beat2beat

i cannot agree with you more on midnight shift being destabilizing. i was diagnosed as bipolar in 1994 and have been mood-swing free and stable on medication for over 10 years. i was fine all the way through nursing school. i just recently graduated and have been working midnight shift for the past 6 months and have been a mood swinging mess. mostly hypomanic. i am back to seeing a psychiatrist after 8 years of having my primary care take over prescribing my meds and i am back in therapy learning how to deal with the disappointment of the re emergence of my symptoms. it also hasn't been the change in sleep hygeine for me, it has also been the fact that i get no time to eat on my job. i have lost over 30 pounds since i started working, so 3 days a week i eat only one meal. i am finally pulling it together with a change in medication, and lots and lots of support from my therapist and my husband. i am glad i found this thread. i work in psyche and it amazes me how much misunderstanding and stigma is still surrounding bipolar disorder withing our own profession. for some reason there seems to be a huge misconception that all bipolar patients are crazy and are a danger to others. even at my worst i was never a danger to others, only to myself. inwardly it makes me angry, but people will believe what they choose to believe.

I will explore the site further. I was looking for a combined program as you mentioned, but have been unable to find one. I am mostly curious as to what to type of different settings I can work in with these credentials.

Hi, I have been working with in addictions treatment for 6 months now and am also a new nurse. The main duties of my job are to assess for detox symptoms and treat the patient with prescribed detox medications. I don't find the patients to be "aggressive", I find them to be fearful (which may come across as aggression) because they are no longer using and they are afraid of the unexpected. Most of the patients are highly anxious which is to be expected. I find the patients to be easily directable. I love my job as an addictions nurse and the satisfaction of seeing the patient come in to treatment vs. when they leave 30 days later is AWESOME!

hello fellow nurses, i just received my bsn in march 2009 and began working in addictions treatment and recovery. prior to earning my nursing degree i worked in the psychiatric field and earned a human services degree. i enjoy working with both populations, psych and addictions. i am ready and eager to jump back into school to further my education because i want to work with patients 1:1 and with groups. i miss the therapeutic communcation that was encouraged when i was utilizing my human services degree. i cannot decide whether to go with the psychiatric np degree or the psychiatric clinical nurse specialist and really am confused as to what the main difference in scope is. is it just that nps hold prescriptive authority and the cns does not? does anyone know what the demand is for psych nurses (both types), what can i actually do with these degrees? any advice please. or if you are a np or cns and would just like to share your experience with your profession please feel free, i am eager to listen. thanks.

I considered being a psychologist before becoming a nurse. I got a degree in Human Services and spent some time working in the field. I love psyche. I stand in awe of the mind and how it works. Working in Human Services for awhile I decided that it was a very unrewarding field because I primarily worked with patients who did not want to get better (even those patients who were capable) and found that it basically boiled down to maintaining the patient. I envisioned it to be different. I wanted to work with patients who wanted recovery, who would go to any lengths to obtain it. When I left Human Services and decided to go into nursing I decided that I WOULD NOT go into psyche. I had my fill. How odd it is that I have basically been locked out of the "medical" end of nursing because I haven't been able to find a job. So here I am back where I promised myself I wouldn't be, and I am truely happy and feel the passion and excitement that I once felt for psyche and had lost. Now I plan on going further in my nursing and psychology education because I want to work one to one with patients, I want to facilitate groups and be out there with the patient where I want to be. Time and time again I have been told that I have a God given gift when it comes to psych and working with psych patients. I therefore find it no coincidence that I was unable to get into the "medical" end of nursing and instead was "forced" into psych because flat out, I needed a paycheck. I am where I am supposed to be, and am breathing a sigh of relief that I am here.

Hi everyone, I have a question about correct per diem protocol. I have just started orientation for a per diem position at a substance abuse recovery program and got a phone call today from a psych hospital also offering per diem work. Am I allowed to work for two companies per diem? Since hours aren't guaranteed I thought it may be o.k. Do I have to tell each employer that I am also per diem somewhere else? I would love to stay with one place, but I may not get enough hours at just one place to add up to full time hours. Any one have any ideas about this?

I graduated end of January 09', took boards in mid-March, and still haven't found anythinge except per diem at drug treatment facility. Hope it turns into full time though. It is right up my alley.

Call HR. I don't think it would be coming across as nagging, or maybe you could send an e-mail telling them you are just checking in to make sure they have recieved all of the necessary pre-employment information needed to secure employment. I would think not calling them would be worse. Also, at least through some back round check agencies you can request a copy of what was sent to your employer if you think something may have come up on it. Don't forget there can be errors on your background check so you may want a copy anyway. Hope you get a call telling you when your start date is!

unfortunately i had that problem at my school too, and i was the one who got ripped a new one like you get ripped while others just screwed up time and time again and got away with it --- but not me, not the other good students. i used to get just as ******. [color=#00ff00]you know what got me real bad was one of my class mates was urgent care hopping and popping percocet at the clinical site. i told the clinical instructor and she did nothing, the girl used to come to clinical giddy and cracking up and then bam she'd be in the nurses lounge with her head down, and this **** was acceptable to them. so then i tell the nursing chair at school, still, nothing is done, so i bring it up to my instructor one day when the girl is totally crocked at clinical and the instructor takes me in a room and rips me a new one. [color=#00ff00]o.k., but guess whose name ran through their minds when the girl wound up in jail the last quarter of nursing school for 18 counts of trying to obtain controlled substance by fraud. [color=#00ff00]i guess it's the same crap everywhere. we aren't rewarded for hard work and honesty, in fact sometimes i believe it is a detriment. all i saw at my school was the liar and cheaters making it by with smiles on their faces. we had like 5 people get caught writing papers on community clinicals that they never attended that they were supposed to attend and all they go was a slap on the wrist. had it been me, i would have been tossed out of the program. [color=#00ff00]so no, i don't think you are over reacting --- i think the nursing schools are under reacting to some of the *hit that goes on. my thing is, if someone is unethical as a student, if someone is popping pills on clinicals or missing clinicals alot, what are they gonna be like in the real world on the job?

hi everybody, my husband and i are considering a relocation to virginia if things don't open up here in the sunshine state soon. my family lives in linden. can anyone tell me how the nursing market is looking in the winchester and surrounding areas? anywhere like an hour and a half in driving time from linden, even d.c. oh yeah, let me add in there i am a new grad:cry:,who hasn't become employed here in fl cause us new grads, we have the plague or something -- no one wants us. the only reason nursing is in demand in fl is to keep the nursing schools in business! so any advice on the market, new grad opportunities and names of hospitals in the areas so i can hit the websites? thank you in advance, you guys are great:heartbeat

Amen to that last statement. I am one of the seriously in debt loan holders, but I too will just face the music. The lenders were good enough to invest in me and make the money available to me, one way or another they will get payed back, but I certainly am not going to lose my mind over it. I too am in the same boat with battling two previous suicide attempts 18 years ago, so I thought that was kinda out of line too. But to each his own. We all have different circumstances, different realities, and different opinions. Sometimes we have to agree to disagree, and mostly whether we agree with each other or not, I think it is important that we try to walk in each others shoes and be supportive of each others struggles. We are after all a community of nurses. We are individuals, but we are one.

I'm in West Palm Beach. You know what, since I am a new grad I haven't developed the foresight of what you mentioned which really has swayed me to make my final decision to not venture into this unless the ADON offers me a full 8 to 10 week preceptorship. I did not think about my license being on the line through my delegation of resposibilities. See I haven't even begun to see the ramifications of certain things yet. Thank goodness you nurses with the experience are here to help me protect myself from things I am not yet aware of. I will explain to her that I think it would be placing myself, the facility and the patients in a potentially dangerous position. If they will take me up on the extended time, I'll go, but if not, this IS DEFINATELY NOT A GOOD IDEA AT ALL!! Thank you so much for shedding light on the situation. I just got my license, it took a lot of time, money and hard work and is the license that will ensure that I have future employment. I cannot and will not put it at risk. Bottom line --- they want a "body", I'm not even sure they want a brain to be honest with you.

Hi Everyone, As I read this thread I sit here with that all to familiar sinking panicky feeling in my gut and I actually am breaking a sweat as I have so many nights laying in bed wondering how I am ever going to pay off these loans. I went to a private college. Initially I was majoring in PTA, but withdrew first quarter to go into the nursing program. My nursing program alone was $50k not to mention my prereqs which were probably close to 9k. Unfortunately I was one of those students who took out above my tuition cost to supplement my loss of income that I was bringing in prior to nursing school. Had I not been able to do that I wouldn't have been able to go to school. I only went to the private college because there are few BSN programs here and the shortest waiting list was 2 years! So, yes I panic, I really do. I am in over $150k, but I have to remind myself that that extra is what kept food on the table and paid half the rent. I'll be paying back forever, but that is o.k. I am in a career that I love and plan to further my education in. I have NO IDEA what my monthly payments will be yet, and quite frankly would like to stay in denial as long as I can. In a year or so, I will be freaking out to all of you about these loans, until then, may all be peaceful and rosey.

Yes, I would be responsible for patient care and for supervision and delegation of assignments to the LPN/LVN and CNA's. The actual title is RN-Supervisor. I would be the only RN on the subacute end from 7p to 11p. The ADON is there til 4:00 so they say there is only a 3 hour window and that I can ask for help from one of the nurses from the residential end. I don't know, this is a bit scarey. It seemed like an awesome responsibility for a new grad, that is why I was suprised they hired me. Honestly my first concern is the patient. I don't want to put any one at risk because I am not trained properly and I don't want to lose my license either. I have decided to call ADON tomorrow can anyone offer me any suggestions for questions I should ask regarding this whole situation?

I am so happy for you. Those of us who are finding jobs right now are truely fortunate.

changeofpace, I went online to see what the facility ranking is (I can't find it). I went on Fldoh and google. I did find a report and noticed that their pressure sore for long and short term patients were above the florida and national average. My next question to anyone is how do I go through this 3 day orientation without putting my license at risk. Should I insist that someone is with me at all times and checking everything I do. If I am going to get only 3 days, I feel sorry for the person orienting me because they are gonna get pelted with questions. You are right I worked hard for my license and I am not willing to compromise it for a facility who is willing to compromise it's patients care by hiring new grads and throwing them out there with 3 days experience.

Hello, OneLoneNurse, I feel the same way about the setting up for failure thing. I think my orientation may have been shortened at the rehab (drug) because I have worked in drug rehab in another capacity an am familiar with the charting and dealing with detox patients. Basically it is meds and assessment. I do feel comfortable with that orientation time, plus at least there will be other RN's there if I need anything. At SNF I will be the only RN on duty - me, myself and I as a RN, after 3 days of training. You know what, that is down right freaking scarey! I may have book knowledge and some clinical experience but I do not consider myself competant to be handling patients lives on my own. These places really scare me. Imagine being a family member of a patient finding out that the nurse treating your loved one just graduated nursing school and has only recieved 3 days on the job training. I don't know whether to laugh or cry.

O.K. so I've been thinking. Drug rehab drop wants me to meet with HR tomorrow to get the paper work rolling. Facility orientation for SNF is on Wed and Thurs. Actual floor orientation with the nurse would be Mon, Tue, and Wed, and the extra 2 days if needed. I am thinking of trying out the first week at SNF and see how I do. If it doesn't go well I can leave and still have the per diem at drug rehab. I will just tell them that I can't start being on call until the 1st of June. At least it will be a fall back and in one way or another bring me in a paycheck which I desperately need. It will also give me time to look into some other psych facilities for extra per diem or tech work. Does that sound like a decent game plan? The 2 to 3 day orientation just blows my mind ---- WOW they must expect us new grads to be the next greatest thing, huh. I think I can handle the supervising and delegation o.k. It is just time management with admissions and discharges. Also maybe I should speak with the ADON in greater detail about what exactly my job description is a registered nurse. Any comments, suggestions?

Hi Everyone, Here I am again. Thanks so much for the words of encouragement last night, now another possible road block and please be honest with me about this, especially the seasoned nurses out there. I called to clarify some things regarding orientation and preceptor time. She tells me that the orientation would be a 2 day unit orientation and then 2 to 3 days orientation and preceptor with a nurse. I could ask for an extra 2 days if I didn't feel comfortable after 3. I asked her if she realistically thought that was enough orientation time for a new grad. She said yes in most cases, but then went on to describe that it was fast paced like an ER. I knew it was fast paced because the DON discussed that with me, but 2 to 3 days, I don't know about that. I fortunately did not put all my eggs in one basket and interviewed with a drug rehab facility today and got offered a job per diem. There are two of same facilities and I offered to float between the two and be "on call" also. The pay is the same. Orientation is 2 weeks, but the nurses role is not as in depth. We mainly do assessments, pass meds, hang IV meds and start IVs when needed. I know psych is not such a great place to start but that is what I did prior to getting into nursing and I need a job. I figured I could also search per diem at the local hospitals which may be easier to get than full time. Help me out here. What is the reality of the situation. Please, feed back quick as I have to decide by tomorrow.

pookatunie, I promised myself that no matter what, I'd stay a year on this job. Some of my classmates are on their 3rd job already and most of us just sat for boards in March or April. It will be tough, I know, but I am eager for the opportunity, am nervous about starting but can't wait to get started. Great idea about helping out the CNA's. Like I said in my earlier post, they are golden to me. I have and will continue to learn from them as well. I know being respectful and helpful to the CNA's makes life alot easier. The Nurse Practice Act is where I should refer to for proper delegation administration, right?

off the top of my head how bout, for bowel and urinary incontinance: Risk for Impaired skin integrity, Self Care Deficit. Alzheimers: Risk for injury, Disturbed thought processes, Impaired Social Interaction, caregiver role strain. Holistically you will want to educate, support, teach and make appropriate referrals for respite care for caregivers. Don't know it that helps. A great book to assist with care planning is Thomson Delmar Learning's Medical Surgical Nursing Care Plans, by Shielda Glover Rodgers. This is great it keeps me fresh too.

I would love to help with this but I am not sure exactly what you are looking for. Are you looking for nursing diagnoses with interventions and expected outcomes or are you looking for the different medical issues with the pathophsiology, etiology and treatment?

I am so glad you all are out there, because I would really be feeling a lot more scared right now if you were not out there for me. I have some questions if any one would like to toss out their thoughts I'd appreciate it. How long of an orientation is usually sufficient? During orientation are you with a nurse, I mean do they teach you? There is this saying, "watch it once, do it once, teach it once" Is it o.k. to not feel comfortable doing it by yourself after the "once" or are we expected to just get it? From what I am understanding I will be a registered nurse supervisor. Once done with orientation I will be managing the LPNs, LVNs and CNAs any advice on supervising and delegation? As a student I always treated my CNAs like gold. I really learned a lot from them. The DON said she is having alot of trouble with the CNA's hanging at the end of the hall chit chatting instead of working and that there is a lot of negativity among the staff. I am biting off quite a bit here and I know it, but I also know I will be great once I catch on. O.k. hit me with delegation, prioritization and managerial wisdom. PLEASE. Thank you so much for being here. If I could give you all hug I would! Consider yourselves hugged and greatly appreciated!!!!

For me the main stressor was clinicals and not feeling guided enough in the clinicals. Up until our last quarter we had to have our instructor with us to do an invasive skill and there was 1 instructor to 8 or 9 students per clinical site, so needless to say some got the benefit of the instructor (usually the students the instructor was afraid to "let loose" in the hospital) and some of us didn't. So lacking skills and then being judged by some of the nurses for the lack of skills was stressful for me, and I am still stressed about my lack of skills as a new grad entering the workforce in a week, but let me tell you, I will catch on real quick! Also my family was a stressor. I basically dropped off of the radar for 2 years, and they just didn't understand that it was necessary for me to do that because I couldn't have any b/s getting in my way. Hope that helps. Good luck with your paper.

Thanks for the advice. I am trying not to let my nerves get the better of me. I mean, the DON must have seen something she liked to hire me, knowing that I am a new greeeeen new grad. The lack of technical skills has always been a concern for me, but I guess they can be easily learned. I can whip out a care plan and critically think pretty well. I do think the BSN programs need to get a little more solid on the skills too though. Good luck on your new job! Mail and let us know how it goes. I am not sure how to set up PM so if anyone knows how to do that, please let me know. We are very fortunate to have been hired the way things are right now.