CharlieRN

On a psych unit the nurse is often the person watching and managing the patient's physical health. There is a whole team of folks focused on the psychosocial aspects of the case. You may be the only one who is aware the patient's low grade fever and chronic cough. If you miss its significance, it gets missed.

My facility is working toward having the nursing supervisor do the face to face on the night shift. The Doc on Call used to have to come in for it. They seem to think that it will be legal. This is important to me because the night supervisor is ME. I don't have issues with my competence, particularly if there are clear guidelines, but I do have questions about the legality.

I would only use it if the product you are selling has a health related aspect. ie. I used to purchase a service regularly from an RN, but I only found out she was an RN by accident. She was my barber. Plenty of RN's are making their living doing unrelated things. For them to put "RN" on their cards is silly and pretentious. On the other hand sometimes you need all the clout you can generate in order to get noticed. I don't use business cards but I sometimes write over an "RN" letter head.

Oddly enough I actually think the nurses at my facility do practice pretty holistic nursing. Not that they are involved in much of what I would term "woo-woo" interventions, but they see the whole person more than the MDs do. In our case, because ours is a psych facility, being holistic involves keeping an eye of the patient's medical status. Since that is not the focus of the attending physician's treatment he/she can miss things. I once had to be very firm with a psychiatrist who wanted to order a medical consult to have a patient seen at the clinic, in a couple days, this for a patient who was having black tarry diarrhea NOW.

Playing devils advocate but I would love to have people smell things that are actually very good for them but have sharp or offensive smells. Garlic, onioin, B vits, Penicillin for example and then some pleasant smelling but poisonous items. It seems that ought to invalidate the whole premise of aroma therapy.

What a hoot! As it happens my immediate boss (VP for Admissions), and I are in the process of modifying the admissions paperwork at our facility to include nursing diagnosis as required by Joint commission. Between us we probably have over 50 years of experience as RN's. We are in complete agreement that the whole concept is a crock. Neither one of us has used them since nursing school or has ever found it useful in our practice.

Anecdotal evidence written in a book is still anecdotal evidence. What double blind studies were done and which major, peer reviewed, medical journals were they published in? If you need to be a "believer" then we are still talking "woo-woo". No one needs to "believe" in antibiotics for systemic infection or surgery for appendicitis. We have solid proof these treatments work. Don't waste our time with pretty theories. Do the rigorous, double blind, studies. Publish the results. After the results clearly prove effectiveness then we can worry about why it works. I'd also like some proof of the idea that the north pole of a magnet necessarily carries a negative charge. Static electricity is not the same as magnetism.

Sounds like snake oil to me.

I'm not familiar with the LVN licensure but I think it is similar to LPN(lic practical nurse). My institution has phased out all its LPN positions. My understanding is that it was felt that their training did not prepare them adequately for accessment of psychiatric symptoms or for accessment of medication side effects. Even if individual LPN's had aquired the necessary skills, their licensure did not say they had. The few we had were allowed to work only as medication nurses until they retired or sought work elsewhere. It was not seen as appropriate for them to function in a unit charge role. I think that case management is more appropriately an RN role.

Just to offer a little balance. Pain meds are addictive. It is perfectly possible to have real chonic pain and be addicted to pain medication. While by no means does everyone who is put on pain meds become addicted, many do. I work with addicts all the time. Addicts lie. So saying that the patient must be the sole judge of their pain sounds a bit simplistic to me. This is a major issue treatment issue which should be addressed by the treatment team, not left up to the individual judgement of nurses. It is possible, even likely, for nurses to become cynical, particularly in high stress situations. Patients sometimes inadvertently trigger that cynisism. I recall once when I worked in the er, we had a woman who came in with a c/o vague but intense abdominal pain, but with a affect that seemed too controled and calm. She kept asking for, "something for pain". The ER staff, from the Doc on down, interperted this as learned "hospital jargon" and evidence of drug seeking. They treated her appropriately, drawing lab work etc. but with no sense of urgency and no pain meds. Until, that is, her her CBC came back low! Turned out she had a preforated gastric ulcer. She had a hole in her stomach the size of a quarter.

This old news, many years old, but I got my emt before my RN. I thought I would be able to earn more as an emt than as an orderly. In fact my emt and $1.50 would get me a cup of coffee. Police and fiefighters with EMTs earn a good wage, because they are police or firefighteers. The fact is the EMT was a great course that has been a resource through years of nursing. Nursing school teaches poor emergency care.

I'm pretty sure that the mint oil is used as a room deodorizer noyt applied to the wound or dressing.

Good luck. If you do find any sound, double blind, scientific studies that support these therapies having curative, as opposed to plative, validity please share them.

Yeah they are a real party crowd who know how to have a good time.

I don't know about licensure requirements. My employer wants potential psych treatment staff to be out of treatment and symptom free for 2 years. I sure there are plenty of depressed nurses with borderline traits working in non psych positions.

They have found a way for Boston to recover? I had given up all hope.

We are have a no smoking policy inside the buildings but permit patients to smoke on fenced in porches. Since they are unable to leave the smoking area, they don't need close supervision. They are not permitted on the smoking porches during the 11p to 7a shift. We did not think this would work but it did and now I'm pretty sure we could deal with a no smoking at all policy.

This is probably not real helpful, but I'm not sure this pt is correctly dx as borderline. He sounds more antisocial to me. Thinking of him as a manipulative criminal/ con man may be helpful in coming up with a way to deal with him. I'm thinking more in terms of containing the damage to your unit and its staff, than in terms of cure. Most antisocials are "treated" in the crimnal justice system. They are cured when they decide to stop being a**holes.

Call the doc and ask! That's what she gets the big bucks for. Some transitions need to be tapered. I could look it up and tell you what the books say, but then I'd be practicing medicine.

This is what I'm talking about. On a med surg unit if a staff person is grumpy or maybe hung over, noone cares so long as she does her tasks. A psych nurse's work is done with their voice and mind and personality more than it is with their hands. If you are depressed, anxious, irritable or chemically impaired you are not just an annoyence and difficult to work around, you are crippled, unable to do your work and a hazard to the unit. This does not mean we don't have problems like everyone else. Just that we are fucused on them and make an effort to help eachother solve the problem. About ten years ago I was in a full time float position. I was approached by another nurse who worked a 24 hr slot as charge and only RN on a small unit where she had so antagonized the staff that they did not want to work with her. I gather she was going through a rough patch in her life and was not at her best. She is a very competent nurse and very firm in her opinions under the best of circumstances. The unit she was on had a more than average "cooperative decision making" style. It was a match made in hell. We arranged to switch so that I took her 3 days on that unit and she worked them as a float. As a float she was in less authority and was never working alone as the only RN and hopefully she was under less stress. She has gotten past her rough patch and still works with us.

I'd second morgans comment. Avoid unnecessary touching. Before I was a psych nurse I was a very "touchy-feely" type person. Now when a client is in distress, I offer them a kleenex. Gives me some physical way to express concern yet is unambiguos. Kleenex carry no sexual overtones. With experience you learn how to fine tune it. I gave a young female patient a hug about a year ago. I had just finished doing a 3 hour admission with her in the middle of the night and had walked her to the unit. As I said good bye and turned her over to the unit staff she held her arms up for a hug. I did not feel I could possibly refuse. Oh yeah, she was 5 years old. However even with a young child I would not touch without a clear invitation, and in a clearly defined situation ie: saying good bye to somone you don't expect to see ever again, and in a public and witnessed situation. I know you wern't thinking of this type of danger but its a real one even so.

I can't give much feedback without data about current/past behaviors. What has she done that makes her of interest to psych?

no white uniform! my peers are sane! seriously, the general nursing population reflects the mental health of the general public. psych nurses are held to a higher standard. and in a good institution we are careful to help each other stay sane. when i worked on the womens specialty unit, there was a weekly group therapy for the male staff so that we could deal with being the target of so much displaced hostility. the sanity of the staff is the single greatest resource of a psych tx facility. its hard to be a turkey when you work with eagles.

frustration with there not being enough money to keep patients long enough to do good work with them. We are frequently pushed to discharge patients before they are ready. Ingeneral health insurance underfunds psych. I suppose that is the publics own fault. We get what we are will ing to pay for. Everyone can imagine being in an acident or having a major illness strike them, but thinks they aer going to become depressed or have a schizophrenic son?

Glad to be of help. sorry about the sloppy spelling, I'm at the end of a very long boring night in admissions and having a hard time staying awake. By the way, I have worked most types of inpatient psych units, and all shifts so if you need more specific answers, just ask.