NurseExec

Take the time off. Be selfish, or self-caring if that suits you better. Get your meds right, so you can be the other things in their time. After I was diagnosed, I took almost a year off to get everything squared away. I'm glad I did. This recent hospitilization (4 years since the last), was much easier to come back from, after having that year.

Newly diagnosed, and your psych won't see you until January? You should be being seen every week to two weeks, and getting your meds tweaked based on how you're feeling. Have you considered changing? I personally love psychiatriac ARNPs--I've been with mine for 6 years. It's not necessary to feel crappy with the right care, I think. For me, transparency has been really important. My co-workers know I have bipolar disorder, and I'll just flat out tell them I'm having a weird day, when I am. Having someone know about it, not sucking it up, and having someone care about how I feel is important to my stability. Also, have you given any thought to taking a leave of absence from work (you have 12 weeks FMLA), and getting into a partial hosptialization program that can help you get some of the "how am I going to live with this" solved. Worked for me a few years ago. Working with this disease sucks. I run a 120 bed short term rehab SNF and some days I wish I could just bag it and be disabled. But ultimately, what I am is a nurse, and I would be lost without that, and my job. I expect that eventually, I'll have to find something less stressful, but I'm not living that far in the future... If you have any questions, feel free to email me Take care.

I have akasthisia from my Geodon as well, although not as severe as what I had with Abilify. I'll probably end up on Cogentin, considering I haven't been able to tolerate any of the other AAPs. It can be managed.

I've been away for awhile. It's been a rough few months, and I just wanted to check back in. I have bipolar I, rapid cycling, mixed state, and after I had gallbladder surgery I ended up in the mother of all mixed states. Anesthesia and lack of meds from throwing up post op I suspect. Anyhow, I took a LOA from my job as a DON, and checked myself into a psych unit before something horrible happened. I'm back to work now (I was out 3 weeks), on a whole new set of meds (Geodon and Tegretol) and am slowly putting my life back on track. I am so blessed to have a wonderful administrator and department head team who have my back, and support me 100%. Most touching were the CNAs who came up to me after I got back telling me how much they missed me and asking if I was ok. I'm one lucky woman-- (a) to be alive, and (b) to be able to work and live my life with this sometimes crushing disease.

I don't staff a nurse in the dining room. I have three aides there, they are CPR certified, and there is an emergency paging phone on the wall. The dining room isn't so far away from the floors that a nurse couldn't be there in under 15 seconds.

That's sort of like insisting people call you Dr. So and So, when you have a PhD in Llama hearding or somesuch, isn't it :)

I grew up in, and live in the south. We use Mr. or Miss followed by the first name. Miss Mary, Mr. John. I also Ma'm and Sir everyone older than me. I remember learning this at a very young age--not addressing anyone older than you in this manner was a major no-no and would net you a chewing out (or worse) from Mom, Dad, or schoolteachers. I like it though, because it accords respect. I'm still surprised though, when my staff call me Miss ...... Somehow it didn't ever occur to me that I would be older than anyone else LOL!

I am a Director of Nursing who happens to have Bipolar Disease Type I. My fellow department heads, as well as my Administrator are all aware of my disease, and are very supportive. I have chosen not to disclose to my employees at this time. I also disclosed to the BON when I moved here, with a letter from my psychARNP. I make sure that I take my meds, get enough sleep, and take care of my physical health as well as my mental. I love my job, and if I didn't I'd find another. Living with mental illness is hard enough--having a job that sucked the life out of you would make life pretty unbearable. Feel free to PM if you'd like. I've also done some posting in the nurses with disabilities forum, if you'd like to read more.

Think about something local for your facility--something that evokes "home" for the elders living in your local area who will become residents.

I lived in Eagle River (just north of Anchorage) and worked at Alaska Regional in the ICU/CCU from 1997-2000. At that time, it was a great unit to work in, and I had nothing but good experiences with the hospital. We did quite a few open hearts, and that was my main focus. We moved there from Missoula, Montana--so I had some idea of how to deal with living in a cold climate. However, that first winter was a doozy. Nothing really prepares you for the sheer amount of snow, the short days (about 4 hours of daylight in Anchorage in December), and the length of the winter. Summers are short (a few months) and it's never dark. Being bipolar, the light changes were brutal on me, and after a divorce, I bailed for a warmer climate.

I am BP1, and I take: Seroquel 450mg at HS Lamictal 200mg BID Effexor 75mg BID Neurontin 300mg at 5p and HS I've been on the Seroquel/Lamictal/Effexor combo for about 5 years, and recently added the Neurontin for breakthrough hypomania in the evenings. Everything is stable. The Seroquel is my main pain in the *** drug--without it, I'm manic beyond belief, but anything more than 450, and I'm too "stoned" at work the next day. Even at 450, I've got to drink at least 2 cups of coffee before I'm well and truly awake. Coffee is my friend!

We use case studies to do admissions teaching. We spend an entire day of orientation on admissions and discharges. Then, they do both during their floor orientation. If they are having trouble after that, the unit manager goes through it with them one on one. Once you have done all your education, it comes down to holding the staff accountable. The unit manager uses an audit tool to check all admissions the next day, and those go to me. Continued problems are dealt with on a individual basis (could be more education, coaching, etc).

You didn't say whether or not the BON had put you in a nurse recovery program (a diversion program). Each state has their own time frame. Where I live, it's a 5 year program, after you attend rehab. You can work, although you may lose the keys for 1-2 years. You would attend a weekly group meeting, and be required to have random drugscreens and provide proof that you attend AA/NA 3-5 times per week. I've been sober for 9 years, and I couldn't have done it without the BON--the support and the accountability was key. PM if you'd like.

Here's what we do: 1. The desk nurse takes off the days orders and during the transcription process, updates both the computerized order system and hand updates that month's POS/MAR/TARs. 2. The night shift nurses check each chart and make sure the POS/MAR/TARs have been updated to the most current telephone orders (redlining). 3. Every day, the unit managers take the previous day's orders and check that the POS has been updated. 4. We print one week prior to the end of the month. I have extra nurses come in and do nothing but changeover. They check the new POS against the old ones (which have ALREADY been checked 3 times), then check the new MAR/TARs against the current ones. Any changes that need to be made are given to the desk nurse, who updates the computer. 5. The desk nurse, for that week, transcribes orders to the old MAR/TARs/POSs as well as the new ones. We miss a few things here and there, mainly times, and lines for BP and so forth. We have a very low med error rate. I couldn't live without my desk nurse--if she's doing her job correctly, then everything flows from that.

It's about time. It's been a 20 year long fight. I look forward to not having to "ration" the number of visits I can make to my psychARNP for a change!

So, if you had a unit manager that helped you with anything you needed (families, patients going bad, incident reporting, admissions paperwork, discharge paperwork, and so forth) they'd "just get in the way?" I'm really glad that my nurses don't think like you do.

I staff a wound/treatment nurse, a desk nurse, and two unit managers (short term and LTC). Short term is, in my opinion, impossible to run without a desk nurse--I have either a MD or an ARNP on the short term unit daily. On the weekends, I staff a free-floating house supervisor on both 12 hr shifts, as well as a wound/treatment nurse, and a desk nurse.

As a nurse with both a mental illness (bipolar disease) and the disease of alcohol addiction, I am absolutely floored (still, after 9 years sober) at the attitude of our many in our profession to addiction and mental illness. The disease of alcoholism caused me to lose a marriage, my daughter, and my career as an open heart nurse. A few days after I took myself to detox, I called the Board of Nursing and reported myself as an impaired nurse, because I HAD NO CLUE HOW TO STAY SOBER IN THIS PROFESSION. They hooked me up with a rehab that specialized in health care professionals, and gave me the support and accountability to help me stay sober. I will be forever grateful. I'd love to see a peer to peer type program regarding addiction that works with nursing schools. I've never heard of one, and I think it's something that is sorely needed. Sadly enough, one of my best friends in nursing school died of an overdose of dilaudid that she diverted only 6 months out of school. I didn't find out until after I was sober. I couldn't help thinking....but for the Grace of God, go I.

1.) What kinds of writing did you have to do to get the job you have? The usual business writing skills. However, I was a technical writer in my previous career, so my writing skills were excellent. 2.) What kinds of of writing do you do routinely on the job? Mainly memos, general DON stuff (call schedules and the like), and emails. 3.) How important are writing skills and communication skills to your profession? Communication skills are extremely important, as I may interface with the medical staff, regional management company staff, department heads, nursing admin staff, outside agencies, and my staff nurses/CNAs in a single day. Writing skills are important, but not as important as communication skills. 4.) Which skills are the most crucial? As above, communication skills are paramount. 5.) How prepared were you for the writing tasks demanded of your job? Very prepared, as I was a technical writer in my previous career. 6.) What do you wish you had known in terms of writing before you started work? I can't think of anything. 7.) Do you write for personal reasons outside the job. Letters, blogs, journals? Blogging is my hobby. I have both a personal blog and a nursing blog. Writing has been a hobby since I was a child. I wish I had all my notebooks, but they got lost in one of my moves.

I only drive 5 minutes to work--which is the absolute closest I have ever lived to work. The longest trip I've ever made was 1.5 hours to my first nursing job. I finally quit driving the whole distance and drove 30 miles to commuter parking, and took the bus the rest of the way. For me, 30 minutes is the absolute longest drive I'd make. I'm too old, LOL, to be driving an hour to work, then working a 12 hour shift. The last time I did that, I was burned out in 6 months.

1. How long have you been a smoker? On and off, since 1985. I'm in an on phase right now. My longest time without cigarettes was 11 years. 2. How often and how much to you generally smoke cigarettes? I smoke 1/2 pack daily. 3. What is your reasoning for smoking? Every time I pick it up again, it's during a time of increased, significant stress. In my mind, it beats picking up alcohol (I've been sober for 9 years). 4. Do you find any advantages to smoking? (Give examples)It has a calming effect on me. 5. Do you find any disadvantages to smoking? (Give examples) The morning cough. Ick. 6. Are you comfortable enough to smoke around non-smokers? Not particularly. Why or why not? Hubby is a recent quitter, and I don't think it's fair to smoke around him, so I attempt not to. 7. Have you ever attempted to quit smoking? (If yes, what steps did you take?) I've quite several times, always cold turkey. I wouldn't mind trying Wellbutrin, which is how Hubby did it, but it doesn't mix with all my bipolar meds. Bummer. 8. What is the longest time you have gone without cigarettes since you started smoking? 11 years, because husband number 2 was a absolute dictator about it. Which was par for the course with him (jerk). 9. Do you think you will quit smoking? Eventually. Why or why not? Because when I'm smoking, I tend to pick up every cold that goes around work, plus I really don't want to die of lung cancer. 10. Are you aware of programs or services that will help you quit? Of course. I'm not one to participate in them, though.

All scheduled drugs, plus Lyrica and Phenergan. We also double lock our EDKs (Emergency Drug Kits), because they contain scheduled drugs.

30 LTC residents to one nurse is the norm in my building. I started out as a staff nurse passing meds, and it took me about 2-1/2 hours. I came from acute care, and was slow as all get out the first couple of months. I got in a groove though, and enjoyed it, once I got my time management skills adjusted. Half of my building is short term rehab, and that ration is 20 patients to one nurse. With all the IVPBs, and the acuity of the patients (mostly post-ops as above), 20 is about all that can be done by one nurse. I also have full-time, free-floating unit managers and supervisors to assist, as well as a desk nurse and wound/treatment nurse.

Good lord. This answer could be miles long, but I'll try to make it short. It won't include ALL the things I do, but it will hit some of the high points! As the Director of Nursing Services I.... Manage the largest budget in the building. That means I manage overtime, meet state minimum staffing requirements and our facility requirements, manage costs while providing all the needed items for the residents, and buy new equipment, while staying in budget. Hire, fire, and coach staff. I hate firing people, but I don't tolerate poor care, and if you're giving it, you're gone. This involves supporting my Unit Managers and Shift Supervisors in their coachings. Manage clinical programs so that we are following our management consulting company's programs to the letter. This includes auditing, educating, and daily analysis of how the systems are working. Ensure all Federal and State regulations are followed in the provision of care. This involves knowing the regulations, auditing, and ensuring and monitoring the systems we have in place. Quality Improvement. Monitor clinical indicators, quality indicators/quality measures and facility benchmarks for falls, wounds, restraints, psychotropics, etc. Work directly with the Risk Manager to put Performance Improvement Plans in place, then monitor those for compliance. That's a quick rundown, and by no means conclusive. Good luck :)

I *love* your enthusiasm. Hang on to that throughout your career and you'll be a GREAT nurse :)