jnks

Newer to this and want to do everything I can to improve.

2 nurses at my work are in disagreement on what day we dispose of a med that expires Jan/2022. One says it expires Jan 1st and we can only give it through Dec 31/2021. The other says it’s good to give through the last day in January and we dispose of it at the end of the month. I’m inclined to agree with the second one but for years I’ve worked in facilities that don’t have meds sitting around for so long, I just didn’t remember for sure. Most of our meds are month/day/year.

I wouldn’t contact the BRN, wait till they send you a letter. It doesn’t really work in your favor whether you contact them first or not. This buys you more time to figure things out, but do what you think is best, of course. Even if you start out as “self-referred” it will switch to “board referred” once they get the complaint anyway. I actually didn’t get the letter offering me diversion and 7 months after my complaint I got a letter that I was under investigation by the DCA (probation usually at that point). I contacted the diversion program and still was able to get in. But again, diversion won’t accept people who do not have an addiction problem (or think they may have one anyway). Best thing to do: go on the BRN website and search the list of nurse support groups. contact a couple nearby (they are probably all on Zoom though) get the info and attend a meeting or two. You will have a bunch of people in probation and diversion plus the group leader to ask questions of. You don’t have to be enrolled yet in any program to attend any groups

Something to think about… Diversion is a voluntary program for nurses with substance abuse or other mental illness. I have seen them turn people down who formally request enrollment in Diversion but state they are there for one bad occurrence and do not have any substance addictions. Then they get the chance to to Probation.

I’m in Cal on Diversion, 2 years in. It’s actually my second time in Diversion. I was in 2010-2014 and ended up relapsing after I completed. So I do have a good bit of experience with the program. HMU with any questions etc.

I’m in that kind of program in Cal. No board action or flags on my license but we still have to disclose to the people hiring because they will need to assist with setting up worksite monitor. As for gaps, it doesn’t sound like you have anything to worry about. All my interviews have been cool about it. Just a couple of them couldn’t find a workaround when I had a narc restriction. On another note, you say you tested positive for Fent from hanging out with your friend who was smoking it?? C’mon now…. We’re just anonymous fellow nurses in recovery here. If you can’t even be straight on this board, you really shouldn’t be working around narcs whatsoever for your own good. Dialysis would be a safer choice. You don’t want to f*# up your program and have disciplinary action or lose your license.

Also I’m Cal but at a PEC. 1:4 here.

I am in California

I work for a big for profit company that contracts with county mental health services. So of course they skimp on worker/patient safety in the name of the almighty dollar. my job is in a crisis center that also serves as a hub for finding beds for patients on holds. Management says we don’t take aggressive patients because we don’t do restraints and are not equipped but then says we can’t turn anyone away. We had a call that a prior patient was coming back our way. He had done a long time in prison for a violent crime and staff had to call 911 last time because he was a threat to the staff’s life. We only have 2-3 staff at night and if there are peds patients, it can be just one staff member alone with 1-4 patients. I can’t get over this fear now about my job. we don’t have a panic button, I think the police would have a hard time getting inside right away. I am thinking about threatening to walk if they won’t hire more support staff. It’s my day off and I’m gripped by overwhelming anxiety and I’m the least anxiety-prone person in the world. I love psych but I don’t want to be scared at work. Any advice on how to handle this? I already see my own psychiatrist and therapist so I’m good on that end but want to handle this in a way that will get our staff some support.

That’s true, I guess “small talk” made me think of talking to strangers/pts not coworkers, but for someone really antisocial, I guess they may not want to talk to their coworkers either!

A lot of this actually makes some sense to me... holding onto the pills can prove she didn’t sell them... testing positive upon entering treatment is usually necessary if you want your health insurance to pay for it... I am dual-diagnosed (pretty severe end type 1 bipolar & PTSD as well) in addiction to long term polysubstance addiction. I played my mental health issues down and that has not been a big deal. They do take suicide attempts/plans/hospitalization VERY seriously (at least in California), seemingly more that substance addiction (but I only know about that with people already in monitoring. Also, I had two separate complaints but on the same license. I completed Diversion from 2010-2014 for diverting Dilaudid. I have been in again for over a year this time because someone found my kit at work (heroin, spoon, syringes etc). It went off my record before and will again should I complete. This is definitely my last chance with them though. I didn’t respect the illness enough the first time and thought I had moved past it. Now I realize I should never work around IV narcotics again and I take Vivitrol.

My initial test with the program was a hair test (In which they don’t care if was a dirty result, they do it as a “baseline.”) I would strongly advise you don’t shave! I did only admit to heroin on my intake and I’m sure my test popped for methamphetamine and benzos as well but they never mentioned the discrepancy. These programs are extremely savvy, it is 100% ALWAYS better to fall on your sword than try and be deceptive. Also here in California they are doing random hair and blood testing throughout the program. if this is your first test, I wouldn’t worry. If you are partway through the program, cross your fingers and hope for urine/blood. They sell special shampoos at head shops if you need a last ditch resort, but IDK if they are very reliable.

SANE nurses in Cal at least are mostly certified in adults and peds. In addition, At my hospital we also covered physical assaults and abuse, which isn’t always the case with many places. My typical day was a 12 hour shift where I hung out in a private office with kitchen, living room, interview room, and exam room. When a patient presented in the ER, I would go down and do my thing if it was straightforward stuff or bring them back to do in my office if it was sexual or something sensitive (After the pt was medically cleared). Some cases had to be done in the ER while pt is being worked on by a ton of docs, which is very stressful. Trying to photo injuries real quick and not interfering while someone is being intubated etc. if someone expires, it becomes a coroner’s case and we are out of the loop. Sometimes we did them on the floor or ICU if we didn’t catch them in the ER. The physical assaults are pretty quick but child abuse and sexual assaults can take around 3 hours. So if you get a backlog of pts, you are stressing. 85% of the time it’s pretty chill and the other 15% is gnarly! Also it involves lots of interaction with law enforcement.

Obviously, surgery is an exception to the rule. It does really suck though. Just because we can’t take things routinely, even with a RX, doesn’t mean there aren’t exceptions, like surgery or an emergency. You can take narcs etc as prescribed in those situations within Diversion’s guidelines (here in CA that means notifying your CM ASAP, notifying the prescriber that you are on monitoring, documenting with the Dr the disposal of any leftover meds and passing clean for 2 random drug screens after finishing the meds before being allowed to return to work).

It’s rare that you have to testify. Sadly, the vast majority of these cases never see their day in court.

Most jobs are all call. You get a little pay hourly and then if you have to come in for a case, you either get a set amount or a higher hourly rate.

I worked as a forensic nurse examiner. They trained me on the job and sent me to SANE training. I worked with adult and child sexual assaults, domestic violence, suspected child/elder abuse/neglect, physical assaults and animal bites. I wouldn’t say it is anything like Forensic Files or any of those shows because you are doing patient care. It involves tons of photography for all cases. For sexual assaults: bagging up clothes for evidence, taking and packaging swabs and doing a pelvic exam (adults) for cervical photos and lady partsl/cervical swabs and also drawing blood/collecting urine. You also give Antibiotic IM shots, morning after pill and occasionally HIV meds. But the focus is always on paTient care. You also have to interview the patients and ask them a series of questions and fill out legal forms and write up a narrative report. I only have my ADN but I was a volunteer for Rape Crisis Center so I that’s what got my foot in the door. I recommend taking the advocate training program through your local rape crisis and doing some volunteer work for a while. As an advocate, you are usually present at the bedside while the nurse does the SART exam so you will get a better idea of what it involves. There is a high burnout factor for a lot of people In this field but I personally love it, it is my passion. Also you occasionally may have to testify in court.

OR circulating nurse. Easier to get in at an ASC than a hospital.

I hated every minute but did it for close to two years as a new grad. It opened a lot of doors for me so I’m glad I stuck it out for a little while. I have worked in GI, ASC’s, Forensics and Dialysis and it’s so nice never having to wipe butts again or feel like everybody’s errand ***. But I would not have gotten most of those jobs without the med-surg foundation.

Definitely the Ironman. Glows in the dark, shows date & time and does military time. Affordable.

Outpatient dialysis pay is not good in southern California at least for those two companies. Also, instead of giving you a 12-hour rate like a hospital, they give you a “base hourly” with time and a half from hours 8-12 and then so on, like overtime on a non-nursing job. This screws you on training days etc when you are scheduled shorter days. TBH, DaVita was the lowest pay I’ve made as a nurse and I went in with 10 years nursing experience. They are such a giant corporation (Fresenius too) who care too much about their bottom line to do right by their patients or nurses. Seems like they will hire anybody. My experience with non-clinical management was not good either but I did love some of the RNs and LVNs I worked with.

Yes. I was fired for diverting narcs in California. I went on disability for a year (the max) and had Cobra for awhile. When my disability was up, I filed for unemployment. I did have to go through an appeal hearing over the phone but it was granted. Helped me scrape by for a few more months till I could work again as a nurse.

I had a RX for a Vistaril and My case manager told me I couldn’t take it.

I would not self report! At least in California it doesn’t really make any difference if you’re self referred or board referred. I would either ask HR or just cross my fingers. Since they told you to reapply, that sounds good. I mean, I actually got fired once for diverting narcotics and was NOT reported. They told me they would not report me to police or BRN. Then got fired from a hospital for refusing a drug screen due to suspicion and again was not reported. I realize this is making me sound terrible but I was deep in addiction. I finally did get reported which likely saved my life and I needed board intervention to stop. I tried rehabs, meds etc on my own. But if you are not an addict, I would NOT self report. Most likely you’ll be fine. It sounds like you have a good rapport with your HR contact, so maybe ask her if they’re reporting you if you can’t live with the suspense.

I know a recent new grad on probation who got a job for an adult day care center. Also, I’m pretty sure DaVita would hire you. They hire new grads and diversion/probation nurses so maybe they’d go for both. I worked there and I hated it. Seems they will hire anybody. Also, if you are willing to relocate, rural hospitals would likely hire you. I knew a new grad on probation for an old dui who got work at the hospital in Joshua Tree on med surg and then moved into the ER.