TerpGal02

I'm not an OB nurse but had a planned c section for placenta previa in May at one of the busiest L&D units in the area. I did not do a chlorhexadine scrub at home prior to surgery. I was told to take a shower with my regular soap but scrub my belly for 2 minutes. I was told the same thing prior to the laparosopic surgery I had in 2020 at a different hospital with a very busy OR.

No I've not seen routine accuchecks for Pts on atypicals unless of course they are diabetic. Usually what I have seen in tje settings I have worked in is that the prescribers will get an A1C on initiation and then regularly thereafter. I have seen Pts being prescribed Metformin alongside the atypical a couple times before. The rationale prescribers have given me is to help curtail weight gain.

I am an INFJ. Psych so far has been a pretty good fit [discounting the trauma I suffered after being assaulted my a pt in his home). The job requires a lot of supportive listening, therapeutic support, motivational interviewing, psycho ed which are all forms of "counselling". I think the operative word is that you cannot provide psychotherapy, if that makes sense. Now I know you will have to go through nursing school to become a psych nurse. I dont know if it's TRUE for INFJs but I felt like a deer in headlights during med surgery clinicals. Also keep in mind that if you work on an input unit, often there is not much time in the day to chat with patients for any extended period. You are more there to keep the pts and the milieu safe. It's a bit different if you work in output. This is a very sort of taxing for an introvert. INFJs are supposed to be the most extroverted appearing out of all the I configurations but the job takes a lot out of you. I know when I get home from work, I have had more than enough social interaction for the day and I need at least an hour to decompress and just be away from people.

I was diagnosed with Stargardt Disease a year ago at age 37. It affects my central vision and is a progressive genetic condition. I have 20/80 corrected in the right eye and 20/60 in the left. So far I can still drive and practice safely with adaptation. I need direct lighting to read most things and my progressive glasses do help quite a bit. I use the magnifier on the computer and use the camera on my phone to zoom in on written materials as needed. I am a psych nurse.

Thanks all! Yes, I have been in therapy for this incident and am now going through EMDR. This individual basically has to come to the office as we will no longer see him in his home if 2 people can't go. He has a long history of violence when intoxicated. The reason I keep hearing that we have to keep him is that the county mental health authority will not allow us to drop him. I was never given a debriefing. A co worker came to court but she was primarily there to support him and give info on our program to the judge. In fact, she didnt know that it was my case she was showing up for until she saw me at court. She was pretty upset that no one told her beforehand. One of the directors at my agency was trying to find me another position in the agency but she resigned. Our agency as a whole is great, it's the leadership of our team that is the problem. The directors did not know about this until almostn2 months later and supervisors are expected to notify them immediately in incidents like this. This has all been handled pretty horribly IMO. I just worry that this level of anxiety and frankly I am worried that I am experiencing some symptoms of dissociation is really negatively impacting my work in general. I dont know what else to say. I was never really offered any time off and I had no idea that my therapy could or should be covered under workers comp. My insurance has no copay for therapy so I haven't even thought about it. But thanks for the well wishes all.

Really I think it boils down to what the law is in your state regarding psych admissions. I don't know of any state, although I am sure they are out there which says voluntary psych patients can just AMA whenever they want. In my state, patients are required to give a written 72 hour notice. As with elk, the clock starts at the time they sign the paper. That doesnt mean the doctor has to keep them 72 hours, it just means they CAN. They can also be certified involuntarily at the end of 72 hours if t2 docs sign off that the pt is a danger to self or others. We usually would ask patients to wait while we did DC paperwork too but if they were demanding to go after the order was given, we would let them leave. Straight detox is another animal. In my state it is treated like any other medical admission and the pt can walk out pretty much whenever, although we would try to keep them until morning if they wanted to leave in the middle of the night. Most of them just needed a bit of TLC and convincing that it would be in their best interest to stay until morning.

One facility Inworked in had all private rooms so problem solved there. Another facility had double rooms and the policy was that trans patients got a private room. The unit eventually moved to all private rooms so again, problem solved. That trans patient is not a Male, she is a woman and should be seen and treated as such, period. The second unit I worked on had a lot of older, conservative nurses who would cisgender trans patients all the time. Us more open minded nurses would cringe and shake our heads.

I have been working in psych for 6 1/2 years now, my entire nursing career. I knew I wanted to work in psych my first day of psych clinical in nursing school. I have seen it all as far as psych goes. Children, adolescents, adults, geri patients, psychosis, mania, depression anxiety, personality disorders, self injury, acute detox.......seen it all. I am currently working with adults on an ACT (Assertive Community Treatment) team. We provide services to clients wherever they are, be it a homeless shelter, their home, etc. In February, I was assaulted by a male client while I was in his home. He was intoxicated at the time. He grabbed me repeatedly and kissed me. Thank God it didn't go any further than that, but on its own was pretty traumatic. I filed charged against him and we went to court. He been in jail for a little over 2 months and got time served. He ended up spending more time in jail for other reasons and just got out recently. My team is continuing to serve this person. I thought I was doing ok as far as coping, until he got out. I am not expected to complete visits with him at all but he is in the office frequently, I have to see him, at times I have had to speak with him (briefly) on the phone. I am having a really hard time with all of this. I am terrified half the time to go in to the office for hear he will be there. If I see him or even really hear his voice, I am immediately in panic mode. My co workers do their best to run interference but it is still hard. Based on this and my many other experiences working in our very broken mental health system, I don't really feel good about what I'm doing anymore and am thinking about changing specialties. Has anyone on here ever done this? I am worried I have pigeonholed myself.

I would review psychotropic meds, their indications for child/adolescent patients. I would also review your therapeutic communication techniques. I would also suggest that you take another look at your Human Growth and Development and your Erikson's Developmental Tasks to review what is developmentally "normal" for the age group you are working with. I think it depends on the culture/patient population as far as what to expect. For example, I worked at a free standing psych hospital that took all ages and as far as child and adolescent went, all behavioral issues-think high impulsivity/aggression. I then worked on a unit in a general hospital that took adolescents and adults. They were more "picky" there on what kids they would take, just because of the mixed nature of the unit. We typically would not take kids with aggression issues. Always on a behavioral health unit, safety is your #1 priority. You will learn to have your head on a swivel, especially when it comes to teenagers. They don't yet have a fully developed pre frontal cortex so they can be impulsive and can also be incredibly sneaky. You will likely see a lot of patients who self harm as as far as the teens go, they can be VERY creative in what implements they use to self harm. I have seen kids burn themselves with pencil erasers, crayons, etc. Yu will need to learn to develop VERY strong boundaries and to stick to them, but also know when its ok to be flexible too. Good luck! I love adolsecents, they are my favorite population by far1 !

I would agree that alternate methods should be tried first just like previous posters have said. If the docs are on the floor, I would let them make the call but the psychiatrists IMO spend on about an hour or 2 on the unit seeing pts then they bugger off. "Imminent danger" is so vague. I will tell you what an old nurse manager of mine said. If you feel threatened by a pt, or you feel a pt is threatening to others, that would qualify as "Imminent danger". IE they are screaming with balled up fists and cant ge redirected, verbal threats (technically, that is assault), lunging, posturing ,etc. It all boils down to your documentation on the incident. Things if TJC pulled the chart, is your documentation sufficient to support your intervention.

It's good to "meet" someone else with Stargardts. No one else in my family has it. I am 37 now, did not start noticing something was wrong until I was 36. No one else in my "real life" has Stargardts either. Being a rare disease, it's hard to connect with people who understand what it's like. A very lonely feeling. Anyway, I'm glad to hear someone else with vision loss successfully able to navigate a clinical setting. Good luck in your adventure as a new nurse and keep us posted on how things go!

You're talking long acting injections right? I work on an ACT Team and I give lots of long acting IM's. Usually when I'm in a clients home I will casually ask them where we did the injection last time (and I do look it up before I get there) then I casually suggest we use the other arm or glutes if we've been doing a lot of delts. To be fair, I have a couple of very paranoid pets who refuse to rotate site. I have one who's been on Haldol Dec for YEARS, has a huge knot but absolutely refuses to let us inject him elsewhere. IMO in that situation with the pts being as sick as they are, they are better off getting the meds in their body.

Hi all! I have been an RN working in mental health nursing for 6 years now. I currently work in a community based mental health agency on a mobile treatment team. In April, I was diagnosed with Stargardt Disease which for all intents and purposes is an early onset version of macular degeneration caused by an autosomal recessive mutation of the ABCA4 gene. All my life up until the last year or so I have had perfect vision. In nursing school I had perfect vision. Now I am corrected with glasses to 20/60 in the left eye and 20/80 in the right eye. It has progressed within the last 6 months but I don't know how much farther it will progress and in what time frame. Luckily, I have NIH in my backyard and am participating in a Natural History study there. As far as functional vision, I mostly have problems with close tasks like reading fine print, working on the computer (without magnification) and reading handwriting. I can barely read my own handwriting anymore. Thankfully everything at my workplace is digital so I dont have to decipher chicken scratch orders or anything. I was wondering if there are other low vision nurses out there still successfully working in the field. How do you manage day to day work tasks and what accommodations do you use to make work easier? I am really new to all of this and quite frightened that I may no longer be able to work as a nurse one day.

We have this at the agency I work for. We habe the outpatienf mental jealth clinic and our agency has partnered with another agency that pdovides primary care so that they have a clinic in the same building. They do this at 2 of our locations. Its pretty great.

If you work on inpatient child/adolescent, things can get quite physical. You will find, especially with kids under 12 that they are in the hospital for behavior problems/aggression along with ADHD. Pediatric patienfs simply do not have the impulse control an adult has.......that whole prefrontal cortex thing. If they want to act out, they will. You are more likely to see aggressive acting out from a 9 year old with ADHD than you ever will from an adult expereincing psychosis. Most psychotic patients tend to be more isolative than anything in my experience.