horus2001

i hate to seem cynical but most of psych nursing is pushing pills. Before i get jumped on, i work as a psych nurse at a state mental hospital so i do have some background. modern psych is give them pills, get them stable and get them out. most insurance companies are cracking down and need a strong reason for inpatient care. as a psych nurse, you can offer some interventions but it is out of our scope of practice to offer therapy. i have caught both psych techs and other nurses trying to counsel patients and had to write them up. as a group, we psych nurses are not trained to run therapy groups, do psychology groups or analyze our patients. most of my day is spent passing out drugs (SSRI's, Atypicals, mood stabilizers and a scattering of ADHD meds), chatting with the patients-checking for AVH, SI/HI and their moods. I also may ask if they have developed any skills for coping with their issues, improved relations with their families and get a general feeling of how they are feeling. Our nurses will run groups that are educational: drugs, ETOH, medication education, STD's and the like. The other thing to remember is that the patient to nurse ratio is really out of whack in psych with anywhere between 1 nurse to 8 or as many as 16 patients. you don't have tons of time as we are putting orders in for the doctors, responding to emergencies, documenting behavior, trying to keep the borderlines away from the desk. i wouldn't worry too much about not being med/surg nurse first. if you like psych go for it. most psych hospitals want the patients medically stable before being admitted. that said, you do have to be able deal with issues like patients who have a hx of ETOH abuse and how to deal with the risk of DTs. psych care is changing though, it seems to be more and more about the pills. i am not comfortable with just pumping them with drugs and discharging them but the simple fact is that the insurance companies call the shots. on our indigent patients, it is on the state dime so they can stay longer but they have high rates of recidivism due to socio-economic as well as mental health issues so you can become a little burned out on the "3 hots and a cot" types that know just what to say to be admitted for evaluation. another discouraging thing in Texas, you can file a mental health warrant on anyone so we do have adolescent patients who get filed on because they are running away, doing drugs or in a gang. the parents expect us to fix their kids. sorry but it ain't gonna happen and you should have set boundaries when they were five not fifteen and using fry and sleeping around. bad behavior is not a mental illness. my favorite are the parents who drop of their kids and then tell us they don't want them anymore because they don't behave.

i too work on a child/adolescent unit. we had a similar situation where a patient struck a nurse so she could get a shot of vitamin T. i asked the nurse if he wanted to call and report an assault. he said yes, i called the cops and then the doctor. the doctor arrived and then the cops showed up. the patient was interviewed and was arrested. management and the doctor were very upset and wanted to write me up because i did not follow policy but.... i think i have them beat. we are state of texas employees. when you strike a state of texas employee while they are discharging their duty it is an automatic 3rd degree felony. i simply explained that i was obligated by state law to call as i am a state employee and i am required by the whistle blower act to report all crimes to law enforcement. for the facility to enact policies to prevent this is a violation of the whistle blower act. therefore they are breaking the law by attempting to censure me. i pointed this out and they said they were going to check their policy with their lawyers. it has been 5 months and i have not heard a peep from them. i suspect they are keeping quiet because should this be revealed, then any psych patient hitting a staff member could have the police called on them without regard to policy. are you a state of LA employee. what do your laws say about hitting state of LA who are discharging their duty and what are your obligations to reporting a crime. research this, i found out i was the only one who has researched this and i have the printouts of the laws and policy sitting in a folder waiting for when they try to call me in again. do i call the cops on all of the patients who assault, of course not. it is dependent on the situation but if i think you can tell the difference between right and wrong. i will call the cops. my staff did not abridge their rights not to be assaulted when they walked through the doors of the hospital. what these hospitals don't understand is that you can't violate employee's rights just because it is hospital policy. my rights are just as valid as the patient's and so are yours.

Seriously? You want to teach? I looked at some of your postings and... Let me be honest with you, in graduate school, you write papers. If the quality of your grammar and spelling is the same as you post on this board, you won't make it. I don't want to seem mean but your posting for this thread is full of misspelled words, comma splices, missing commas and run-on sentences. When you write, you need to be able to clearly express your ideas. I would suggest you take an English class or two at the local junior college. At the Graduate level of school, you are expected to be able to put a complete sentence together. If the teacher can't understand your ideas as written then the onus is on you to improve your skills. Again, I am not trying to be cruel but you need to improve your writing skills before you start taking classes focused on writing papers. You can't be a professor with the level you are at now, your would-be students won't be able understand what you have written.

I need to vent but i also want to pose a question. today, i had a six year old psych patient who threw a tantrum on the unit. This kid functions at the level of a 18 month old, so the tantrum i can handle. he then started slamming doors, i intervened because i did not want him to chop his fingers off. the tantrum then grew more violent and he bit me. i did not medicate him because he really is not able to understand his actions as well as someone who is all there. i just wrote up an injury report and moved on. Later in the day, i had another kid (17 year old) who got angry because the doctor would not increase her meds. She threw chairs and overturned a table and finally punched a nurse in the eye. At this point, i had the nurse who was assaulted call the police to file an assault report. they came on to the unit, did their due diligence and finally decided to arrest her. she was led off in handcuff. The problem is that the patient advocate was angry with the police for doing this as well as being upset at the nurses for calling the them. she was demanded we implement a process for going through administration before we call the police. now my questions are (keeping in mind i work at a state hospital in texas) 1. what right does she have to trump my right to file a report of assault? 2. has anyone had this problem before? 3. just because i do a job as a nurse does not mean i will allow myself or staff to be assaulted, am i out of line for thinking this?

best paying jobs are in the medical center area. there are several large players with outlying hospitals in the suburban area. check st. lukes, methodist, md anderson, Texas children, memorial herman. there is st. joes in downtown. every suburban area has several hospitals (clear lake, sugarland, kingwood, woodlands, tomball). check to see if the hospitals are hiring, i understand that some of them are cutting back on hours and holding off on hiring until the economy is better. i know the UT system is still in a hiring mode but only for nurses and doctors. rice and baylor college of med. are supposed to merge but what that means for the new hospital that baylor is building is questionable. in general houston fared better during this downturn but the hospitals are still very cautious as they have no idea what obama is going to do with the health care plans. as far as the outlying hospitals go, it is dependent on two things, people having jobs and insurance and how the hospital system that owns it is doing. i have heard but can not say for sure, some of these hospitals may questionable. there have been numerous hospitals that have gone out of business but that has to with competition and poor management.

i used hurst. i ended up with 75 questions, finished in 45 minutes. passed the nclex no problem, much of the success i owe to hurst. it was simply the best prep program i encountered.

it sounds like they are still W/Ding. i know if our patients meet certain vital sign parameters we can still give them a PRN to help them per the vitals. does your doctor have any PRNs scheduled like that to help? it seems a bit sadistic to make a person go through this even if they are junkies. let's face it, after a 3 year binge of bars, a couple of 25 mg libriums won't hurt.

ahh but there is a difference between being religious and spiritual. the difference is that religious people follow a specific dogma and set of beliefs. you can be spiritual and not religious and vice versa. as far as the indian example, it does not hold up. most people don't understand but all of the gods in hinduism really represent various manifestations of one supreme reality. now, if i were religious, i would not pray shiva if i were not a hindu but a spiritual person may understand and embrace the idea of shiva being a manifestation of the supreme reality. i don't believe any of the dogma of conventional religions but do believe there is something greater than me. until someone can explain how the universe got here and i have yet to find an atheist who can cite an example that disproves the first law of thermodynamics, since energy can be neither created or destroyed but changed into another form, how did all this get here? beats me but i quote shakespeare's hamlet: "There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy"

i did find this: http://www.beliefnet.com/Faiths/Secular-Philosophies/Atheists-In-Foxholes.aspx the thing to consider, as we as a culture have advanced, we have become more and more hostile towards the idea of something greater than ourselves. it has become more acceptable to be atheistic over the last 40 years as we have moved away from the influence of religious leaders toward the hedonistic tendencies of modern western civilization. think about when you were a child, there was no issue, it was merry christmas. now it is seasons greetings. we have moved from tolerence to hostility towards those that hold christian beliefs. now before i upset everyone one, i will provide an example: in england and canada there is a movement that is gaining acceptance to use shiara (islamic) law. if christians tried to have canon law used in day to day interactions, the backlash would be swift and strong. we as a culture have created a separation of church and state that applies only to christianity. the question will be not "how do i handle someone who is religious" but "how do i deal with those whose religious beliefs are so different from what i know". if you don't feel comfortable with someone quoting scripture, try dealing with someone praying in a language you don't understand, wearing clothes unfamiliar to you and actively treating you in a manner that could be construed as sexist or biased because of religious teaching. i think as nurses we need to understand that many people who use our hospitals are new to our country. most from s. america, asia and africa are religious and we need to respect and understand these beliefs.

the statement those who tend to become religious were already religious does not make sense. people become religious because they have reached a point in their lives when they need something bigger than themselves. people who are religious don't tend to be religious, they are religious. maybe you meant people who have been exposed to a religion as part of their day to day lives as children tend towards participating in that religion out of choice as an adult. hmm, i would question these studies based on this thought, when are these beliefs set? the person i am now is not the person i was when i was 20. the beliefs i had when i was 25 are different from those mine as a 40 year old. many people who were brought up in the church as children, left it as teens. some found a different path and some returned. there are plenty of examples of people who were brought up in an atheistic household find belief in a system that they never knew growing up. most people i have encountered who were very sick or dying, have turned to a belief system to help them cope. the point is that people change as their needs change. i was raised a catholic, i left the church and now i don't go. will i return to catholicism? depends on my needs and how i change as person through life.

i don't know about that. i encounter a lot of nurses that are very religious. i think it a coping tool for dealing with issues that are beyond our power to resolve. Also just as the saying goes "there are no atheists in foxholes", as people become sicker or have very poor health, the tendency to become religous is very strong as they, the patients, need and want spiritual support. i am not very religious so the level of enthusiam for god and jesus does make me a bit uncomfortable. But i do see that it is important to others and is very meaningful, so i put my feelings aside and smile.

anything other than a stud ear rings should be forbidden for safety. that nose ring seems pretty cool until it gets ripped out by a patient who is psychotic or caught on something during a code. it all comes down to safety, if not the patient's, yours. i always think: if i got punched in the face, would it cause me damage? a stud in the face would likely tear up the gum and cut the aggressor's hand (blood spillage) if you got punched. i understand that you want to honor him, get a piercing that is not seen. my brother had nipple piercing that he liked.

umm, under most normal circumstances, the nose is a lovely holding tank for staph and other bacteria.

well, anyone with capital can open a clinic and hire docs to work for them. i can't see much value in opening a clinic as a non-prescription writing nurse. You can't write orders, can't order tests, can't give meds, what exactly can you do? nursing diagnosis, how about "altered energy field" yeah, i can't see that kind of stuff being exactly what will help separate the customer from their cash... seems like you would need an affiliation with a doc to get anything really done. as far as writing scripts as an np, it depends on what state doesn't it? any type of clinic will require a large amount of capital, and you are now competing with doc-in-boxes, minute-clinics at walmarts and CVS. as far as nurses imagining what nurses can or can't do, i don't need to, my practice is spelled out by the BON. anyone can open a business, being a nurse is not a pre-req to success or failure for that matter.

you question does not make any sense. nurses can't practice medicine. doctors practice medicine. Usually, a group of doctors (who often have a very high income) will invest in a practice and hire staff (including nurses and others). it does not work the other way around. besides, have you ever priced the cost of insurance for a doctor, depending on the speciality, it can very high...you mentioned ob-gyn, you should see how much insurance costs for a gyno doc, there is a reason why many are leaving the practice. no offence but a mba and 3.00 dollars will get you a cup of coffee and little else.