Jump to content
SoCal student

SoCal student

Member Member
  • Joined:
  • Last Visited:
  • 51

    Content

  • 0

    Articles

  • 2,534

    Visitors

  • 0

    Followers

  • 0

    Points

SoCal student's Latest Activity

  1. I've been working in acute psychiatric/chemical dependency for about 7 years now and have always considered incorporating music more in my care. I work in a smaller hospital with plenty of autonomy and have been known to bring my guitar in for times when it's slow, playing requests from patients. My hospital does not currently incorporate music therapy (we used to), and I'm considering putting together a proposal for a program that I can run that is within my scope of practice as an RN. I believe my supervisors would be very responsive to the idea if done within nursing scope/guidelines. I would like to create a full program that would entail something along the lines of: a weekly/biweekly group on each unit where we listen/reflect on pieces, utilize evidence-based approaches for our geriatric/dementia unit, maybe using smaller groups of patients who play an instrument to create our own music, etc. I was wondering if anyone is familiar with similar programs being utilized or can point me to any resources. I've googled a ton and haven't come up with much that would be limiting. Of course, I would not refer to this as "music therapy" or represent myself as a "music therapist." Other than that, nurses seem to have free reign in using music therapeutically.
  2. SoCal student

    Appropriate use of AED?

    Awesome, thanks for the insight, ya'll.
  3. SoCal student

    Appropriate use of AED?

    I've been an RN for 7 years in acute psych inpatient and administered CPR for the first time just this week. I never even had a chance to administer CPR as a student and have been lucky enough to have not needed it in 7 years of practice. It was also my first time ever using anything other than a practice AED. Pt. fell suddenly, possibly hitting her head on a desk (no trauma noted) and was unresponsive. APN present could not locate a pulse and CPR was initiated. The AED was expectedly as dummy-proof as the practice ones - I opened it up, threw the pads on and let it do its thing. AED advised a shock and the patient was shocked once. CPR was resumed and pt. was responsive within about 30 seconds. We detached the AED. EMS arrived, took over, and transferred pt. to hospital. But, one of paramedics apparently questioned "Why did you guys shock her?" in a condescending tone. I wasn't present at this point but other nurses felt that he was implying we did something wrong. It's my understanding that they shock manually based on the rhythm they see. But I also assume he knows that we use automatic defib that does all that work for us. This seems pretty straight-forward, right? Putting an AED on an unresponsive pt. with no pulse and allowing it to shock when advised? The AED only shocks if it deems necessary, which means she was in an appropriate arrhythmia? I've yet to return to work and assume we'll debrief with admin on this as it's something that is extremely rare at our facility so I've just been sitting around kind of anxious about it.
  4. SoCal student

    Phenergan Abuse?

    It's been my understanding that many opiate (among other) addicts also abuse phenergan as it can potentiate the effects and can also be sedating. I work in detox/rehab and patients consistently request phenergan, specifically IM. Our docs have instructed nurses to only administer IM if it has been confirmed by staff that patient is actively vomiting. If only nauseous, we should give PO. A couple of patients have been agitated with me recently for this reason as I've refused to provide the IM when they are solely nauseous. I've read a couple articles that confirm a potential for abuse, but they stated that the actual reasons for abuse aren't completely understood. The potentiating effects as well as sedation were mentioned. Anyone have insight into this? It appears the IM is strongly preferred over the PO in addicts. I assume this is because any desired effect comes on quicker/stronger?
  5. SoCal student

    Holding voluntary patients - illegally?

    That power point states very basic information that I've been well aware of for years. You're kind of missing the point again. I'm not talking about holding them for any extended period of time against their will. I'm talking about opening the locked doors to the facility immediately, before having a doctor's order, discharge plan, etc. My facility's policy is clear. We don't open locked doors until those requirements are met. Company policies don't supercede civil rights.
  6. SoCal student

    Holding voluntary patients - illegally?

    Thanks for weighing in. As to your last point: I truly appreciate you noting that. I've come here with this question after being dissatisfied with my coworkers' approaches towards this issue (basically, "Well our facilities policy is..."). They seem completely oblivious to the fact that private companies cannot override civil rights. I've got a lot of responses from well-meaning people here. But, I'm equally dissatisfied by the response of, "How you do you not know this? You should know this by now." As previously stated, this is a hypothetical that I have yet to encounter. I've been able to avoid this situation with 100% of voluntary AMAs I've encountered in the last 6 years. I can almost guarantee I could finish the rest of my nursing career in my state without knowing this answer. But, if I want to be able to advocate more for my patients than my facility, it would be great to know.
  7. SoCal student

    Holding voluntary patients - illegally?

    I already explained the requirements and process for initiating, certifying, implementing a legal hold in my state. I have also already explained how voluntary admissions and discharges work in my state (at least in the facilities I have worked in). So, obviously, I am familiar with the requirements. This knowledge has served me well for 6 years. Yet, I'm curious as to the legality of a hypothetical situation that has yet to present itself to me. I appreciate your insight but I have to fundamentally disagree with your (and a couple other members') apparent assertions that nurses that do not understand 100% of laws and regulations are somehow ignorant/negligent/irresponsible. As I've states numerous times: this is a hypothetical situation - I've 100% been able to de-escalate/reason with/work with voluntary patients requesting AMA over 6 years. So, should I be constantly scouring my state's laws based on hypotheticals I come up with in my head, just in case? Do you really thing nurses do/should do this? Nurses should undoubtedly be aware of their Nurse Practice Act and should have some limited knowledge of their state's statutes. To expect nurses to have an in-depth, nearly all-encompassing understanding of the law is unreasonable. I remember learning in school (and am reminded at every JACHO audit) that nurses don't need to know the answers to everything. They do need to know when to seek the answer elsewhere.
  8. SoCal student

    Holding voluntary patients - illegally?

    With the exception of the probably purposely confusing run on sentence, this is pretty much exactly what I was looking for. I really appreciate you finding it! Can you tell me the source of that passage? Thanks!
  9. SoCal student

    Holding voluntary patients - illegally?

    Would you mind pointing me precisely to your state's law that cites this? If you can't, you're pretty much in the same boat as me. Psych nurses, at least in my state (the sample of co-workers I've asked - the only ones I have asked before asking here), do not know the answer to this. They understand how a legal hold works. They understand how an AMA works. No one has been able to point me specifically to the state law that outlines the patient's rights in this situation. So I guess that makes me what? Neglectful? Ignorant? Sounds more like the confusion and lack of an easy, straight-forward answer is more a systemic issue than an individual one (me, being a psych nurse of 6 years that "doesn't understand this.").
  10. SoCal student

    Holding voluntary patients - illegally?

    Maybe I worded it wrong. Sure, you could find me liable. But, if you're a patient that was falsely imprisoned and you're suing for damages, do you go after the RN or the hospital that enacted policies that, when followed by staff, resulted in the false imprisonment. As this thread shows, there is a lot of confusion and disagreement in this scenario and I doubt an attorney would waste time going after a nurse that, following established practices and policies of their facility, didn't unlock a door. They would go after the facility or umbrella company. And while I'm asking all of this to better advocate for my patients, I also stated above that I would not (and have never) unlocked a door for a patient that hadn't already been discharged by the physician. Sorry, but I think, in a case like this, if you were to vote against the nurse.... I would hope for your sake that you don't find yourself in a suit where, while trying to do no harm, you may not understand the nuances of an uncommon occurrence.
  11. SoCal student

    Holding voluntary patients - illegally?

    I've searched the Nevada statutes and could not find an answer. I haven't asked everyone in my facility as I'm not keen on being marked as anything (even if for a valid reason). I have asked a number of people and, no, they do not know the answer. Figured I'd ask here first before going to the nursing board, dept. of mental health, etc. Yes, I've worked as a psych nurse both privately and publicly in NV for 6 years. Why don't I know the answer? Ninety-nine percent of my admissions have gone along with the process rather easily. There have been a few instances that escalated to the point of calling a house sup/doc/admin immediately and those patients were discharged quickly. Still, that didn't answer my question of whether we were, up until that point (after the pt. requested AMA), falsely imprisoning them. Knowing the legal requirements, etc. is important. I agree. In this case, I would assume with false imprisonment being both a tort and a felony, that the law would be fairly identical or at least extremely similar across the entire country. I am very well-versed in our state's process of initiating a legal hold, certifying it, petitioning patients for court, etc. Most nurses in my facility come to me when they have questions regarding this process. But let's not act like every nurse knows every law. This particular, nuanced question was apparently never important enough to be taught in nursing school (in NV), at various orientations/in-services, etc. Not a big fan of being accused of some sort of negligence for seeking out the answer to a question that no one seems to know the answer to. Again, I assume a patient would have every claim to false imprisonment in the same circumstance nationwide. Given that, why can't anyone here answer completely in the affirmative? Maybe because there is confusion and we're nurses, not lawyers. In NV, various people can initiate a legal hold (LSW, RN, MD, police officer) and it then must be certified by a psychiatrist or psychologist. I've initiated many legal holds. We do the same as well - try everything we can to talk a patient into staying - which usually works. I totally agree with you. Especially if you get a particularly litigious patient. I'm not touching them until I need to. But I'm also at this point not unlocking the doors. I can't imagine a jury would ever find me liable for not opening the doors in this case. I think they'd find issues with the hospital's policies and training. Still, I'd love to have the law on my side and be able to justify any of my actions in real time. Unless you work in a completely involuntary, locked facility, I don't think there's a difference - that's my point. I would think a voluntary patient in my hospital would have every single right (in terms of AMA) that a voluntary patient in a medical setting would. The only difference is the doors are locked. So they can't just walk out. My hunch is any lawyer worth their salt could easily make a false imprisonment claim if such a patient was not allowed to walk out of a facility for any significant amount of time.
  12. SoCal student

    Holding voluntary patients - illegally?

    Yep, it used to be in the paperwork (not sure why it was removed) and the common reply to that from detox patients was "I was so intoxicated/I was withdrawing so badly upon admission, I signed so many papers, I don't remember..." That's another question altogether - and I'm not saying the patient is right about that. Also something I wonder about though.
  13. SoCal student

    Holding voluntary patients - illegally?

    Yes? I appreciate you weighing in and I'm not being facetious either. Just as I'm trying to figure if a legal right exists for me to keep a patient against their will when they do not fit criteria for a legal hold, you would need to figure out if a legal right exists for you to (possibly?) falsely imprison them. Again, if a patient is medically/mentally stable and does not meet criteria for a mental health hold, what is your response to them getting up and walking out of a non-locked facility? Tackle them? Restraints? That's crazy. Is someone going to sit on the witness stand and say "Well yea, we restrained him. Why? Because there wasn't a doctor's order for discharge."
  14. SoCal student

    Holding voluntary patients - illegally?

    Totally. And that is my ultimate question. What is the state's legal precedent? Yea, my employer would fire me if I opened the doors. And it's very unlikely that a patient would come after me personally for liability if I followed policy and, went up the chain. Still, I want to know my patients' rights within the law so I can effectively advocate for them. I'm sick of sycophants trying to skirt responsibilities and/or make more money for the admins by dismissing patients. If voluntary patients who just happen to be in a locked facility wish to leave AMA and, by law, have the right to be let out of the hospital immediately, I want to know that so I can advocate for them.
  15. SoCal student

    Holding voluntary patients - illegally?

    If a medically and mentally stable patient stands up and begins walking out of their room/hospital, are you going to physically lay hands on them as they say "I don't care, I'm leaving against medical advice"?
  16. SoCal student

    Holding voluntary patients - illegally?

    I'm a psych RN of about 6 years. I've gone along with my facility's policies as I'm usually able to de-escalate a pt. and, once they've made enough noise, I can basically force a doc to see them and shift the onus to them. My facility is a psychiatric/behavioral health hospital, but patients are either admitted as "psych" or "detox." While the detox patients are always voluntary (at least on admission - they may be placed on a legal hold of that becomes necessary), psych patients can be either voluntary or on a legal hold. I ask because I work with many who blindly follow the facility's policies with no regard to what may actually be lawful. "Oh he can't AMA, it's passed 3pm." Ok, this guy is here voluntarily for detox only. Not suicidal, not homicidal, not psychotic, not unable to to care for self. Now he's calling his lawyer saying he's being held against his will. Are you willing to go to court and possibly let be held liable as "the policy says..."?
×

This site uses cookies. By using this site, you consent to the placement of these cookies. Read our Privacy, Cookies, and Terms of Service Policies to learn more.