lovinghands

Pacific for Specific. I pacifically told them! Makes me crack a smile everytime. Gotta love the human race...

15 bed admission unit AM - 3 staff + 1 RN PM - 3 staff + 1 RN NOC - 2 staff + 1 RN covering 2 units

I've never had any trouble giving Consta but your pt population sounds different than mine as I work in a acute setting. Is it possible that you give it ventral gluteal for those who have the scar tissue? I've always given it dorsal gluteal as its to be injected in deep muscle. I guess this is something that I would discuss with the pts attending & pharmacy as it would influence the pts treatment outcome. Nice to know that Risperdal has a helpline - let me know what you find out.

You might want to speak to one of the nurses at the hospital that you are considering or see if you can view/take a tour of their facility. I can give you some general input based on my own experience but I don't know of their guidelines. In my facility, which is a state psych hospital, there are 3 geropsych units aka nursing home units. These pts that reside on these units have similar medical conditions to nursing home pts. I would not classify any of their medical conditions as minor as they are in need of nursinig home care. Its not uncommon to be dealing with catheters, feeding tubes, IVs on these units - occasionally they have a trach pt or someone on comfort cares. So assessment skills are critical when working with this population as their emotional/mental/medical conditions may be a barrier in their care. Not all geriatric pts that have a mental illness are placed on nursing home units, at least not in my facility. New admits, including total care, are initially placed on one of our acute/admission units. The admission unit helps determine the pt needs and future placement. Most pts on our admissions units are discharged to home. If placement is necessary, community resources are reviewed first. Unfortunately for some pts this is not an option. Hope this was the kind of info that you were looking for. Good luck to you.

I posted this message quite awhile back under "What's your day like?" and "Typical Day in Psych Nursing." Btw, I'm not blowing smoke anywhere ... I am a psych nurse on an inpatient acute unit. I work 8 and 12 hour shifts. Generally I am the only RN on the unit - if I need backup, I call neighboring units or the supervisor (if he/she isn't too busy). My unit is usually full, 15 pts, and we run with 3 aides depending, of course, on acuity and staff availability. I count and get report at 2:30 and am on the floor by 3:00. The beginning of my day is usually busy - orders and finishing up tasks leftover from dayshift. The Dr and PA-C have a tendency to write orders late in the day, so I may be working on admissions, discharges, med changes, referrals, following up on abnormal labs, etc. I deal with all medical and acute psych issues - everything from a scrape to chest pain to suicidal thoughts or aggression. I am the med/treatment nurse. I am also the team leader, so I deal with delegation and personnel issues on my unit. Somedays run smoothly and other days it seems all I do is set out fires and race the clock. We are an admission unit and most of our admits come in the evening, usually I have one but I have had up to three in an 8 hour time span. If I have an admit, I complete a nursing assessment with the patient, deal with immediate medical/psychiatric concerns, take off admission orders, contact their family, and of course document every intervention and write up an initial treatment plan. I am engulfed by paperwork my entire shift - it seems for every intervention there is triplicate paperwork to complete. I love patient care, hate the paperwork - it's a necessary evil though. There is a high level of unpredictability when dealing with psych admissions - I deal with patients with varying diagnoses, including medical, and crises (s/p suicde attempts, mood disorders, psychosis, homicidal ideation, dementia, etoh/drug withdrawal and personality disorders). I have worked with some awe-inspiring patients over the years and a few that I'd prefer not to meet again (to put it nicely ). Some of our patients can't communicate their needs so assessment is critical. I don't think this can be emphasized enough with this population. It's easy to pass things off as a "psych issue" and then have it blow up in your face a few hours/days later. I follow my gut instinct if I can't pinpoint a specific problem - fortunately we have a great medical team who listen to staff concerns. Somedays I am assigned the defib nurse if there is code in the hospital and other days I handle scheduling conerns for my department. There are many small tasks that I complete throughout my shift - I try to help the aides out as much as I can and vice versa. We work as a team and we depend on one another - I could not do my job without their help. The last hour of my shift is usually the calmest, most of the patients are in their beds and the staff seem to unwind at this time. I finish up on my last minute tasks and try to spend a little time with staff in between doing things. It's my favorite time of the day, sort of a debriefing for us. Then the oncoming nurse shows up and I count/give report and try to let things go as I leave for the day.

(((Tweety))) You have given so much over the years to the members of this board, it's about time we are able to give a little bit of that back. You are in my thoughts and prayers. Be good to yourself. God Bless.

I think your instructor wanted you to concentrate on your task at hand = much easier said than done. There are times that I need to ask a patient to give me a moment when performing a task but when it comes to meds, I will stop and listen. Once the med is given, it's given and there is no turning back. Best wishes to you in your nursing career

Oh boy, I can really relate to this one. I got on my soapbox with the CEO ,of all people :uhoh21: , last week in a meeting and now dread going back to work this week. I am the talk of the program and do not want to be. Keep your chin up - we all have our moments...

It sounds like you are in terrible pain and it is affecting your personal and professional life. Please see a doctor so you can be properly evaluated and treated. Best wishes to you and your aching feet :wink2: PS Have you considered telephone triage?

Are you thinking of harming yourself? Others? How can I help you be more comfortable? This med is for ... Did you have a bowel movement today? How do you handle this at home? You have a choice... Tell me about ... When was your last drink? Do you need to use the restroom?

Glad you moved on. It sounded like an ugly mess. Smart move. :wink2:

Lack of structure and organization, short staffing, disgruntled workers, holey policy and procedures - I think there are much bigger issues at hand than a few cuss words. In this environment, it would be hard to take a supervisor seriously when being reprimanded for secondhand reported derogatory remarks. I am not saying that its right to namecall, etc but IMO there are much bigger fish to fry. You might just win these staff over if you start addressing those real issues. Best Wishes

Great quote!

I generally swipe my hand a couple times near their face and if their eyes track the movement then I have a good idea what I'm dealing with. Btw, they recently renamed this activity to "seizures of a psychogenic nature." The word police is another rant for a different day...

1) please review privacy practice acts r/t psychiatric progress notes. 2) who are you to question my professionalism?

i am a rn who works in a large state psych facility. i work with forensic evals, sex offenders and violent perps pretty much on a daily basis. i will not share any personal information with this population including my last name. i will not put a bullseye on my back - not even for the sake of professionalism....

These are the top 3 that sprung to mind. 1. The violence and unpredictability of some pts 2. Managers telling me how to do my job who aren't nurses and/or never worked the floor 3. Pseudotherapists As I get older the violence has become more bothersome to me. I don't know why that is. Please keep in mind that most pts are more likely to be victims than assailants but there are those that you need to take serious precautions with to protect everyone involved. I hope your interview went well. Best Wishes

I'd have a total fit if this happened to me! Btw, I am a glove-aholic.

try the direct approach - ask your staff and really listen to what they have to say. why not take a chance and open up the lines of communication between mananagement and staff? it may just benefit everyone.

I posted this message awhile back under "What's your day like?" I am a psych nurse on an inpatient acute unit. I work 8 and 12 hour shifts. Generally I am the only RN on the unit - if I need backup, I call neighboring units or the supervisor (if he/she isn't too busy). My unit is usually full, 15 pts, and we run with 3 aides depending, of course, on acuity and staff availability. I count and get report at 2:30 and am on the floor by 3:00. The beginning of my day is usually busy - orders and finishing up tasks leftover from dayshift. The Dr and PA-C have a tendency to write orders late in the day, so I may be working on admissions, discharges, med changes, referrals, following up on abnormal labs, etc. I deal with all medical and acute psych issues - everything from a scrape to chest pain to suicidal thoughts or aggression. I am the med/treatment nurse. I am also the team leader, so I deal with delegation and personnel issues on my unit. Somedays run smoothly and other days it seems all I do is set out fires and race the clock. We are an admission unit and most of our admits come in the evening, usually I have one but I have had up to three in an 8 hour time span. If I have an admit, I complete a nursing assessment with the patient, deal with immediate medical/psychiatric concerns, take off admission orders, contact their family, and of course document every intervention and write up an initial treatment plan. I am engulfed by paperwork my entire shift - it seems for every intervention there is triplicate paperwork to complete. I love patient care, hate the paperwork - it's a necessary evil though. There is a high level of unpredictability when dealing with psych admissions - I deal with patients with varying diagnoses, including medical, and crises (s/p suicde attempts, mood disorders, psychosis, homicidal ideation, dementia, etoh/drug withdrawal and personality disorders). I have worked with some awe-inspiring patients over the years and a few that I'd prefer not to meet again (to put it nicely ). Some of our patients can't communicate their needs so assessment is critical. I don't think this can be emphasized enough with this population. It's easy to pass things off as a "psych issue" and then have it blow up in your face a few hours/days later. I follow my gut instinct if I can't pinpoint a specific problem - fortunately we have a great medical team who listen to staff concerns. Somedays I am assigned the defib nurse if there is code in the hospital and other days I handle scheduling conerns for my department. There are many small tasks that I complete throughout my shift - I try to help the aides out as much as I can and vice versa. We work as a team and we depend on one another - I could not do my job without their help. The last hour of my shift is usually the calmest, most of the patients are in their beds and the staff seem to unwind at this time. I finish up on my last minute tasks and try to spend a little time with staff in between doing things. It's my favorite time of the day, sort of a debriefing for us. Then the oncoming nurse shows up and I count/give report and try to let things go as I leave for the day.

D Oh I am having flashbacks of nursing school!

I'm so sorry about your new job. This must be a major disappointment for you. I agree with the above posters. You must protect your license as well as your patients. There are wonderful orientation programs out there that are supportive and want motivated employees like you. Move on - there are better opportunities waiting for you. Best Wishes :)

Is his psychiatrist and tx team aware that staff are allowing him to displace his aggressive urges onto objects? If so, is this "intervention" outlined in his tx plan? I would hope this is behavior is not a recommended form of therapy. Object aggression is still a form of phsyical aggression and should be taken as a serious threat, particularly in violent individuals. I recommmend you follow your chain of command and let it be known this child is stabbing, mutilating items with weapons (pencil/spoon) and this is not only being condoned but encouraged by the following staff then name them. I would not want these staff members on my unit - who knows what else they are encouraging, even in good faith.

Just my 2 cents here. Keep in mind that most patients suffering with borderline personality disorder are undiagnosed and never see the likes of therapy, let alone inpatient care. These ppl are in our communities, struggling and attempting to function in society to the best of the means. The pts with this disorder that I see on my unit are usuallly extreme cases. So I don't quite see the connection between the system inventing this disorder. I do see hospitals fostering dependency in borderline patients by enabling manipulative behaviors and offering inadequate resources of treatment.

I've seen a few pts on 900 mg of Seroquel. The highest dose that I've seen is 1500 mg which the pt was slowly tapered off of after admission. Many of our docs believe Seroquel is mislabeled as an antipsychotic - seems to work better on mood, impulsivity and sleep.