tom7044

I with keeping cool, calm and professional. Once your orientation is complete, will you possible have an opportunity to meet with the office manager and possibly this nurse and discuss simply and succinctly what your experience was like. Unfortunately, there are some nurses that are simply "crude". This behavior does not belong in the workplace. When these nurses are very good at the tasks involved, it makes it more difficult on managers and supervisors. That does no free them from their responsibility of seeing to a smooth running operation. It costs a lot of money to hire and train a nurse and if this person has been responsible for two nurses leaving, that is an important point. Often managers will attempt to excuse rude and inappropriate behavior by saying: "that is just her personality" or "he/she is a bit crusty..." That doesn't excuse unprofessional behavior either. Sometimes this indicates an individual with narcissistic traits and that is difficult to deal with. Bottom line, she represents the whole practice as a group. If this is in front of the patients or people that do not work there , it is not a good public image to have. Your orientation will end soon and then please take it to the next level and save the next good nurse that comes along from this type of inappropriate behavior.

I work in a free standing, medical detox unit. we have patients from three to five days and see them through acute withdrawal and use mostly Valium and Suboxone (for our) opiate addicted patients. I love what I do because it is never the same. Besides the routine of passing medications, doing assessments and triaging patients requesting admission, there are always unusual situations that makes each patients care challenging. Perhaps they are using a combination of substances and knowing what protocol to use and talking with the providers to get orders, can be very challenging. Often the patients give very complex and convoluted, conflicting histories. Sorting through the information and formulating a plan of care can be difficult at times. I do a lot of physical assessments before the providers see the patient. This is most important in getting the orders and implementing them. We are not attached to a hospital and we are an acute care facility so determining which patients can be taken care of safely in our facility and those that need to be seen by an ER physician is a large part of what I do. The other thing; the attitudes of many of the clients can be difficult to deal with for some nurses. Often angry, entitled, victims, resistant to help is something that you have to work with. Also, some have complex medical problems made worse by drug and alcohol issues. Heart disease, HTN, Diabetes and other problems that are often neglected by the addicted client make the job even more complicated but not impossible. I do a tremendous amount of patient education on an informal basis, i.e, when giving medications or helping with diabetics diet choices. This is my favorite job in years. I was CARN certified two years ago and I am grateful for that certification because it gives me recognition as having the specialized body of knowledge required to provide the best care possible. Good luck!

I have worked for two large Correctional Health Care companies. They all have problems like any business does. It boils down to the "Contract" which spells out what the agency expects from the company and that the company will provide. The overall goal is to make money on these contracts. So the company tries to provide the best medical care possible for the least amount of money. I also worked for a large county jail system, where nurses were employed by the county. Plenty of problems there. Staffing one major problem. Going back to the private guys. In my opinion, the success of a contract in a county jail depends on the on site management /leadership. If the Health Services Administrator and the Director of Nursing are strong and deal fairly with the problems like "bullying" and they are not afraid of the corporate and speak up for what that site's needs are, it is a good place to work. Too often, the on site leadership has a "you against us" management style. The leadership must keep the morale of he general staff positive by being supportive and reasonable.

I congratulate you on recognizing just how important specialty certification is. I think that having the CARN certification has opened doors for me. Through this certification I have the opportunity to serve on the Nevada State Board's Disability Advisory Committee. This gives me a way to serve the Board, the community and my fellow nurses. I think that Addictions Nursing is a specialty that is coming into its own. I had over 15 years working in corrections and psych and substance abuse units before I took the certification but still took about a year to prepare for this test. I am glad because the exam itself was much more difficult that I expected. I have the CCHP certification in corrections nursing and by comparison the CARN exam was more difficult. If you buy books for CARN exam review don't by the Passbooks Certified Addictions Registered Nurse test. It was a waste of time and money. The text Certification Review for CARN by Blomfield is much, much better. The IntNSA's Core Curriculum is great but a little pricey. I work in a free-standing medical detox unit and have found my niche. These patients are by far some of the most challenging and difficult to care for but the rewards and gratification far out ways the challenges. Best wishes for your continued success.

Absolutely not is the only correct way to answer this question. Addictions Nursing is a speciality unto itself. This is established by the International Society of Addictions Nusing and Addictions Certification Board. You need some basic psych nursing skills as you do in any area. Sound medical surgical skills are essential and specialized addictions nursing courses. You need to know some of the basic neurological concepts. Basically, you need experience in addictions and you can get that experience by finding a job where the staff is willing to train and mentor nurses new to this specialized are

The whole "Boarding" of VA nurses is not easily understood by those nurses that don't participate. The guidelines or the criteria that nurses have to meet to go from one Grade or Step to another is written in a manual , but it is so lengthy and complicated and has so many exceptions and the process always seemed to me rather subjective. I worked for the VA years ago and was first "Boarded" as a "Full Grade" That is like three grades up the totem above the junior grade and associate grade. My supervisor was disappointed. I do know that on a certain day the nurses that are senior management people like Associate Chief Nurse of Education and The Associate Chief Nurse of Long Term Care and the Associate Chief Nurse and the Chief Nurse plus one or two of their chosen underlings - maybe a nursing supervisor go into a meeting and go over each new nurse's background and discuss what they know about this nurse and then declare the nurse a"Full Grade" or Associate Grade" etc. there are several steps between grades. Yes, the BSN Degree certainly helps but often a Master's Degree will be given the same weight. Because my Head Nurse liked me and was pleased with my nursing care and I had experience prior to the VA that was invaluable on the particular unit, I was boarded again the next year I think. I hit the Jack Pot. I was "Boarded" as an Intermediate Grade with EQA (enhanced quality or assignment). The nurses that had been with the VA for years and were good nurses were almost all at the Intermediate Grade. Now, why am I going on so? I think it is important to recognize the difference in salary in let's say a Full Grade RN and an Intermediate Grade RN. The annual salary for the Intermediate Grade RN is significantly higher. Thousands of dollars a year higher. That is what is so important about the "Boarding" process it sis the money.

take the job

I have been a Registered Nurse for forty years and still work full-time in an acute care setting. I have little in the was of management experience because I never want to be in the position you are currently facing. Having to deal with conflict and dissension and solving those issues as a major part of my job. No thank you. However, I will tell you what I would do not based on any formal experience or training but just what I personally would do. I would create a time without restrictions that both your unit manager and the Supervisor could meet with you maybe even outside the facility - be a time when no one has to return to their shift etc. I would ask that they do this as a personal favor to you and as professional responsibility. I would start with the positives; ex[experience, valuable to the facility etc. I would tell them that you are leaving your position but that does not mean you no longer care about the facility or them. tell them you want to give them some advice and some insight. They do not have to like one another . The work place is not a popularity contest. They must, however, work together and respect one another at all times. Each one must learn to compromise; that is what allows us to get along in life. Bottom line, this is not about them and what one does or does not do. It is all about the residents, their co-workers and the company that pays them a salary. Their behavior and attitude is not good for morale or team-building. When this is the case, it is the residents who suffer. So now it is up to them and it will not affect you one way or another except you know you have done the right thing before your leaving. Best of luck where ever you go and whatever you do.

Wonderful response; this is the type of nurse I would want as a mentorl

I was recently hired by Armor Correctional Health Care for a per-diem position at the Washoe County Detention Facility here in Reno, Nevada. I was a former employee of Corizon Correctional Health Care (Prison Health Services) at the same detention facility. Armor was selected by the County Commissioners as the new contract company to provide medical services at the facility. My experience so far with Armor has been wonderful. The company is bringing in a new electronic medical record system that is essential in a facility of this size, the Regional Vice President in one of the nicest and most professional people I have met associated with correctional nursing in a very long time. Most of all, from the beginning the representatives of this company make you feel that they are truly interested in you as a person and as a nurse. Their dedication to correctional nursing is obvious and sincere. They recognize the role that the Registered Nurses have in the correctional setting is an essential one. In contrast to Corizon , where the nursing leadership always made the nurses feel like they were doing us a favor by allowing us to work there, Armor has been wonderful and welcoming. I am so looking forward to my experience with this company.

I am not being critical however DaVita is famous for hiring nurses for acute dialysis and offer training but often the training is with an acute dialysis staff nurse and it is so difficult to train a nurse on the job doing acute patients. Those runs can be second by second horrifying or uneventful but it is usually the first. Sometimes just trying to get the patient on circ. without them becoming profoundly hypotensive or experience some cardiac problem or their access is horrible or sometimes even clotted. Then their is the problem of heparin with clotting times every five minutes. Sometimes the MD orders no heparin and your focus has to be on not allowing the lines or the kidney to clot; sometimes you do everything just right and still every thing clots and you have a mess on your hands. If you are dialyzing someone in the critical care units with every type of drip possible and on a vent sometimes the Critical Care Nurses think that because you are a nurse you can deal with all of those issues and dialyze the patient at the same time. Rare but does happen.Then there is always the possibility of your patient just going into a full cardiac arrest when you least expect that to happen. Remember anytime you are dealing with extra-vascular circulation with blood pump which is both pulling and pushing a volume of blood the hemodynamics are going to change. Blood flow rates and dialysate flow rates are always being adjusted as needed. At least you have the principles of dialysis down. That is the important thing to know the basic principles of dialysis and go from there. DaVita does hire acute nurses that have no dialysis experience and have to be taught from step one how to string a machine prime the kidney check alarms and conductivity. Those nurses even the experienced critical care nurses are often overwhelmed and seldom stay with dialysis. The best training is good sound medical surgical experience then a structured classroom and practical hand on training usually in a chronic unit then transition slowly into the acute arena. Many hospital operated units (not company owned units) carefully select the right nurse and train them this way or send the nurse to a large medical center hospital that has a training program for dialysis nurses. This is sometimes a 6 week period. DON"t get discouraged even with this description of what the real world is like. Ask questions ask questions and ask questions then Read Read Read. I was a hemodialysis nurse for more than 13 years; 10 of those years as an an acute dialysis RN. You will find a talented, experienced, mentor that will do anything to help you learn and be comfortable. These nurses are not usually management but just staff nurses that love what they do; stick to them like glue. Good Luck!​

I have been working with addicted clients for more than ten years. During that time I have observed one incidence when a client became violent. This was because of the client's co-occurring mental health disorder, not from the addiction issue. My recommendation is that you have a some medical nursing background. You need to be comfortable giving the medications associated with the treatment of acute withdrawal from drugs/alcohol. Many of these are from "Protocols" or "standardized procedures". Some medications routinely given are not compatible with medications used for withdrawal, i.e. Suboxone. Also good physical assessment skills are very useful. Much of what you will be doing is based on nursing assessments. You will not always have a provider on site so when you call for orders you must give a good and accurate assessment. Also some basic psych nursing skills are necessary as in learning to set limits and being consistent. Many patients have mental health diagnoses such as Borderline Personality Disorder or Antisocial Personality Disorder. It is helpful to be able to recognize the cardinal signs and symptoms of these disorders. Be prepared to deal with clients that are often demanding, hostile, and rebellious and have a low tolerance for pain (emotional and physical) and frustration. You must be compassionate, caring and be have empathy for your clients. Be firm, helpful and understanding. These things do not come to you overnight. It takes months and even years to master these principles but always be willing to grow and learn new things. Addiction Nursing takes a life-long willingness to learn. Become a Certified Addictions Registered Nurse (CARN) when the time is right. I began my career as a Critical Care Nurse but somehow I found my "niche" and love every minute of working in this specialty. Best wishes!!​

As a Registered Nurse with over 20 years working in urban jail settings; mostly as an Intake Nurse or Intake Supervising Nurse with CCHP-RN certification you present a challenging and perplexing situation. The facilities I am familiar with and the law enforcement agencies operating then would hire you in one capacity or the other. I have worked with several nurses that were former police officers often times having more skill and experience than the custody staff we worked along side of and found it difficult not to intervene when they observed bad technique of poor compliance with acceptable standards and practices by sworn staff but had to adhere strictly to their job descriptions as Registered Nurses. I would suggest that you contact your State Board of Nursing and inquire of that agency about your dual role. Make sure that you have a specific job description that you , your medical director ad the ranking officer that is in charge of medical services all are in agreement and understand exactly what your role is. The National Commission on Correctional Health Care would be an excellent resource. Best of luck

I studied for 6 months to prepare for the CARN examination."Rudman's Questions and Answers on the CARN Examination" from the Admission test Series was not helpful. "Nursing Care of the Addicted Client" (Karen Allen)was the one reference I would recommend as the ONE most comprehensive and helpful. There were several questions relating to the Developmental Model of Recovery and I agree, a lot of critical thinking. Best of Luck, Tom, CARN

i think the general accepted staffing ratio for acute detox patients is 1 rn to 12 patients maximum if not located within an acute care facility. the state board does not mandate this ation but this is the guideline from the sbn. we staff with one rn, one to three cna's and there is an apn on site during the hours of 10 am to 6pm. we are a free standing unit not located within an acute care facility.