PsychRN98

Thanks for your input @oldmahubbard. I am actually surprised by that no-show rate! Not sure how long the wait was at your practice, but I do wonder if the no-show rate was partially because those folks ended up needing a higher LOC after having to wait 6-8 weeks or more to be seen. That is what the wait times had been nationally for med mgmt providers in my experience anyway, for past 5-6 yrs, when I worked psych case mgmt. Anyway, the grant is for a year, with the possibility to be extended, and it is only PT for now. I am hoping because it's only PT that I won't burn out too quickly. You are correct on the NP part; I already told the office that my long term goal is to become a psych NP:) I am looking at the bigger picture in this job, which is that hopefully if I do well the docs there will provide me letters of recommendation that I will need to get into a good MSN program in a few years and perhaps I will be able to network well enough to find a provider for a collab agreeement.

Hi Guys! It has been quite some time since I have been on, but I am looking for suggestions/advice/thoughts about a new job. I was hired at a peds practice for a grant-funded position as a BH Nurse Navigator and I start next month. This is a brand new position that the providers were seeking because they feel there is a huge access problem with BH ...i.e not enough therapists/psychiatrists accepting new patients, providers are out of network with insurances, provider/insurance lists are out of date, appointments are being scheduled too far out, parents get frustrated with process and kids don't get needed care, lack of knowledge, etc. The practice felt bringing in a BH nurse would help to bridge this gap a bit. It is very exciting to be part of something new but also a little intimidating because of the unknown. I will be responsible for ensuring pts. with MH dx receive comprehensive/coordinated services, conducting BH intakes (hx gathering, review of patient/teacher questionnaires, screening), acting as community liaison for the practice for BH networking and info gathering for community resources, providing education/counseling to patients during office visits and via telephone, and providing practice telephone triage support as needed. The only hands-on stuff I will be responsible for is regular f/u visits for kids on BH meds, (mostly ADD and anxiety/depression) where I will check VS and monitor for SE, and if there are any issues then the provider prescribing will step back in. They said these will be billed to insurance as "nurse visits". Advice/suggestions on working in this environment(peds practice) with the job description listed above? Have any of you done anything like this that you can share some of your experience with me? Seems like case mgmt with some education/advocating/counseling thrown in, right? Any concerns that you see from what I described? (I am an ADN RN (20 yrs), starting a BSN program in January. My background is in acute IP psych, psych ER, and telephonic psych/BH case mgmt. I have years of experience helping kids' families navigate the system but minimal hands-on peds experience. I am NOT a therapist but would like to pursue my NP in the future so I can legally be:))

OP, check out a company called Accolade, Inc. Essentially, they are nurse concierges, but apparently a lot more too! The RN position is titled Clinical Health Assistant.

Haldol and Ativan IV? Never gave it that route in either the freestanding emergency psych facility I worked at for 8 years or the hospital-based psych unit and psych ER I worked at for a year. We always used IM meds, and usually they were effective. Of course there were a few exceptions over the years of those who no amount of meds would touch (pcp, etc). Usual dose though was 5 of Haldol (never gave 10 at once) with Ativan and either Cogentin or Benadryl. The freestanding emergency psych was much more liberal with the meds ordered than the hospital-based one, interestingly.

This is actually very common. Many of the psych techs I have worked with have went on to become psych nurses, and of course get jobs right away b/c they are known to the facility already. Absolutely a smart move. You will get to see so much and learn great people skills, which will be essential once you become a nurse. You will have a hand up on those folks fresh out of nursing school who are green. Good luck:)

Yes, America has quite the nasty psych history as well, so I believe what you are saying completely. One of the reasons I went into psych nursing was because I saw how horribly people with psychiatric illness have been treated, and unfortunately still are in some places. Even our fellow nurses, who aren't in psych, have been known to look down their nose at our chosen profession, and oftentimes our patients. It's great that there are now laws against the barbaric treatment that you are referring to and newer forms of "treatment" are available. Would you mind a dialogue about general psych care in Ireland vs. the States, i.e. what are your restraint policies, does it vary by facility or is government mandated, etc? I find it quite interesting, would love to hear the comparisons, and would welcome the opportunity to possibly institute change for the better.

@manchmal All very good questions to be asking ahead of time, as in the moment it can be very high-adrenaline. Know that the first few times you might shake a little and be nervous about giving a shot with 10 people standing around. I always hate when staff has someone down on the floor and I'm drawing up. The Ativan seems to take forever in that moment, lol! But over time you will do this very frequently, and you will get better each time. Also, you will see many different techniques, does NOT mean they are the right way to do it. Learn the right way(as you are doing), try the right way, and determine what works best for you. In these situations sometimes things are a bit tweaked and oh the positions you will contort yourself into in order to safely give an injection to the patient, and not your peers, who are in very close quarters with you, lol! Also @chevyv had some very good advice and I can totally relate to what was said about other staff just wishing you would put restraints on right away. It can be tough but usually it comes down to "I have a license to worry about, so we are doing it this way." Really does take patience! Good luck with your new career @manchmal:)

That's so interesting @irishpsychintern that you have to, by law, ask a pt. 3x to take something po. I'm sure that gets old in a code situation.

This post made me chuckle. I have been a psych nurse for the past 12 years, low on the nursiness scale. And to make matters worse I am now back in school for healthcare IT and hopefully eventually informatics. WOW..way off of the nursiness scale. I don't give a hoot, I earned my credentials and I did/am doing what I enjoy. Who gives a hoot what other more "nursey" nurses, or the general public for that matter, think?! I do not. I used to love psych. And when I didn't anymore, I chose to go back to school for something else I love. What could be better than doing what you enjoy, despite others' opinions? I have respect for all of us here that have earned our credentials, wherever you work.

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I actually went to a private 4 yr college right after high school b/c my family wanted me to be a doctor. Well, that lasted about a year. I came home, went to CC, and became a nurse. Now I'm going back to school again, choosing CC again (for many reasons) but will eventually pursue the higher degree as needed and my new career demands. There are obviously advantages to both and it really depends on what you want to do with your life. Education is never a waste!

Oh, and this unit also did not allow any personal devices of any kind. Pts. are admitted from the ER in hospital clothing to the psych ER and any visitors onto the unit had to pass through a metal detector. All cell phones, mp3 players, etc had to be either given to family members to hold or placed in lockers until they were discharged or transferred. All under the auspices of safety; which after you have a a few pts swallow batteries I guess is just something that is not taken for granted. Also, I worked at an acute freestanding psych facility for 8 yrs, and there also were no personal devices of any kind allowed onto the unit. In both situation, pts. were permitted to use the phones on the unit.

These things are sometimes trial and error unfortunately, and a lot of times it seems to be because "it hasn't been done before". And then it takes some negative event for change to come around. I was lucky enough to work for a hospital that opened up an 8 bed transitional psych ER and they did have to learn a lot through trial and error. They did get some advice from psych staff, but not as much as one would expect considering it is a specialized unit we were dealing with. For instance they learned that televisions in rooms, but not behind protective nonbreakable plexi-glass, were not a good idea. That was after one was smashed because a patient didn't like his dispo plans. Also, some silly things like having sinks out in the hallways with enough accoutrements that any savvy borderline could have a field day trying to hang themselves from. However I did like that although they had clothing racks on the doors, for instance, they were collapsible after a certain amount of weight. There were many good things, and things done right, with psych staff input. Anyway, I don't have any articles as you were asking, just adding to the conversation a bit. Good luck with your new unit and I'm sure it will add great stuff to your resume.

Canchaser, I am going back to school in August for my HIM bachelor's, starting with a coding cert, with my ultimate goal to get into informatics down the line. Anyway, would you mind if I PM'd you about your coding experience and your thoughts on that?

This is kind of funny. I have been a nurse since 1998 and I am looking to get out of bedside care. I had been researching for many months what the options might be for someone like me. I think ultimately I want to go into informatics, but one needs computer experience/education AND the clinical component to be taken seriously. Why I find this funny is because I am going back to school in August to get a second degree, a bachelor's in Health Information Mgmt, with an RHIA cert (which will begin with the coding aspect). Oftentimes, contrary to what you all are saying here, all the jobs in that field nowadays require a cert and usually an education beyond high school, and most want 2-3 years of experience. Anyway, I am going to use this degree, along with my nursing, as a stepping stone up to informatics, as I will gain quite a bit of computer education along the way. I want to make sure this is what I want to do before I spend the big bucks on the masters degree needed for informatics.