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Meriwhen ASN, BSN, RN

Psychiatric sheep...er, nurse

Content by Meriwhen

  1. Meriwhen

    Per diem rejections

    I had that happen to me. I ended up getting the job and staying there for more than two years.
  2. Meriwhen

    Written Up

    IMO, the orders are clear. But I wouldn't have thrown both doses at the patient at one time...not because I'd be worried about overdose (while I'm not writing off overdose concerns, a 1 mg dose of Xanax is fairly common), but because if the patient was either anxious or awake later on in the night, she doesn't have a PRN left to take. I would have given the sleep PRN dose first since--in my facility anyway--we have a cutoff time for giving sleep medications. Then if necessary, the anxiety PRN dose could be used. If the patient is still anxious--and therefore still awake--despite getting both doses, then the PCP should be notified because they may need to adjust the dosing and/or change the medication. I also think writing-up the OP was a bit extreme.
  3. Meriwhen

    Associates if I don't get into a BSN program?

    It also depends on your job market. If most of the employers in your area are hiring only BSNs, having an ASN is going to put you at a disadvantage. Granted, who knows what the market will be like when you graduate in two years, but it's something you do have to consider. That being said, it's not impossible to get a job as an ASN in a BSN-preferred market. Just not easy.
  4. Meriwhen

    Alzheimer Requirement

    Here you go: https://www.nursingce.com/ceu-requirements/massachusetts/rn#requirements https://www.nursingce.com/ceu-courses/alzheimer-s-disease-diagnosis-treatment-and-research You can Google for free nursing CEU sites. There's tons of them out there...just make sure they're approved by your state's BON.
  5. Meriwhen

    New Telemetry Nurse

    I actually bought one of those Incredibly Easy guidebooks to learn the basics of reading strips. I also found some websites to practice on. But then again, I'm not a telemetry nurse so keep this in mind...I just know enough about strips to recognize troublesome rhythms as well as pass ACLS every 2 years I would imagine it gets easier with practice and being a tele nurse, you're going to get a lot of it. Perhaps find a nurse on the floor who is willing to share some of their tips and tricks with you?
  6. Meriwhen

    Less Saturated areas of CA?

    IMO, take the offer on the east coast, get a year or two of experience, get your BSN if you don't already have it, and then come out to coastal California. The job market is better for experienced nurses than for new grads. Though if you insist on coming out here, definitely look inland. I don't have personal experience with this, but based on what I've seen, the further away you are from the CA coastline, the better your prospects as a new nurse might be. There are some new grad programs in San Diego, but there's a lot of competition for them. Definitely apply, but I would wait until you land a spot in one of them before you pack up and move out here. Best of luck.
  7. Meriwhen

    Notice of resignation

    If a person fails to work the required notice, it doesn't go on their "permanent record." At worst, it makes them a Do Not Rehire and can be told to potential employers who call to verify her employment there. HR frequently have policies regarding how much notice an employee has to give before resigning. Typically, it's 2-4 weeks' notice. It's very unusual for a place to require a 6-week notice period, but it could be possible...though not likely, IMO. If there is no policy regarding the amount of notice to give, the minimum accepted standard is 2 weeks. So it sounds like she either a. doesn't want to leave her employer stranded in mid-schedule like the previous poster suggested, b. the place really does require 6 weeks (very long shot), or c. she really doesn't want to quit this job for whatever reason. In that case, you and she really need to sit down and talk about your family's plans to make sure you're both on the same page before making any drastic changes. Best of luck.
  8. Meriwhen

    Would this shirt get me into trouble in class?

    Nowadays, it seems like one could wear a plain white t-shirt and someone somewhere would take issue with/be offended by it. IMO, the fact that you are asking for outside opinions suggests to me that you feel that for whatever reason the shirt may not go over well. If that's the case and you're not comfortable dealing with any negative reception from wearing the shirt, then save the shirt for your off-hours.
  9. Meriwhen

    Agency Nursing

    Agency nursing (also known as registry nursing) is the provision of nursing services on behalf of a staffing agency. The nurse is an employee of the agency; the agency sends the nurse out to various facilities to practice. Agency nurses can be found in all specialties of nursing. Agency nurses may work part-time or full-time. RNs, LVN/LPNs and advance practice RNs all can do agency nursing. Many nurses choose to work agency as their primary job, or as a secondary job to pick up extra income or experience. Nursing Practice The nursing practice of the agency nurse depends on the licensure and specialty of the nurse, as well as the specific assignment that the nurse is completing. The wise nurse will keep in mind their state's scope of nursing practice at all times. In addition, the wise nurse will make it a point to learn the policies and procedures of every facility that they are sent on assignment to. Practice Settings Wherever you can find a nurse, you could find an agency nurse. Agency nurses get sent to many different types of facilities. The most common types of facilities that agency nurses get sent to are acute care, outpatient, home health and private duty. Benefits of Agency Nursing The main benefits of agency nursing are earning potential and flexibility. Salaries of agency nurses are often (but not always) higher than those of salaried or permanent staff. Many agencies offer same-day or next day pay, which is convenient for a nurse who needs to make quick money. Agency nurses are free to set their own schedules, though some agencies may have minimum scheduling requirements. You can work anywhere from the odd shift here and there to the equivalent of full-time hours. You can schedule yourself weeks in advance, or you can pick up shifts on short notice. You can also cancel yourself from working on short notice. Much like per-diem nursing, agency shifts can allow a nurse to have a flexible schedule or more free time while keeping their skills and resume current. Many nurses that are raising families or going back to school look into agency nursing. Agency nursing is also a good way to break into the job market in a new location or to make yourself known to a particular facility. Some agencies may offer benefits such as medical insurance, retirement plans, and continuing education. In addition, there is the potential for short- and long-term employment contracts to give you some stability. Some agencies offer the option for you to be hired by the facility following completion of a contract. Some agencies are part of a franchise or chain, with locations throughout the state, the region or even nationwide. This allows the nurse to transfer to various locations with minimal problems. Keep in mind that the practices of and benefits offered by individual agencies can vary widely. Be sure to check with your agency for the specifics that will apply for you. Downsides of Agency Nursing The greatest downside of agency nursing is that, much like per-diem work, the hours are not guaranteed. Agency nurses are usually the first ones to be canceled by a facility, and usually, the cancellation is done only a couple of hours before the scheduled shift. Agency nurses are also the first to get sent home should the census drop. If you NEED a stable schedule or income, you should think twice about relying solely on agency nursing to provide this. Agency nurses work without benefits or PTO unless their agency offers benefits independently. Agency nurses are not eligible to join a facility's union, as they are not facility employees. Therefore, they are not offered the benefits or protection of the union. Also, agency nurses often get the worst assignments or the work that the permanent staff doesn't want to do. It is common for agencies to have non-compete clauses in their employment agreements, such as prohibiting you for working for another agency while in their employ. Or they may penalize you for accepting an employment offer from a facility that you're sent on assignment to, unless a certain amount of time has passed. The agency cannot stop you from earning a livelihood, but they could take you to court to enforce the terms of any employment agreement that you sign. Therefore, be sure to carefully review the employment agreement before you sign it, and consult legal counsel if necessary. Some agencies have less than savory reputations and practices. You should investigate the credentials and reputation of any agency before signing an employment agreement. Again, the practices and benefits of individual agencies can vary widely, so check to see how your agency does things. Finding an Agency To find a nursing agency, look in the Yellow Pages, job websites such as Indeed.com or LinkedIn, or through threads right here at AllNurses. However, our Terms of Service prohibit solicitation by or on behalf of an agency. You can also try searching online via Google or Bing. Suggested search terms include "nursing agency", "staffing agency" and "nurse registry". Word of mouth is also a great way to find agencies, especially as most agencies offer referral bonuses if their agency nurses bring in new talent. In addition, word of mouth a great way to learn about the agency's reputation and whether people are happy working for them. Finally, it is not uncommon for agencies to recruit nurses, especially those who have posted their resume online at job sites. Basic Education To become a nurse in the United States, you need to graduate from a nursing program and pass the NCLEX. You can work for an agency as an RN or an LVN/LPN. Experience REQUIRED Unfortunately, agency nursing is not well suited for the new graduate nurse or a nurse looking to switch specialties. This is because agencies expect their nurses to be proficient in their area of practice. The orientations provided by both the agency and the work site are usually minimal, more of the "here is how we do things and where everything is located" than Nursing 101. Getting only a day or two of orientation is about average for the agency nurse. Therefore, almost all agencies require at least one year of nursing experience. Some agencies, particularly home health, may be willing to take on a new graduate nurse. If you find an agency that will take you on as a new grad, be sure to inquire about the type, quality and length of orientation and training that you will receive. The reality is that you are NOT going to get the same caliber of orientation and training that you would in a hospital's new grad program. And keep in mind that should something happen while you are on assignment, YOU and not your agency will be held accountable. Certification and Professional Organizations There are no certifications that are specific to agency nurses. Nurses can obtain certification in their specialty area through the ANCC or other certifying agency. As far as I know, there is no professional organization specifically for agency nurses...and if there is, please tell me about it so I can update this! Nurses are free to join whatever professional agency best suits their interests and professional practice.
  10. I have social media sites, but I follow the rule of not posting anything that I wouldn't want my parents, my children, my supervisor and a whole room of third-graders to see. I also don't post anything that I won't own up to in person. And I keep my settings as private as possible on top of that. So yeah, my social media sites are pretty dull: mostly pictures of the little ones, funny cat videos, and the occasional what-I'm-up-to post.
  11. Meriwhen

    Are 24-Hour Open Visitation Policies a Bad Idea? (Yes)

    True. The patient may be estranged from their family and would rather a close friend visit instead, but their acuity may be so bad that they are not able/capable of making that known to staff when they arrive in the ICU.
  12. Meriwhen

    Are 24-Hour Open Visitation Policies a Bad Idea? (Yes)

    I don't work ICU--well, not medical ICU, anyway--so keep that in mind when you consider my two cents. I understand and support 24-hour visitation in the ICU, especially given that there's a good chance that the patient may not survive until the next designated visiting hour period. So family should be allowed to be there at any time. However, I do feel that the 24-hour visiting should be limited to immediate family only: parents, children, spouse/SO. There is no call for the extended family reunion complete with third cousins once-removed to take place at the bedside. There can be a designated visiting hour every evening for others to be able to visit. There should also be restrictions in place that accommodate both the providers' needs and a therapeutic environment for patient care, and staff should be able to enforce them as needed. Such as limiting the number of visitors, limiting the visit length, limiting or prohibiting children, having certain times that are no-visitor so providers can do what they need to without visitor interruption/interference, and giving staff the ability to remove and restrict visitors that are unruly/uncooperative/refuse to follow the rules. But alas, I agree with the others who say that we've become too customer-service oriented and spend too much time and effort jumping through hoops getting good Press-Gainey scores when we should be spending that focused on providing quality patient care.
  13. Great article even without me in it :) Charting objectively is a challenge in psych because if you don't document specific behaviors, it can easily be construed as opinion and/or challenged by others. It can also be confusing because one person's idea of "inappropriate" behavior may be another person's idea of behavior that's isn't really too bad. What helps me is using "AEB" to explain why I've charted someone/something as I did. It's old school, but it works for me. There's always the possibility that someone may disagree with my assessment of a patient, but with "AEB" they can see what behaviors, quotes, observations, etc., that led me to my conclusion.
  14. Meriwhen

    Agency Nursing

    Thanks for the info! You definitely have more agency experience than I do :) I'm happy you could fill in the gaps I missed.
  15. Meriwhen

    Do Not Over-Share!

    And this is why I say "NO" when nurses wanting to work in psych ask if they should share their MH diagnosis to help land the job. More often than not, it comes back to bite you in the rear. You're not "identifying" with the patient population--you're placing a target on your back instead.
  16. Meriwhen

    Nursing the End of a Leash

    We have a small herd (no pun intended) of animals that visit our patients. They do a wonderful job interacting with the patients--and they with them.
  17. Meriwhen

    RNs: How much vacation time do you get?

    If I were to sign on as a full-time employee, it'd be roughly two weeks PTO. Not quite enough to convince me to do it over staying per-diem.
  18. Meriwhen

    Scam Schools And Diploma Mills

    Yeah that. Keep in mind that for-profit doesn't always mean diploma mill: a lot of for-profit schools are legitimate and accredited, so your would be earning a bona-fide degree. But as already stated, they cost big cash, credits don't always transfer, and unfortunately some employers do not look favorably upon them. Doesn't necessarily mean it's a bad idea to go to one, but it's something to keep in mind depending on what your future plans are. You really need to do your homework about the program you want to attend.
  19. Meriwhen

    Scam Schools And Diploma Mills

    Good article. One thing...there are reputable brick-and-mortar schools that offer online classes or online programs, and who sometimes give their tests online without proctoring. Students are bound by the honor contract that they signed, and the online activity of the student is usually monitored. It may be all of the tests, or the testing would be a mix of unproctored regular tests and a proctored final. So that practice by itself in an online school isn't necessary a red flag: it needs to be taken into consideration with other factors. Now if the school did that AND had a few of the other warning signs, or didn't take its online testing seriously, then I'd be very concerned.
  20. I refuse to buy into the "I can't pee!" mentality. There is very little that can't wait for me to take the minute or two to go to the restroom. No, I'm not going to run to the bathroom during a code or if someone absolutely needs a medication now. But the other 98% of the time, there's nothing that can't wait the one minute. I may not always get to eat a meal or even take my 15 minute break, but I will use the restroom whenever I need to, come hell or high water. Having to go to the bathroom has never caused me to stay late because I didn't finish my work, or cause anyone to criticize my performance or write me up. I think nurses in general put more pressure on ourselves about it than others do.
  21. Meriwhen

    Who's Afraid of the Big, Bad Psych Patients

    The hospitals I work at use both LVNs and LPTs (licensed psych techs--they can pass meds).
  22. Meriwhen

    Who's Afraid of the Big, Bad Psych Patients

    This article made the APNA's Facebook page Go psych nursing!
  23. Meriwhen

    Nursing and The Art of Arboricide

    With all the paperwork we have to do--and with how management likes to give us even more--I'd often say to my staff that we were sending yet another tree to its doom
  24. Meriwhen

    How to Handle Student Incivility

    As a psychiatric nurse, please let your students know that when they attend groups, they should be participating in them. If they choose not to participate, they should at least be sitting there quietly and paying attention. They should not be whispering to each other or to patients, reading, texting, sleeping, playing games, etc. My patients do care about their groups and nothing gets a nursing student removed from my unit faster than patients complaining about inappropriate student behavior. My staff and I can tolerate more--such as the two chatterboxes that I wrote about--but I will not tolerate anything that compromises patient treatment. Also ask them to dress appropriately. I know most schools allow them to wear casual wear to psych clincials. Remind them that they are not at a club or a bar, and trust me--they DO NOT want to attract my patients' attention in that way. Nothing skin-tight, no jeans, no strap tops, no sandals, no overdosing on the makeup and perfume. Even if they complain that "the girls" are big and its hard to find a shirt that fits them right, tell them they can buy/borrow a cheap baggy sweater and wear that...same thing with pants. And that's not my policy; that's the facility's policy. In short, tell them they should dress as though they are going to church or to court.
  25. Meriwhen

    How to Handle Student Incivility

    As far as student nurses visiting my unit, I tell them up front that I never hesitate to go to their instructor and/or remove them from the unit at the first sign of unacceptable behavior. Like the OP, I set the ground rules up front and make it clear that they will be obeyed if they wish to have their clinical experience on my unit...and I have gone to instructors and requested that students be removed. I reported a pair not too long ago for spending a majority of their time standing at the nurses station--and being in our way--gossiping to each other instead of interacting with patients. Word must have gotten out--nearly every student from that school that I've had since have been no problem whatsoever. Though I did hear from staff on other units that those original two students have not learned from their mistake. Their loss.