nurse lala

I am gobsmacked by something that happened today. I had an intake with a new primary care provider at a local UC hospital. I received recombinant zoster from the heath tech who directed me to call to schedule a follow up injection and to request a nurse appointment. I asked if the clinic at this very prestigious teaching hospital had nurses? No, just one LVN. The Inj will be with her, the health tech. She reassured me of her qualifications. I have no qualms receiving the injection from a HT. but, labeling an appointment as being with an RN, when the clinic has no RN seems fraudulent to me. I value your thoughts on this.

There are excellent resources at https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nursing-certification/

From my experience, mental health readmissions are usually related to resistance accepting mental illness. Chronic mental illness demands dedication to treatment to stay out of the hospital. Mental illness has a larger burden than other diseases because of stigma. The person usually must come to terms with their own morbidity and learn to negotiate societal beliefs in order to comply with psychotropic medication and/or behavioral therapy. The long term goal of care is to increase understanding of the disease process and develop skill to maximize and maintain functioning. One needs good if not exquisite support to achieve these goals. The early stages of acceptance of being mentally ill is a dance forward embracing compliance, and back into denial. All made more complicated by access to housing, finances, travel and healthy social support.

Groan

Her husband insists the veterans support dog will deliver.

In my state we can place individuals on a legal hold if the person is unable to communicate a viable plan for self care. In this case family would have to agree to accept the individual back home, if not the individual can be kept for Grave Disability.

What first came to mind reading your question, is that Admin is communicating changes in rules or regulations. Every year JC further refines safety indicators. And we refine policy and procedures as indicated. But you infer that the new charting expectations are irrelevant. Please can you list some of these things you are directed to chart? And I agree with our colleague Koalified that you are allowed to refer the reader to another part of the medical record if already documented. With reservations. So in the case of a Complicated situation I will narrate a timeline of events and include vital data already documented elsewhere, because I want to make sure the reader understands the full narrative of what occurred. That's defensive writing for court.

On a scale of 1 to 10, with 10 being the most acute, I placed the VA on a range of 5 to 9. Post 911 Veterans are young and strong. They are trained to kill. Veterans make up 10% of the population and 20% of all suicides. I think that is a pretty daunting number and reflects the damage done.

Ive been there 26 years. I've worked in every MH clinic and unit, including the walk-in clinic, outpatient, Geri psych, acute psych, substance abuse...and some. There are many compelling reasons for a VA career. Amongst them are the focus on education, diversity, TIME OFF! Also darned good reasons not to bother. I have addressed a few good points. My Facility is a teaching hospital. We have access to a tremendous library online and library staff who will retrieve publications in mere days and will even do a search for you. We have interns in most every discipline. Daily rounds is fascinating. There is active engagement with the entire team. The Attendings are always explaining the reasoning behind medication decisions made. There is true collaboration. I relish the opportunities to mentor nursing students, for them to shadow me, then talk about what just happened. And in fact did my own MH rotation at this same facility. The VA Encourages nurses to return to school and will pay for an advanced degree via the National Nursing Education Initiative. There is weekly Journal Club in which a study is analyzed and discussed. We have monthly grand rounds. There are daily classes in a range of subjects. RNs are encouraged to participate in RN research. Did you know that the practice of using normal saline to flush ports instead of heparin was a result of VA RN research? We have 10 legal holidays, 26 vacation and 13 sick leave days per year. At least the RNs and Advanced practice clinicians. Everything is a process demanding redundant documentation. It took them more than a year from hiring me until the date I started work. My pre-employment screening by a VA NP yielded some concern but I could not be told over the phone. So about 3 months after I provided my vital fluids, I was directed to come in person to be informed of the ABN results. I was scared. Do you know what the VA discovered? I might have had a UTI, 3 months earlier!! Processes have multiple points of potential failure. Sometimes things don't work, like Travel will cancel a planned pick up without telling anyone, including the patient. Usually this happens with the fragile or difficult patient for whom you spent way too much time organizing same day appointments for several healthcare providers. It's ridiculous how hard it is to get things done. The poor communication between healthcare groups and from administration. Many silos of power. Furthermore nothing happens to the dunderheads that chronically mess up because it's cheaper to keep people then fire and hire. If you wish to develope coping and other skills beyond your wildest dream this is the place. YOU CAN MAKE A DIFFERENCE IF YOU CAN TOLERATE IT.

To a certain degree people will adopt whatever disease de jour they see in the news. Reference Gluten-intolerance. A very small percentage of people actually suffer from it. So explain that. What is the deal with the others? hypochondriacs? delusional? Gullible? There are studies on this phenomena. I believe Gender Dysphoria is real. Just like anorexia is real. Please find Peer-reviewed articles on Gender Identity at MedScape.

Never been hurt? That would be me. I have 30+ years experience in MH. The lions share on acute psychiatric units. I have taken a rogue punch back in the day. No good MH RN hasn't taken a punch. That happens when we lay hands on an individual against their will. Or happen to be near when someone decides to act out. Or when a person is scared and confused. We are dealing with folks on the worst days of their lives. I am adept at keeping myself safe, having been raised with a dysregulated parent. I have good communication skills. An effective de-escalation style. I stay fit by exercising which helps maintain quick reflexes. And makes me a less likely victim.

Short of a staff member holding each hand, you cannot keep this person safe. Wouldn't shackles be indicated for such high risk?

An all time favorite is Psycho-cybernetics by Maxwell Maltz. He writes for the non-acedemic reader.

The voluntary patient First we talk about expectations of respectful behavior. We reinforce expectations. Then discharge. The he involuntary patients get behavioral interventions. Then are dced ASAP.

Restraints and seclusion can be accomplished with a closed door as long as staff can see the patient. Seems a closed door is indicated for a screamer, but I would consider medication management as well.