PMHNP10

I'm certain I'll offend but here goes. Society is like a person with a borderline personality in that things are black or white and shades of gray do not exist. The pendulum swings too far in one direction and forces exert their effort to bring things in the other direction, which happens, but then things swing too far in the other direction. Then wash, rinse, repeat. I'd contend amongst a few other reasons this is why the US has the POTUS we have...as a counterbalance to extreme shift to the culture of everyone is a victim, they should embrace victim hood, they should rejoice in this, and everyone should be offended. It never ceases to amaze me to see how far virtue signaling SJW's will go. You can never be in full compliance with the pc culture because the goal post is constantly moved. And no this song isn't an isolated incident, it's happening across this planet and sadly it's not even one of the most extreme examples IMO (thinking specifically of the idea of incarcerating an individual for calling a transitioning male to female, a he or some other scientifically correct pronoun as 1 example). I value the US Constitution/Bill of Rights; single most important document to date. It is the foundation of this great nation. Amongst many rights/freedoms it grants us,freedom of speech is included and our courts have determined there is no such thing as hate speech and only restricts that freedom in limited capacity (e.g., yelling fire in a crowded building). Now should we conduct ourselves as civilized human beings by not calling our fellow man (oops I think I committed a micro aggression) any number of derogatory names; of course. But our current course in this country is certainly worthy of concern, not just because of where things are headed present day but because the farther the pendulum swings in its current direction; the more momentum it has to swing the other direction. Terrifying. I'm all about diversity of thought and the uniqueness of every human being in general but this is one instance I wish we were all kinda moderate, common sense oriented.

Actually the constitution states the fed laws supersedes state--article 6 supremacy clause

Most unfortunate if this is still happening. Wasn't good then; isn't good now. ok so I'm intrigued. Are they posting pics or are we talking ugly like someone being ugly? I must try to find this thread.

I was triggered by your post and felt the need to respond as a good triggerin' is apt to do. I joined a bunch of years ago ('03 I believe) and was pretty active until around 2010. If memory serves my decreased activity was at least in part associated with a time which the website was experiencing a bit of change that some might say was not for the better--cliques were forming amongst various members, people were banned and ultimately feelings were hurt; it got quite nasty unfortunately and a splinter group attempted to start a similar website, but one of the things that most stood out was the very significant increase in mod activity, deleting and editing posts at the first sight of some post possibly being perceived as offensive to someone. I mentioned this because it would seem based on what I'm reading in this thread that the happenings of 2010 were the beginnings of what many of you are reporting today (hopefully with less bannings/post deletions), so it seems like a natural transition over time. I must say I've noticed that it's been more difficult for me to find a thread that might be interesting to participate in or prove helpful, but figured it was because of the changes in the website that made it difficult for me to find stuff.

interesting question. Unfortunately I had the experience of 4 months of visiting my daughter in the NICU and I did mention I was a NP just as a way to relate to those taking care of my daughter. I tried to make it clear I only treat things going on between the ears and not what's happening below the neck (and I've chronicled my lack of l&d/babyhood knowledge on this website) but I do wonder if we became a topic of discussion (wife is RN too) amongst the numerous nurses who provided care or if they generally didn't care. I know our baby became like a local celebrity during her NICU stay as well as the 2 subsequent pedi floor admissions because they always had her at the nursing station when we weren't at the hospital and others from all over the floor would come by...

C'mon, you were asked what makes a good day, not to detail your wildest fantasy. For me a good day is simply that each of my clients show up on time and I do not fall behind. A great day is that a majority are doing well or at least better than they were the last time I saw them and if someone has a need I'm able to address, I do so. A great day may also be hearing that someone decided to act on something we discussed at a prior appointment and this resulted in them making a very positive change. I land in the middle of fantasy island wishing everyone was med/treatment compliant and in remission, but it sure would be nice.

I have a cure--abolish each and every one of these scourges or our educational system. See...no test = no anxiety about the test.

Winry I think you're on to something. In spite of the popular narrative seen in the media, maybe, just maybe all (or even a majority of all) police officers don't make decisions based on race. The preconceived notion is very unfortunate.

I don't want to assume, but are OR NPs given full practice independence/autonomy--i.e., can Rx sched II-V without physician oversight, practice without a collaborative or supervisory agreement, therefore able to open their own private practice and practice independently? I suspect the AMA will do everything in its power to ensure NPs do not become credentialed providers within many PPO/HMO plans. So that's great, you get to make as much as an MD; good luck finding an insurance plan other than Medicare/Caid to credential you. Maybe I'll be pleasantly surprised.

I would say it is. The VA I recently left instituted policies where it would almost take a letter from congress to get an opiate and if you were on an opiate, you were likely going to be switched to tramadol whether it worked or not. We had a pain mgmt. clinic but it was pathetic when it came to medicating. If someone tested positive for a benzo or barb or amphet they would automatically dc the opiate and refer them to substance use; never mind that they were on Zoloft or ibu or Wellbutrin; they didn't want to take the time to further investigate. And the opiate ban like the 3 strike criminal laws--permanent--althought you only got one strike in this case. Typical fed govt idiocy. I of course would have to deal with these individuals when they came to the crisis clinic and reported they were going to commit suicide rather than deal with the pain. I get that. Pain is debilitating. From an anectdotal POV, I severely sprained my foot a year ago. I was out of town and went to an urgent care clinic thinking something very well could have been fractured given the pain/swelling and discoloration. The doc/staff were quite surprised nothing came up on x-ray, but then again the swelling may have covered up a crack. So while I was there they gave me a lor-something. This was a Saturday. I asked for a Rx for 3-4 days. He said that if I wanted something beyond the 1 he gave me I'd have to go to my MD. So most PCPs don't do weekend hours and even if they did at least Saturdays, I wouldn't have been able to get home before their office closed. Also, it's not always a guarantee that you'll be able to get an appt. same day, so no guarantee I would be seen on Monday. So I had to live with ibu. I like ibu fine for most issues (fortunately I don't have any chronic pain issues), but yeah that was quite a miserable weekend and by the time I got in to see the doc the pain was manageable by ibu. When I was earning my MSN I did a paper on the misuse of prescribed opiates. I ran across a source (which I could never find again) which said the US uses like the upper 90% of all opiates in the world (and I wanna say it was 99%). I'd be curious to see more recent statistics to see how much the pendulum has swung, if at all.

Not sure what's ridiculous about it--I'd love to find an original research article, but here's a link to a Medscape article on one study indicating there is in fact an increase in violence in individuals with PTSD: Medscape: Medscape Access I don't know that I totally agree, but once again, more studies needed to get a definitive idea. Smoking Marijuana Not Bad For The Lungs - Medical News Today Not correct. I don't know how much experience you have working with schizophrenic patients, but have you ever noticed why schizophrenics smoke like chimneys (and at a significantly higher percentage than the general population)? Also, if you observe them they often take real deep hits of their cigs. There is a reason for this. Schizophrenics have a really hard time with congnitive function such as focusing on a particular stimuli. So if you are speaking with them in an empty room and are trying to educate them (because that is what we do as nurses) the air coming through the vents, the sounds of traffic and/or people outside the room and any other noises take equal precedence to your voice. When nicotine hits the nicotinergic receptors in the brain they achieve brief moments of mental clarity, so to speak. Unfortunately nicotine's action on these receptors last a few seconds, hence the need to smoke 'em while you got 'em. If someone makes a blanket statement that marijuana is safer than alcohol (i.e., without a qualifying statement such as abuse, addict, misues, etc., which a few did make blanket statements), I say that is a false assumption as I stated in my OP. For example, a glass of wine with dinner for most people who do not have a history of an unhealthy relationship with alcohol is less problematic than casual use of mj (whatever one might consider casual use given there are no established safe guidelines for mj use). I did not say or even imply mj use predisposes anyone to schizophrenia. I said there is an increase incidence of mj users later meeting criteria for a dx of schizophrenia; there is no causative relationship, rather a correlation. To be clear, individuals can have the genetic predisposition for schizophrenia and never exhibit a psychotic symptom. Perhaps chronic mj use is that environmental factor (or one of many possible factors) that result in the expression of that schizophrenic gene. I'm not a genetics specialist, so I can only speculate about the possible details of the link between mj and the dx.

I'd only advise caution in general on this--While your employer may not do random drug tests, it is possible that if you were to get a needle stick or other exposure to bodily fluids or some other injury on the job, or if the narcotic count is off, drug tests might be a part of the standard protocol.

I don't know that I'd be billing as I'd be working for a company that would take care of the billing.

I have a few questions: 1) What do you think of telepsych? 2) What should one expect for reimbursment? Revenue split? Hourly (what rate)? 3) What should one look for/expect from the telepsych company? 4) What do you feel have been the positives of delivering psych care through a monitor for you? Negatives?

I just read an article that someone posted on Facebook about this. I thought this was new news and made some off-the-cuff statements like the nurses will **** and moan but ultimately pick up their mops and scrub brushes and get to work. 4 months later...

Mostly it was to demonstrate my point that i dont treat HTN. I just pulled the first med that came to mind without giving any further thought such as if on any other anti hypertensives or dosing. Fwiw I've rx'd kapvay for ADHD which calls for bid dosing, so the form with a reduced half-life isn't a daily med.

Bits and pieces about my perspective on things mentioned in this thread: 1) Psychiatry is an art AND a science. 2) As a whole, I give meds 20% of the credit; the other 80% is on the client. 3) I remain aware of medical Dx's that might mimic any given psych, and certainly I'll order tests to rule in/out a medical cause of presenting symptoms, but to Rx meds to treat things like HTN, diabetes, pain, hypothyroid, pernicious anemia etc. adds significant risk to my license; I opt to refer. Put it this way...patient come in with BP 195/101 (no other symptoms). Assuming the BP is not a SE of my Rx, do I order clonidine 0.2 mg daily, or tell them to get to the local urgent care/ER? Have I any any way whatsoever done anything which could possibly bring harm to the patient with the latter suggestion? Can the same be said of the former? Which of my actions are more easily defended in court/before the BON, should they follow my treatment plan and something goes tragically wrong?? 4) Benzodiazepines = a pill form of alcohol. Is it good medicine to tell someone to have a shot of tequila TID PRN anxiety? Long term use ultimately worsens anxiety, depression, ST memory deficits, etc. That said, I avoid the words "always" and "never". Short term, PRN use while waiting for the SSRI to do it's thing can be a reasonable option...fortunately not the only option, though.

hmmmmm...I never got an email telling me anyone had responded anywho, funny you should mention about the family; I have a cousin who has a child with ADHD and tourettes; she lives in a rather podunk town and so healthcare access isn't so great; the kid's on a stim and it does ok with ADHD symptoms but supposedly the interpersonal and social anxiety is a nightmare and getting worse; he's also saying he's seeing lizards with red eyes coming after him, and is hearing voices, and he is distressed by this; I suggested he needed to see a doc pretty quickly and might need to get off the stim and try something like intuniv or the like (he was on tenex before, and it was very helpful, but was taken off because he was always sleepy, but he was also taking it QID); she happened to have an appt booked with his neurologist and the MD switched from 1 stim to another and added lexapro; she decided she didn't want to follow the neuro docs orders so now she has to wait until her pedi doc comes back from India in August before he can be seen; in the mean time, I guess her sister who happens to be a nurse for a pedi got a couple month supply of intuniv samples and gave it to her (forget about the legalities and such; that pedi doc 's just one big mess from the horror stories I've heard); point being, as a novice, I allowed myself to get trapped, but the situation was pretty serious and she just doesn't have many resources, unfortunately; stamp sucker on my forehead; on the other hand I really didn't think the answer to anxiety and hcns was to switch from 1 stim to another and add an SSRI to treat the anxiety I would never feel comfortable about treating a family member, so now, should a similar situation occur, if you don't mind, I'd like to use your response about not Dx'ing or Tx'ing unless getting paid; but then what if they say they'll pay...I'll have to think of a witty response for that, or just be more blunt if I cannot come up with something witty

I'll take a stab at 1 reason. I suspect there are many many call-ins in a nursing home, just as there is in a hospital. Difference being that there are usually float pool and maybe even agency nurses available to cover some of the holes in a hospital, whereas there are not going to be as many resources for a nursing home. So if you have someone call in for 12 hrs in a nursing home, that's a huge deal, because you are short for half of a day. At least with 8's, if someone calls in for the am, you still have half of the pm shift time to get folks bathed and cared for, whereas if you have 12s going, you don't have that luxury because they are getting folks in bed shortly after they arrive--not much time to do baths on the unit

So as psych nurses we're painfully aware of the stigma that is still alive and unwell within psychiatry from the general public towards the patient, the patient with X Dx towards the patient with Y Dx, the patient's family towards the patient, the non psych nurse (and sometimes even the psych nurse) towards the patient, the non-psych nurse towards the psych nurse, the insurance company towards psychiatry, and even the medical community in general towards psychiatry. Well this weekend while with some in-laws I experienced one that I'm guessing many of us have experienced, but it never really occurred to me until I was analyzing the encounter while driving home from this outing. So there is a serious history of substance abuse with this family (vast majority EtOH). Well last night while one in-law was on a drunken rant he became particularly agitated with me and amongst other things he made the statement: "I see you over there analyzing me". So the truth is that there wasn't much to analyze and I was feeling particulary uncomfortable in this setting because I knew the conversation he was having with others (I was mostly a bystander) was not going well. So why feel threatened about me "analyzing him" (which, I wasn't doing); like anything I "uncover" during my in depth analysis will impact his addictive behavior in a way they would rather not experience. So the moral of the story is that in addition to dreaming of the day when none of the other stigmas mentioned above exist, I now look forward to the day when a family member looks at their FNP/CRNA/WHNP/etc. loved one and says "I see you over there analyzing my physical health." Give me a break people; it really does not require that much effort (i.e., analysis) to realize you're miserable. So go hate your life on your own time; I have my own troubles.

Feeling salty today waiting for the ANCC to take their time to approve a certification application while having $0 income. Yeah no rush. So I ran across this thread and thought to myself--Psychrn03, here's an an idea--let's beat eachother down some more over improper grammar, punctuation, spelling, etc.; and let's criticize others while making our own errors. After all, it's what matters.

Hardly a scientific observation, but regardless, the above observation doesn't change the fact that a majority did in fact vote for the union. So now you have a choice between becoming active in your union (similar to what TXdude is stating he'll do) and making your union work for you OR you can take a 2nd vote with your feet OR you can be a malcontent, marking off days on your calendar before the impending decert. vote I'm hoping you and your fellow workers do as TXdude says he plans to do and become active; who knows, even though your facility doesn't need the union (that by pure accident happened to be voted for by a majority, because the hospital is already a great place to work with ratios close to the ones in CA, regular pay raises, solid benefits, ability to advocate for your patient, your fellow nurses, and yourself without fear of administrative backlash) maybe, just maybe you can find some way to make your hospital even a little better; or at least that is my hope for you and your colleagues

I have an idea--go to the patient and ask them what they'd like to be called--honey, sweetie, Mr./Mrs. ______, etc. In an environment where they have so little control over their lives--i.e., when they eat, what they eat, when they shower, where they travel to, who they interact with on a day-to-day basis, what they get to wear, etc. afford them this one thing--a bit of control--that might be the greatest thing you can do for them in their opinion, and really it is (or at least should be) about what they prefer, not what the nurse or the LNA prefers

I'm sorry, but I do not know which statement someone might take too literally. Could you please point out the specific statement I made that you're referring to (after all I made a million of them, give or take)? As for Dr. Schmo--as a rule, while working as a staff RN in an hospital I usually don't care what MDs think of me either; they cannot hire nor fire me as a staff nurse if I manage to upset them because I call in the middle of the night for an emergency PRN, or to report a significant change in status, etc.; however, in a primary care setting, where your are treating clients as an APRN, the MD hires you and to a degree you are their business partner; it is probably a good idea to impress them with what you know because 1--if they believe you are not any good, they won't keep you around and risk losing clients; 2--you might have noticed that we (APRNs) are not at the top of MDs Christmas card list; burn 1 MD and you'll have a difficult time finding another job with anyone else because MDs do communicate; and 3--by providing outstanding, competent and compassionate care, not only do we help the client and our reputation as a provider, but we also help maintain a positive reputation of APRNs everywhere to MDs as well as the general public; does this mean that my value as a human is based on an MDs opinion of my knowledge in a primary care setting? Of course not, but certainly my life will be far less stressful if I somehow manage to become a respected provider amongst MDs, PAs, and fellow APRNs