Euphrosyne7

Hi Jules: I think you are misunderstanding. I am working in a csu, it is a 9 bed unlocked unit. When I say emergency services, I do not mean emergency department. The emergency services in this clinic is a room where people go who are having psychiatric issues. They may then be sent home, sent to ed via a section or placed at our 9 bed inpt facility. I only work on the 9 bed facility which is in the same bldg as outpt for 3 hrs tues through thurs am. I do the rest of the day at outpt. Basically what they want me to do, is to give a verbal order for medications that a pt who has walked in off the street to ES says he/she is taking even before a clinician sees the pt. At times this medication can be suboxone, which incidentally I am not certified to prescribe. I can't check labs before anything as this is an acute maybe 3 day admission, to a facility that barely has a glucose monitor. They aren't even supposed to take anyone who may be withdrawing from substance or etoh. I have more than enough pts to keep me busy outpt for the three hours in the am, and there is no reason why they cannot place another prescriber in this area. Also what I am trying to explain is there is no med rec and if so, it is done by the clinician/therapist. So basically they wanted me to give the lpn medication orders on a pt who was not even seen by the clinician ( for all I know the pt could then report oh I just took 1000 pills) after I orderd and pt was given what supposedly is the prescribed medications. I feel like it is just a mess. I also work inpt in a real hospital psych unit and nothing like this is going on there!

A "certfied" psych RN is I think a certification you may be able to get from the ANCC however, a Psychiatric Nurse Practioner requires at least a MSN and is a APRN. Best wishes

Help! Currently working in community setting part csu and part outpt. The csu is a mess, numerous med errors, pts admitted that are either not safe for unit or needing more care. Asking me to "give med orders" for pts who are not yet on the unit but in the "emergency services " area, before they are even evaled by a clinician, many times pts come in with all kinds of bottles of meds that the nurse cannot tell what pt is actually taking or not taking and expects me based on the pts word to do verbal orders for same overnights. I told them I feel my lic is in jeopardy there and habe told them i am not going to be able to work in that part of clinic effective immediately after this past weekend something happened , yet again, that i felt put pt in danger. They are telling me I need to give a notice. Thoughts? Im meeting with ceo tomorrow who is a clinician and the agency is completely clinician run. No help from medical director, as for some reason she thinks it is ok, to give a verbal order for medications that have not been reconciliated before the patient is even seen by a clinician while in a holding area, that is voluntary and pt can simply leave at any time. Thanks in advance and you can pm me if youd rather make private comments

Hi there: I stopped working as a RN for my last year of grad school. (I, too, only had approx. 3.5 years total as a RNat that point) I decided to focus on school and also had a very sick family member who I was helping out. Once you graduate, you should be able to list your clinical experiences on your CV, and can just say that you wanted to focus on school. I had no problems at all getting a job.......in fact, I ended up having more offers than I could accept. I wouldn't worry about it as being a NP is quite different than a RN and if you are truly stressed about your work and can afford to take the time off, I say do it. You'll have more time to focus on school and clinicals. Best wishes! Carla

Hi TraumaRus: I'm not sure what states are considering it, but it has to do with that whole matter of making advanced practice nurses scope of practice the same in each state which they are calling the advanced practice nurse consensus model. In RI, we really don't have many psychiatric nurse practitioners. Most prescribing psych advanced practice nurses are psychiatric clinical nurse specialists. That being said, their curriculum at URI which is the college in RI which offered that track, didn't, until recently (if at all) include what they are calling the three requirements for all advance practice nurses.......advanced health assessment, advanced patho, and advanced pharm. Currently the CNS program at URI is now "on hold" and from what I hear they don't want to offer a Psych NP program because they feel there is "not enough interest". I don't know about other CNS's in other fields, but as far as psych is concerned, lots of CNS's here in RI are upset because if this thing passes, then they will be grandfathered in as a PCNS in RI and at their current job, but will not qualify to go to another state. (from what I understand) I know of a PCNS who is on the board of this consensus model, and she, herself, was applying to psych NP programs so that she would have flexibility in the future if she decided to move out of state....and she has been practicing as a PCNS with prescriptive privileges for quite some time. This link has some more info about the whole thing: http://www.rinpcouncil.com/news-views.html Hope this helps answer your question. Carla

P.S. CNS won't be grandfathered in as "NP's" but as advanced practice nurses.

Hi: From what I understand, CNS' will be grandfathered in as far as RI and in whatever respect they are working in; however, they will not be able to move to another state, etc, which is why, I decided to get my PMHNP instead. Starting salary in RI for PCNS/PMHNP seems to be anywhere from $80,000- $120,000+/yr (depending on how many pts you will be seeing, inpatient vs. outpatient, with/without benefits depending on facility. I know at this time, they are looking for a PCNS/Psych NP in Newport (PM me if you want the info as they emailed me yesterday)........also I know that there is a huge tuition reimbursement (approx. $60,000) being offered if you sign a two year contract at Thundermist in warwick & woonsocket. Not sure if that position is still open. Also family services of RI was hiring CNS/PMHNP not long ago, so they may still be looking. Good luck! Carla

Hi: I attended Drexel University in PA. I am hearing that it is now very competitive to get into.........they are receiving over 400 applicants per each new class that starts.............and the curriculum is only offered at certain times throughout the year.....So once a year the 1st clinical rotation begins and you are unable to start again until the following year. Carla Carla

Hi all: Just wanted to chime in with a few thoughts. First, I agree that it seems most DNP curriculum seems to be lacking with regards to what would be most beneficial versus theories, research, etc. That being said, I am now able to understand research/methods as well as able to differentiate between a study that is robust vs. one that looks good but, in fact, isn't. This is actually helpful for practice, but is also not the end all be all in practice either. One thing that I did enjoy about my MSN program was that besides research, etc., it also included another 30 hrs of advanced pharmacology specific to the track you were in. For me that meant an additional 30 hours in psychopharmacology on top of the 30 of advanced general pharmacology. Differential diagnosis was incorporated into our classes, and we used the same text books that medical schools are using. While we did have a class on evidence based practice and research, ethics, and informatics, the majority of our other classes were really more medical model based. We didn't have to suffer through nursing theory and we were required to do a total of 640 clinical hours with the exception of the FNPs who had to do more. I have a friend who attends a local university, and she is studying for her ANP. She has told me that while she feels she is acquiring a good education, it sounds like my program was more stringent and more medically based than hers, and I was in a psychiatric NP track. The ACNPs and FNPs in my class did get classes in xray and diagnostic study interpretation as well as suturing and a plethora of other experiences which I did not as they would most likely not be very useful in psych! I think the experience/education you receive all depends on what school/program you are in. Currently I am looking to go back for my DNP but I don't want just a "general" degree. I am hoping to find a good program which specializes in Family psych and which is based more on clinical/medical rather than theory and management which would be the most useful in real life practice. Most university's seem to have a curriculum that contains yet more research/statistics, and other courses that would seem to be more pertinent to a phd rather than a "doctor of nursing practice". It is pretty frustrating. Thanks for reading, Carla

Hi Nelly: I attended Drexel. I do think that Family PMHNP is more marketable (but PMHNP seems to be pretty marketable too) because then you can see children so depending on where you want to work, it may make a difference. Also to consider is the fact that psychiatric illness has a strong familial connections. Many of the patients that my preceptor saw had children/adolescents who also needed to be seen. In many cases, he was treating entire families. Kind of like ANP vs FNP. If you are considering doing an online DNP for family psych, I would suggest also checking out University of Missouri, Sinclair school of nursing.........they also have an online option for FamilyPMHNP, DNP and it is where I am considering applying. Carla

Hi Nelly: I just passed the boards the end of July so not even licensed by my state yet.......still waiting for them to process the paperwork! I am certified to see ages 13+, however, in RI, many of the CNS's see all ages (it seems that if your collaborating physician does and precepts you, it is ok according to RI but I don't think that according to the ANA you are supposed to) I can do therapy but will probably not due to billing/insurance reimbursement which is much lower for therapy vs med management. I have been hired by a group and will see all of my own patients at their facility. At some point, I may decide to be in private practice but as I am just starting out, I will likely benefit from being in a group. Initially, I was pretty nervous about seeing children, but during clinicals I got to experience seeing pedi/adolescents and decided that I enjoyed that population so my plan is to go on for a DNP with a specific Family PMHNP track. After that, I will be eligible to sit for the Family PMHNP ANCC certification. Hope this helps, Carla

Hi all: Just took the NP exam at the end of July, and there was no question like that on it! I'm sure we don't all have the same exact exam, but this is the first I have heard of any type of nursing board question asking something like that. Carla

Hi Anne: Sure PM me. That's fine. Carla

Hi Dr. Tammy: This is off-topic, but I am wondering did you have clinical for your DNP program at Duke? I am currently looking for online MSN-DNP programs and am noticing quite a bit of differences within the curriculums...............for example, some schools seem to offer classes for the DNP which I already completed during my master's degree and many are requiring a total of 1000 clinical hours (between MSN +DNP clinical time)........... Also not sure if you would know, but I graduated with a MSN for ADULT psych NP and if I were to take go for a DNP specific to FAMILY psych, would I then be able to sit for the ANCC Family Psych certification?? Thanks in advance, Carla

Hi: Psych NP's are also able to do therapy and my NP program (Drexel) did have a quarter on therapies as well as required clinical time. Perhaps you could get a psych NP and then further your knowledge regarding particular types of therapies w/seminars, etc. That way you would be able to do both prescribing and therapy and would be more marketable in your area? Where I live, the psych CNS is able to obtain prescriptive privileges so while they do some therapy, many of them also do quite a bit of prescribing. Hope this helps. Carla

Hi there: It can be profitable to open your own practice in MA. I know several CNS'/NP's who have. You must have a supervising physician and learn about reimbursement or initially use a billing company so you will get paid. There is quite a bit involved in it so the best thing to do is get your license first then look into it more. Carla

As I just passed the ANCC for Adult PMHNP, I would suggest purchasing their practice questions online, using Barkley review and also the ANCC review book. As a side note, I am selling my 2011, Barkley PMHNP review guide w/CD's. If anyone is interested please PM me. Thanks & Good luck to everyone! Carla

Hi: We are in the ED. What we do is give a verbal report privately then round to each room quickly to see if the patient needs anything and let the pt know the status of their disposition at that time or let them know that the dr. will be in soon as their tests have come back, etc. Even with patients in their own rooms, it is difficult to give a full report while rounding without violating HIPPA as patients and family members from other rooms are always kind of standing around and waiting for their results. This seems to work pretty well as we get a quick look at the patient to make sure all is well, the patient and family see us (which lets them know we are aware of them and their status), and we are also "covered" on camera as doing walking rounds. Carla

Hi: I agree with the others who have posted. Particularly as Bluegrass mentioned, some patients who smoke will be adamant about getting a nicotine patch but when it comes down to it, the doc will not order as the patient may have some underlying medical reason not to. As others mentioned, if the charge nurse felt that she wanted to get a nicotine patch and give it to pt, then let her do it herself. It then becomes her problem and not yours. A nicotine patch is not an emergent need so worst case scenario, the patient has to wait a bit to get one. Carla

Hi again: I also wanted to add that we also evaluate each class at the end of the quarter. Our instructors are physicians, NP's and Doctorate prepared RNs. Our classes (once we are done with the general requirements) are pretty small (approx. 12-16 students), and we are pretty cohesive, insofar, as at this point, it will just be this same group for the rest of the program. We also are able to discuss case studies and do pretty much anything that you can do at a B&M school....you just cannot actually see the person you are talking to until you have campus visits. Thanks, Carla

Hi there: I felt that I would comment here as I currently attend the Drexel online PMH-NP program. First, in order to succeed in an online class, you must be extremely organized and motivated. There are online lectures as well as what is called Wimba sessions where everyone can interact, the instructor can put up a powerpoint and lecture while you follow along (these can be archived to view later as well), and once you download the proper software, you are able to "raise your hand", and using headphones w/speaker, ask questions, speak, etc. just as you would in a normal classroom. Furthermore, tests are strictly proctored. They send you this device that must be hooked up to your computer, it takes your fingerprint, picture and records both sound and video in a 360 degree view while you are taking a timed test. If the proctor notices movement, noise or anything out of the ordinary, your test will be stopped, reviewed by an instructor and so there is no way to "cheat". The classes have been very rigorous. I had started taking master degree classes at a B&M school prior to this. The online classes are as rigorous, if not more so, in some instances than the classes I took at the school. The instructors have been great as well. They are available via pager, phone, and email and always have responded promptly to any questions or concerns. We must make campus visits during advanced physical health assessment & diagnostics to perform a head to toe on a standardized (real, but paid actor) patient. This I will be doing in the upcoming quarter, but I hear they are quite strict with regards to pass/fail. We are required to obtain our own clinical sites. This can be daunting but is possible. We must attend clinical for a total of 160 hrs per quarter for four quarters as well as make campus visits each clinical quarter for another standardized pt. exam. The ability to be able to complete a large portion of the didactic component online has been great regarding flexibility, and instead of having to drive to campus once/twice a week, I just get up, turn on my computer, grab a cup of coffee, and follow along with the lecture. Many of the textbooks we have been using are the same used by B&M facilities as well as medical schools. I certainly feel at this time that I am learning as much as I would be if I were attending a traditional program, and I have the added convenience of flexibility. We are also required to pass each class with a B, and some B&M schools are only requiring a C (UMASS Dartmouth) so I don't know how other online schools are, but I can only speak positively about Drexel at this time. Thanks, Carla

Hi there: I find that after working a 7p-7a shift, if I go to bed almost immediately after getting home, sleep for about 5 hours, get up then go to bed at the usual time, the next day, I am "flipped back" to a regular schedule. However, it also helps if I do at least 2 shift at a time so I can be on a pm schedule for two days and then revert back to a normal schedule. If I have to keep flipping during the week, I end up having a terrible time of it. I would suggest getting some earplugs and make your room as dark as possible. I also have a machine in my bedroom that has the sound of crickets. This is soothing to me and filters out other noises. Good luck........once you get used to it, you should be alright.

Hi again: Well since my first post, a lot has happened........my brother had radiation for 13 weeks, chemo for a year, and a total colectomy with a permanent colostomy. The cancer mets to the liver. So this summer, he had a wedge resection.............and just when his PET scan showed nothing "glowing" as of two weeks ago, he had a CT of abdomen which showed a "mass" located to the left of his colostomy. This mass appears to be subcutaneous and you can feel a hardened area about 1' by 1 1/2 inches. His stomach muscles appear to be under it. SO he had biopsy of that area..........and today at 2:00pm, we will go to discuss the results of same...........I feel like I want to throw up................ To the 26 yr old in Texas........I hope that you are well and have not had any further problems!!! Please pm me if you wish. Please keep my brother in your thoughts and prayers. Thanks, Carla

Hi: It kind of depends on you. I found it to be a useful studying technique to do questions as well as study mode. The reason being that sometimes, particularly while taking NCLEX, you kind of have to know how to answer the question even if you aren't exactly sure of the content. I had studied endlessly in order to pass the HESI exit exam so I was pretty knowledgeable about content, but when I took the NCLEX, there were several questions that I had absolutely no idea about. I felt that by doing so many questions prior to (about 3000), it helped to be able to answer those types of questions for me. Best wishes, Carla

Hi: I know you had inquired about RIC previously and found they have a long waitlist. I am not sure where you are located, but have you thought about either URI or UMass in Dartmouth? Since you have all of the prereqs as well as cognates and other requirements done and are a second degree candidate, the time you will spend waiting for admission to one of the community colleges, you may be able to get into one of the above. At this time, I think the wait is longer for the CC's than those two. I know it is frustrating. I wish you luck! Carla