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Umberlee

Umberlee

RN
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  1. Umberlee

    How many different nursing positions have you had?

    I spent 12 years working in a residential setting for adults with brain injuries, but only part of that was as a nurse. Then I went to group homes for the developmentally disabled and then acute psych, then to community psych. So with BI/DD/MI I've had a pretty solidly "behavioral health" career, I suppose. I have never done the hospital thing nor ever really wanted to.
  2. Umberlee

    Psych nursing? scope of practice

    Different places have different names/titles for direct care staff in psych settings. We used to require our mental health workers be CNAs, but now the job qualifications emphasize more training or experience in behavioral health. Most of our mental health workers are students who want to do something in the field of mental health...undergrad psychology students and the like.
  3. Umberlee

    Keeping up nursing skills

    I'll admit I was kind of appalled when I started working the floor at my psych hospital and saw the lack of comfort that long-term psych nurses had developed regarding routine medical procedures. I've even worked with a few psych nurses who stated they had gone into psych because they didn't want to deal with the "gross stuff." The direct-line staff are usually the mental health workers and they have such minimal training when it comes to personal care that I think it's really unfair when a nurse expects a MHW (who is busy juggling a lot of diverse duties at any given moment anyway) to be the one to do a much-needed shower on an extremely obese person with candiasis in every skin fold, or to be responsible for catheter care and ensuring that a leg bag is aseptically switched to a downdrain bag, or those types of things. I see a lot of "passing the buck" in our hospital and it's really unfair to the patients. That isn't really along the lines of nursing skills per se, but a more basic problem in the culture at the facility where I work. We don't even have catheters or insertion kits here and not long ago we had a gentleman actually have to go to the ER just for a poorly-draining catheter...could have totally been managed with a flush if we were set up at all to deal with really basic medical issues.
  4. Umberlee

    Networking for ACT/CTT?

    Part of the issue is that the fidelity model we're following is one provided by the state, since they are funding the grant paying for our team. It's quite a bit different than the model espoused by NAMI, and missing key components such as having a program manager and having P&P. Our state's model does specifically state that we must have a peer specialist but it seems like they could benefit more from having someone to help them with resources.
  5. Umberlee

    Networking for ACT/CTT?

    Yeah, your staffing is insane compared to ours. They expect us to take on 40 clients with the 3.7 FTE staff we have now. And one car, and double-staffing appointments. Honestly we couldn't stop double-staffing even if our team lead and management decided it was okay, because of only having one car. How did you schedule visits? This is another piece I'm finding to be a big deal. We don't have a program manager so we have no P&P, no admissions process, and the team just sees people whenever. Right now with our whopping ten clients we are not even seeing each client once a week, though there are several who are typically seen more often.
  6. Umberlee

    Networking for ACT/CTT?

    This has been a big issue for us too...housing is such a problem, and when these guys disappear onto the streets it can be soooo tough to find them and figure out how to keep them stable/safe/etc. We also have quite a few clients who are chronic cancelers/no-show-ers for really important appointments, which can be really frustrating because I'm trying so hard not only to keep them psychiatrically stable but also dealing with dental care, vision, pain specialists, etc. As it stands now, our team is a full-time (40 hour) therapist, a full time case-manager to deal with housing and vocational concerns, a full-time peer specialist, our psychiatrist who is designated at 5 hours per week for the team, and myself at only 27 hours per week. It's been insane already trying to manage all the clients' medical needs on only 27 hours. They all take their meds wrong, many need shots, most have primary care needs, some have serious pain issues, and now we're looking at picking up our next client who has type 1 diabetes, CHF, and kidney failure. If they can't get this guy in an ALF right away I'm going to freak, lol. Our team members are great in some ways but I really feel like I'm the only sort of type-A person on the team. At 40 hours per week, the other team members aren't even seeing our ten clients weekly and don't seem very concerned with making sure they get some face time in with them. It's easier for me because I have legitimate reasons to see each of them every week, but I have so much case-management stuff to do in between visits and appointments that I feel like I'm just running at 100 miles an hour all the time and it is frustrating to see co-workers who are just kind of lackadaisical in doing their "thing" with these guys. The peer specialist especially seems to just kind of tag along and be a second on a lot of visits and may chit-chat with them for a few minutes but isn't doing a lot of notes on anyone and in between visits has no case-management so she is looking up trails she wants to hike on, reading books, etc. and it's very frustrating since I really need that time. Since my wage is a lot more than hers they don't have it in the budget for me to be full time (grant-funded at this point) but it just seems so bass-ackwards. I'm not the team lead so I don't have any power to assign extra duties or anything like that, though I am trying to be assertive in saying, look, we all need to be doing regular visits with everyone, even the people we think don't "need" our services. My boss has told me that she feels I'm the team lead in practice, because our therapist is so passive. Which is okay as long as we don't end up with hurt feelings or undue tension. I don't want to be team lead or anything, I just want to be sure we are seeing people to the state's satisfaction and at least TRYING to do therapy and stuff with the clients, even if they are resistant/psychotic/whatever. I took a HUGE wage cut to take this job and my daycare expenses quadrupled. I was working relief night shift at the psych stabilization center and only had a few days of day care a month as I'd mostly pick up shifts when my husband would be off. But I'm just starting grad school and I wanted the experience of working in community psych because I feel there will be a strong need for it and I'd love to be able to keep in that vein or go back to it in the future someday if possible. I also wanted to be the first ACT nurse in the area since it is a brand-new team. It's basically my dream job, aside from feeling a lack of structure. Oh, one thing that is hugely aggravating is that being brand new, like I said, we are really on a shoestring budget. Although there are four people on our team and we can only see people in pairs, we have only one car. This leads to soooo much stress when it comes to staffing appointments and doing visits. We also have these really old, ghetto 2001-type cell phones when what we really need is smartphones where we can schedule out in the field and have GPS and data. We are just using our own phones for these purposes, but they are a NEED. Additionally, and this REALLY sucks, we are actually going to lose our office space in a big remodel coming up and everyone who is community-based (several teams and in total about 20 people) are going to share a big lounge-type room that will be more like a college computer lab. Our own personal desks with all our files, supplies, references, documents, etc. will be gone and we will just all be sharing lockers and workspace. So I feel like things are going to actually get worse rather than better when it comes to having adequate resources for doing our job. Thanks so much for the response! I hope you get the job. I love it, I have not felt threatened or unsafe as of yet and I'm hoping I don't get attacked anytime soon. Our caseload is going to quadruple in the next few months, though, and things are going to get really crazy then. They let us start out with a very small group of clients until we got to where we had documentation/care plan issues ironed out and got a feel for what our roles would be. We still don't have any referral or admission process, which is desperately-needed, but I'm hoping that will fall together soon. I think it's really cool to be part of the ground-floor of a new program in this area (rural Colorado).
  7. Umberlee

    long-acting IM going SQ?

    Ugh, I feel like such an idiot...I have a client who is getting stable on haldol decanoate, but he is gaining weight due to taking PO lithium as well. I gave his decanoate in his deltoid, per his usual preference, but I was on the fence as to whether I needed to go with a longer needle due to his weight gain. In hindsight, a one inch was definitely too short and I don't know what I was thinking. I'm beating myself up over it. In the meantime, today (three days after his shot) he's reporting that it's been hurting ever since his injection, his "whole" arm is swollen (no fever), and he's been feeling sick to his stomach and having trouble sleeping as well. The only thing I can think of that I possibly did wrong is not going up in size on the needle, so I'm guessing that the pain and swelling is because of a pocket of medication knotting up in the space prior to the muscle?? And maybe the nausea/sleeplessness is due to pain and agitation? No reports of any oversedation or change in mood etc. I can't assess the client because none of our team is on staff and everyone is busy this weekend with Memorial Day weekend plans (just received a call from his mother about it) and we are prohibited from seeing clients alone. I just advised her to have him ice and elevate it and if he has a temp or any systemic symptoms, OR if she is really concerned about the swelling and it seems beyond just sore/irritated to take him to the after-hours clinic. What I'm most worried about, though, is whether it not being IM affects the bioavailability and distribution of the haldol. I haven't been able to find anything about whether it will be or not. Has anyone ever accidentally given an IM wrong? I feel like such an idiot and I feel horrible for my client. He has been doing so well but he's very suspicious about his meds and I'm afraid this will make him reluctant to continue with being med compliant.
  8. Umberlee

    How important is your 'look' as a nurse

    Awesome, now where can I find 40-inch heels??
  9. Umberlee

    Networking for ACT/CTT?

    It seems that this forum is heavily crisis stabilization/inpatient, and the public health nursing forum is heavily medical. As a community-based psych nurse, I'm desperate for a little networking and camaraderie with other ACT/CTT nurses. I'm part of a brand new ACT team and am facing some issues that I'd guess are more or less unique to ACT teams, particularly in meeting fidelity to the accepted ACT model. I know there are a handful of nurses here who have been involved with ACT so I'd love to get some input on a few things. First of all, did you feel the resources provided to you were adequate in helping get your clients' needs met? As a new team we are on a shoestring budget. Did you have to double-staff each and every interaction with a client, I.e. never seeing a client alone for safety reasons? I can understand the reasoning behind this but double-staffing obviously eats up an inordinate amount of staff time, especially doing things like attending Dr. appointments where we are sitting, waiting, sitting, waiting, without a real ability to insert any therapy/case-management/teaching without "outing" the client as a mental health patient. We can chit-chat and do some superficial assessment but that's about it. Were you responsible for managing all your clients' psych AND medical concerns? What other staff members were present on your team and what role did they serve? Did you have faith in your team members? I am finding the rest of my team to be not exactly "assertive"... What did you find the biggest challenges of being an ACT nurse? Any words of wisdom you would share with a new ACT nurse?
  10. Umberlee

    How important is your 'look' as a nurse

    I've been thinking about this more and more recently. My very first job as an LPN I was made to take out my nosering due to my supervisor's opinion that it was "unprofessional." As I'm feeling some sort of early midlife crisis approaching, I have the urge to throw a few piercings in and streak my hair pink or something. I've always felt like I became kind of a sellout in maintaining the middle-class corporate America kind of image. My big reservation, of course, is dealing with the prejudices and snap judgments of others, especially supervisors or managers, even if it's just something as simple as "how unprofessional. "
  11. Umberlee

    Working Alone

    One of my jobs is as a nurse contractor, and that's about the "alonest" of a nursing job I've gotten. I do 90% of my job via phone calls, texts, emails, and faxes. I don't have to staff appointments or worry much about the day-to-day goings-on in the houses, just make sure that staff is trained on meds, that MARs are accurate and have orders backing them up, that we have stock of medications, and dealing with disposal of medications. And putting out fires for weird health issues that pop up in the specialized population being served. It's pretty sweet in a way but means I'm sort of at their beck and call all the time and have to deal with some weird breakthrough issues. I'm new to it but since I can do most of my work from either home or my other job sites, it's an easy way to just pull in some extra money. And not having to actually deal with people often is kind of nice in a way.
  12. Umberlee

    Your first experience with a dead person

    I remember a tiny, extremely contracted little lady with very advanced dementia. She was just like a little ball of a woman, arms and legs and back and everything bound up so tightly from strokes and disuse, she had hardly any range at all. When she passed I was just dumbstruck by how all those contractures suddenly just let go. Providing postmortem care to her relaxed and free little body was probably the most unique and profound death experience I've had.
  13. Umberlee

    haldol

    I typically see the haldol only given when the patient has a history of addiction.
  14. Umberlee

    Yikes! Violence?

    I worry about violence too...I'm now working a mixture of inpatient and outpatient, but primarily outpatient. As part of a local brand-new ACT team, we're seeing clients in their homes and in the community. So far we have a very small caseload so I haven't been in too many dicey situations. I honestly feel more comfortable seeing clients in their home than I do on locked, secured, inpatient units. I don't feel "scared" of our clients but the other members on my team are really, really uptight about never seeing anyone alone, thanks in part to our therapist being a former women's self-defense instructor. He doesn't even want me to go just deliver meds to a client alone, even if I just knock on the door and hand the meds over. I find it pretty over-the-top and a huge waste of staff time, personally, since one person is just sitting around a lot watching things happen. What I get most nervous about is someone going off the deep end and coming into the outpatient building and attacking people. In that case I guess it would just be random dumb luck or lack thereof if I happened to be around and get shot or whatever. It does make me a little nervous because yeah, I don't wanna be taken from my kids or anything, and I think the risk is significantly higher than just some random setting like at the grocery store or something. But what are you gonna do...just hope for the best, I guess.
  15. Umberlee

    Working crazy hours

    Right now I have four jobs, and I'm not all that happy with any of them. My "main" job is only 27 hours a week but it's split over four days which is ridiculous and costs me an extra couple hundred a month in day care. Because of that I picked up a new consultant/PRN job which sounded like it was going to be on my own time much more than it is actually shaping up to be. Not to mention no actual reimbursement for being on call, just the time you actually go in. I also have a position at the psych hospital that I don't really like (I love psych, just not crisis stabilization I guess) and a PRN gig at a couple group homes which are horribly managed so the nursing turnover means I work way more there than I want. I'd guess I'm pulling 50 hours per week, plus five kids and going to grad school full time online. I'm not sure I can keep this up for much longer but I'm making hay while the sun shines, I guess.
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