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Words Matter BSN, RN

Psychiatric Mental Health, Addiction, RN-BC, CARN
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Words Matter has 6 years experience as a BSN, RN and specializes in Psychiatric Mental Health, Addiction, RN-BC, CARN.

Words Matter's Latest Activity

  1. Words Matter

    Lead Clinical Nurse is Dealing with a Negative Nelly, HELP!

    I appreciate your feedback and strong opinions. We all have so many experiences, personal and professional, informing our opinions, responses and reactions. I like what was said in one of the earliest comments about going high when someone comes in low. This is something I need to take ownership of to the point it is ingrained in my character. Honestly, I'm not there YET (AEB the thoughts and silent dialogue that sometimes occurs between my ears!), though at the very least I want my actions to communicate I am a fair and approachable leader. There is too much us v. them in the world in general. I appreciate the awareness of this problem and direction toward collaboration in healthcare. Though I don't foresee getting away from "doctor's orders" anytime soon, interdisciplinary teams/councils/committees, patient centered care, trauma informed care, the care continuum are all the result of working together 🙏
  2. Words Matter

    Brief scale for benzodiazepine detox?

    I am just curious if anyone is aware of a brief benzodiazepine withdrawal assessment tool, like the CIWA-A. The CIWA-B just has too many questions! Many of our nurses use the CIWA-A because our only two options are that or COWS which of course is completely unrelated. Thanks in advance!!
  3. Words Matter

    Lead Clinical Nurse is Dealing with a Negative Nelly, HELP!

    You are absolutely right. And we have had several 1:1 conversations at her request which end with her sending a text or email stating she appreciates feeling heard and supported. I want her to succeed and feel she's done good for at least one patient during each shift. During the short time with my new team we have gained a person who is dedicated to patient rounds (in behavioral health, because the patients are engaged in milieu therapy and have varying types of safety risk factors, we must document each patient's location and affect/behavior Q30 minutes), and fast tracked RN's ability to assess an intoxicated pt at intake rather than waiting until they arrive on the unit, which will lead to a reduction in immediate ED transfers for medical clearance, reduction in Code Greens responding to belligerent patients, and hopefully decreased AMA's < 12-24 hours. RNs used to do the rounding until a few months ago. I like your suggested scripting in the last major paragraph of the referenced post. I am going to borrow that.
  4. Words Matter

    Lead Clinical Nurse is Dealing with a Negative Nelly, HELP!

    I'll keep trying on this effort. I have faith people will rise to the occasion. So far, recommendations I have made have been shot down by her, "I did that before, and nothing came of it". I encouraged her to try again. I have even coached her on the type of data she can document to support her effort for another FTE. We must have the data to back up any proposed changes and requests. I invite her to our monthly UPC which meets through Microsoft Teams, and request input on the agenda with an invitation to be part of the conversation. Currently, her personal annual goal is to attend a seminar on nursing management/interventions for the anxious patient, and I suggested I could request admin hours from the manager for her to prepare a brief presentation for her peers during UPC to apply interventions with our detox patients. All annual reviews are to be done a month early this year, so I hope the seminar is prior to her review. I would love to know her excited about the material she was exposed to in the seminar. BTW - no next level conversation yet. She was on PTO, then worked the following weekend when I directly observed two instances of misconduct and defiance while she was charge RN and I was on admin. Per my manager's recommendation, I have reached out to HR for guidance on appropriate documentation leading up to and throughout the disciplinary process, if this is the necessary path. Everything must be just right, so we follow all union agreements and the law. I took this role because I was excited about the ways we could improve our patient engagement, care and programming. This whole experience with this nurse has been too much reality...
  5. Words Matter

    Lead Clinical Nurse is Dealing with a Negative Nelly, HELP!

    Thank you Nurse Beth! I’ll let you know how the conversation goes, and will be certain to keep the focus on her performance. Sounds to me like you have rumbled with this type of employee. The good news is my manager completely supports my efforts, has faith in my abilities, and is available for guidance.
  6. Words Matter

    "Addiction" Nursing is an outdated term.

    I am also a CARN, 5 years in psych dual diagnosis and mood disorders, though now I have the opportunity to focus on inpatient detox. The term "addiction" does not solely encompass substances. There is gambling, sex, relationships, food, sugar, drama, etc. Evidence shows the same parts of the brain are engaged when the individual is partaking in their drug of choice, even when it comes in the form of a donut. Naltrexone is being used for craving management in prevention of opiate use (IM-Vivitrol), alcohol abuse (PO-Revia), and binge eating disorder (PO-Contrave). Similar interventions and therapies are used to teach our patients no matter what they are recovering from. Why do you think you can find a 12 step recovery program for alcohol, narcotics, overeating, gamboling and sex? Because people have successfully learned a different way of life through the same concepts. Words only have power we give to them as a culture. In my experience, "addiction" is a condition, period. "Addict" can carry the same stigma as "alcoholic" or "dope fiend", and whether or not to identify with the label is up to the individual who is living the experience. Do some research on the use of person first language. I believe you are correct in a clinical "PC" or diagnostic regard of using SUD over the term addiction. I'm uncertain there is a DSM-V diagnosis for addiction, though I do know SUD and AUD are in the DSM-V. But, when we are talking with our patients, we use the terms they prefer. For many, it will be addiction.
  7. I currently work for a Sharp Hospital. We are in it thick with union negotiations. I was able to find the UCSD bargaining agreement on their website. Does anyone have a copy of the Kaiser San Diego contract? Or even just the wage grid? Thank you!!
  8. Words Matter

    Aggression Risk Assessment Scale

    I work at an inpatient acute care freestanding psych hospital. As a violence predictor we use the Broset Violence Checklist (BVC). The main con is users not assessing properly. The various categories are assigned a score based on that behavior being Present or Absent/Baseline. For example, if confusion is a person's current presentation, but it is also the patient's baseline, the nurse should tick Absent/Baseline which would score 0 for this part of the assessment. An uneducated nurse may tick Present and unknowingly flag the patient as an increased assault risk. Proper education and follow up can prevent this from happening. A lot of research went into choosing this assessment tool for our facility.
  9. Words Matter

    A (Long) Note to New Grads

    Thank you for the post. I have also wanted to get into psych nursing since before my nursing program. I was told this specialty is where nurses go to retire; so I was hesitant to announce my interest until our psych nursing rotation. Where others were uncomfortable asking about SI or talking to a depressed patient, I thrived. Monday will be my first day with patients at an acute care psychiatric hospital. I am fortunate to be part of the RN residency program. We met with a few leads from the specialty units, and I have an idea in mind of where I am hoping my home unit will be. I feel that nursing is such a broad career path of opportunity and specialization, there is absolutely NO REASON to enter an area of practice without excitement and passion for the work to be done. The bonus of my particular residency is that the hospital is part of a larger healthcare system. If I decide I would like to get some Med Surg experience under my belt, I am welcome to request a unit transfer. We also have a Geri Psych unit; I was told this is where we would utilize more of our technical nursing skills. ECT is an option for cross training (opportunity to keep IV skills in check). I am interested in knowing more about your liaison position and how this is different or more involved than being a direct care RN as we are responsible patient advocates.
  10. If you know the school you will be attending, I advise you speak with the nursing clinical coordinator about your situation. The person in the school of nursing tasked with arranging clinical assignments will have the best insight and direction to share with you. The reason is, that more than likely, limitations are based on requirements of the facilities where clinical placements are made. Do not speak with a general admissions counselor if at all avoidable. Your situation requires very specific knowledge. Additionally, know what your state's laws are regarding expungment for a felony. The requirements and allowable offenses are different than misdemeanor expungements.
  11. If you are getting ready to enroll in an upcoming cohort, or are trying to figure out if this program is for you, I just want to let you know to have faith. There is a reason that students who have passed Med Surg are smiling. If you can keep a positive attitude, and manage your time well so that you are able to make the connections between theory and clinical days along the way, THERE IS HOPE AFTER MED SURG! Make the most of your time in Pharm. When it is suggested to learn the classifications of the drugs and how they work in the body, this is good advice and will serve you well during clinicals especially when interacting with your CI and mentoring shift nurse. Regarding FINANCES (personal) - during my initial orientation I was told to be prepared not to work by Med Surg. I was able to arrange with my current long term employer (non medical related) a planned leave of absence. I am a single mother to an elementary school aged child and I have a pet in particular who requires a bit more care than the average bear. Please know that if you are in a similar situation and use to being self supporting, financial aid will not cover ALL living expenses even with the additional allowance. Be prepared with a back up plan to cover your essentials. I cannot compare this program to any others. This was the only path I looked into. If you are debating between this program and another, there are two major points I would like to share which I have learned along the way. First the bad: There is no externship after our program is complete. We have great clinical experiences along the way, but no foot in the door with an externship. Now the GOOD: Again, I have no experience with other schools, but I can say that our clinical rotations occur concurrently with our theory course of study. This means, that when we are learning about Maternity Nursing and newborn care in theory, we are also attending clinical days on the L&D units of our assigned facilities. I have heard through Clinical Instructors and staff nurses that this is not the case for all schools and that sometimes a clinical site may be assigned without any baseline classroom or textbook knowledge. It is truly a benefit to the patients, staff nurses, and student to have this experience of concurrent theory and practice. Just though I would share a bit of my experience in hopes that this is helpful to a future nurse.
  12. Words Matter

    Online Science Courses

    I have applied through National University and at least at the tim eof the orientation for the Nursing program they said it did not matter so long as the labs and lectures were both taken for each of the pre-requisites. They said there is no was to tell if the courses are online or in person because that information is not included on transcripts. However, I am still waiting on approval for courses I found through TUI University which I would like to enroll in to complete my pre-reqs. Best Wishes!!!
  13. Words Matter

    Online Science Courses

    Has anyone had experience in taking A&P I/II and Microbiology (all with labs - 4 units each course) through TUI University California? The courses are on CD with virtual labs. The school is accredited by the same institutions which accredit National University (the BSN program I am looking to enter). I have not yet received an answer from my admissions counselor who said he needs to get the approval from the head of the nursing department. I am just trying to get into action here - the wait feels like forever!