Hallows_Eve

Our facility just ended years of wearing street clothes and started requiring scrubs again, they almost made them uniform, but couldn't come up with a justification for the stipend they would have to pay. So its our own scrubs. I was already wearing either scrub pants (cargos) with a casual top, or a scrub top with yoga pants. I needed the pockets generally, and to be able to move. I pretty much would wear the same things when not at work, most of my scrub tops could be casual tops. Now that we are all scrubs, its been fun scouring ebay and the like for funky patterns. Many are one of a kind, others are $5 or less, lots of room to play into your style.

Our BH units include a fair amount of detox and rehab areas- the former especially keeps up my med surg skills as all types and conditions go through various withdrawals, from alcohol, pain meds, crack, street rx drugs, etc. I do stoma cares, trach cares, wound care, incontinence care, foleys, IV checks and blood draws. We also look out for DTs and seizures- all told an excellent combo of medicine and psych. Whether your workplace includes detox in behavior health or not can vary, but even on the psych units we find ourselves doing a fair amount of wound care and foleys, just not as often as on a med surg floor, but to me not seldom enough to completely lose the skills, and we get the added bonus of the patients not staying in their beds :)

Not sure if this helps but in the Psych ER where I float to we are seeing a lot more K2 and Bath Salt cases, which often are marked by lingering paranoia and anxiety (24 hours+ after the hit), and doesn't turn up in normal tox screens, especially the K2. They often try minimizing behaviors, usually realizing that they don't want to seem crazy in the psych er and would like to leave quickly- but they can't usually cover the paranoia or anxiousness for long (it's also in their vitals). The Amphetamines on top of that possibility- eeek. Hopefully someone was able to keep the patient there under physical observation: In NYS we have an involuntary hold to keep a patient for 24-72 hours for observation- then the doctors can make the determination of certification and involuntary inpatient hold. I think its looked at over here as whether or not the person has the capability of hurting themselves or others, purposefully or not (as in following delusions). State mental health laws vary wildly though.

I am a float LPN at a BH program that includes about 10 different units. You didn't mention how safe you felt at your workplace, but I can say in ours that safety is a factor in our turnover rate- not just physical safety (although that is huge) but license safety too- the likelihood of being disciplined or suspended for whatever reasons. Often how this plays out depends on the Unit Manager's interpretations of Administrator's set of rules. Where one unit manager just needs to make sure bodies are on the floor and all the charting is correct because 'that's what the Director expects' , another may be more concerned about patient to nurse interaction and not as focused on dotting the i and crossing the t 'because the Director wants more one to one interaction'. One unit manager will have a true zero tolerance for violence on the floor, while another may initiate disciplinary actions against staff for not being theraputic enough when a violent incident happens on their unit. Whether or not all violent incidents can truly be diverted and how differs from unit to unit, as well as whether our hospital can give itself a 'no restraints necessary' brag, which to some managers and admins is like the Grail of Mental Health achievements. For a while we had security guards on every unit- then suddenly they were replaced by plain clothes 'Security Assistants'- one per every two floors, or about 1/3 of that original security. Each unit manager saw this administration decision differently, one stating that it was because patients were too intimidated by police looking folks hovering around and therefore contradicting a theraputic environment (particularly those with ODD, or police centered paranoia). Another UM stating it was a state thing having to do with medicaid- as soon as a uniformed officer touches a patient, medicaid is said to stop payments on their treatment as it becomes a criminal justice issue. (About 75% of our pts have Medicaid). Yet another UM stated is was a budget cut, pure and simple, and that the replacement panic alarms overall saved the hospital money. Overall thing to ponder would be how comfortable the nurses and staff feel about their security, whether they feel that they have each other's backs during escalated situations, and whether they feel the nursing is a priority over charting where you are. HTH!

I am a float nurse that is often scheduled between the in-patient floors and the psych ER. For inpatient, we too usually assign staff to specific tasks, as an LPN I am often either the med nurse or the milieu nurse (nurse on the floor with the patients, attending or even running groups and rec therapy). Med nurses have to check for signs of medication compliance, floor nurses often do the environmental and room checks- keeping patients out of rooms not their own, looking for contraband, watching visitors who might give contraband, watching meals for pocketed objects or hoarding. There are usually two RN's, one or two LPNs, and one or two HA. (Four to the unit, so the breakdown is technically 4 patients per staff for end of shift notes). There are variances for things like adolescent units (age appropriate activities and groups, many more behavioral issues at play than psychiatric per capita), and geriatric and detox combines a lot of Mental Health with Med-Surg. Its a bit different for our Psych ER. Again there are assigned jobs, LPNs with the milieu or meds, Charge RN, but here additional RNS to admit, discharge, and interview patients. There are also security officers posted and often special guest appearances by local law enforcement bringing in or taking out patients. It is much more fast paced, patients here are usually arriving in the middle or just post acute phase. (Also, a lot of people brought in for being under the influence and staying/doing the wrong thing while their BAC is jacked). A lot more restraints (often brought in as such), and PRN medication ordered. For myself, I like the psych er most- You don't get sick of seeing the same faces every day (except for some frequent flyers) and you get to learn a little bit of everything. I do like the inpatient floors too, since by comparison you have a little more time to spend with patients that may respond to your nursing style. My mindset with these patients is pretty much to treat them like that one friend or friend's parent/sibling/grandparent that we all have somewhere, who somehow keeps getting in a rut and a run of bad luck, and you root for them and try your best to help them pull through. Some patients will love how you do your job, some hate you and like someone else's methods instead. Before orientation to the floor, I had extra training on non-violent self defense, deescalation techniques, and restraint practices- four and five points. These things we review in service every year. A lot of the main differences between psych and med-surg is that psych patients are usually not confined to bed and are instead mobile throughout the unit. The rooms do not have medical equipment, tv's or phones in them (all hazards to psych patients), and instead the phone and tv are communal in the lounge. Visiting happens in a specific room, not the patient room, and staff must watch all interaction. Lots of group activities, and of course there are some violent or grossly psychotic patients that will go after you for any reason, so there is an increased level of awareness for safety measures and locations of other staff members. HTH!

I am an LPN, and I've worked on the Behavioral Health floors at my hospital for nearly a year now, also floated to the drug and alchohol rehab floors as well. In my area (WNY), there were plenty of openings for LPNs for BH. I was hired literally right out of graduation (and before I had even passed my boards). I am not sure if it was because of a shortage of RN's wanting to work in mental health, but where other floors and hospitals here seemed to keep LPN's at a minimum or phase them out, we are seen as a necessity for the BH floors. Our set up is that the RNs (usually two per floor) do assessments, complicated treatments, and work directly with the doctors, reports, admissions and discharges. LPN's (one or two per floor) often take care of the vitals, fingersticks, patient assists, environmental checks, and medications- often we run nursing groups as well. The HA's (Zero or one depending on how many LPN's) also does vitals, environmental checks, and patient assists. Both LPN's and HA's can also be assigned to do one to ones- sitting with one patient all shift long due to a danger to themselves or others. For a while it was a bit overwhelming, some folks only last a few months or hang out only as long as it takes to transfer to a med-surg floor, and there are cases that come through the door that you'd think are only made up on tv or in books, but now that I am used to it I rather love it and think I will stay in the department. HTH!

Just some ideas to toss to you... going off of memory from Catholic school. If you go with Catholic faith, you could discuss the processes of the Anointing of the Sick and Viaticum. There is also the cultural aspects of the patient going through Confession and receiving the Eucharist during this time, as well as the nursing aspects. Ex: HOB for a patient depending on what they are affected with, whether they are in a condition to/should receive the wafer or Olive Oil (anointing oil) on their head and hands. Knowing when to give patient private time with the priest for confession without family being present, or keeping rosary beads or patron saints' medals nearby to give the patient comfort (and meditation in prayer to calm the vitals, potentially). There is the aspect that mainly only priests and bishops can administer the Anointing of the Sick, as with baptisms (for babies) but anyone can do it in an emergency. Catholic Nurses may be asked by the family to fill this role, and you have the ethical question of this as well. Also, there is the aspect of postmortem planning. I believe that many churches prefer to be called first, over a funeral home, and it can be the church who comes to take care of the body. If there is a Catholic health system near you, you may be able to bend the ears of the nurses, priests, or nuns there. Hope this helps!

Not sure if this will help, but if you received an email to a school-run email address, you might be able to have the IT for the school's system show that your address got the email, but you did not open it up. This will be a bit harder if it was a personal email address instead though. Best of Luck.

One thing that came up in my interview was my promptness- the interviewer noted that I was 15 minutes early (as noted by the receptionist) for my appointment with her. They also took note of my preparedness-there was a letter regarding what paperwork and documents to bring, and I had brought them in a folder, and dressed as if it was an executive interview- little things that definitely worked in my favor as well. Not sure if it was on their checklist, but it helped make a good impression. I was asked a bit about my background- being an older student and having been in an internet business management position prior to applying for nursing school, etc. They asked about my support system, reliability for transportation and child care, and whether my physical and vaccinations were up to date. The interview was maybe 15 minutes in my case, my entrance test having done most of the work for me. Starting class in about 2 months. Hope that helps!