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SwampCat

SwampCat BSN

Psychiatry

2 yrs of pedi psych and 2 yr s of older adult/dual diagnosis

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SwampCat has 3 years experience as a BSN and specializes in Psychiatry.

Late to the game; but still winning.

SwampCat's Latest Activity

  1. SwampCat

    Gero-Psych... good resources and essentials

    How weird, I did two years in child psych and just transferred to the "older adult" unit. That staffing is unsafe in my opinion. We have pts with stable med issues (maybe an iv a few times a yr) and for 22 pts there are 4 nurses and 4 techs (2/4 nights) and when I pick up eves I feel like it is nonstop. I can't imagine having medical issues thrown into it
  2. SwampCat

    LGBTQI and Psych Nursing

    I'm not an MSN either, but at least once a month we get a kid on the floor that is here for one thing but the kid is also questioning their gender identity. The youngest I've seen dealing with this was 10. My floor does 5-12 years old.
  3. SwampCat

    Geropsych?

    One of the great things of geripsych is you don't lose all med/surg skills. I will go and help out on the geri floor now and then and it is always busy! It appears to me that morning is the same as afternoon which is the same as night. A lot of sundowning. Med passes often. Quite a bit of reality orienting.
  4. SwampCat

    Pros and cons of psych nursing?

    How often does one work with a violent/aggressive patient? (daily, weekly, monthly?) Verbally aggressive is a all day thing where I am. Physically aggressive is usually at least once a week. Aggressive to the point of full blown restraints, a couple times a month (all depends on the crew of kids I have). Is being a psychiatric nurse rewarding and satisfying? Is it an interesting career? Currently the floor I am on is not rewarding whatsoever. We all feel as if it has become a detention center for boys with aggression issues. When we do get an actual psychiatric patient (yes behavioral is psychiatric, but you know what I mean) then I feel as if it is rewarding. How emotionally draining can the work be? I excel at not bringing work home with me, unless it is a funny story. While I'm at work I am constantly drained. I take none of it personal, but it is incredibly draining to have insults and swears hurled at you when all you did was ask a simple question. If it is one kid, then it's usually easy to keep it from dragging me down, but when I have this kid over here throwing chairs, and that kid over there cussing staff out, and this other kid running around without regard to staff's directions it gets old very fast. It's also exponentially draining if your teammates are useless (or worse: escalate the kid because they feel like they need to have the last word). I know other areas of nursing are draining, too (I was a tech on a med surg floor), but in different ways
  5. SwampCat

    Self harmers

    We really try not to use it, but we have a restraint chair which is essentially a wheelchair with restraint straps. We have a de-escalation team we page and they come down (maybe, if their units aren't acute) and help try to talk the pt down or help place them in the chair.
  6. SwampCat

    Adolescent Psych RN

    Every day I thank the gods of my place of employment for hiring me onto pedi instead of adolescent. I wanted adolescent, now I cringe when I float up there. I've seen 17 year olds trying to kill themselves because mom took the phone away. I've seen 13 year olds with PTSD from sex trafficking. Once in a great while we'll see a psychotic patient. A majority has bpd and are so emotionally draining. Many are runaways who then state they will kill themselves if they go back home. Many are kids having been through the system. Maybe 1/10 interactions I have with the adolescents make me feel like I made the slightest difference. Most of the time I feel like I am putting out fires and trying to reverse bad parenting. I have zero job satisfaction when I am up there. Of course, ymmv. May you find your niche. I am still searching, too.
  7. SwampCat

    Theraputic ideas for patient activities

    Jenga with questions about goals, coping skills, aspirations, etc on each block
  8. SwampCat

    Wanting to switch to psych nursing - questions

    I am super new in this field, but I will share what I have experienced. I am currently working the pediatric floor on the day shift in a stand-alone psychiatric facility that is affiliated with two major hospitals on the same campus. Full capacity in my unit is 9 kiddos. 7am: shift report 7:30 - 8:45: wake kids up and they shower and clean up their rooms; set out breakfasts away from each other. Orthostatics, morning meds, and a few minutes chilling out on their couches to watch some cartoons. At 7:30 charge nurse meets up with our sister units (adolescent and the Psych ED stepdown) to compare staffing notes and see if anyone needs to float and if there is enough staff for evenings. Kids can make phone calls or have visits. 8:45 morning meeting. Yes, we RNs run it more often than the techs. I'm on a kid unit, so I don't really care about the public speaking. Also, think about your crowd; It's a psych hospital, not a prestigious awards banquet. Your public speaking prowess or deficits will likely be overlooked by the clients. We go over the daily schedule, any housekeeping stuff, and then each kid gives us a goal and we give them feedback on that goal ("You do a good job following directions already, let's see if we can think of something else you can be working on" "How will I know if you are meeting your goal?") 9-11 is school down the hallway. There is staff there plus the techs so I will just pop in now and then. I mostly work on updating charts, care plans, placing phone calls, starting any discharge/admission paperwork, prepping for team. 11 is usually recreational therapy until 11:45. Tech's and RT do something fun while we are out. 11-12 is when we do team meeting. RN, Psychiatrist, social workers/clinicians, and private insurance reps come together and discuss how each kid's stay is going, what needs to be done to get them home, what services we can help them get, and what their tentative d/c date is. 11:45-12: cartoons, phone calls, visits. 12-12:30: lunch and noon meds. phone, visits. 12:30-1: quiet time. They get something off the quiet time cart and have to play by themselves during this time. I like to go around and really assess my kids at this time. I can get a good 5-10 minutes uninterrupted with each one. Sometimes they open up, sometimes it is all superficial chit chat. I try not to sweat it because my main job as an RN is to keep them safe. If they do not want to open up to me, I will let the clinicians work with them. Oftentimes the clinicians will take the kids to their offices at this time, too, to do a session. 1-1:45: Rec Therapy 1:45-2: phone calls 2-2:30: snack & pm meds & "Rounding" where we sit with the Pdoc and each kid comes up and we chat about what's going on in their stay and how it is going, med concerns, etc. It's amazing how much these kids know about their medications! 2:30-3: social skills group 3-4: quiet time while the shift changes and loose ends are tied up. I will be swapping over to second shift next week and that is generally: 4-5 freetime/playground 5-5:30 supper & any supper meds 5:30-6:30: rec therapy 6:30-7 showers, pj's phone calls. 7-8:30: movie time/ free time/ night meds I haven't done a night but getting report from the night nurse in the morning sounds like it is a lot of redirecting kids back to bed, helping with nightmares, trying to get kids back into bed if they are up before 6am, toileting, etc. Pyxis audit, chart audit, housekeeping things, etc. I'm sure I am missing some things, but this is the general M-F schedule. No school on weekends, instead is free time/playground if they have earned it. The adult and geri units are less structured with much more free time. Psych Pros: I get to pee within an hour of the urge WICKED interesting field!! I work right next to the Pdoc and we go back and forth about how each kid is doing. He knows me by name and that's important to me. I actually feel like I am making a difference to that person. On m/s I felt like I was making a difference to their ailment. You can only give so much "holistic nursing" on a med/surg floor. Psych floor is all about holistic nursing. Here I have 20+ minutes to talk, because that is my job. Who has that luxury on other floors? Cons: restraining is few and far between, but it still happens for safety reasons and i feel terribly when I have to. Hearing their stories... very few come in with average kiddo histories. Violence can happen at the drop of a hat (even if Broset said they were low risk). Some families are just as bad, if not worse, than the patient. Not everyone will open up so we can help them. That is the most frustrating aspect of the field in my opinion. When the whole team wants to help this one person, but they deny everything and insist they are okay. It's heartbreaking, no matter the age of the patient. I originally went into nursing school with the plan of CNM. So glad I got sidetracked!
  9. SwampCat

    Spanish resources for psych nursing?

    I didn't know that. I will ask this morning. Thanks!
  10. SwampCat

    Spanish resources for psych nursing?

    Nope, no translator phone. I tried the translation app on my phone but it had a hard time understanding the kiddo. He doesn't get "hablar despacio". But I also think this would be a good thing to learn. This is my first fall semester in 7 years that I haven't taken a class, so I feel the need to learn something :)
  11. Yesterday we admitted a kiddo that is Spanish speaking only. Our facility is not particularly capable of handing this, and these past 24 hours have shown that our unit is probably the most poorly prepared unit in our facility. I made a cheat sheet of basic info (Sit down, this is quiet time, raise your hand, hands to yourself) but this obviously has become nothing more than mere babysitting. How am I supposed to have a conversation with this child about his SI if no one can translate? I would like to take a crash course in Spanish. Medical Spanish is probably not what I need, so what do I do? Is there such things as a Psych specific Spanish class?
  12. SwampCat

    Patient Population?

    I'm starting orientation on Monday for the under 14 crowd. I rotated through this floor during my clinicals and I'm not really all that excited. I originally wanted to get into adolescents (I did my capstone on adolescent unit) but now that I have a teen with BPD in my own house I'm singing a different tune. School health and women's health are my main interests. I would love to work acute detox. I often had to 1:1 for patients like these at my PCT job and I found them so interesting. It blew my mind to see them go from coherent to DTs and then start to come out again throughout their stay in the CCU. I can't deny that I also found their hallucinations somewhat entertaining, especially when this one older gentleman thought I was a prostitute and he was trying to get me to climb into the bed of his truck (the hospital bed).
  13. SwampCat

    UMass Memorial?

    Thank you both
  14. SwampCat

    Stay at home mom after degree?

    I was a SAHM for 10 years and it was the hardest, most isolating thing I ever did (no family involved, but did join the cliquey-catty MOMS Club). If it were me knowing now what it was like (and if I had my license then), I would work part time through the pregnancy, enjoy the 3 month FMLA and then go back part time. My sanity is worth it. I'll be the first to admit it, and I don't care what other people think, but I am a much better part time mom than a full time mom. I have more patience, more interest in doing what they want to do (ever play baby dolls with a 3 year old for 8 hours straight while raising an actual baby?), etc. Totally not trying to dissuade you, I am more or less just thinking out loud. I know some people are born to be a parent and tend to their kids 24/7 but I learned quickly that wasn't me. This coming from the chick who wanted four kids and wanted to stay at home until the last one graduated. Then I had one and the world changed more than I could have ever imagined. Whatever your decision, I hope you find it is the best for you and your family. It is certainly not an easy decision. Thankfully you are never really bound to what you choose. You can always go back to work (keep in touch with your networks, take other courses in the meantime) or you can always reduce hours or quit. Congrats on the pregnancy!
  15. SwampCat

    Would I be in over my head? - long

    With some digging around, I actually found out that per CT regulation 10-212-2B, they should not even be looking at hiring me: Each nurse or nurse practitioner shall have at least the equivalent of one year full time working experience as a registered nurse within five (5) years immediately prior to employment as a school nurse. Bummer. It was overwhelming and exciting idea that I was looking forward to potentially tackling. I guess I should email them that.
  16. SwampCat

    Would I be in over my head? - long

    Today I interviewed for a school nurse job that splits between a middle college and a magnet arts school. Basically, they have no system. No nurse to guide me. No policies. ...NOTHING! It would basically be "here are the keys, I don't know what papers are necessary, holler if you need us but we probably can't help." Obviously the first thing I would do would be to find out if this is legal. Can two schools 30 minutes apart share a nurse? We are talking more than 200 kids on total. I guess administration holds down the fort at which ever school is nurse less that day. Second step would be to find a mentor. I was thinking about getting in contact with the school RN I had a clinical with, but I'm doubting that she will remember me. I went one day a week spring 2014. I'm sure a nurse around here would be nice enough to guide me. Not only running the nurse's office but they want me to do seminar-y things for the kids and staff now and then and also come up with and take some of the kids on field trips... my first thought was take them to help out at the cardiopulmonary rehab exercise class at the local hospital and see what smoking can do to you. I asked them what they expected to be accomplished in the first year and they were very vague...I guess because it is a newer school and they are still finding their way also. I am a go-getter and feel semi confident that I can slowly put this together but I want to be realistic. I do feel as if this is a job for someone who has a few school nursing years under their belt but I can't deny the fact that I love the freedom it offers and it follows my kids' school schedule. And the whole idea of being part of a community is so alluring. Sorry this is so long but any input would be greatly appreciated!