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McNabK9

McNabK9 MSN, RN

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  1. McNabK9

    Assault and Restraint in the Psychiatric Setting

    I have worked as a psych RN for the Department of State Hospitals and CDCR State of CA for the past 8 years both inpatient and outpatient. I want to address what your fiance can do to take care of himself in this kind of situation. In my experience, the investigators have very little to go on unless there are cameras. The investigators appear to be more interested in "finding" something, like a thread, in the staff statements, that they can pull on. Then they interview everyone and further find something to blow up. My personal feeling is that this is done so they can garner some recognition and get promoted. Investigations are necessary, but from what I have seen, they appear to serve the investigator and their career more than the institution. Forget the union, they are pretty worthless in a situation this serious. The two most important things he can do are: 1. see a physician about the stress and injuries caused from the experience and have the physician take him off work; if he has FMLA so much the better but it sounds like he was hurt on the job so he would be covered by workers comp; 2. see an attorney right away. Being off on disability or workers comp will protect his job and the attorney should be the one to field the investigators questions. If he chooses to participate in an interview, he should take a witness, preferably the union steward . The first thing that should be asked before any questions are answered is "is this a criminal investigation?" If the answer is yes, then state I will not answer any questions and leave. Generally after that, they have nothing to go on and will drop it. Unless they interview witnesses and find something further to go on. There are very specific protocols for how to handle patients and use of force. Psychiatric hospitals have rampant histories of handling patient physical situations in an ad hoc manner and hurting or killing patients. The patients have all the rights and the burden is on the staff. It sounds like he had physical injuries so why isn't he off on workers comp? He needs to do that and find an attorney used to working with this kind of facility. You can find a lot on google. He needs to get himself in a position where he has some protection, the institution finds they are dealing with attorney so they leave him alone. It doesn't sound like you are in California so let me clarify that I am speaking as a California worker. Psych nursing is exploding, but for many years it was managed by people that rose up through the ranks and had no experience as managers or worked anywhere else. Don't talk to investigators, get an attorney, get off work for your injuries so the job is protected.
  2. McNabK9

    County Jails- Please tell me your experience

    Greetings, I have been a state of CA corrections nurse in mental health for the past eight years. Here is what I can share about jailhouse nursing based on what I have seen from admissions to the State of CA from county jails and other nurses that have actually worked in county jail systems. The nurses I have known that have worked at county jails were county employees not contractors. For me, the most important aspect is custody which equates to safety. i have been told that the level of custody is not the same as in the prison setting. My guess would be because the jail population is awaiting trial and may not have prior crimes. Custody levels in state prison are based on an inmates crimes and their behavior, i.e. staff and peer assaults, while incarcerated. If the custody protecting the medical provider is not strong, the provider can end up in a position where they are not protected by an officer with pepper spray, a baton, and a badge. An example of this is Martinez, CA county jail. An admitting RN was hit over the head with a desk lamp by the inmate during the admission process. She later succumbed from a brain bleed days later. If you had experience around inmates or with custody situations, you may not be so threatened. I always feel safer in prison where all inmates are in cuffs, bellies, and ankles based on their custody, i.e. danger threat. When doing admissions to the state hospitals from the county jails, i was appalled at the condition of some of the inmates. This is not to be blamed on the medical staff from the facility the inmate came from because they have the right to refuse. I take exception to the jail transfers that came in COVERED with lice which is a public health issue. Some mental health patients in jail would be brought up to competency if their psych meds were administered while in jail. it would save the state alot of money but it appears that administering these is not a priority except for one county, Sonoma, which did a great job. Based on those two negatives, it seems the medical staff in the county jails are either too overwhelmed or uninvolved. Both are negatives to me. Lastly, you will get inmates detoxing from or continuing to be on street drugs which makes it dangerous for staff. Lots of drugs in prison and almost every inmate has some kind of a weapon hidden on them. If you are in CA, I would recommend working for the Dept of State Hospitals first and then CDCR. The pay is outstanding, the benefits packages are worth $35K annually, and there is a pension. But there is no free lunch and working with this population of inmates as well as the very inexperienced (most have only worked in the state system where there is very little accountability) and entitled management within both systems can be a hardship making every dollar compensated a dollar earned.
  3. McNabK9

    Problem with Custody Sargents

    I work for the Department of State Hospitals. We are housed within one of the medical facilities for CDCR so I work around custody, but the boundaries are very defined because DSH and CDCR are two separate entities. I have had this problem when I worked with Psych Techs. What does the RN duty statement say? Does it say RNs will receive work direction from CO's? I think it can broken down three ways: What type of work direction, i.e. clinical? That is a no as RNs have the greatest license on the floor except for the physicians. Are they expecting RNs to do custody work? I would hope not but that would clearly not be ok as custody needs a badge and nurses didn't go to the police academy unless they are a Medical Technical Assistant who only have a PT or LVN license so again the greater license, they work under the RN license. So maybe they are giving administrative requests? If so, it should be able to clarified that in their duty statement. If it is RNs, theu would be a member of SEIU local 1000 Bargaining Unit 17. They can look in the Memorandum of Understanding, y which is posted on the Cal HR website if you need to access it from work. It is not blocked on Cal HR. They could also call their union. I would be very wary of taking work direction from a CO. If it is not in the duty statement and there is a negative consequence, they will be held liable. A CO is only required to have a high school education. Working in these big government entities, lines get blurred and staff gets asked to take shortcuts and work outside boundaries. Most of the workforce has never worked outside of state employment where staff is held accountable. There is pressure to go with the "party line" and sometimes it is hard to set boundaries. As the SRN, I encourage you to get the information you need so that you can share that with a CO or their Seargeant if they ask the RNs to do something they are not supposed to. Do your research, plan ahead and help the RNs have a response figured out so they can feel confident setting boundaries. My answer would be that it is my license, and I am not willing to risk losing it. It may be hard for them to understand because they didn't go to nursing school, but you can make the argument that they would not want to risk their badge.
  4. McNabK9

    Aspen University Online RN to BSN

    You are correct about the accreditation. In CA, they will not accept any of my work at Aspen, but I knew that going in. I'm an older RN so I am not looking to set the world on fire career-wise. It is a very important point to consider in your planning, particularly if you are looking to do an MSN somewhere else as you mentioned.
  5. Greetings, I am a RN with the Department of State Hospitals, State of CA. Many years ago, this department transition from community psyche objectives to 99% patients found NGI and placed in one of the state hospitals. Coworkers and new grad nurses with psych experience as an LVN or PT that became an RN, are getting aggressively solicited for very high paying jobs. I believe that when the AFCA made mental health a medical diagnosis, the game plan changed for many hospitals and this created jobs for experienced mental health nurses. Recently Mark Zuckerberg and his wife built a new hospital in San Francisco as part of San Francisco General Hospital which is City and County of San Francisco public health. A nurse I work with, 6 years experience, applied and was accepted for a position. He showed me his acceptance letter. He was slated to start at level 3 (1 is the lowest and it goes to 6). At level 3, he would be started at $127,000 a year. Ultimately, he was bumped up,without asking, to level 5 and he is getting around $140,000 a year. To gauge the need, even interim permit RNs are being hired. I have not heard of this for a LONG time in the SF Bay Area. Another LVN I work with became and RN and he could not keep up with the offers immediately after he was licensed. I am asking if anyone has experience working at San Francisco General Hospital in their psche department. I am interested in how safe it is since it is not a corrections setting.
  6. McNabK9

    Common Correctional Nursing Interview Questions

    Good luck!
  7. McNabK9

    RN-MSN program at Aspen University

    I am currently enrolled in Aspen RN to MSN. I am planning to take the proctored exam necessary to move on to grad school portion. There are two formats for the exam: multiple choice or essay. I choose essay. Can anyone share any recommendations from going through this experience? I don't have all my books still so I was planning on ebooks to access since it is open book. Do they allow you to use your own lap top? Or do you have to use the computer at the proctor's site?
  8. Greetings, I do not have information to share about being waitlisted for this program. You wrote about being part time which alerted me and compelled me to comment. I started this program in my 3rd semester of nursing school. I had a BA and started the bridgework while still in nursing school. I was very motivated and completed everything with a 4.0 including my first semester in the FNP program at SSU. I was the first person to land a clinical site for second semester, which is difficult to do. When I enrolled in SSU, it was strictly as a part time student in the FNP program. The same for other fellow students. As I entered my second semester, I was told that there was no longer a part time program.....told in such a way as if the program dean pretended there never was a part time program, any discussion would about it would disappear. Yet there were students ahead of me, semester-wise, that were on a part-time status. So poof! the part time option disappeared. I think what happened is the school could not afford the part time option so it was taken away without ever communicating that to the students. The repercussions for me were that my employer would not let me work a condensed schedule, Saturdays and Sundays, so I could be in the clinical site as much as possible. I also had to take more courses, the tough ones, at the same time as the clinical which is not what I had planned for. Ultimately I had to drop after all the expense and work. in my second semester I had to drop. So my advice to you, is get something in writing signed by the nursing school dean confirming your ENTIRE program is part time. I liked SSU. It is a good school and they turn out a lot of FNPs. What I did not like was the shadiness of the program management. They also hired a lot of nurses for instructors that had very little experience teaching. There was constantly a lack of organization and structure to follow what the program materials stated were to study or be tested on vs. what the ad hoc instructor, who had to get a job near Rohnert Park because she and her husband just bought a vineyard, thought we should be tested on. She kept inserting her agenda which was not the agreed upon curriculum. That would have been fine to have her perspective if our grades and advancement were not contingent on the coursework established by the program directors and not her. Be wary of these women running this program. Once they decide to take things another direction, you have very little ability to get your needs met. Good luck.
  9. Greetings, I attended new employee orientation this week for the CA Department of State Hospitals. One of the topics was wound care. The educator/trainer that taught the course struggled with some of the verbiage (the word exudate). At one point, I volunteered some advice that if the institution had a wound nurse but the physician wrote the wound care orders, it may be worthwhile to run the orders by the wound nurse as physicians are not always up to speed on the latest and greatest in wound care. After my comment, the educator/trainer followed by commenting "if you feel comfortable questioning the doctor's orders". Well that statement is always a dead giveaway..lol. I checked after class and the person teaching the wound care class was a psych tech not a registered nurse. I did not think a lesser license could teach a greater license in clinical skills. The psych tech did not have any special certification to teach wound care. Does anyone know how this works in California?
  10. McNabK9

    Common Correctional Nursing Interview Questions

    Most nurses think in terms of "taking action", but in corrections nursing, the action you take is to make sure you are safe first before attending to the inmate involved. My action in this case would be be to assess the environment and pull my alarm or yell to bring help. The corrections officer would make the call about the situation being safe to proceed. Most likely, there would be a combination effort of supporting the patient while he is being cutdown. Most facilities have special cutdown knives for this purpose. For purposes of interviewing, they are looking to see if you will approach with a safety first mindset and follow the protocol in most facilities which is to not enter until the C.O. has deemed it safe. A lot of things can happen in forensics....did other inmates set this up and hang the inmate straining so that staff would run in to the scene and make themselves vulnerable. if you don't have experience in forensics, the default protocol is: don't enter the scene because you don't know if it is safe, call for help, wait for the ok to proceed, then follow the facility protocol for the action needed. If you have not already, look through the list of interview questions for correction job interviews. This forum is great for finding support and answers.
  11. I began RN school at 55 years. My age afforded advantages over my younger peers and opportunities to support them when needed. Considering there are more centenarians now than ever, and the numbers are growing, my advice would be to go after what you want and enjoy as you may be working for many years still. I had wanted to be an RN since 3rd grade. When I passed my licensing test, my peers from elementary school all remembered my dream and congratulated me! The only thing that matters is how bad you want it and how hard you are willing to work to obtain it. Good luck.
  12. McNabK9

    Aspen University Online RN to BSN

    I know it can be unsettling to return to school after many years away. I am in the RN to MSN program at Aspen. Please know that the administration, leadership, and instructors really want you to succeed. I hope that hearing that makes you feel better. I started an ADN to MSN at Sonoma State University while in my 3rd semester of nursing school. After graduation, I continued the program. Then in 2008 all bets were off. Due to the recession, the school no longer had the funds to offer the program I wanted. They were only going to offer the FNP. So now I had purchased my ticket, so to speak, but I was standing at the gate and there was only one choice. I did not want to be an FNP but I had to move forward. I did one semester of the FNP grad program and then had to drop because the school and my employer would not accommodate the schedule I needed to go on rounds with physicians. The reason I bring this up is because I spent a year away from school and ultimately went to Aspen because they were so liberal transferring all the bridge work I had already done and paid for. At one point, I became frustrated because I was repeating the Health Assessment course, I had already taken at the grad level. I told my advisor that I really was frustrated because I was taking Health Assessment again, at the undergrad level, and did not want to be treated like it was my first rodeo in regards to feedback. You have to understand I was deeply frustrated and saddened when I had done all the coursework already at another SSU, had a 4.0 and then hit a wall because of what I deemed lack of interest from my employer. So I was not the most diplomatic when dealing with the Aspen administration. They were very accommodating to me, had the dean of nursing call me, and "talked me off the ledge" so to speak. They really want you to succeed. So being worried is very valid. At the same time, it may be a waste of energy because as long as you do your part, Aspen will be there to meet you. The best advice I can give you is always get the instructors cell number in the beginning of the new course term. Many of them work and it can be difficult to communicate when something is urgent. Look on your course site on the Aspen class platform where you turn in your homework. There is a list of who is enrolled. You may find someone from your geographical area you can strike up a conversation with and establish a friendship for support. I am not a fan of some of the instructors only because I feel they are not as good as others and it shows. But the whole package of Aspen is a VERY viable way to get your degrees. Aspen makes it a point to keep any financial aid loans at a minimum as they pride themselves on graduates that are not financially wiped out at graduation. If you hit a bump, ask for help as they do want to help and support you. It sounds like you will have no problem! You will have a BSN and MSN. Think about how great that will look next to your name after all your hard work. Good luck
  13. McNabK9

    Common Correctional Nursing Interview Questions

    Congratulations! It sounds like you have a good idea of what your patient demographic is, and you made the choice to be there. Here is some unsolicited free advice from me: I would read through Lorry Schoenly's blogs for some quick education for starting the job and go back and read it more when you have time. Ask your facility for the DMV paperwork you can file, through your facility, to have your personal information suppressed for privacy. Always trust that little voice in your head, but never trust an inmate, though give them the same respect, as earned and with appropriate boundaries, to the inmates that you would want. Do what you say. Inmates know the staff that does what they said they would do and the ones that do not. It is the fasted way to earn respect and have the population work with you. Always go to your team and immediately report any funny business like inmates trying to get you to bring things in. For example, I worked with a nurse, and went through school with her, that was asked by an inmate to bring in a flash drive. Of course she refused. Because he was to be discharged in the near future, she let it go and did not report it. The inmate, probably as an offense, told staff she was soliciting him for sex in the treatment room. It almost ruined her career, caused her license to be in jeopardy and she was under investigation. It all turned out well but it was a lot of hell to go through. In any gray areas report and chart. I document any staff related issues by sending myself an email on the hospital email which gives it a time and date stamp. Believe me, sometimes it is hard to tell the inmates from some staff. Sometimes the less said to inmates the better, i.e. explaining certain processes...that can set someone off if it isn't what they want to hear. Never be alone. Fresno has a HUGE meth problem so that is probably a lot of what you will see. Keep in mind that most of your population will be detoxing whether it is drugs or alcohol which also makes them impulsive and dangerous. If you are a RN, you are most likely the highest level of medical during your shift unless the physician is present. Remember that and do not let any staff try to circumvent you on clinical decisions. I work for the State of CA. You may want to look at the open jobs in the state hospital system. It is also forensic, butdifferent kind of population as it is psych. The pay and benefits are very, very good. Best of luck and get used to not wanting anyone walking behind you ever.
  14. McNabK9

    Common Correctional Nursing Interview Questions

    Thank you all so much for these sample nursing interview questions. I'm a new grad RN and I have an interview in two weeks and I'm a little nervous about interviewing in front of a panel. My experience is the panel is retired employees and they are very nice. If this is a state facility in CA, you generally have to do two interviews: the first to see if they want to employ you, the second to actually hire you. The first one is called a "QAP". If you pass that, you go on to the next interview. I took a tour of the facility with my mental health instructor and I loved it; the autonomy, the challenges you have to face on a daily basis and having to think "on your toes" is why I'm truly excited. I'm fully prepared with all my paperwork, I was thinking about making photocopies of all my required documents and then taking the originals just in case, does that sound like a good idea? I also have a letter of recommendation from my Mental Health instructor that has health fairs at the same prison every couple of months; should I take that in with me? Again, if this is a state or government facility in CA, they have a very structured process. I turned those kinds of documents in with my application to the nurse recruiter at my facility even though it was not required. I figured it couldn't hurt. It's always worth a try. I'm great with Med-Surg but it's hard for me to get out of that thinking "patient safety is first", so basically from what I see on here, if they ask an emergency scenario question, just always get a correctional officer first? I just want to be completely prepared for any question they may throw my way so I can make a good first impression. ANY advice would be helpful!! Since this is a special kind of nursing, I would prepare for questions about why you want to work there and do that kind of nursing. Questions about how you would critically think through scenarios like a prisoner telling you they already got their insulin or didn't get their vicodin order...how would you treat that...what process would you use to clarify it? Also patient safety is important but your safety is number 1. As a nurse, it is different to think of not immediately responding to an injured or sick patient. Your thinking should always be about not going it alone, how the whole scenario looks/appears and what is your process based on that? Pull your alarm? Wait for the officers/support people to be there? What if someone fell down grabbing their chest? Are you going to immediately respond? If not, then what will you do? Good luck. I love my job!!!
  15. Greetings, I work in a forensic psych facility with mainly PC 1026 and PC 1370 patients. Occasionally we get a patient without mental illness but a personality disorder. Recently we received a 28 year old man that is classic Borderline Personality Disorder. He is 6'9" 300lbs. He has been performing self injurious behavior since he was 12 and continues to do so. The nursing staff, comprised of RN's and PT's is becoming burned out. We had two staff assaulted by him today. We have had to send him out almost daily due to SIB because he was dumped on our unit without a plan specific to his illness. This patient now has a treatment plan which is walking restraints, spit hood and mittens when not in locked room seclusion with a suicide blanket and gown. Even with that, he continues to be assaultive when the opportunities arise, like removing his restraints to put him in locked room seclusion. In talking with a co-worker, I thought that maybe the nursing staff needs a treatment plan of their own. It would probably look more like a set of agreements among staff, but I want to give them something to hang onto and I thought treatment plan would be more promising. Since our management is not capable or maybe interested in preventing burnout, we can take it upon ourselves to help ourselves within our unit. I work in a state facility without electronic charting and the repetitive charting in different places is an opportunity for burnout on it's own. Some ideas I had: -Honor your schedule by taking breaks, lunches, and leaving on time. -Submit an Assignment Despite Objection to management anytime you question the safety of the assignment. -If the workload cannot be completed because of lack of resources, staff, or time, don't kill yourself to do so. Document and let management know that a take down or restraint event took up your entire morning. -Speak up and ask for what we need to get our job done instead of trying to accomplish the impossible in certain situations. This could be handled different ways. It would be great if we could provide metrics to qualify. -Utilize ancillary staff as back up for times when we need a lunch hour covered. I would really appreciate any suggestions. We have a very strong team that love working together and respect each other. We can practice autonomy and use our power to create what we need within our team instead of waiting, like victims, for management which is not going to happen.
  16. McNabK9

    Common Correctional Nursing Interview Questions

    search correctional nursing on this site. Lori Schoenly administrates this subject on this site. Also, my experience, as an RN, which would probably apply to you as well, is: s/s hypo and hyper glycemia, prisoner tells you he already had his insulin injection...what would you do? Find a man down, what would you do, boundaries with prisoners i.e. asking you to do them favors, bring items in, etc.