RIRN512

Hi again, There are protocols with standing orders that include phenobarbitol for the clients detox-ing from Alcohol and a small tapering dose of methadone with prn comfort meds (clonidine, bentyl, vistaril & motrin) for the clients withdrawing from opiates. Most of the meds we try to give at 6 hour intervals (06-12-18-24) except for the Day one alcohol clients who are medicated every two hours based on their CIWA scores for the first 24 hours. Medications for medical problems (once verified) are administered as well ---after they have been approved by our medical director. Recently, there has been in increase in clients coming to our facility on prescriptions of Geodon, Gabapentin and Seroquel and various new antidepressants. More practioners are trying to integrate treatment for the psych issues that go hand in hand with substance abuse. It sounds a bit overwhelming at first (and it was !) but after a while you catch a rhythm so that even with a full census, I'm busy but comfortable. And of course, I frequently get an admission during the night. Our facility is "free standing" providing in-patient detox and is a bit different from a formal hospital setting. On third shift, I am on my own with telephone assessments and the decision of whether or not to admit someone --- especially if I feel that the client needs more acute care than I can provide. In the case where I would not accept a client--- then it's likely that client would be referred to a hospital where I am "assuming" would have more nursing staff to provide care for the "acute" client. Hope this helps..... MC

Hi, I love third shift. It takes about 3 weeks for your body to adjust to time changes. I bought a sleep mask and a sound machine (that played rain). I don't need the sleep mask anymore but it helped a lot at the beginning. As for psych..... I work in a substance abuse treatment facility. One nurse and one treatment assistant for 20 clients detox'ing with medical assistance. Many of the clients are dual diagnosis suffering from bipolar, depression, anxiety disorders in addition to or because of their subsance abuse. I find the work and the clients interesting-- always requiring some thought when administering and timing their medications. The average length of stay is 5-6 days. Most of the clients have learned patterns of behavior that are manipulative and many are "med-seeking" (no surprise). But there is lots of room for compassion and TLC. It is rare that someone on my unit is confrontational or threatening. I'm 5'3 and weigh 120 lbs. I have never felt in "danger" from this population. To the contrary..... when trouble arises or someone becomes acutely ill, the other clients most always rise to the occasion offering assistance. The med-psych at your hospital might offer a bit more exposure to patients requiring higher levels of medical (and psych) care....... but certainly, you will see many of the same that would seek help at our facility. It's not for everyone. But I have had a great experience working in this specialty. (and 3rd shift is great!) MC in RI