limandri

You are NOT too old. I've taught many students older than I and, in fact, like teaching those students. They have a stronger base from which to learn, know how to learn from their environment, have good thinking skills, but tend to have demanding families who still want to see them. Please don't let age be an excuse from advancing yourself.

I'm curious if the patient still needs to continue on medication for depression. In which case it is not just weaning but switching to a different medication. All of the SRIs can cause a withdrawal effect but Paxil is probably the most difficult. I agree that cutting the dose in half for the first decrease is best then slowing down even further. In addition to breaking tablets in half, it is also possible to crush the tablet and mix with a known amount of applesauce, yogurt, peanut butter, pudding, etc then take a proportionate amount. For example, crush a 40 mg tablet and mix with one tablespoon of applesauce. Then take 1/2 tablespoon of the mixture for 20 mg, 1/4 tablespoon for 10 mg, etc. The remaining amount has to be thrown out because it deteriorates even with refrigeration. When switching to another SRI, it can be a simple switch with equivalent doses. The longer the half live, the less likely to have withdrawal effects. In fact fluoxetine (Prozac) hardly needs titrating because it has a half life of about 2 weeks. When I am completely discontinuing a SRI with a client, I usually taper down as low as possible (e.g. 2 mg of Paxil) then give them 2-3 tablets/capsules of Prozac to take every other day until gone. If they still have some withdrawal symptoms, I give them one weekly dose of Prozac (90 mg tablet) and let it taper itself out.

Don't mean to be a hair splitter but CNS doesn't refer to a degree but to a role and a particular certification. Times are changing and eventually so will the title. The American Psychiatric Nurses Association will soon be certifying advanced practice psych nurses with simply the title of Advanced Practice PMH. The degree is a masters degree in nursing and can even be a doctorate. The American Association of Colleges of Nursing has recently published a white paper proposing the Doctor of Nursing Practice (DNP). I'm not sure I like yet another title but the point is that advanced practice requires advanced degrees. Each state has within their Nurse Practice Act what is required for advanced practice and what the title is in that state. Most states have some kind of prescription authority. The best resource is the Journal of the American Psychiatric Nurses Association last issue (Dec 04?) that provides a complete update state-by-state regarding advanced practice. I practice in Oregon that tends to be very progressive. As a APRN I prescribe independently and have done so for about 20 yrs. I have both a masters and a doctorate in psych nursing. I love the work that I do and enjoy the autonomy.

I think it is great that you are interested in psych nursing. There is quite a bit of flexibility and diversity in this specialty and you can get there by many routes. I have my doctorate in psych nursing and I am a psych nurse practitioner. To be a basic nurse in psych you need to get a BSN and work in psych (usually inpatient but not necessarily). To do advanced practice, like I do, you need at least a masters degree in psych nursing. Depending on the state you decide to practice, you might provide psychotherapy and prescribe medications in the advanced practice role. I have to admit that I love what I do and have been doing it for a long time. I advanced my education a little at a time and worked in mental health between and during each return to school. In school you do not specialize in a diagnosis. In fact the psychiatric diagnosis has much less relevance to what you do as the client's problems (which isn't the same as the psychiatric diagnosis). Like you, I am very interested and concerned about those who cut on themselves, not because of the cutting but because of the pain they are trying to stop with the cutting. Oftentimes these young (and older) women have experienced traumatizing lives that they need a great deal of well informed therapy and a very patient, compassionate therapist to help them. Think you could do that? I bet you can. Keep your sights high and please don't hesitate to ask more questions.

I have been a nurse educator for many years and looking to retire in about 5-6 yrs. Have taught mostly BS undergrads and MS psych mental health. Lately I've been excited about teaching web based courses. Like developing them in such a way that they are friendly and human in spite of the technology. My question to those who have done web based courses: what do you like and dislike about these courses? I'd like feedback that isn't tied to course evaluations or teacher evaluations, i.e., the stark truth. I'm especially interested in ways to improve this teaching method. Thanks for your help.

Sorry to read about your distress, ParrotHead. Altho I have never left nursing completely, I have had more than one of those long dry periods. What worked for me was to change positions in nursing, but it sounds like there is so much going on for you that a pet groomer might give you a bigger break. (When I retire dog training and breeding is my choice too.) On a more serious note, you have some very serious stressors going on for you and maybe nursing is the only one that you can control right now. I sure home you are seeing someone for therapy and support. You really need it and deserve it. Funny how nurses take better care of others than themselves. Barbara

I have been a psych nurse for a long time (both in-patient generalist and out patient advanced practice) and I truely believe a new grad should first get psych experience before going into med-surg. It is much more difficult to develop those interpersonal and supportive skills in med surg and they are so very needed. On the other hand nursing skills in any area that aren't practiced will get rusty. Starting with a year of med-surg doesn't assure that your skills will be current, it just postpones developing psych skills. After a year where ever you are practicing you will find those skills you haven't been practicing get outdated. If you choose to be in psych, start there. I worked in med surg briefly after graduating and can't say it was all that helpful in my career except to affirm my desire and talent was better in psych. Personally, I think this one year in med-surg is a myth promulgated by med-surg faculty and hospital employers.

I'm curious about this as well because I am a PMHNP (psychiatric-mental health nurse practitioner) in Oregon. I have been working as such in both private practice and clinic settings. I'll bet psych nurse generalists don't have much contact with NPs and would love to know what is the experience out there. Also have some self-interest in knowing how NPs are perceived.