normj

Ditto. I had only 6 months of med-surg before i went into psych, and i am regarded as the unit 'expert' on medical stuff, often fielding questions from nurses with 25+ years experience in psych who have no recent med experience. Plus, people with MA's in psychology or education are a dime a dozen in most markets (not to denigrate them, it's just reality), so they are cheap to hire ... that's why they frequently resent us nurses with much lower education (in terms of time spent in school) who make much more money. I'd do more med-surg before going to psych if i had it to do again. I catch our docs doing dumb moves (e.g. too much insulin) all the time.

yes, and if all else fails, have them arrested for indecent exposure ... i don't understand why folks are so concerned about using restraints here ... we would put them in locked seclusion immediately ...

We call it a B-52 ... 2mg lorazepam 5mg haloperidol 50mg diphenhydramine IM, all in the same syringe ... Nighty-Night!! :stone

I find that lorazepam frequently only disinhibits such patients.

The old saw "You don't HAVE to be crazy to work here, but it sure helps" definitely applies on my unit ...

personally, i think the best therapists, psychiatrists, psych nurses, psychologists, etc are folks who have been there, done that ... and are now keeping themselves well thru application of tested treatments. you certainly should not be caring for patients if your own symptoms are not under control, anymore than you would show up for work on a med surg floor with a galloping case of TB (a limited analogy, i know, but useful). you really, really need to be able to be objective however ... are you really well? how do you know? i have worked with several staff members from several disciplines on psych units who were actively ill ... and they were truly toxic people, to patients and other staff. good luck!

Clearly, asking your attorney is the right thing to do in this case; every state has different laws. Good luck.

or you could just hide a stool sample in their bookbags ... sorry, couldn't resist ...

I got into nursing to be a psych RN ... Did my 6 months in purgatory (ie, Med/Surg) ... And I've just been offered a job on a psych unit! I am going to take it ... my unit sucks, even the director quit ... our management is suffering from chronic, incurable cranio-rectal co-location ... so I am outta here, baby! :angryfire Looking forward to getting started in my specialty after 3 years of school and a hellish 6 month intro to nursing ... Norm

Of course there is always the subject of restraint use ... as a nurse, you could put a great spin on it, such as Pt rights versus RN safety ... and if you do do that, post your paper here so we can see what you have learned!

I know that at Harborview MC, in Seattle, WA, USA, there is a full-time staff of RNs and others designed to receive, triage, assess, and process involuntary and voluntarily detained psych patients in their ER ... they are a level one trauma center ... and they are generally always busy. sounds kinda like that to which you refer ...

Thanks Osorry! That is exactly the kind of thing I thought I might hear ... I know we could use that in our joint, especially since a "Psych Consult" on a med/surg floor where I am at consists of a pissy psychiatry resident coming up and "evaluating" the patient then leaving in a huff after doing nothing ... I can't wait to finish my year of med/surg so I get into psych where i belong ...

Thanks Osorry! That is exactly the kind of thing I thought I might hear ... I know we could use that in our joint, especially since a "Psych Consult" on a med/surg floor where I am at consists of a pissy psychiatry resident coming up and "evaluating" the patient then leaving in a huff after doing nothing ... I can't wait to finish my year of med/surg so I get into psych where i belong ...

Hi, Anyone care to elaborate on the role and need for psych CNS/NPs in the Acute care hospital setting? In particular, I am wondering about how often they are employed to do psych rounds on med/surg and critical care to evaluate patients and write orders/teach nurses on topics related to the care of psych patients with medical disorders (and vice versa). Anyone work with, or are you, a CNS/NP employed in this capacity? Norm - soon to be psych nuse doing my med/surg penance ...

I just started my first RN job on a med/surg floor ... and spent all of last night dealing with the typical shenanigans of a galloping borderline who has a multitude of medical issues. Orginally got into this because I want to be psych nurse ... and I am already glad I have chosen to do med/surg first. I'll probably do no more than a year because I am not happy with my current unit, then switch to psych.

1) Nothing about your post points to Borderline Personality Disorder ... read the DSM-IV criteria for this disorder to learn more ... 2) See above #1 ... if she is leading a "pefectly normal life" then she cannot have BPD per the criteria delineated in the DSM-IV ... Not to be dismissive, but I think you may be misunderstanding BPD ... check http://www.bpdcentral.com/resources/basics/main.shtml for a decent intro ...

Hello, I am a recent ADN grad, studying for NCLEX ... I got into this thinking I wanted to go straight into Psychiatry as an RN ... I have worked as a Psychiatric Tech/Mental Health Specialist. Instead, I am going to start out in Medsurg/Onc until I learn a few things, then switch if I am still interested ... My questions are these: 1) If you are happy in your current situation, why? What about your unit makes it safe, well-run and a good place to work? I ask because the places where I have worked are unsafe, non-therapeutic pits of misery for patients and staff, with crappy management who literally should be imprisoned, or at least de-licensed, for their horrific mismanagement. 2) How do you recommend that I "shop around" for a good, safe, therapeutic milieu in which to work? What are the hot-buttons to look for when interviewing? All of the psych jobs I have had seemed like a good deal until I had been there about a month or so ... 3) How do you deal with incompetent, counter-therapeutic, just plain mean, or sick coworkers? It is a cliche in nursing that we who work in psychiatry are all nuts ourselves, and in my admittedly limited experience, that stereotype is grounded in truth ... Anyway, I really want to work in psychiatry, but with the decline of funding and diminishing quality of care in I have seen, I don't want to be a rat jumping ON a sinking ship ... All replies appreciated ... Norm

Hello, I am a recent ADN grad, studying for NCLEX ... I got into this thinking I wanted to go straight into Psychiatry as an RN ... I have worked as a Psychiatric Tech/Mental Health Specialist. Instead, I am going to start out in Medsurg/Onc until I learn a few things, then switch if I am still interested ... My questions are these: 1) If you are happy in your current situation, why? What about your unit makes it safe, well-run and a good place to work? I ask because the places where I have worked are unsafe, non-therapeutic pits of misery for patients and staff, with crappy management who literally should be imprisoned, or at least de-licensed, for their horrific mismanagement. 2) How do you recommend that I "shop around" for a good, safe, therapeutic milieu in which to work? What are the hot-buttons to look for when interviewing? All of the psych jobs I have had seemed like a good deal until I had been there about a month or so ... 3) How do you deal with incompetent, counter-therapeutic, just plain mean, or sick coworkers? It is a cliche in nursing that we who work in psychiatry are all nuts ourselves, and in my admittedly limited experience, that stereotype is grounded in truth ... Anyway, I really want to work in psychiatry, but with the decline of funding and diminishing quality of care in I have seen, I don't want to be a rat jumping ON a sinking ship ... All replies appreciated ... Norm

hi, is anyone aware of a concise chart of the most relevant lab value ranges, to use as a study aid for nclex? i am thinking of flipping thru 400 pages of my lab book and typing one out, just to force myself to study them ... i would only list the common ones, (AST, ALT, CBC, WBC, blah blah) leaving out obscure ones with limited applicatoin (my rationale being that perhaps nclex is less likely to ask about a truly obscure test, and more likely to expect you to know ABGs, lead levels, etc). thanks ...

hi, is anyone aware of a concise chart of the most relevant lab value ranges, to use as a study aid for nclex? i am thinking of flipping thru 400 pages of my lab book and typing one out, just to force myself to study them ... i would only list the common ones, (AST, ALT, CBC, WBC, blah blah) leaving out obscure ones with limited applicatoin (my rationale being that perhaps nclex is less likely to ask about a truly obscure test, and more likely to expect you to know ABGs, lead levels, etc). thanks ...

it is entirely within your rights to assess the situation by going to your dean/director and asking him/her what his/her impression is of that statistic ... they might have some interesting info for you on that ... it could allay your fears or give you rational impetus to find another school ... whatever their reaction, don't trust an answer of "i/we have no idea"; if it is true they have no idea, then they are not in touch with what is going on in their own program (i.e., they suck as a dean/director) ... if they say that and they are lying to cover up known problems, well, then they suck even more for lying to you. it could be good old fashioned statistical variation, a change in the testing, a decrease in the overall academic stature of applicants to your program, or a bazillion things ... i wouldn't panic over it though. good luck. norm

it is entirely within your rights to assess the situation by going to your dean/director and asking him/her what his/her impression is of that statistic ... they might have some interesting info for you on that ... it could allay your fears or give you rational impetus to find another school ... whatever their reaction, don't trust an answer of "i/we have no idea"; if it is true they have no idea, then they are not in touch with what is going on in their own program (i.e., they suck as a dean/director) ... if they say that and they are lying to cover up known problems, well, then they suck even more for lying to you. it could be good old fashioned statistical variation, a change in the testing, a decrease in the overall academic stature of applicants to your program, or a bazillion things ... i wouldn't panic over it though. good luck. norm

hi, all ... today i took the mosby online assess test. it is a 265 question nclex-style test ... once you are finished, it gives you a more detailed analysis of you results than the prep books/cds i have seen ... plus, it gives you a probability of you passing the nclex based on a normative sample of 4000 people who took the assess test in 2001 then went on to take the nclex ... for example, if you score x% on the assess test, they say "of those who took the assess test in 2001 and got a score of x%, y% went on to pass the nclex". i got 75% on the assess test, and they say that gives me a 98% chance of passing based on the predictive power of the 4000 who took it in 2001 ... (for whatever that is worth, of course) ... i am still studying my butt off ... at 40 bucks it isn't inexpensive, but it was quite valuable to me ... good luck ... here is the link: http://www3.us.elsevierhealth.com/OnlineAssessTest/

hi, all ... today i took the mosby online assess test. it is a 265 question nclex-style test ... once you are finished, it gives you a more detailed analysis of you results than the prep books/cds i have seen ... plus, it gives you a probability of you passing the nclex based on a normative sample of 4000 people who took the assess test in 2001 then went on to take the nclex ... for example, if you score x% on the assess test, they say "of those who took the assess test in 2001 and got a score of x%, y% went on to pass the nclex". i got 75% on the assess test, and they say that gives me a 98% chance of passing based on the predictive power of the 4000 who took it in 2001 ... (for whatever that is worth, of course) ... i am still studying my butt off ... at 40 bucks it isn't inexpensive, but it was quite valuable to me ... good luck ... here is the link: http://www3.us.elsevierhealth.com/OnlineAssessTest/

Well, now I can actually party, I passed my two make-up final exams today ... will be able to hopefully take the nclex in a month or two ...