lmd32

We have a foreign doctor in our nursing program. She speaks excellent English and is very knowledgable, especially in patho. She tried to pass the boards for 10 years but had trouble getting a residency because she had just finished med school in the Phillipines and had not practiced independently. She has had a few issues but they are more cultural than nurse-doctor stuff. I think she'll make a fine NP. I do resent that bit about "swallowing their pride" though. We also have at least 3 people in my program who chose not to go to medical school and prefer nursing.

Do you want to just work with DD folks? If so, I'd try the state agency employment web sites. You could also look for private DD service agencies and see what they know. Another resource might be the ARC or even Special Olympics. I am currently a psychologist in a state institution for DD adults. We have lots of nurses, both RN's and LPN's. One of our docs told me that you can certify as a DD nurse. I have contemplated specializing as a nurse practitioner for the developmentally disabled when I finish school.

A major factor in going back to nursing school is the opportunity to work something other than days. Swings are my least favorite with a family although I didn't mind it when it was just my SO and me. Night shifts are probably my favorite. I work a flexible job while in school and I often show up at 2am and surprise the night crew. I even did night clinicals in LPN school.

I guess it depends on how rural you want and how far you're willing to drive. I have a friend who lives in Roslyn and commutes to Bellevue every day. It probably takes him about an hour each way but he's always liked to drive. I know several nurses who commute over the mountains from Cle Elum to Seattle. Also crazy I think. Let's see, it's Seattle you're looking at? Would you accept a ferry commute from Bainbridge or Vashon? It's a little longer (I think the ferry alone from Bainbridge is about 30 minutes) but I never minded that commute since you got to sit and look out the window and not drive. What's always worked for me is to get a map and a compass and draw a circle around where I wanted to work at the outer limits of my commute. Then drive around inside that circle (or look on the web if you can't come and look) and see what you like.

I have to disagree with what seems to be the consensus here. I'm not going to argue the merits of Kroger's vs. Wallmart vs. mom-and-pop. But, to get back to the original question, should employees pay for part of their health insurance... I have worked for the state of Washington for the last 12 years. When I was hired, the state paid 100% of my health insurance, my family's health insurance, and my dental. This was a HUGE benefit. About 10 years ago, we got a small raise and at the same time began to pay about a little less than the amount of the raise for our health insurance. We didn't strike but I sure wanted to and did my best to convince others. It was a "foot in the door" phenomenon. Every year, the percentage of my health insurance I pay has gone up and my wages have not kept pace. I know that most employers require employees to pay for part of their health insurance but if you luck into a place that's paying 100%, fight to keep it. I would take a pay cut to get back my employer paid health insurance.

4th career, huh? That may put you one up on me. One nice thing about nursing is that there is plenty of variety. While nurses do get bored or burned out (just read the posts), they can often change to another type of nursing rather than a whole phase shift. I like the "incredibly easy" series (and their siblings "ridiculously simple"). Some of them seem to start too simple for me but others I really need the basics. I particularly enjoyed patho made incredibly easy. I also like their NCLEX review books, mainly because they're organized by subject. Check out the student nursing section. The "teach a student something a day" thread is very helpful in figuring out the basics of nursing school. Good luck to you!

I have a vegan daughter and one who used to be a vegetarian but now has added fish. (we call her a fishaterian). So, we are having: Fruit salad (my specialty, via Granny) Vegetable antipasto (currently marinating) Shrimp kebabs (for the fishaterian, she's making them) Tofu kebabs (for the vegan) Turkey and gravy (for the rest of us) Stuffing (in the bird and vegan in a casserole) Mashed potatoes and vegan gravy (made by the vegan girl) Some kind of yams (ditto) Cranberry sauce (apparently the other daughter's specialty, involves craisins and mandarin oranges, sounds good) broccoli with lemon pepper sauce rhubarb pie and vegan pumpkin pie (made 'em last night) sparkling cider for the kids and mimosas for the grownups I used to do 2 dinners one on Tday and a vegan one the day after but we have less people this year. I am thankful (among other things) that I ditched the dysfunctional husband and his dysfunctional family. Talked to him last night, their not having Thanksgiving because his brother's in jail for DUI. So, what about the kids? I invited them all to my house but they wanted to stay at his mom's and mope. Just as well, we'll have a better time without them.

I worked on an acute care, mainly voluntary, inpatient psych unit in a community hospital. We had no policy about searching and rarely did. Along with occasionally being aware that there were illegal drugs and alcohol on the unit, I remember walking past a patient's room one day and being aware that there was quite a breeze coming in. The man had used the toolbelt he brought with him to remove the whole window from the frame because he was feeling overheated. We were on the 5th floor and there was a 6x6 foot hole in the wall. Scary!

I tried to call Washington State Protection and Advocacy Service but got stuck in voicemail. So, I sent them an email. It said: I am a student nurse, currently doing a mental health rotation at Western State Hospital. I am appalled by the procedure used to implement med overrides. I understand that, in Washington state, the right of a patient to refuse psychoactive medication can be overridden on the strength of an evaluation by 2 MD's. However, the method used to administer these medications is barbaric and abusive. On the ward where I worked last Wednesday, I observed a woman overpowered by a group of MHTs, placed in 5 point restraints, and an NG tube shoved up her nose against her will. The placement of the NG was not successful, and considerable bleeding resulted. The nurse then inserted the tube in the other nostril which was successful, but the patient pulled the NG tube out before medications could be given. IM Ativan was then given and the patient took the oral medications 30 minutes later after she was calm. On this ward, 5 point restraints and an NG tube is the standard order for administering refused medications. I question why there is not a protocol with a hierarchy of less restrictive and intrusive interventions and why, specifically, IM medications are not used. If I can be of any help to you in investigating this procedure, please contact me. Also contact me and advise me if there is some state agency I should report this too. I have not heard back from them. I checked with some of the other students and, apparently, most patients are cooperative with the procedure if it is presented to them as inevitable. I just happened to see a particularly bad example. I still think it's needlessly intrusive. I also question the wisdom of exposing student nurses to this type of mental "health" environment. I can assure you, no one in my class wants to work as a psychiatric nurse. And I know that inpatient, long term, chronic state hospital patients are not the only psychiatric patients in the world. I don't feel my instructor is supportive. As I have mentioned before, she has been very defensive of the staff and I feel I am getting a reputation as a trouble maker. I do need to pass clinicals. Maureen- what's a code 8?

One last one for the night. Y'all are dredging up memories. I once worked with an RN whose first language was not English. She was a very good nurse but sometimes forgot the words and had to be creative. We had a patient come in with a penile laceration. She couldn't remember the correct word and drew a picture instead.

Okay, this isn't exactly a blooper because I know what they meant but I laugh every time I see it. Our case managers often chart "patient evacuates spontaneously" meaning that they know how to find the door if a fire alarm goes off. But to a nurse...

We've been having quite a few transcription errors come through. Can't remember them all but "rule out lime disease and berry berry" stands out. The patient apparently had an overdose of fruit salad.

I'm going to try to make this relatively brief so as not to bore folks. Michael, you are welcome to pm me if you want more info. The Deparment of Developmental Disabilities in my state (Washington) serves mentally retarded children and adults. Their IQs range from 70 on down. Most were born with their disability, although some suffered accidents or illnesses that impaired cognition. As long as it occurs between birth and age 18, it's technically DD. As you probably know, birth defects cluster so a lot of these folks have seizure disorders, physical problems, and mental illnesses as well. Nationally, there is a trend to de-institutionalize the mentally retarded (and the mentally ill). I believe that Oregon, among other states, has completely closed their state institutions. Washington is moving more slowly. I work for a large state institution. As the trend toward community placement has grown, we have moved out a lot of people. We're pushing the envelope now and we are moving out a lot of people who we would not have thought were ready for community living. People with intractable seizures, multiple medical problems, significant mental illness and behavioral problems. To our surprise and delight, some of them have done very well. The folks we are left with now are the ones we truly believe the community is not ready for. So, in my state institution, you would find people with serious problems, either medical or behavioral (in addition to their MR). We have 4 full time medical providers (3 MDs and a PA), a psychiatrist, and several PharmD's. We have physical and occupational therapists and aides, speech pathologists, psychologists, and social workers. The nurses where I work see a variety of medical problems, both acute and chronic, as well as behavioral issues and mental illnesses. Most common chronic medical problems are seizure disorders, endocrine disorders (including diabetes), and lately, as our population is aging, dementias. We serve only adults. Our youngest is 19, he still goes to public school. Our oldest is in her 90's. In a community setting (group home or tenant support), you would have generally more tractable folks. A lot of them would be more functional and just need some help with more complex skills such as money management. Since there is more community support and acceptance now than there was 70 years ago when my place was built, children with DD are cared for in the community, either in their own homes or therapeutic foster homes. There are a few residential treatment facilities for children with mental illness. And that's my story.

IMHO, unlicensed personel do the real work on the psych ward. They're the ones out there interacting with the patients, implementing behavior management strategies, and often, running groups, providing recreation, supervising work or school, you name it. What you do varies a lot from setting to setting. In short term (

my heart is still crying out... i'm not for nursing... i want to bail out... but i love my parents and i don't want to disappoint them... i know that they just want what's best for me... oh, amy, i'm so sorry. it's awful to put a lot of time and effort into a field, only to realize it's not for you. all i can say is that nursing is an incredibly diverse profession and there is probably an area you will love even if you haven't found it in school. don't worry about being "selfish", we all are and would be crazy if we weren't. think about what you said in that presentation and look around and see if there's an area of nursing that fits your wants and needs. best of luck to you.

Great thread! For me, the only never is home health, just because I had some awful experiences. I've been attacked by a dog (the sweet LOL said "please let the dog in" so I did. I had to chase him out with a broom) and also found myself in more than one unsafe situation due to isolated conditions and a lack of back up. I had some really good experiences as well but I wouldn't go there again. For now, I'm saying "no psych". I won't say I'd never do it again but that's been 90% of my work history for the last 25 years, first as an LPN and then as a psychologist. I'm really burned out. And thoroughly ready for medsurg or something.

I, too, thought about it for a while. You know, when you're uncomfortable with something and wondering whether it's okay, it probably isn't. Since everyone at this institution thinks it's okay and my clinical instructor doesn't seem to think it's out of line, I was thinking that maybe I was just a newbie and didn't understand some underlying compelling reason. Thanks for the reality check. I checked the state law that covers it and I guess it is legal although I'm pretty sure it's not what the legislature intended. Next time I'm at clinical, I'll check the institution policy manual. And I'll check with some people I know to see if this is institution wide or just this ward and this doc. And then I'll take a deep breath and make waves. Not what I want to do as a student but ethics are ethics. What do you all think my approach should be? Routes I have considered are: the state protection and advocacy association for mentally ill people; my clinical instructor and my SON advisor; whatever regulating agency oversees this place.

Thanks for the feedback. I was appalled and am trying to get a handle on 1)how common this is nationwide 2)why they do it this way 3)what alternatives there are. Right now (when I'm not a student) I work at a residential treatment center for DD adults. We have a lot of dually diagnosed folks (in this world that means DD/MI not MI/drugs or alcohol) and we do have folks that refuse meds. The only meds we give involuntarily are those which would be life threatening if not given. Around here that usually means seizure meds and insulin. And even for those we write a med administration plan with a hierarchy of steps. Most drugs we just wait.

I'm a student doing my psych rotation. In our state, you can get a med override to give meds against a pt's will if 2 MDs agree. On the ward where I am it is always done via NGT. You call a code, 8 guys show up, you 5 point the pt. and shove an NG tube up their nose. Luckily, as students, we don't have to do this. I have enough trouble getting an NG tube down a pt. who agrees to it. I have watched though and there is blood everywhere. It is incredibly traumatic. Is this a common practice? I worked inpatient psych (some at the state mental hospital where we're doing our rotation) about 10 years ago and I don't remember NG tubes except for pt's who refused to eat. For med overrides, we tried po with a show of force, then IM meds. I asked my instructor and she said it was probably because a lot of newer psychotropics don't come IM. Well, what about a little Ativan then, wait 30 minutes, then try po again? What about IM Haldol or Geodon? There's gotta be a better way.

I'm not an ER nurse but a nurse where I work collects stories of local candidates for the Darwin Awards. My favorite is the front page picture of the guy with a bandage over an eye and the caption "I feel so stupid!". I guess he and his buddy were drinking and thought it would be fun to shoot a gasoline can off each other's head with a bow and arrow. Apparently his buddy had the poorer aim.

Hope you all won't mind a slight change of subject. I wandered off to work and when I came back the tone of this thread had changed before I got a chance to put my .02 in. A patient's point of view: A few years ago, my GP referred me to a specialist who, I felt, treated me badly. I now see the NP in the office who is wonderful. She listens to me (what a change), encourages me, respects my opinion.... I could go on. My problem is that every time I go in for an appointment, the office staff refers to me as "Dr. K's patient". I always correct them and say "No, I am Ms. T's patient". I think I am getting a rep for being difficult but I'm not giving up. I'm looking forward to the day when I can say "I'm an NP" like docs say "MD" and have people know what it means.

Okay, I'll play. Pacific Lutheran University, Tacoma, WA. I'm in the Entry Level Masters Program (brand new program, we're the first class). I get my RN sometime between August '04 and January '05 (we're still arguing that one) and my MSN in May '06.

All right, maybe this guy (are we sure it's a guy?) is a troll. But, I have to put in a plug for "professional" staff rolling in the trenches. As a clinical psychologist (now going back to school for an MSN) I have gained an incredible amount of credibility with direct care staff (I work at a state institution) because I share with them that I have been a CNA and I am not afraid to shower people, clean up vomit, etc. and pitch in where needed. I vote strongly for MD's, PA's, NP's, PT's, Rt's, PhD's, RN's and all health-connected professional to walk a mile in the line staff's shoes. --Lynn

Gotta sympathize. We have an odd class mix also. As graduate students mixed in with BSN students (it's an accelerated entry level masters program, we all have BA's (not in nursing) and tons of life/school experience), my colleagues and I have had some interesting moments this last year. Some of it has been helpful/interesting, particularly when we are in with LPN's who have more clinical experience than we have. But some of the time we are frustrated. Mostly by the lack of professionalism at the undergrad level. When you have a group project and (out of 10 people) 3 are organized and prepared (that's us), 4 don't show, and the other 3 don't have clue what they're doing, it's a drag. Another thing that bugs us is when our instructors say "oh, you don't have to know that, you'll learn that if you go for your masters" (happens a lot) I'm sure we irritate others by wanting to know WHY you do things and wanting to know things in depth but we are "going for our masters" and we do have to know it.

As a student, I wear the most hideous all white uniform: white polo shirt (I have never looked good in polo shirts, too busty), see through white pants, white lab coat, white shoes, socks, and undies (yes, you can see my undies). You can't bleach the tops and labcoats because the school logo is on them in black and gold. When we did clinicals at the local hospital, we were told that all the nurses were required to wear white because there was research that showed that patients preferred white. I looked it up and there really is a study: First impressions of the nurse and nursing care Journal of Nursing Care Quality; 1997 Jun; 11(5); Mangum S; Garrison C; Lind The researchers showed a large group of nurses, patients, and administrators pictures of nurses in various garb and asked what they preferred. The white pants uniform with stethoscope won hands down. Last was street clothes, followed by scrubs. Personal opinion: I don't care for all white, it makes me look dead and reminds me of bad horror movies with evil psych attendants. When I graduate, I plan to wear white pants and patterned tops. I think it looks professional and allows some creativity. As a patient, I prefer names embroidered on lab coats or bigger tags that are pinned on and don't flip. What do your tags say? At this hospital, all the nurses, techs, support personel tags said FIRST NAME (big letters), last name (tiny letters) TITLE (big letters). But the doctors' tags said DR. SO-and-SO, MD in big letters with no first name. They said it was to protect us from the patients knowing too much about us. Well, they could still read my last name if they had good eyesight and apparently the doctors (being super human) didn't need the same protection?