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accepting new patients, providers are out of network with insurances, provider/insurance lists are out of date, appointments are being scheduled too far out, parents get frustrated with process and kids don't get needed care, lack of knowledge, etc.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.

the himss board of directors approved this position statement describing how to transform nursing practice through technology and informatics nurses are key leaders in developing the infrastructure for effective and efficient health information technology that transforms the delivery of care. recognizing this vital leadership role of nurses in providing quality patient care, the himss board of directors approved a [color=#5a6d91]position statement describing how to transform nursing practice through technology and informatics. leaders from the [color=#5a6d91]himss nursing informatics community, representing over 2,900 members who not only serve the nursing profession, but also, the broader healthcare industry and himss membership at large, developed the position statement. the position statement supports the landmark report from the institute of medicine and robert wood johnson foundation, future of nursing: leading change, advancing health report. the report provides criteria to transform the nursing profession, leading to new roles and leadership positions for nurses in the redesign of the healthcare system. as stated in the report, "the united states has the opportunity to transform its healthcare system, and nurses can and should play a fundamental role in this transformation. however, the power to improve the current regulatory, business, and organizational conditions does not rest solely with nurses; academia, government, businesses, healthcare organizations, professional associations, consumers and the insurance industry all must play a role." himss concurs with this statement and has outlined specific actions in its [color=#5a6d91]position statement for each of these constituencies. in addition, as noted in the position statement, a new type of nurse leader role is emerging: "the nursing informatics executive." ...himss expects a growing demand for this strategic and operational role to permeate the majority of healthcare organizations to support not only nursing practice, but the entire care delivery team in anticipating and adapting to changes in the healthcare environment. emerging nursing informatics leadership roles are critical to engage in the necessary transformational activities and bridge the new care delivery models into clinical practice with the right technology solutions...(from the position statement) "nurses are an integral part of successfully achieving improved outcomes, optimal wellness and overall population health management,'" says joyce sensmeier rn-bc, ms, cphims, fhimss, faan, vice president, informatics, himss. "involved in all aspects of healthcare, nurses play a role that truly puts them in a pivotal and important position where they can both influence healthcare reform and manage patient care needs across the continuum of care." about himss himss is a cause-based, not-for-profit organization exclusively focused on providing global leadership for the optimal use of information technology (it) and management systems for the betterment of healthcare. founded 50 years ago, himss and its related organizations have offices in chicago, washington, dc, brussels, singapore, leipzig, and other locations across the united states. himss represents more than 35,000 individual members, of which more than two thirds work in healthcare provider, governmental and not-for-profit organizations. himss also includes over 520 corporate members and more than 120 not-for-profit organizations that share our mission of transforming healthcare through the effective use of information technology and management systems. himss frames and leads healthcare practices and public policy through its content expertise, professional development, and research initiatives designed to promote information and management systems' contributions to improving the quality, safety, access, and cost-effectiveness of patient care. to learn more about himss and to find out how to join us and our members in advancing our cause, please visit our website at [color=#5a6d91]www.himss.org.

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.

I feel a great disservice has been done to the mental health community by closing the majority of psychiatric State Hospitals. They were working, making a few bucks, feeling useful, finding comfort in the solidarity of peers, and most importantly, being treated at the same time for their illness. Now granted, way back when some bad things were happening in psych of course, but I think the state hospital system should be reinvented. There are so many beatiful old buildings rotting and even more beautiful old sick people rotting on the streets, b/c they are unable to care for themselves. This was especially evident when the closings first started happening. How can you take so many people, who have only known institutional living, and expect them to care for themselves, with such severe illness? Anyway, I naturally agree with mental health care needing reform and more money being spent on it. Hasn't anyone that matters noticed that so many medical pts. also have untreated mental health issues? (don't we all?...lol) Great topic Dave!

I've never been a hiring manager in nursing, but I think honesty is important. Tell them just what you told us. Your enthusiasm will show. Good luck with your interview and your journey in psych nursing:)

I went to psych right out of school and mostly loved it..did it for 10 yrs. Then I got burned out from nursing altogether, but not the patients I was working with, more the politics of nursing. Now I'm going back to school for Health Information Technology/Health Information Mgmt and eventually Informatics. Do I have any regrets? Yes, I wish I would have had the confidence to do something a little more medical, that I had done some basic med/surg type nursing here and there, for skills upkeep. Other than that, no, psych was incredible and will always be my heart. I love my psych patients...all of 'em!

When my unit was transitioning to siemens EMR, bar code med admin, CPOE, etc, all this past year or so, they had mandatory training sessions on all shifts. You had a certain amount of time to complete it, i.e you had to fit yourself in to the class but there were a month's worth of classes you could go to and it was paid b/c it was done during your shift. The facilitator or nurse manager would find coverage for you to go to your training sessions. During these sessions the instructor (a nurse informaticist) would have an overhead going where she would go through all the screens and show us what to do, and we would all be in front of a computer, on a simulated training type version of the program, and have a chance to go through everything and actually work on simulated patient charts. You could ask any questions at that time and get additional help if you didn't understand something. Most of the stuff is very user friendly and very few nurses had trouble picking it up. Hope that helps!

I just found this post while doing a search for HIM and clin doc specialist, in my seemingly infinite quest to figure out which direction I want to go to get away from the bedside. Eerily, I took the test and am also an INTJ. Literally as I read the description, the hairs on the back of my neck stood up and I got chills. I could relate to so many of you on here in your descriptions of yourselves. I personally am looking into HIM/HIT and informatics so coming across this was kind of like a welcoming beacon for me. However, I have been a psych nurse for 12 yrs and I am not sure that without med/surg or critical care experience that I will be accepted into a clin doc specialist role but I am certainly going to do some serious looking into it!

Have you looked into nursing informatics at all? There is a forum on here about NI which is very informative and can probably answer some of your questions and possibly guide you a bit.

here's the content...computerized system slashes psych drug errorsby charles bankhead, senior writer, medpagetoday reviewed by robert jasmer, md; associate clinical professor of medicine, university of california, san francisco march 24, 2011 use of a web-based computerized system accessible to all caregivers has cut psychiatric medication errors by 75% over five years, according to the team overseeing the system. the number of errors declined from 369 in 2004, the first year of the program at a large urban inner-city hospital, to 89 during 2007. the overall error rate decreased by 80% to 90%, whether defined in terms of patient days or billed doses of medication. the improved performance occurred during a period when annual admissions to the psychiatry unit doubled, as reported in the march issue of the journal of psychiatric practice. "the process of studying one's own system and the teaching of a culture of safety have broad applicability," geetha jayaram, md, of johns hopkins, and coauthors wrote in conclusion. "the [approach] can be easily adapted to many systems, including paper-driven ones. "it should also be noted that we did not encounter much resistance to the system launch and application. we continue to refine the options offered by the [prescribing system] to exploit the full scope of an electronic system in error prevention." in report released in 2009, the joint commission identified medication errors as one of the five leading causes of sentinel events, defined as an unanticipated event that results in serious injury or death unrelated to the natural course of a patient's illness. many other events that do not meet the definition of a sentinel event often go unreported, the authors wrote in the introduction to their paper. as a consequence, hospitals and other healthcare institutions might not learn the true cause of the errors and determine how to prevent them. psychiatric medication errors have also received scant attention in the medical literature, the authors continued. in particular, no long-term prospective efforts to reduce medication errors in psychiatric care have been reported. in an effort to generate needed data, jayaram and colleagues conducted a prospective evaluation of psychiatric medication errors before and after implementation of new medication error reporting and medication ordering systems. prior to 2004, medication errors were reported by means of a pharmacy-driven electronic reporting system. in 2004 the medical center introduced the patient safety net (psn) error reporting system, and all healthcare personnel received training in use of the system. the switch to the psn marked the transition from non-standardized reporting of medication errors to standardized documentation. the pharmacy-driven electronic reporting system required less than 30 seconds to file a report, the authors wrote. in contrast, each psn report requires three to five minutes to complete. though available to all healthcare personnel, the psn is used primarily by the nursing staff. the system allows healthcare personnel to enter events at the point of care and categorizes the degree of harm caused by the error, following criteria developed by the national coordinating council for medication error reporting and prevention. jayaram and colleagues documented psychiatric medication errors that occurred in 2003, the year before the switch to the psn. then they compared results from that year with those from 2005 and 2007. the five-year study period encompassed 65,466 patient-days and 617,524 billed doses of medication. during that time, the number of admissions increased from 13,226 in 2003 to 26,894 in 2005 before declining slightly to 25,946 in 2007. comparison of 2003 with 2005 and 2007 and comparison of 2005 with 2007 revealed significant reductions in medication errors for all comparisons (p the reported error rate per 1,000 patient-days declined from 27.89 in 2003 to 5.50 in 2005 to 3.43 in 2007. the reported error rate per 1,000 billed doses declined from 2.07 in 2003 to 0.69 in 2005 to 0.39 in 2007 (p the number of errors declined in all categories of the medication process, including prescribing, transcription, preparation, administration, and monitoring. three errors met criteria for causing harm to patients. all three occurred during 2005 and all of them met the minimum threshold definition of harm. although applicable to a wide range of psychiatric-care environments, the reporting process works best with access to computer and related resources. "this in-hospital study demonstrated that the highest rate of prescribing success is achieved with computerized systems that have integrated decision support for drug selection, dosing, drug allergy alerts, drug interactions, patient identifiers, and monitoring, as compared with manual systems with minimal decision support," the authors wrote. limitations to this in-patient study included its single-institution design, which restricts its applicability to another facility and to an outpatient setting, the researchers noted. additionally, jayaram and co-authors wrote that the scope of the review of the actual error rate was limited by sampling only 120 randomly selected charts and many errors may not be self-reported or detected by provider order entry. thirdly, they acknowledged that although there was a reduction of manual errors, computer-generated errors were encountered and "such errors highlight the need for constant retooling of the system." they added that a doubleblind design would have been superior, "since it would have yielded clearer results concerning benefits and outcomes of interventions."

Hopefully this link works. From my 2 favorite fields, psych and informatics. https://readingnurse.mednewsplus.com/html/topicdetails.asp?topic_id=25519&section_id=146

Also having worked in many aspects of psych nursing for the past 12 yrs, including psych ER and intake, I would concur with mentalhealthRn completely. You really need to have experience in psych assessment before being able to do this job. There's so much liability in this position. I mean ultimately the docs decide who's admitted, but as was previously stated, they depend on the nurse's thorough assessment and judgement in helping them decide who to admit vs who to send home, who to send to outpt, etc. Sometimes the doc will literally look at your assessment, say "what do you think" or "where do you want them to go", talk to the pt for less than a minute, and send you orders for what you suggested. So its very important that you feel knowledgeable. Also you may have to deal with insurance companies, precerts, etc which can get hairy when you are also doing all the psych evals. Its a very interesting and at times exciting job, b/c you never know what's coming through the door. But you will also get those same feelings on the floor with psych and it would be wonderful if you could get even a little experience first. Best of luck to you starting out in psych:)

At the freestanding psych hospital I used to work at, most people wore street clothes. Could even be sweats on the night shift if you wanted to. The night call docs wore them all the time, and slippers. And would actually come and eval pts. looking like that. It was pretty funny! In the psych unit I worked at most recently, which was attached to a medical hospital, and had more medically compromised and geripsych pts, most staff wore scrubs. However if you wanted to you could wear nice khakis or black slacks, kind of business casual, but few did.

I concur. Of course I worked all psych, including substance abuse/ dual dx/etc. There were more times than not people at the med window yelling for their pain med, coming up saying they have 10/10 pain after they were just seen on the unit catching a smoke, standing around with other patients, smiling and laughing and appearing to be having a grand old time. How can you be in the worst pain of your life, unbearable 10/10 pain, and be doing these things? I don't think so. I will give you what you have ordered but for those patients in particular I am not calling the doc( who we have already asked b/c you were so upset earlier)for MORE pain meds. Now don't get me wrong, there are lots of patients that are really in pain and use their pain meds appropriately. I know, I know, pain is what the patient says it is. But let's be real folks, how much are we really doing for the seekers out there?