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DAL2010

DAL2010

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  1. DAL2010

    Staffing Levels

    1 RN to 8 pts; 1 Tech to 16 pts. Acute detox, all substances.
  2. DAL2010

    "Addiction" Nursing is an outdated term.

    I remember a while back we were told to not say PTSD but to say PTSS (replacing Disorder with Syndrome). The goal was to improve patient participation in care with the thinking that no one wants a Disorder, but hey, a Syndrome, not so bad, anyone could have one of those! Yeah. Didn't last long because the terms don't matter.
  3. DAL2010

    Violating Theraputic Bounderies as an RN?

    As a Psych nurse, our standard is that if we believe a patient to be concealing items that are unsafe, we address it with the patient first, then if necessary, we call the doctor to report our concerns, then conduct a skin assessment if doctor orders it. We also require a doctor's order to search patient rooms for contraband. In your scenario, after the patient denied contraband or seemed insulted, I would have spoken with that patient's primary nurse, who should have spoken with the patient. If primary nurse did not address the situation, I would have taken it to the charge nurse. If neither nurse addressed the situation, I would have contacted the supervisor, who could speak with the patient and/or call the doctor for search orders. (Even though you are a nurse yourself, your actions were limited because you were working as a Tech at this time.) I actually find it difficult to believe that accidentally & casually waving a pen could impart a great enough pressure to pop styrofoam through a shirt - sorry, but I find your explanation a little light. While I can't say this was fireable, I would say it should have definitely led to education for you on appropriate interactions with patients and appropriate elevation of concerns.
  4. DAL2010

    Medical Clearance for Psychiatric Unit

    I disagree with canoehead. I have a strong background in Cardiac/Neuro ICU/IMC and have worked the past number of years in a free-standing Psych hospital, in Admissions. A big part of my job is screening patients for medical clearance (in addition to Psych need and appropriateness). We will not accept a pt with systolic above 159. We also have parameters for EKG, HR, Electrolytes, BAL, WBC, Platelets, BG, CIWA, CINA, 3rd trimester pregnancy, Med levels (eg Lithium, Depakote) and Acetaminophen. We also require all patients to be fully ambulatory on their own and able to toilet & feed themselves. Canoehead seems to speak from an ER perspective, and sometimes when I'm screening, I get pushback when I instruct ER staff to replace K of 3.2 or give insulin for elevated BG, to facilitate patient transfer to my facility. It's all in the interest of patient safety - as a psych hospital, we are not equipped with the supplies to handle a CVA or MI or to stop bleeds (no IV supplies or IV meds in the building). I advocate for patients to be in the safest environment for them: they can receive Psych or TelePsych in the ER or medical hospital, but they don't really receive emergency or life-saving medical treatment here. If that means transfer to my facility is delayed, so be it.
  5. DAL2010

    Thinking of Transitioning to Psych

    Background is Cardiac/Neuro IMC/CCU. Have been exclusively Psych for a few years. Psych Nursing experiences can vary greatly based upon patient population. My facility has distinct units: Detox, Mood Disorder, Gen Psych, Psych ICU. Detox can be medically complicated. Mood Disorder patients can be mentally exhausting (esp. Borderline DO patients), Gen Psych includes all aspects of Psychosis - nonviolent, PICU includes Psychosis/Behavioral with violence and nudity. Working the Mood Disorder Unit requires offering great time and emotional support, not physically demanding whereas PICU is very much physical (as in stopping patients from hurting themselves or others regularly). I'm currently in Admissions, so I am the first point of contact for new admits - I frequently end shifts emotionally fatigued, especially when speaking with trauma victims and suicidal patients. Their histories and experiences are sometimes heartbreaking. I'm sometimes threatened with physical assault. I am thankful I work at a facility that actively teaches and practices safety for patients and staff - we are very good at de-escalation and working together and have very few injuries to staff or patients. Similarities to bedside nursing are time management and prioritizing patient needs vs patient wants. In general, I've found that Psych Nurses treat each with more compassionately and with more respect than other areas of nursing I've worked. It's a "we're all in this together" mentality. Important skills/traits for a successful Psych nurse include: compassion, kindness, a genuine want to help people, listening & speaking without judgment, practicing with rational detachment.
  6. DAL2010

    Home Health Nurse pay??

    Former Home Health. Enjoyed the work. Could not live on the pay. Paid per visit: $30 regular, $45 admission/recert. Recerts are every 3 months. Medicare/Medicaid require 60 minute visits. Private insurance 45 minutes. So, while a company may say $40-50 per hour, I never saw anywhere near that because travel time is your own (some companies pay mileage - mine paid less than the Federal Government allowed, so I filed my miles at tax time). The amount of work taken home can be a lot - requiring paperwork before leaving in the morning and after getting home at night. I was required to use my personal cell phone - which meant patients/families had my phone number (I've heard some companies give out company phones). I had a 20 patients a week, with most having weekly visits, occasionally two for wound care. That was less money than I'd made as brand-new grad on Med Surg. I went back to hospital nursing to make more money and have my time off really be time off. Numbers could vary a lot based on geography and agency size. I was with a small agency and lived in the Midwest at the time.
  7. DAL2010

    Do Psych Nurses Travel?

    I have worked as a Travel Nurse in Cardiac, IMC, ICU and Psych. Yes, there are horror stories (and people love to share them!) that Travel Nurses get the most challenging assignments. This was not my personal experience, but I saw it happen with other travelers. It depends on you. I went into each new site confident in my nursing skills and abilities, but humble in the fact that I did not know everything about that site/unit. I asked appropriate questions (like where to find supplies), then proved myself as a nurse with my work quality. I never felt I was given difficult patients on purpose. I did work with 2 different travelers who were cocky and frequently told permanent staff things like, "that's not we did it at such-n-such last job," and they just had "better than you" attitudes all around. Those two people did seem to get harder patient loads. It's important to realize though that Travelers are needed to fill staffing shortages for many reasons, including: unit/facility is poorly managed, patient acuity is generally very high/overwhelming, etc, so the units needing Travelers may be generally perceived as more difficult over all than well-run units. The permanent staff generally appreciated Travelers, because our presence took some of the load off them, especially if they'd been pulling a lot of overtime to cover shortages and were getting worn out.
  8. DAL2010

    Staffing Ratios

    My facility is a free-standing Psych hospital that is part of a large not-for-profit hospital family in Texas: Mood Disorder Unit: RN 1:8, BHT 1:16 Detox Unit: RN 1:8, BHT 1:8 General Psych: RN 1:7, BHT 1:12 Psych ICU: RN 1:6, BHT 1:8 (more BHTs added when pt's highly acute) Plus, we staff 2 Float BHTs each shift: 1 to help out Mood/Detox units and 1 to help out Gen Psych/PICU units.
  9. DAL2010

    Pre pulling meds

    I've worked as an RN across multiple states and specialties and have always been told: Pre-pulling meds is against JCAHO and against most (if not all) state boards. If anyone is found pre-pulling during audits/visits, discipline will be given to the particular nurses involved and to the facility. I left one facility after only a few months because they told me pre-pulling was the only way they did med pass. It felt wrong to me. They lost accreditation the following year - this was among the reasons why: unsafe medication preparation and administration practices. Pre-pulling is also found to increase errors. Labeling medicine cups is not allowed (HIPAA). Pulling one patient at a time and then immediately administering to that patient is Best Practice according to pretty much every resource out there.
  10. DAL2010

    Plus Size Scrubs

    I really like my Carharrt Cross Flex. I also wear Navy, and the color stays true after over a year of washing. The fit is comfy and loose enough, without being baggy - I have just the right amount of room to move. I wore a 3x top and 2x bottom, and now 2x top and XL bottom. Each size I've purchased has fit nicely for the size I was.
  11. DAL2010

    Guys, I'm an unintentional job hopper.

    Is Travel Nursing or Contract Nursing an option for you? In my first few years, I worked Med Surg, Cardiac/Neuro Critical Care, Home Health and Psych. Was always content at work, but never quite happy. After a few months, I would get itchy for the next thing. I took on Travel Nursing and left home with only the next 13 weeks accounted for. I did multiple contracts in different states, and lined up my next contract about a month before the current one ended. I always chose 13-week contracts, and finally, one new city - in a part of the county I'd never actually considered living in - just felt right to me, and I decided to stay. Before my Travel Contract ended, I contacted the internal float pool manager, and secured a job as a Float Pool RN. I finished my Cardiac unit contract on a Saturday, and oriented to Float Pool the following Monday. It is a large city and my hospital has a large presence, so as a Float Pool nurse, I worked Med Surg, IMCU, ICU & Psych at a total of 6 facilities. After a year and half, I realized I felt truly happy at the Psych Hospital, and transitioned there full-time. That's been 2 years ago now, and I am truly happy with my work. The variety that led me here gave me a strong basis for how and where I want to practice, likely, for the rest of my career. I no longer have impulses to try the next thing; I just want to continue to grow where I am. If leaving your geographic home to travel is not an option, you could just look for contracts in your area. Local contracts exist, anywhere from 4-12 weeks at a time. They would be premium pay, as well.
  12. DAL2010

    TEAs study guide

    Go to ATI and buy the official TEAS V study guide. It is geared specifically to this version of the test. Spend the extra money to get the online practice tests. It should be around $80. Some people complain this is too much money, but look at what it leads to in the long run. I studied twice a week for about a month, then took the TEAS V and got over 90 on my first try and I've been out of school since 2001!
  13. DAL2010

    Arrests and Nursing School?

    Many nursing schools will let you apply and may even let you in, but where I live, all of our info. is given to the clinical sites and they get veto power to say "such-n-such student is not allowed in our facility." If you cannot get clinicals done, obviously you cannot complete the degree requirements. I agree with the previous poster who suggested you NOT get arrested.
  14. DAL2010

    NLNAC vs CCNE nursing school

    Check the local jobs posted in your area. In the Midwest, an incredible majority of them state "must be a graduate of an NLNAC program." So, in many areas of the country, people are graduating from CCNE programs only to find out their time, hard work and money were a waste and they must then apply for a NLNAC school. Of course, CCNE schools will not tell prospective students this.
  15. Ivy Tech ASN is the most reputable program for many parts of the state, so if you have a campus near you, check it out first. You can get a job as a student nurse extern after foundations (first semester) and that may be even sooner for you with your dual-credit high school experience (SNEs -student nurse externs make about half RN pay so approx. $12.50/hr.). After getting your RN from Ivy Tech, then try to work at a hospital that pays for your BSN. Many hospitals in big cities do this. You can apply for RN-BSN programs as soon as your license comes through, so the overall time length will only be about 6 months longer to go ASN then BSN as compared to the BSN route right off the bat. Plus, Ivy Tech has great rates and your ASN will allow you to earn RN pay while you complete your BSN which means you will be earning $22-$30/hr while completing your BSN, whereas if you went straight to BSN, you cannot work as a student nurse extern until after your 4th semester and you will not earn full RN pay until your degree is complete, plus your overall costs will be higher.
  16. DAL2010

    teas v as hard as online test?

    I took the practice tests in the book and the ones online and I found the actual TEAS V to be much more similar to the book tests. I scored 80s on the book practices, 70s on the online practices and 90 on the actual exam. Just review a bit each day and try to be calm the day of your test. Read the items carefully: there really is enough time to be thorough so don't let rushing lead to unnecessary mistakes. The site should give you as much scratch paper as you need so use it! Good luck!
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