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behavioral health
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inthesky has 1 years experience and specializes in behavioral health.

I'm a persistent independent thinker who will eventually succeed with my credences intact. I am excited to be starting my psychiatric DNP in the fall!

inthesky's Latest Activity

  1. inthesky

    nursing students and behavioral health units

    You can be the nurse who is different! It is a bummer. I knew that I wanted to work psych after doing behavioral health tech work, not after nursing school rotations. I did BHT PRN for an agency. I'm not sure what is up with psych and students.
  2. inthesky

    Being a Team Player

    I think the ideal form of 'team player' is very important. At my work, the term "team player" is often perverted into a way to criticize and bully colleagues. I do my very best to help out and spend every single minute of my floor time for work. I barely even check my work email and never bring my personal cell phone to the unit. I am finding that I end up staying an extra 30min-hour at work 'helping out' in order to avoid the not being a team player criticism. A few months ago, I was called out for spending too much time with my patients and not enough time helping other nurses with their workload. Sorry. I know how important team work is...but I cringe at the term, due to my unit's interpretation of it.
  3. inthesky

    Advanced Patho stress!

    I can relate. I just finished a 5 week neuropsychopathology class. It make it worse, the professor is an absent slacker and missed the first week and other than online discussions it was pure book learning without handouts or recorded lectures. 100 page neurotransmitter brain structure reading at a pop is near impossible. I'm going to pass the class because the exams are open book unlimited time and for papers, I can use my book and the internet. I almost felt the physical pain of my neurons dying of excitotoxicity today. The program is 4 years long so hopefully I'll get this eventually =P I recommend frequent getting up and walking around between readings. One good way to test your understanding is attempting to teach someone else what you are learning. (I didn't actually grasp my own material well enough to do that besides really general stuff >_
  4. inthesky

    What's the dumbest remark you've heard yourself make...

    I was reading this thread in amusement, deciding whether to post anything. I say far too many stupid things to ever chronicle. I tell patients to follow me around the corner (there is no corner) to my med window (it is actually a door with no window at all) every single work day without fail. Today, a patient amiably confronted me today about my lack of med window; it was amusing.
  5. inthesky

    Advice on Choosing a Job - MUCH shorter version!

    My question for you is where do you want to end up? Which job will better suit that?
  6. I have a love/hate with 3-11. good: more sleep, later bedtime, no early morning, less stressful busy shift bad: sleep too much, go to bed too late, get nothing done =P I websurf too late as well.
  7. inthesky

    adverse reactions to medication handouts

    Nope, it was definitely thorazine. After the patient panicked, they THEN tried trazodone. The patient still didn't really have good results; she probably needs a sleep study. As an update, the unit manager decided that this was indeed a legal issue and handouts had to be provided. The catch is that the only thing we can print out for patients is what our hospital provides (bare bones information ie side effects only). One nurse even went on a rant about how horrible my medline gov handouts were >_
  8. Boo to that "HR" policy of having to call every few hours and not being paid for it! Thanks for putting some things in perspective. Psych is rough to skeleton crew as our 'codes' are violent patients going off. Sometimes we can make special calls to the manager to allow the second nurse if we suspect a patient could get violent. The unit only had 8 patients during the most catastrophic shift I have ever had (I was activated from on-call for this one). There were only 11 patients during one of the busiest, most demanding, frustrating days I have ever had just a few weeks ago. There might as well have been 20. Nobody even called the manager about census. I told the charge nurse that I wouldn't leave her. As I'm sure that it is not uncommon that one ICU patient can be more work than 3 combined. Last time I was on-call for the AM, I just went back to sleep with the phone next to my head because what is one non-morning person going to do when awoken at 5am? *plunk back to sleep*
  9. inthesky

    adverse reactions to medication handouts

    hmmm mandated.. i should dig out a patient's bill of rights or something. I have my next shift tomorrow and will probably just verbally ask the doc for general med handout permission rights. If that fails, I'll just get back to the printer anyway and play ignorant. I don't bend to stupid and unethical =P I thought that Thorazine was weird as well. She said she would kill herself if she couldn't sleep so I think desperation set in. Ambien, seroquel, temazepam, and remeron have failed. I say bring on the trazodone and possibly a sleep study. thanks =)
  10. It has been 1 year and 3 months since I started my first nursing job. It has been an extremely dramatic roller coaster of events and emotions. Nursing is the most love/hate entity I have ever experienced. I started psych right away. Med-surg is the 'preferred' way to begin, but I get tired of the 'shoulds' of life, and do what I want and what will make me happy. The medical part of psych nurse has been an uphill learn, but I've climbed it with help from other nurses, my own determination, and all that lovely stuff which I had not forgotten from nursing school =P. Jan: Passing the NCLEX and getting my nursing license is one of the most exhilarating happy experiences of my life. I cried when I saw my license number written beside my name online for the first time. Nursing school was a very rough eye-opening experience in itself. Feb-March: first job! Not unlike other new grads, it was terrifying, but not something I felt I could not do. I was so fortunate to get an amazing preceptor. He taught me how to be a nurse and embodied the kind of nurse I wanted to be. He encouraged confidence in myself. He was kind enough to allow me to schedule myself for nearly all of his shifts after my preceptorship. I still think of him in my practice and keep contact with him even though I work at a different hospital. April: I'm on my own! I'm expected to serve as a fully functional nurse. I don't think it is actually possible for a new nurse with 8 weeks of experience to complete the exact job of a 10 year experience RN. I'm slow. I'm awkward. I get stressed and overwhelmed. I have trouble delegating the techs because they don't yet respect me. Everyday, I come across some situation I have never dealt with and don't know what to do. My preceptor is proud of me and tells me that he enjoys working with me and my patients give me good feedback. I can do this...I'll get the hang of this....eventually. The responsibility of all this way weighs heavily on me. Nursing is hard!! =P May: I continue to schedule myself with my preceptor. Night shift is beginning to wreck my health and my moods. The quality of my work continues to improve. I make my first med error (milk of mag instead of maalox). I watch vigilantly after my patient with horror as the nurse I am working with laughs at me and truly doubts an episode of a fatal poop. My patient enjoyed the extra attention and never actually had a bowel movement =P. I get into the routine of things and feel less like an idiot every night. I get a good 90 day performance review. June: My nightshift health issues culminate to the point in which I need to take medical leave. You're in trouble when you haven't slept well for months and mixtures of ambien, seroquel, and benzos fail. I lost nearly 15 pounds of a small frame due to gastric issues. My mood goes to crap and I panic that I failed nursing and try and come up with other career options desperately. Nursing is supposedly a career of so many opportunities, but a BSN is a bit of a dead end if you don't want to be a nurse. What do you think of a career that you love and hate at the same time? July: A bit of luck and some "reasonable accommodations" and I get a daytime job at the sister hospital. After a month of leave, I'm physically much better and ready to work again. Dayshift is not like nightshift and the stress of the activity and constant demands is overwhelming. My job responsibilities at the new unit are also very different and I end up needing weeks of unexpected orientation. I was close to walking away from the job entirely in defeat and demoralization. I come to the realization that it is completely unfair to expect a new nurse to fill the shoes of an experienced nurse completely and that my job is stressful and unenjoyable. Not only am I miserable, I wonder whether I am even capable of keeping up here. August: I get used to the routine and finally begin keeping up. I get very good patient feedback. For some reason, management decides I'm ready to be charge nurse, probably due to necessity. More orientation. People begin to look at me like I'm retarded for more orientation. The new nurse excuse burns itself out after awhile. September: I survive my charge nurse shifts with great pride in myself. Although nothing bad happens, some nurses gang up on me and I nearly get fired for being 'unteachable' and 'challenging' to others. I keep my job because my patient feedback is so positive and my work is close to error-free. No one had ever said anything before so I am completely blind sighted. Apparently I was asking too many questions and people were getting offended when I asked why I was doing something rather than blinding doing it. I acted in the very same manner with my preceptor and he found me refreshing and told me that teaching me helped him to become a better nurse. I worked hard to make the necessary changes no matter how unfair I feel I was treated. I bitterly resent that I begin to learn much less from my job as I am afraid to ask questions and clarification. I contact my original preceptor in tears and he re-energizes my confidence. October: The fire at work eventually calms down and I gradually stop anticipating every shift with dread and anger. I hate my job so much that I burn inside, but my patients still make me smile everyday and I feel like I do make a difference. I begin to feel nursing competency and experience gradually creep in. I come home to my boyfriend going on and on about how much I hate my job and then afterwords about how excited I am about some of my patients getting better and regaining hope. Love/hate... I turn in my applications to nurse practitioner programs. Psych is my calling, but inpatient nursing is not. November: a good month at work. I feel independent and capable and I'm better at handling the stress. I try and approach the nurse manager with excitement of mental health parity passed with the stimulus package and the mental health walk in March in hopes of helping to set up a team. She grows cold and tells me that the doc doesn't like NAMI and she already knows about mental health parity. There goes ever voluntarily talking to her ever again. I brought the mental health parity article to work and my co-workers were interested because they had not received the happy memo. Job dissatisfaction re-invigorated. December: I am getting along well with everyone and charge nurse shifts are being considered again. I work my first charge nurse shift and of course a patient ends up being restrained twice at the last 30 minutes of the shift after a week of overtime and I cry at the stress of all the paperwork I have never filled out and out of pure exhaustion. People are disappointed and decide I'm still not ready. Jan: A psychotic patient gets violent. I complete the necessary measures and even stay 2 hours after my shift to help out, but I am visibly scared at the incident. The night charge (who has a nasty mean streak) and a tech (who lied and actually got fired last week) filed verbal complaints against me to the manager. I almost get fired a second time. The manager says the worst thing any nurse has ever said to me "I've been working in this field for 20 years and I know that you don't have the personality to succeed here." I told her that I can overcome and the other manager said "no honey, you can't". they tried to trick me to quit, lying about all the outpatient opportunities which actually don't exist. I begged to keep my job anyway. They were obviously torn and hesitantly agreed as my job feedback was very good from the patients and by this time even good from most of the other nurses. The economy has entered the dumpster already and the job hunt goes nowhere. A day charge nurse supports me to keep fighting as does my original preceptor. She recounts her own tearful visits to the managers office. Feb: A doctor chews me out for 'second-guessing' him. This is where I find out that the docs don't like me for being challenging. I apologized to the doc and actually thanked him for his honesty as this is one of the very few disagreements in which I actually got to work out without the managers punitive micromanaging fingers. The doc was satisfied and doc relations improved as I also made efforts to modify my behaviors. I was going to originally make a year anniversary survival post here in celebration, but I can't and feel deflated and disappointed. March: I once again hate this job bitterly, tempered with my love for caring for my patients. I halt my job hunt as I wait for my NP program acceptances or rejections. I get accepted by all three universities and choose =). The fire at work begins to cool down. I find out that lack of initiative, ambition, and quietness are great for staying under the radar and I'm much less stressed nowadays. The decreased stress of working less hard actually improves my patient feedback. By now, I'm actually rather confident in my nursing competence and don't find a whole lot of situations in which I feel like I have no idea what to do. April: I wait for the backlash for my lack of initiative and now occasional laziness and lackadaisical attitude. I sometimes feel guilty for giving my 90% versus 100%, but my disgruntlement outweighs my guilt. Apparently there are hotter fires in the helm and 3 techs are fired and that day charge nurse who supported me is back in the office for a supposed racial slur I believe was exaggerated by the claims of both the employees who almost got me fired. The manager begins to lash out at everyone and there is general unhappiness in the air. Another nurse tells me that I'm doing a great job out of nowhere which makes me very happy. May: I'm looking forward to my first class in June as I prepare to go part-time. I have already given my notice to go PRN when the full time program begins in August. To my surprise, management is being very flexible with me. I'm so excited to get back into academia. My desire to grow is immense. I feel confident in my abilities. So much that, I feel strangled and held back with a lack of practice autonomy and close-mindedness. You never know what you will get each day you walk into the hospital, but I feel like I can eventually handle whatever comes at me. Nursing has been an extremely tumultuous love/hate ride for me, but I have survived. In about 5 years, I will be an BSN, RN, PMHNP, DNP. :monkeydance:
  11. inthesky

    Can nurses be forced to work during pandemic

    I'm a psych nurse without med surg experience. I would want to do my civic service, but this would be awkward. Keep me away from critical care patients and IV starts and I'd probably make do with supervision. =P
  12. it is a record 101 today, so you might be in luck =P
  13. I work on a small 15 bed behavioral heath unit at a local hospital. Even though the economy took a dump, our census has not really been affected. More and more people come in depressed with nervous breakdowns due to financial pressures, job and home losses, and marriages crumbling in those stressors. What has changed is our staffing policy when the census does have a dip. When the census dips to 11, a nurse has to leave or be put on the dreaded 'on-call'. For example, let's say that I get a phone call at 1230 to put me on-call for my 1500-2330 shift. I have to be ready to come into work whenever I am called. This means that I cannot do anything with my day, not knowing. The stress of not working is more than if I were at work. Usually that patient #12 does come in because well.. it is rather ridiculous to be able to predict the census for the entire afternoon and night at 1230. When I do make my way in (I live 30 minutes away), the single charge nurse looks ready to cry with the stress of admitting patients, dealing with the doc, and giving patients their meds. Even our on-call docs don't have to come in! I make new grad pay and get a measly $4 an hour for on-call. One day, I was really pulled around. I was called at 1300 and told I was on call before a 1500 shift. I was called at 1445 to come in . I was lazing around in my PJs reading a good book. It took me a rushed 45 minutes to get there and I was very angry in my car. My day turned around when I arrived to the lovely day nurse waiting for me and people happy to see me. It was just dumb, but being at work was a relief from the on-call stress :icon_roll. It is much worse for the day charge nurses when their AM med nurse is called in. How one charge nurse is supposed to pass meds and PRNs (psych patients get a lot of PRNs) for 10 patients, transcribe all new orders, deal with the docs, put out unit 'fires', be harassed at the desk for things like patient belongings and laundry issues, and admit patient #11 is beyond me. This is one of the reasons which I have not fought to renew my charge nurse status after previous issues at work which have faded for the most part. A 20 year experienced extremely capable nurse told me that she locked herself in the med room and almost cried. It made me feel so bad. This on-call policy strikes me as wrong and unfair. I'm sure that employees (who keep their jobs) in every job field around the world are being abused in one way or another and I'm lucky to have a decent job. However, that doesn't make this right. Anyone else have to be put 'on-call'?
  14. My unit has found yet a new way to hinder nursing practice. It is procedure to give patients handouts when they receive new medications. Being med nurse, it is extremely important to me (and my job) that patients know what medications they are taking and why they are taking them. Out of everyone, I would say that I am the most prolific printer of med handouts. I do use judgment and will not initiate a handout to a very paranoid delusional patient (if the patient asks me, it is his right). On Sunday, I printed out a handout to a mostly Spanish- speaking woman in spanish. Apparently after I left, she read it over and panicked that the med was going to kill her and refused the med. This patient does not have any psychotic disorder, but is definitely one of those patients who always finds something to ruminate about. It makes me wonder whether it is the first spanish med handout she has ever received >_ So the wise minds of the unit decided that med handouts should be a doctor's order. what??! As much as I desire more MD-patient medication education, it seems like a waste of their time to write out every med sheet they want each patient to receive and endless irritation for nurses having to ask the docs. The night charge told me tonight that I will need to tell the patients to ask the docs for permission for the handouts. If I answer every question with 'ask the doctor', I am useless. In my opinion, this is a huge undermining of my job as med nurse. There is no intervention that will benefit every patient. Perhaps, rather than banning her from handouts, this just means that she needs more education. What if she were just watching TV one day at a commercial of her med and stopped taking it because of the side effect warnings at the end of the ad. There is also a legal standpoint of the ethicality of giving a spanish-speaking patient a med when the language barrier makes the administering nurse unable to adequately describe the med verbally. Is this truly as ridiculous as it appears to me? Am I over-reacting? I will need to drag myself to the next nursing "leadership" meeting to fight this one with the half an ounce of credibility I still have here. I think it would make more sense for the docs to tell us whom {not} to make handouts for and assume that we make handouts for everyone else for all new meds and any requested med information. Thanks for listening to another of my job rants =). :trout: *counting the days until my NP program begins*
  15. inthesky

    I must be an idiot.

    You are definitely not an idiot =P Nurses get very little psych training and it's great that you are interested in learning! Everyone is different, but for my anxious patients.. *Let them vent. *go over all treatments one at a time without an air of hurry *encourage deep breaths *discussion of flight/fight response *encourage them not to try and solve all the world's problems in one moment It's frustrating that nurses don't have near enough time to do this all the time. Learn to cope with anxiety is a long process, so said patient will still be anxious when you leave, but they will be better for having been given a nudge in the right direction. =)
  16. inthesky

    psych-mental health NP vs Psychologist

    PMHNPs (at least in my state) do much more medication than therapy. I'm a pharmacology nerd so this is ok for me, but psychology might truly be a better fit for you.