marshmallowstar

We assign q15 rounds in 1 hour blocks at the beginning of the shift, nurses are in the rotation just the same as MHWs. On the RARE occasion that Q15s didn't get done (it's only happened once for me and it was when two behavioral codes were happening simultaneously) we have to do an incident report that gets sent directly to QI. Check your policy it may dictate what reporting needs to happen if standard procedure isn't followed. I would hope QI/Admin would want to know/fix things. Is there a staff meeting you could bring this up at? How do other nurses handle it? Ultimately patients' safety is at risk and this needs to be addressed.

Davey, I've been waiting for you to chime in and you never disappoint :) :) :)

That's great that your unit has psychologists doing assessments and therapy, a lot of hospitals have cut it out sadly. The unit I worked on has an incredibly tight treatment team that all rely on each other's input and work. Concerns that some PsyDs/PhDs have had to adjust to when coming inpatient with us is staff splitting, because we are so tight and work with an extremely difficult population (trauma/dissociative disorders) It wasn't uncommon for a therapist new to our unit to "let someone off the hook" for something that the remainder of the team was taking very seriously. SO they may be worried you will do that, even if you won't. If having the psych/therapy team is new to the unit the nursing staff may not know how to utilize you or ways that you can be helpful to them. Something I always appreciated during team meetings when discussing a patient that was difficult for nursing staff was when the therapist would ask, "How can I be helpful? Are there specific things that I can help hold the pt accountable for or help them process that would make your (nursing) work with them better/easier)" I think sometimes nursing staff feels like we take the brunt of the "bad guy" wrap, we're the ones constantly redirecting, setting limits and boundaries, if they see you're willing to do that difficult work too it will help gain their respect. I HATED when therapists would come in and try to be friends with the patients to build rapport, it set up such a bad dynamic. I think the education you're doing with the staff can be really helpful too. Psych nursing is not stressed in a lot of nursing programs, there is a rotation but depending on the 1 instructor and 1 clinical setting you're assigned the learning opportunities can be fantastic or horrible. Also boundaries in other forms of nursing are EXTREMELY different, it is not uncommon to touch patients, to talk about what you did over the weekend or if you're married/have kids, some nurses have a hard time keeping it so client focused when they move to psych, which you know can make working with PD patients even more difficult once you've already revealed personal information and then try to back pedal. Also for newer or burned out nurses and techs (who often are still in undergrad studies) they be so focused on behaviors (understandably so) that they don't realize the motivations and internal processes that are causing the behaviors. I know understanding the internal struggle helped me manage the patients' behaviors more effectively so stressing that in the education piece of how the theoretical understanding of their illness and their assessment results can help direct their behavioral care in these concrete ways. Sorry I rambled, I love psych, and I miss my unit dearly (I left for work/life balance, scheduling reasons) Feel free to direct message me if you have questions about specific ways our team supported each other.

I agree, the university systems I've worked for preform root cause analysis on errors to find out if there are system issues that need to be evaluated. Organizations that look for individual scapegoats are not healthy places to work. It would be different if it were a pattern of behavior for a specific employee but first offense med errors usually lead to a root cause analysis and a "warning" with corrective action plan if no system issues are found. I wouldn't worry too much about your license, remember it's the board, not your employer who takes action on your license. So even if your employer reports it to the board they will do their own investigation and you typically can have legal representation through that process. That being said I've not known of anyone having their license removed for a single med error.

THIS. I worked for an FQHC and our dentists would squeeze in emergent patients. FQHCs do sliding scale and have case workers and assistants to help patients sign up for insurance. Sometimes the bureaucracy of the larger FQHCs can be difficult to navigate (large phone trees and transfers ) so if you can reach out and get the contact info for the practice manager and refer patients that are in true need that will help your patients. I know if you called our appointment line and asked for a new patient appointment we would tell you at least 3 months out but if your spoke with the practice manager, a nurse or dental PSR we would get them in sooner for emergencies. You can locate your nearby FQHCs at Find a Federally Qualified Health Center - FQHC Locations — FQHC Link - A Product of FQHC Associates Also large university dental schools often do clinic 2-3 times a week. It may be difficult to get the initial appointment, I know for our local one patients line up starting at 4am as they only take the first 20 patients in line each day but once you're established it's easier to get f/u care.

In case anyone is looking for this info in the future. The interview process is pretty in depth. Did phone interview with HR, then in person interview with HR where they also had self assessments to complete and a med/treatment recommendation quiz. Meds were pretty basic except I'm out of touch with advanced cardiac meds so I missed those. Which was ok, I still got moved on to the next round. Next round was in person interview in clinic with nursing supervisor and clinic director and then shadow time.

Talk about your interest in FNP, why do you want to do that? Those should be similar reasons to transition to clinic. If you're doing it only for the hours, don't. I can tell you that anyone who has come to my clinic and stated that in their top two reasons have not worked out. At my clinic you have to be ok with telephone work and being at a desk for at least parts of the day. Most floor nurses have not been happy because while you'll have lots of things to do and prioritize it is a different flow than hanging meds and doing q2 hour assessments. The problem solving is different, coordination of care and interacting with insurance companies can be extremely frustrating. The biggest plus side for me is doing more in depth patient education on dx process and treatment. Definitely ask for a shadow day and make sure it's something you want.

I work for the largest inpatient psych hospital in Baltimore, no coats.

Hi, Has anyone interviewed with/work for Patient First, they're an urgent care chain in the Mid Atlantic. I searched for previous posts and they're all several years old, and we all know cultures can change. Just wondering what the experience is like. Also previous posts mention a test on med compatibility, it's been a long time since I've pushed IV meds just wondering if this is something they still do. Thanks!

My understanding is under Title VI if your hospital receives medicaid/medicare funds it is required to provide a translator. My hospital has an interrupter come on site from 8am till 10pm for psych because the interactions are so varied, you can't get the pt to speak on the translation phone if they're escalated (I understand you don't even have the phone ) I would speak with your patient advocate/ombudsmen, it's not fair to your patient to receive such subpar care and it's potentially dangerous for staff and patient.

I was on the Code Blue team at my psych hospital, Keystone Kops indeed. For the *most* part our nurses are competent, it's more the residents (and sometimes attending psychiatrists) who want to do ALS when we are only BLS certified and have BLS supplies. There is a medical hospital across the street and we call 911 to transfer them. The biggest calamity of errors I saw was a seizing patient (no known seizure disorder, no known withdraw issues) and the old school attending wanted us to put something in the patients mouth to keep him from biting his tongue, then wanted us to start an IV (which we don't even stock supplies for). Luckily myself and the other nurse were both confident and able to say no and that we were going to follow protocol, the fairly egotistical attending was trying to argue with us while the other nurse and I were rolling the patient on his side, getting suction set up, drawing up IM valium, directing the floor staff to manage the other patients who are starting to escalate, luckily one of my attendings then showed up to the code (it wasn't our unit). The old attending is still yelling at us that we're being "insubordinate", my attending walks up, politely greets the yelling attending and says "Marshmallowstar, what do you need?" I said "An order to administer the valium we just drew up." She gives the order and we get the patient off to the medical hospital but jeez that other attending was quite a distraction and escalated the unit's patients and staff by his behaviors. Also had a time when a not competent nurse thought a 10 year old boy was having a stroke, was panicking, giving a very poor report to the code team and was ready to send him out 911, however I was able to get out of the patient (not the nurse!) that he had just received his first dose of risperdal 20 minutes prior, never knew that IM benadryl was a cure for stroke My best advice is to review your emergency policies, your crash cart, expected emergency med dosing and equipment and be the most educated you can be so you can be an advocate for the patient in the moment. Medical codes may not be your comfort zone but remember all your training, you went to nursing school just like the med surg nurses and have the knowledge, it's just making available in times of crisis. Sounds like you did a good job, know that med/surg nurses second guess themselves after codes, especially when a patient doesn't make it. There's no going back, if there's something you would do differently, remember that for next time and move forward. Does your hospital/unit do debriefings following critical incidents? I've found them to be helpful to get support from peers and often multiple members of the staff are impacted.

Sometimes if patients are well known, you may known they have a history of exaggerating or extending their w/d sx to receive PRNs. For opiates, I don't much mind, we really only do sx relief and clonidine so if they want tylenol or imodium and it's time, go for it. Even the vistaril we use for anxiety management is this situation is fairly benign and I haven't really had anyone seek this too inappropriately. Benzo/ETHO withdrawal is where it gets a little trickier since you're typically giving them a benzo to relieve sx and prevent significant withdrawal events. I use observation skills as I'm preparing to assess the patient, how are they presenting, relaxed? fidgeting? withdrawn or engaged with peers? If the patient's presentation changes once they know I'm observing or actively assessing then I may take things with a grain of salt. It's a balance of not wanting the pt to have dangerous withdrawal events and not wanting to continue their addiction. We had a patient that was on benzo withdrawal for 2 weeks because a newer nurse had been doing meds/withdraw assessments her first week and the patient had essentially been getting 8-12mg of Ativan daily because of her subjective scores for the first week with no tapering till one of the more senior nurses realized what was happening and had the doc switch her to a scheduled taper and assisted the newer nurse with assessments. I also make it a conversation with the patient if the score they're reporting seems out of proportion with the behaviors I'm observing. You're telling me that your nausea is at a 5/7 (on CIWA) but I saw you eat all of your dinner an hour ago and the rounds (we document q15 minute checks) say you haven't been to the bathroom since. Were you able to keep it down? If they say yes but that they feel sick to their stomach then I educate them that's probably a 2 or a 3, that someone with a 6 is actively vomiting or dry heaving. Once I challenge them/educate them on the scale I tend to get more accurate numbers. Also asking them to describe their experience instead of just a number can be helpful, "How does your skin feel?" "It feels like pins and needles, like when your foot is asleep" and "I feel like I have bugs crawling on me" gives you much more information than just a number. It's also about developing that rapport, acknowledging that tapering/withdrawing off of meds can be an anxiety producing process and encouraging them to be proactive in acknowledging and managing the anxiety instead of feeling overwhelmed and needing the med. Of course how much they're interested in changing their behaviors and addictions plays a huge part in this too.

I've worked in psych for 15 years, on and off. I've always left my full name on my badge. I've worked inpatient psych at a state prison, escorted sexual assault survivors to court hearings and testified in court against a domestic abuser, where I had to identify my full name and employer in front of the criminals. It's not a matter of whose patients are worse or more dangerous, the reality is if someone is preoccupied they will find your information when they want to, whether it's nonchalantly asking a coworker information about you, requesting their records, or any of the other thousand ways they have of getting their needs met (we all know the resourcefulness of our patients when they're determined.) I agree with elkpark, if psychiatrists have their full names out there so can we. Also I don't know of any parole officers, judges or social workers that carry firearms with them to work, and many of the police officers I know do not carry when off duty. Obviously it's concerning to you so I would also check with your portal committee. I've not heard of any portal that is posting individual progress notes, that is a tremendous amount of data to push out. Most are supplying test results and discharge summaries, which would not have a nurse's name listed. Check to see exactly what information is being provided

We have a med box with basic meds, IM epi and Benadryl since we give allergy injections, sublingual nitro, aspirin, narcan and IM Valium. Only nurses administer meds from med box. O2, again only administered by nurse. We have an emergency box that has glucometer, pulse ox and ambu bag. We don't do separate competencies for ambu bag as everyone is healthcare BLS certified and its part of that certification. We also have AEDs.

IM Geodon, Ativan are our go to emergency meds. I work on a trauma unit where pt's can become highly escalated with flashbacks or selfharm/SI impulses, but not typical acute psychosis. Our docs choose Geodon because they want to take the edge off so the patient can work through the experience not just give them a quick fix, have them sleep and have the whole situation restart when they wake up. Although we definitely using Halodol sometimes when things are just out of control. The trick I've learned with reconstituting the geodon is to NOT SHAKE. It dissolves by effervescing, you can normally see the air bubbles come off of the disc when you add the water. So I add the sterile water and let it sit while I'm drawing up the ativan, since that's going to take a hot minute itself, and then go back to the geodon. By then most of it has dissolved, I find that a swirling or rolling method works best for the last little bit. Hope this helps.