RN2begin

There is no nursing shortage in NH right now. Depending on how much experience you have, expect to find slim pickings, if any.

I left my first job out of school d/t ratios of 9 - 12 :1...new nurse or not. In addition the work environment was caustic. My experience is that by and large most new nurses are thrown to the wolves. However, that being said, you don't have to take it...it's a vicious circle. You would think that a profession of mostly women would be more protective and mentoring...but good new nurse experiences are hard to find. I believe that if a new nurse accepts poor treatment...part of her/him becomes complacent and angry...and the cycle repeats. Please take care of yourself...stick up for yourself...and let someone know. If nothing is resolved, move on...it will be their loss. In a nation faced with an astounding nursing shortage...any facility not willing to be accountable for what you are describing is short-sighted indeed.

I really want some "cool" scrubs that don't consist of flowers and cartoons...I was hoping to find a pattern so that I can pick out some material that more closely reflects my personality but I cannot find a pattern to make scrubs anywhere...can anyone help???

At my facility you DO become a specialist RNC upon successful completion of the previously referenced exam. There is a "Nurse Specialist - RNC" assigned to each shift on each unit and they are essentially the bosses. Again, at my facility, RNC = at least a $4000 yr. raise. In order to qualify for the exam you have to have worked as a psych RN for two years. I think what you are referring to is an "Advanced Practice Registered Nurses". The following links should help bring you up to speed. http://www.nursingworld.org/MainMenuCategories/CertificationandAccreditation/Certification.aspx http://www.nursingcertification.org/pdf/value_certification.pdf

Yes and upon passing it you become a Psychiatric Nurse Specialist...which equals a great deal more respect at my facility...and lots more $$$ check out this link, it will give you all the info you need... http://www.nursecredentialing.org/NurseSpecialties/PsychiatricMentalHealth.aspx

So this leads to a dilemma...we spend alot of time educationg our patients that what they have IS a real illness, just as diabetes. They require medical care to get better and hence a "medical" staff works at the psychiatric hospital where I work...we just aren't supposed to look like medical personnel...I think that being newly admitted to a psychiatric facility, especially psychotic and paranoid, scrubs rather than "dress casual" allow the patients to decipher who is who...right now the only people who wear scrubs are our environmental services staff (housekeeping)...once they are used to the system...they hopefully are able to decipher nurse (khakis) from tech (jeans)...

Definately an OMG learning experience. No matter who initially made the error (pharmacy sending up wrong med...) you will suffer the consequences if the error continues and harms the patient. The pharmacists at my facility are understaffed and BUSY...aka...ALWAYS read your vials...if it is only for IM use, it is probably caustic to veins...you got lucky. Thank God you had the courage to continue to question it.

Don't forget...as a nurse you have an advantage in the job market, especially with a year under your belt. It might be worth it for you to see what else is out there. You HAVE to take care of yourself FIRST. Lack of sleep (while I know it is a RN staple) has a caustic effect on your body and mind. By keeping yourself well, you are keeping your patients well. Unexpected errors are made when RNs are exhausted and once done they can't be taken back. You owe yourself better.

Go easy on yourself. Who cares if your voice shakes when you call 911-you didn't drop the ball on providing the STAT care needed for the situation. In fact, I would be more concerned if your voice didn't shake...you are human! I personally think that the ability to look back and ASSESS the situation is a huge positive. This is the only way you grow and learn...we are not super heroes...even though we play them on television.

I work at a state psychiatric hospital and we are docked 30 minutes whether we take it or not as well. 11 - 7 staffing is minimal, but our units are set up so that two are connected by a short hallway "sister units". We are allowed to report off to the adjacent nurse who then provides care PRN for my unit. Not a perfect system...but you have to work with the system you have...

I must respectfully disagree with you. This patient obviously has axis II deficits that cannot be met by changing tx providers on a whim. In fact, it is the WORST thing you can do. She assaulted a nurse. She was not assaulted by a nurse. Unfortunately administration and exam questions have much in common in that both are completely disconnected from the realities of frontline psychiatric care.

Absolutely. However, patient is most often found incompetent to stand trial and the charge is dropped. This does not mean that you shouldn't do it. Outside the hospital, similar assaults would not be tolerated, so if the goal is to discharge patients back into society, why not maintain some "real world" action=consequence. I know I am preaching to the choir...but just my $.02.

I completely appreciate your frustration and disgust with the system. Just be prepared...RN school clinical rotations will test nearly every ethical bone in your body. I started to feel like I was going to nursing school on Mars because often I would find things r/t patients quite concerning...but no one else (primary RN,MD, etc., ) seemed the least bit concerned...DON'T GIVE UP!!! We need nurses like you....desperately. I think that our society often assumes that because someone works in the health field, that they must really care about people. This should never be assumed. Prior to RN school I had blind faith in the system...now, after knowing what I know and seeing what I have seen, I would be scared to death to be admitted. A license in nursing is just that...the most important traits of being a nurse can never be taught...

Thanks for the info...but peds is not my thing, psychiatric or not. 18 to 60 year olds are my range...however, the closer to sixty, the less chance for an orifice kicking...I find myself being pulled closer to that pole....

They are discharged to a group home...go off their meds (because it is their choice)...become psychotic again...get kicked out of the group home...live on the streets until they do something that upsets a local citizen...re-admitted to the hospital/sent to jail...stabilized on meds (hopefully)...discharge to a group home...repeat cycle...repeat cycle...repeat cycle...

My hospital has a love/hate relationship with the "hospital" handle r/t benefit/deficit ratio respectively...while our staff wear business casual, our patients all wear name bands...which, after a recent incident, is probably essential to their protection. You see, we are so short staffed, that more often than not, the unit is staffed by float staff from another unit...who for the most part have no idea who the patient is...and sometimes even refuse to believe the patient, when they report to the staff who they are. We recently had an "adverse outcome" on one of our long-term units. There were two patients with the same name. One of them had been put on a "med holiday" in an attempt to tease out some symptoms of autism so that he could be transferred to our neuro unit. Long story short...the float RN went to the latter patient's room (alone) and insisted that they the meds that she had set up, which included two antipsychotics at very heavy doses, as well as various other meds. The patient apparently told her that he was not said individual, but the RN would not relent and the individual finally took the meds...only to end up being sent to the ER via ambulance less than two hours later based on his behavior, which a mental health worker observed to be completely out of character for this individual...he had on a name tag...but because we hand write them (we are super-high tech) they often blur in the shower... Just my

Right On StuPer Also, I think it is important to take into account WHY the person in smoking...there are new studies that show nicotine reducing anhedonia, avolition and other neg sxs in people with mental illness that include psychotic features...it explains why so many people with mental illness smoke, and sometimes quite a bit. It is a cheap (compared to the patch, gum or antipsychotics) and seemingly "self controlled" way to contain their illness. Also, why the sudden focus on smoking? ...we seem to be able to rationalize type II diabetes as a side effect of atypicals and yet put no regulations on diet...it's hypocritical and decreed by people completely disconnected from the "trenches" of treatment... I am very much aware that smoking is deadly. I am also very much aware that patients are allowed to make educated choices and refuse their medication...I am not sure how we get away with regulating smoking (outside) for consenting adults...especially if it helps in any way, shape or form. Most often these people have lost an immeasurable amount, physically, emotionally, financially due to their mental illness. If they want to have a cigarette...we can at least give them the choice. "Nicotine's stimulation of dopamine could help explain the high use of nicotine by patients with schizophrenia as a form of self-medication to reduce negative symptoms" http://psychservices.psychiatryonline.org/cgi/reprint/50/10/1346 "Nicotine Helps Schizophrenia Patients with Attention and Memory Problems" http://www.medicalnewstoday.com/articles/26516.php "Nicotine restores the disorders observed in schizophrenics on early evoked potentials." http://www.medscape.com/viewarticle/483888_4 etc., etc., etc.,

Dear here_kitty, I would absolutely love to here about the protocal once it is posted for you all. The hospital where I work is in DESPERATE NEED of this as most staff, including nurses know what BPD is, but have no idea what DBT is...as a whole, my hospital just "feeds the beast" so to speak...Ideally I would love to have a specific unit for people with BPD completely reliant upon the DBT model...if we don't we might as well install a turnstile in the admissions suite... Please feel free to send me a personal message...I am unbelievably curious as to what hospital you work at and how your model could help us...

That is absolutely perfect protocal! Because people with BPD tend to split staff to gain power and meet needs (divide and conquer)...a true therapeutic DBT environment prohibits any treatment (other than essential needs) by anyone other than their DBT therapist and perhaps any other person that that therapist works in conjunction with. DBT is a HUGE commitment for people with BPD, in fact, they usually have to sign a one year contract to participate in it. It is a behavior/consequence based cognitive therapy with the goal of learning new and effective coping skills...I can remember when I worked as a case manager, if a person with DBT called emergency services over the weekend due to unsafe behaviors...or they missed an appointment with their DBT therapist, they were forbidden to make an emergency appointment with their DBT therapist, they saw them as scheduled with no exceptions. It is believed by most BPD specialists that suicide is extrememly rare among indiviudals with BPD and if it does occur, it is most often an accident... self harm is the ultimate negative coping skill and these individuals must learn the skill of accepting responsibility for their own safety....

I learned nothing but obligatory CYA stuff mandated by the state. For example, we had a whole hour of "Diversity" training. Granted, some of the material was interesting, but not at all realistic. When I filled out my evaluation at the end I stated that starting out, even just one day a week,on a unit would so much more helpful. The adjustment wasn't terrifying for me as I had previously done 3 years of case management with severely mentally ill individuals...but for some people who had little or no background in psych, didn't make it through their first week when they were sent to their unit...after three weeks of classroom "preparation"...I know that I must sound a bit cynical. I love my work but continue to be amazed at the disconnect between the "front-line" care providers and the administration who make the rules from their third floor offices. You won't be missing anything. Your best education will be on the unit.

Dialectical Behavioral Therapy

Are you at all familiar with our healthcare system over here in the US of A? Let me sum it up for you...WE DON't HAVE ONE :no:! It's not about putting up with absurd patient rations...it's about having a job...even if you literally get your orifice kicked in the process...

"The lady doth protest too much" :bowingpur - Shakespeare (look it up...)

Hi there, I graduated with a BA in psych in 1998 and was able to transfer nearly all of my gen eds to NHTI A.S. program that then morphs into the ADN (RN program)...i didn't have any issues and my classes were like 8 years old...for some of them I had to jump through some hoops re: getting course info from original school and presenting it for review at NHTI... I think if you went to a NH state school it might help with the process as well. Good Luck:up: