NCindasun21

Hello Experts! My daughter has asked me to take a doula certification program so I can be present for the delivery of my first grandchild. I've been an RN for 18 years, the last 10 in Mental Health. I do a lot with complementary medicine and am a certified aromatherapist. I have no doubt that I'll do well in the course but I'm curious about whether I should look for an in-person program (few available) or if a virtual program would be enough with my experience. Looking forward to hearing your thoughts.

Hi! I just sat through our VISNs Town Hall and during the open mic there were several questions about retention and sign on bonuses being offered since so many nurses are leaving for remote jobs. Only certain existing RNs are being offered retention bonuses and they tried to get us to buy into the idea that Education Debt Reduction Program is a retention tool. As someone who has long since paid off my loans how can I possibly think of that as a reason to stay?! Almost feels like age discrimination. Anyone else have thoughts?

Hello, Looking for VA BHIP / Mental Health nurses to pick your brains for a Shared Governance project we are working on in my VISN. We've spent nearly 2 years working from home or rotating into the clinic. Most Veterans have had no idea we were at home when we were calling or doing VVCs. Providers were happy as long as there was a nurse available for IVC or vitals and injections. We are now being told we have to come in full-time because "it isn't fair to the PACT nurses". Comparing Mental Health and PACT nursing is like comparing apples and oranges. Mental Health nursing has been really hard for the last two years and we don't see it getting any easier in the near future. Working from home, even part time, has helped with some of the burnout. Many of us have to drive 45 minutes to our CBOC so it gives us 1.5 hours back to our day. We know that the VA is hiring MH RN/Care Managers to work remotely so they must agree on some level that it is possible. Curious to hear of your experiences in your VISNs and if teleworking is working for you and why. Thanks in advance!

"Booty Juice"

I had terrible plantar fasciitis a few years back. Too many years of wearing clogs they tell me. My sister is a surgeon and she wears MTBs. The toe box was too small for my fat toes but the clerk at the Good Feet store recommended that I try Chung Shi Chung Shi . They have been amazing. Not the prettiest shoe in the world but I've gone from Q4 months cortisone injections in my heel to being pain free. They aren't cheap but they are so worth it. Now for general advice. I found that the toes of my white shoes were getting scuffed up something terrible. As a psych nurse you are constantly looking behind you as you go through a thousand doors to get any place. I tend to unlock, kick door open while turning my back to make sure no one is charging me, hence the ugly tips of my shoes. This latest pair I bought are gray with black soles that roll up over the toes. They have been perfect. Again, not the prettiest shoe but you can run, stand for hours, everything you need in a good psych shoe.

Agreed. I have had many MHWs that were Psych majors. Some decided to go on to nursing school, others not. It's definitely a good intro to in-patient psych and we always need MHWs who are educated and interested.

Patient to staff ratio - how many nurses vs mental health workers are on the unit. If there are more than 12 patients, one nurse may have difficulty doing it all. Turnover is a red flag. If you get to meet some staff, ask how long they have been there. If everyone is young, that may suggest that the more experienced nurses have left.

Thirty bed unit - 6 pts to 1 STAFF member with preference going to MHWs. On any given day the RN is the only nurse and that includes giving meds and attending rounds. The burn out rate is very high.

I work Child/Adolescent and I'd honestly be surprised if they ask you any serious questions on the interview. For our hospital it's been hard to find experienced psych nurses so we've been getting a lot of new grads. Here are some of the issues I face daily with my patients - ADHD Bullying Cutting PTSD Borderline Personality Disorder Oppositional Defiant Disorder Eating Disorders Sexual Orientation (goes along with bullying and cutting unfortunately) Substance abuse (Alcohol, Marijuana and Spice are the biggest concern) Autism Spectrum (including Aspergers) Medications - obviously there's a ton to know about them but that comes with time. (Vyvanse, Abilify, Invega, Saphris, Tenex, Risperdal, Seroquel, Zyprexa seem to be in fashion lately along with antidepressants) Good luck with your interview.

Jeckrn, I am an RN in a private hospital that has had a wing contracted by the military for an extended period of time. Any ideas that would be appropriate? I did Sleep Hygiene yesterday, jazzing it up with different forms of media and examples of non-medication sleep aids which they seemed to appreciate but what next? Thanks!

Greetings! I've been given an awesome opportunity to work with some active duty patients. Some have been on deployments but others are just out of boot camp. Some love the USMC others just want out. Some are dealing with PTSD, others don't like to take orders. In other words, it's wide open. With our usual population we have set groups that we do. In looking at our binder, I'm finding that many aren't appropriate. They feel too basic. These men and women have been through a lot and having them completing a worksheet seems like a cheap and easy way to say I did a group. We're supposed to cover topics like Life Skills, Self Expression, Living in Balance. Can anyone suggest topics or activities that might work with this population? Thanks!

Here are the topics that I feel are currently relevant to child/adolescent psych. I wish more staff would be exposed to these issues. It's what my kids are facing. Bullying - including cyber Eating disorders - Athletes are overlooked. Pressure to make weight, etc in school sports is intense Self injurious behaviors - Many believe that boys don't take part in SIB - they aren't looking at the right part of body or behavior Gender Identity / Sexual Orientation - so many are struggling Anxiety disorders - so many of my patients with suicidal ideation are really suffering from Anxiety disorders Hope this helps.

Greetings! I've found myself with an opportunity I'd like to explore. The facility I work at is starting to see a lot of returning soldiers with PTSD. I've been studying up on the topic and have completed the VA's PTSD 101 course. I've not yet approached my supervisor about transferring to that ward because I want to be able to present a well thought out proposal. I have been a psych nurse for quite a while and I'm considered one of the senior nurses in the facility. I'm the go-to nurse for everything from med questions to calming out of control patients and family. My biggest hurdle is that there is "competition" for the positions from 2 vets. I would NEVER take a job away from a vet. Both of them are employed by the facility and are in no danger of losing their positions. In your opinion, does NOT having military experience hinder or help my ability to provide a positive experience for the patients struggling with PTSD? On one hand I've done as much of the academic preparation as I possibly can and my other skills are very strong. I am older and calmer than most. I've worked with some of the toughest patients without the need for restraints and Thorazine is used only as a last resort. On the other hand, I can't possible be able to relate to their experiences but I've also never been in a gang, raped, been addicted to drugs, etc, as my other population has. Do the vet nurses run a risk of triggering their own PTSD or being drawn into "commiserating" with the patients? Am I over thinking this? I truly only want what's best for the patients and the opportunity to expand my skills is very exciting. Your thoughts?

Thank you. I'm going to print out your saying tonight and have it hung by tomorrow. Bless you!

Greetings fellow psychics I work on the Acute side of a psych hospital that is going through a major turnover. Nurses are leaving to go to larger hospitals in the area, most staying in Psych. Our ratio is 1:6 and that includes nurses and mental health workers. So with a 31 patient bed unit divided into 3 groups (teen boys, teen girls and under 13 kids) we usually end up with 3 MHW and 2 nurses. It's not the nursing I signed up for, more like herding kids and managing bedlam. It's very difficult to keep up with the charting, rounds, discharges, admissions, and med passes and you rarely get to know your patients. That said...what keeps you at your hospital. We have an awesome nurse manager that is always open to suggestions. We probably can't change the ratio. We are owned by a larger corporation and the ratio is set by them. I want to help administration come up with some creative ways to help keep the nurses we have. Thanks!

As a student nurse I drew the "lucky" card to do a one day phlebotomy training. After practicing setting up, reviewing which tubes are for which labs, etc, I was ready. A little nervous, but ready. My very first draw was to be from a heroin addict. You could see the track lines all over her body. Would you believe that woman started screaming before I even got the cover off the butterfly? Finally got the stick but not before two people helped hold her down!

I just worked the worst two days I've had in a long time. I've got 12 boys in an Acute setting and the majority of them have been diagnosed with ODD, one has anti-social tendencies, one with RAD, and one autistic. Our census guidelines allow me to have one MHW. The past two days I've had a MHW who did NOTHING with these kids. Every time I looked up they were sleeping or watching TV, both of which aren't part of programming. I tried joking, pleading, threatening the MHW to do SOMETHING. Of course it's the RN's responsibility but what are you to do if you have a MHW who is ODD too? That will be taken care of Monday when I speak to my supervisor. My question to you is "What groups, ideas do you have to keep ODD kids interested and in line?" I've been using films (teachwithmovies.org is a great resource) but the one film I have to use with boys is "The Outsiders" and with this group of thugs (said warmly) I'm not sure that's the right choice. Med Education will end up being a talk about how to get high, Feelings and Emotions - "there's nothing f#$*ing wrong with me". You get the picture. I've been working with teens for quite a while now, so they don't frighten me. I just want to be prepared with a way to keep them focused if I get a MHW who can't handle them so I can do all my other work. Thanks in advance.

I have found that reading first person accounts of mental illness has given me more insight to what my patients are experiencing than most subject matter books. Recent reads have been Mind Race: A Firsthand Account of One Teenager's Experience with Bipolar Disorder Monochrome Days: A First-Hand Account of One Teenager's Experience With Depression The Day the Voices Stopped: A Schizophrenic's Journey from Madness to Hope Me, Myself, and Them: A Firsthand Account of One Young Person's Experience with Schizophrenia Get Me Out of Here: My Recovery from Borderline Personality Disorder I buy all my books used on Amazon (cheap). Many of them are also available for Kindle.

Thanks so much!

Hello fellow psychics :) I'm trying to put together a "cheat sheet" of sorts on documentation for a new grad nurse I'm working with. While looking at some charts I noticed that many nurses start their notations with "Pt exhibits labile affect and irritable mood". Can you get any more bland? I can explain to her that affect is something you can see, the expression of feelings or emotions. But how do I explain mood? This definition I found doesn't speak to how the observer can determine the mood. "Mood - A pervasive and sustained emotion that colors the perception of the world. Common examples of mood include depression, elation, anger, and anxiety. In contrast to affect, which refers to more fluctuating changes in emotional "weather," mood refers to a more pervasive and sustained emotional "climate." Types of mood include: dysphoric, elevated, euthymic, expansive, irritable." In working with kids, they don't always have words to explain their moods so they usually respond "Fine". I've been doing this a while and I can "feel" their mood but I don't know how to explain it to someone new to it. Any help would be greatly appreciated.

Thank you. Great ideas!

I'm wondering what kinds of things you have on your units for younger patients. We're looking into getting more than just crayons and coloring books but are concerned about the safety of some items. What works for you? What didn't? Thanks!

Dizzylizzydog, With so many large corporations taking over mental health, where exactly does one move on to?

Details please? I'm looking for hope... Hope that we'll go to electronic charting Hope that management strives to make things better, even if it involve tough change Hope that serious effort is put into milieu activities Hope that staff will be held accountable for not following rules, for teamwork, for safety Hope that those who go above and beyond will be recognize, not only with money, but with kudos and encouragement, so that you don't feel that everything is for naught Thanks!

I work on a 31 bed Child & Adolescent Acute ward. With Christmas just days away I asked what was planned for the kids. To my surprise I was told "Nothing" but was given the ok if I wanted to do something to switch things up a bit. I'm hoping that the census will be down but I've got to come up with something! I've already ordered the movie "Santa Buddies" (think cute golden retriever puppies saving Christmas), have my staff baking treats. I have to stay away from the religious aspect of the holiday for all sorts of reasons. I thought about doing some projects involving the approaches to Christmas of different cultures. Educate while entertaining. Any other ideas/experiences? (Of course there will be eggnog with special sauce in the kitchenette for staff )