in long term care was years ago, I have worked a variety of facilities and am adaptable. My first job as a CNA and LPN was through a staffing agency in Arizona. I had zero experience but I was hired and sent to various facilities (and home care environments) around Arizona, when I tested and received my LPN license, my agency manager did not hesitate to send me right out to work as an LPN. It was scary but I did it. Again thanks for your encouragement :) I need to start by updating my resume and focus on what I have done as a lifetime career as a nurse, despite their preferred requirement for two years of recent experience. The right manager will see the continuum of my experience in various settings and consider it an asset . As far as psychiatric nursing, although I lack on paper the inpatient hospital experience, the right recruiter will see the strengths of having worked as a case manager . Community nursing really broadens one's resources and skills, perhaps as I work towards the psy NP role, I'll end up taking a position as a public health/community PNP as opposed to working in a hospital . :)
  8. thekid

    travel nurse psych and LTC?

    Hi all, I recently posted in the NP forum as I am kicking around a few ideas. Most of my experience aside from case management has been in LTC, I worked the ranks as a CNA, LPN, then later an RN. It's familiar and I know what to expect. I love the elderly dearly and I know there's a fair amount of job security with it. My other interest is psych nursing but I have only worked in psych case management. I live in Hawaii and am licensed here and in Arizona, and I can hardly stand the thought of leaving Hawaii , but our job options here are just not as varied. So I have considered applying for travel nurse positions. My first pick would be psych nursing because I enjoy it the most, but lack the "on paper clinical experience , although nurse case managers can definitely hold their own . But I would consider LTC nursing as well and may have a better chance at finding assignments. When I graduated in 2000, I worked in LTC and hospice for a few years. I have been out of the clinical setting for many years now but since I worked in so many facilities as an agency nurse in LTC in the past, I don't feel that far out of the loop. Are there a lot of opportunities for travel nursing in psych and in LTC? I could also do geri-psych . I would not need to work year round running from assignment to assignment. Would love to hear from nurses who work either of these specialties. I know most travel contracts will require two years of recent experience, however I also know when there is a big demand for nurses, the right employer will consider a nurse's entire background. Thank you.
  9. Hi all, I'm an RN with licenses in Hawaii and Arizona. I never worked med/surg and was hired into hospice when I graduated many years ago. Due to some burnout issues, I went on nurse hiatus but was reinstated in 2011. Without any recent clinical experience, I was hired into a case management job and I enjoyed certain aspects of it, mostly the autonomy and working from home. I did medical and then later worked strictly with the behavioral health population. I love everything about psych nursing, I've never worked in a hospital in psych but was familiar with a lot of it because case managers were directly involved with admissions, medication management (which I loved) and discharge/follow up. The main challenge of course being that our population was not compliant with treatment so I felt like I was more a clerical personal assistant than a nurse. I have thought about applying to the psych hospitals in Hawaii where I have lived for 10 years, but it's hard to get a foot in the door, and also because I had a gap in employment, and am a A.A.S. nurse (no BSN), I'm up against a lot of obstacles. I've often considered studying for my master's and working as a psy NP . I seem to have a knack for the medications and anything psy related, and had a decent insight into community nursing as a case manager. Being 44 years old, with no savings, an 8 year old in Hawaii, I feel like my choices are a bit limited. Of course I wonder if I'm too old to pursue a master's and would that be tough for my 8 year old. His father and I are not together and while his father is helpful with child raising, he is based in Hawaii and he has never really taken my nurse work seriously, in other words I've always tried to find nurse work that works around his schedule. I feel life passing by and have decided that if this is something I really want to pursue, that I need to do it soon. What I lack on resume experience, again I make up for with an intuitive knowledge for psy disorders and management. I've often felt like I have not worked up to my potential academically and professionally, but then again with a young son, priorities in life change. I've considered getting licensed in other states and to attempt travel psych nursing (inpatient) but I know that may require me to leave the state. My other family lives in Arizona and there are a lot of psychiatric hospitals , and even with my lack of experience inpatient, some of the recruiters have acknowledged that case management would be considered an asset. Potentially, I could build up experience in Arizona then look into travel assignments. I want to remain flexible with options to accommodate my son. But the voice in me from my 20's keeps saying that if I wanted to be a psy NP, then go for it. Financially I cannot afford it so I would have to apply for loans. I imagine it would take three years of academic work and then I would be a newb NP . I don't know where I'd go to school (Hawaii does not have a psy NP program, only general NP). And I don't know where I would work after I graduated. It is very hard to consider leaving the island because it is just as important as any career. Are the online NP programs reputable, would it be possible to remain here and complete an online program? Or should I focus on gaining more "resume" experience by working as a psy RN inpatient (although I really felt I learned a LOT with case management because we were in the field alone ). I'm not new to crisis intervention or deescalating patients. I understand milieu in hospitals, I know what a COWS assessment is, how to score for suicide/harm to self to direct a one on one, I have done med passes as an LPN in nursing homes, as I mentioned as a case manager I spent a lot of time in psych hospitals here so I'm not new to it, unfortunately hospital staff often views case managers as the go to when stable housing cannot be found or a pt is noncompliant with treatment. I've seen both sides and I understand the insurance side as well , having working in medical case management/ UM. Personality wise, I'm confident in what I know but I respect the experience of others. I felt frustration when I didn't agree with a treatment plan or a doctor's change in medications. I work very well by myself and have always enjoyed the creative problem solving "overall" planning for pts. I quickly pick up on the gaps and barriers in healthcare and prefer working towards long term solutions . Although I spent time as an LPN in LTC, and I know how to task, "clinical" skills have never been my favorite part. I enjoy pt contact but am seeking a role that is more comprehensive, more autonomous, and possibly more authority (hate that word) . It's not so much that I want to write scripts as that I enjoy the entire management of care that can be customized for each person . A lower patient case load with more intense long term care is my ideal. And I like to write :) Wow, that's a lot, and I certainly don't anticipate an easy answer. I know the obstacles with where I live and being a mom, yet I'm not sure working to be a psy NP is the best choice. I've often heard psy RN's state that they enjoyed being an RN but they LOVED being a NP. I know it also comes down to a matter of deciding what is most important, and that's the tough part. I want the best life for my son but I don't want to pass by what may be something very satisfying. Because of where I live (and love it) and lack of savings, I think the part that concerns me the most is, what if I earn the master's and don't enjoy the work? For many many years I felt that way as an RN, it was before I worked in psych and I never felt a pull towards ICU or ER . Hospice nursing was something I enjoyed because I agreed with the mission, but psy has been the only area that I've felt I was in the right place. I don't want to go into debt and find out psy NP is not how I imagined it would be (again just like when I became an RN) , then again I don't know if I would feel challenged enough working as a psy hospital RN (and that is in no way meant as if to sound that psy RN's are not as smart or important). I've spent quite a lot of time looking into the role of the psy NP but I guess you just don't know if it's a fit until you are in the shoes. Thank you, any input or words from the experienced are welcome. I know what I want in theory, but is it reality?
  10. thekid

    Are DON's on 24/7 call

    Apologies for my typos , I'm using an iPad . Thanks for the responses so far, it appears my instincts are not far off target. Yes, this is a free standing facility, very small. There is an executive administrator who does not return calls or emails. I'm really not quite sure what he does. I have asked him about the survey with no response from him. He is not available after 4 pm (but doesn't answer anyways) . I am shocked, too, that a manager is not available . The DON worked the NOC shift and became DON a year ago. I am truly baffled why she would choose to vacation during this time, unless like was mentioned, she plans on not coming back . I have been shadowing on the dementia unit and so I'm familiar with that population . I was shocked to find out that we don't have security and the cameras set up outside the perimeter to monitor in case a wanderer somehow gets out, are not working. I can make a list of things that the facility will get dinged on . I think I'm being lied to and yes, I spent the wee hours filling out applications for other places . For someone who was hired full time, I'm getting 16 hours a week right now and tentatively scheduled for just a couple more shifts through mid November . Upon hiring me she said she badly needed help since two nurses were leaving (greener pastures) , but then I find out one guy is staying . I'm kind of stuck there until I find something else. Surely the surveyors will question why the DON is gone. I got hired into a nightmare . Another lesson learned .
  11. thekid

    Are DON's on 24/7 call

    This post is part question and part story, I'm trying to understand the DON role. I was was recently hired as floor nurse in a very small 20 bed facility . I was hired because a full timer was leaving but on my first shadow shift, he told me he was staying. the DON left the state the next day for vacation . I did send her a text asking if I would be keeping full time status since the other nurse changed his mind. Her answer was vague and she said we would sort it all out when she got backs... In two weeks ! We we don't have an assistant DON and no other managers. During orientation I'm learning the patients and other things you'd expect to train on,. No issues there. But we have no one in charge. Are DON's expected to be available by phone 24/7 even while on vacation (she also timed it during a survey/audit and I'm not comfortable enough yet , so naturally I'm nervous . I had had to ask for a formal job offer letter. It was typed up after she was gone. When I was hired it was for the 2 pm shift , but the letter only gave my rate and said hours would vary, meaning I'm not sure if I just got blindsided because the other guy is staying . I know she's on vacation but I have rent to pay so I texted her asking for clarification. She was dismissive and kept saying we would work it out when she got back. No one is managing the place in her absence . I'm very nervous that she kept me around just in case but when she gets back, she will no longer need me. I find it strange that no one is covering for her and she got irate when I simply asked if I'll still have a job. In fact when she does return I'm certain my schedule will be a low priority. I've never started a job before and not had a manager around. I have no idea who takes care of staffing if someone calls in sick . And I'm worried that she didn't consider for a moment that I was very clear that I could only work Eve's. I turned down another job offer when she offered the job. Yet the generic offer letter indicates next to nothing. I wont know a thing at least until November 10th. I'm stuck because I don't want to Apply to other places in case it worKs out. Hopefully this lack of contact and hiring me the day before Is not setting a precedent of how things will be when she gets back. It's a small facility but shouldn't she still be on call for urgent matters? I'm certain my hours are not urgent to her but I feel like there's a lack of courtesy on her part for not addressing it. Maybe I'm not understanding the DON role well enough . But as I mentioned there's no other manager. thoughts?
  12. thekid

    A typical day as telecommuting CM

    Are there companies that have CM positions that are strictly telephonic, and the CM can work in any state? This sounds appealing .
  13. thekid

    Psychiatric RN agencies

    Hi all, I'm wondering if anyone here works agency and specializes in psychiatric nursing? I have been working at a psych hospital to get the usual request for two years experience , so that I can later apply and work either agency or do travel contracts. But I'm first wanting to get a feel for this. Are there agencies or travel nurse companies that specifically employ psych nurses? What is the anticipated job outlook for per diem psych nurses ?
  14. thekid

    HELP. Telephonic case management Too good to be true?

    Oh.. I later had a position as a RN case manager strictly for SMI (different company). The nurse turnover rate averaged 2 months, not kidding. I lasted nine months. There were a lot of problems with management but mostly, we did not receive a lot of training or support and despite the 50 hour work weeks, anything that went wrong with a client was always the fault of the case manager. We had our own company on our backs, the hospital discharge team on our backs, the insurance company, housing/shelter.. most of us felt that we were running on a treadmill. I dreaded Mondays.