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medpsychRN's Latest Activity

  1. medpsychRN

    Trend To Decrease Use Of Seclusion And Restraint

    DOrothy, The place to check the law in Indiana regarding restraints is through The Department of Developmenatal Disabilities. At least that's what it's called in Illinois. There are specific laws which may vary from state to state which provide the law regarding the use of restraints, ROM, toileting and hydration. In Illinois, the physician is required to see and document at the beginning of the restaint and every eight hours. There also must be a restriction of rights completed every 4 hours. In this restriction, a copy which must be provided to the patient, the nurse must state the reason for the restraint. In addition, in Illinois, the nurse must document every 15 minutes the behavior of the patient. If the patient is sleeping, he is no longer a danger and the restraint must be removed. In addition, the patient must be monitored one to one by staff. Meaning a staff memeber must be present at all times. In Illinois, complaints are filed with guardian and advocacy. I'm sure Indiana has a similar agency. On the back of the restriction of rights, in Illinois, the location and phone numbers of the offices are listed. I have never heard of "forensic restraints". Hope this helps.
  2. medpsychRN

    Health Care: The Ticking Time Bomb

    If folks would like a view of how the government presently "manages" healthcare ask a serviceman. My sons have been enlisted in the Air Force since before 9/11. There are wonderful physicians but trust me there have been nightmares. There are 2 incidents with my daughter-in-law, that if she hadn't been in the military we would have sued. One involved her tearing her vagina from the cervix to the opening during delivery of my granddaughter. I attributed it to unsupervised pitocin drip. Beyond that, all treatments are scripted. Meaning if you have a particular complaint, you are prescribed a certain medication. There is little if any flexibility. They have been treated at various bases throughout their career and are always prescribed the same medication.
  3. medpsychRN

    Health Care: The Ticking Time Bomb

    Perhaps someone has already addressed the question of what will happen to the salary of nurses. One sure way to maintain a budget it to cut staff or cut hourly wages. Imagine the amount of money you've spent on your education. I don't know any other profession which would allow the government to set their pay grade. Lawyers??? No way! There are many ways the present system is being abused. I'm sure there are many people that can be blamed. I believe one solution is to FIX the present problem before taking on another. What's the rush for nationalized health care???
  4. medpsychRN

    IV Dilaudid problem patients!!!!!!!!!!!

    I have had some bad experiences giving Dilaudid in the past so it's not on my favorite list. In regards to drug addicts, they can be near coma and still complain of pain and demand more meds. Recently, when an addict was admitted to psych and on IV Dilaudid, I asked for specific parameters, e.g., respirations above 8. Even if the patients respirations were above 8 there were many times when I told her I wasn't giving her any more Dilaudid. Just because it's ordered doesn't mean I have to give it. I cannot financially afford a lawsuit because the patient gets what she wants and then falls flat on her face because she's sedated. Since it's highly unlikely the patient will be discharged on IV meds, the pain service needs to see ASAP and recommend a plan for a patch or for oral meds. Drug addicts can be needy and demanding folks. If it's safe for them to get meds, they can have what's ordered. However, I have five (or more) patients to take care of and the majority of them think their problem requires immediate attention. Thus, the addicts have to get in line and when I can get to them I will. This isn't an attempt to make anyone suffer. I can't ignore other patients. Sometimes it's okay for addicts to have an awareness of delayed gratification.
  5. Been there ten years and it's been the best learning experience of my life. Mds are outstanding. Nurses are fantastic. I work nights and I can call any floor and ask for help with procedure or medical problems. I work hard. I have seen illnesses I have never heard of! Patient's with multiple, complicated diagnoses. It's a challenge but that''s why I love it. Pharmacy 24/7. Most of pharm have their doctorate. Night pharmacy rocks. Almost completely computer charting. Another challenge but this has really reduced the number of errors. Would not consider going anywhere else for my medical care. The worst part of the job is the attendence policy. You are allowed so many occurances before you are written up. Best advice: don't be late (one minute late is a tardy) and don't forget to swipe. I think you'll love it.
  6. For my patient who drops the f bomb every time I ask him to do something..."right back atcha!" LOL
  7. medpsychRN

    The end of C-diff testing??

    Because we are a psych unit, we don't have those wonderful dispensers outside each room for handwashing. We were instructed we must wash our hand upon entering a patient's room. However, because of some new, unknown JC reg, (I'd like to meet the person who thought this one up) the faucets have no handles, come on by tapping the underside of the spout AND only stay on for about 30 seconds before shutting off. The showers are on for ten minutes and you have to wait another ten minutes for the water to go back on! We were asked to stop emailing the IC nurse in the past when we had questions about MRSA. I'm sure I'd get called on the carpet if I asked her about c-diff. The MD was very clear about not testing. Patient could get Immodium 2mg TID PRN. I asked for an increase in the dose and it didn't happen. Can't send a stool without an order and if this is the policy, I won't be able to sneak an order from the resident. Some of our patients are street folks and haven't had a bath in forever. Some are too depressed or psychotic to care. I'm worried about getting it and infecting my family. Also, would be hard to prove I got it at work if we're no longer testing. Thanks for the responses. Would be interested to know if this is happening at other hospitals. BTW, I work in a large university hospital. Thought they'd be better about taking care of patients and their employees.
  8. medpsychRN

    The end of C-diff testing??

    Cared for a woman on nights over the weekend. She had an episode of massive diarrhea (bed, floor,toilet). This was the third night she had diarrhea. Saw her attending Monday morning and I mentioned it to him suggesting we get a stool for C-diff. He told me the hospital wasn't testing anyone for c-diff who'd been hospitalized longer than 48 hours. They don't want it to look hospital acquired. I'm thinking of a million reasons why this policy is a problem. Does this increase the potential for c-diff spreading to other patients and staff? Since it's a system wide policy, it's a system wide problem now and in the future. Am I wrong about c-diff being so contagious? Any info would be appreciated.
  9. medpsychRN

    Question about Seroquel

    A lower dose of seroquel is not going to increase sedation. I don't know why the MD would say this.
  10. medpsychRN

    Illinois: "Nurse Staffing by Patient Acuity" bill passes

    The law now in Illinois is to staff by acuity. Nothing has been determined legallyhow this will be accomplished. How are they getting away with cutting staff? I work on a psych unit. Patients used to be assigned 1:1 monitoring for suicidal behavior or for example if the patient was disorganized or confused. The nurse would often ask for the 1:1 order. Now, if the nurse places someone on 1:1, they have to call the unit manager first AND she determines if the patient needs 1:1. A few months ago we had a developmentally disabled patient who had been 1:1 because of combative behavior, fall risk etc. They took him off of 1:1, put 4 matresses on the floor and put the patient on the floor as well. It's tough giving patient care on your knees. Last weekend, I spent almost the entire night with a patient because she was disorganized, confused, gait unsteady. The manager refused to let her be placed on 1:1. We are told daily we are overstaffed and need to have staff leave early. When you complain, your abilities are questioned. There is alot of shame and blame. I stay as I am a weekender and only working weekends. I'm sure I won't be here forever.
  11. medpsychRN

    Illinois: "Nurse Staffing by Patient Acuity" bill passes

    When the Illinois bill was announced last year we were advised by the hospital to call our state rep/senator and support staffing by acuity. We were told should a nurse/patient ratio bill pass, we would have to do more patient care as support staff would be eliminated. Since I expected to do patient care when I became a nurse, I didn't have a problem with taking this on. BUT, the implication was I'd have to work harder and get my hands dirty. Well, since the bill passed, I am working harder and getting my hands dirty. In addition I am asked to take on more responsibility because we are working with fewer staff. The budget is a hot topic and they have steadily cut staff in the last three years. Since it continues to be an issue, I am confident they will continue to find ways to eliminate nurses and replace them with lower paying staff. Taking an accu check doesn't bother me. If I had a patient on hourly accu checks, I'd be doing it anyway. The issue is safety. Employers will do whatever they can get away with. Nurse patient ratios have worked well in California. This is something we can stand behind to ensure we have some rights and the ability to care for patients as they deserve to be cared for.
  12. medpsychRN

    Illinois: "Nurse Staffing by Patient Acuity" bill passes

    About 3 weeks ago, in a general staff meeting, we were told we would be staffing by the numbers NOT acuity. I work in Illinois in a large university hospital and yes the hospital is forming a committee on staffing. I should also mention in I work in Chicago where tradition dictates a "business as usual policy". All the hospital has to do is change the rating of acuity numbers and they will be in compliance using the same amount of staff or less. I am guessing when I am unable to complete my work assignment in 8 hours, I'll be called to the office and asked about my time management abilities. I wrote the INA, state rep/senator. There is a federal bill sitting on committee about nurse patient ratios. To protect ourselves from unsafe assignments, nurses need to support this endeavor.
  13. medpsychRN

    New To Child/Adolescent Psychiatric Hospital

    I guess you can try it out. There isn't enough staff for 54 patients. Our ratio is at the highest 6:1 (RN- not including support staff).
  14. medpsychRN

    An admin vent of sorts

    I work in a magnet hospital. Either we all work in the same place or our managers were trained by the same people! My manager only micromanages when SHE believes you've done something wrong (God forbid you ask for advice) and not only will tell you about it but tells everyone else whether your present or not. You can work your buns off, get rave reviews from patients and MDs but according to her, you are only doing your job.If you want a raise you have to serve on hospital committees, volunteer for the hospital, conduct inservices and develop a unit quality improvement project. All of this is on your time. Staffing is cut daily and we are obligated to take PTO or no pay for call offs. The new hospital motto is "do more with less". They aren't kidding. Her latest method of improving staff morale is to develop a policy for the unit regarding tardiness and attendance. If you are one minute late, you are late and subject to a written warning. I hear it's no better on the other units. Everyone I've talked to is wondering how we can get the union in. There are some great reasons to stay...for now. Wonderful, compassionate physicians and I love working with patients. BUT, I have to admit, I'm having a bit of a problem showing gratitude to this (evil) woman for my job on a daily basis. White Castle is looking pretty good for my next job!
  15. medpsychRN

    pacify or orientate? Alzheimers...

    Interesting post. I work nights on an inpatient psych unit. We are the overflow for the geropsych unit. Not all, but the majority of the dementia patients we treat have an advanced disease. These patients come to us agitated. Reality orientation only increases their agitation. Medications are sometimes helpful. But medications don't make the patient any more agreeable to reality. It just makes them sleep...when they work. Ativan disinhibits patients. We use it rarely in cases of dementia. Atypical antipsychotics seem to work best. However, you have to be very careful when dosing elderly patients. They can experience side effects more quickly. Restraints are useless and are only used when all else has failed and safety is an issue. If you thought they were agitated - restrain them...it gets worse! We use lots of distraction techniques but what seems to work best is walking. I have walked many a mile at night. I wish I could say that I know all there is to know about working with dementia patients. I don't. They teach me something new every time. I also wish (really wish!) I had the solution for calming someone. It is a horrible disease and these patients are suffering. When it comes to "lying", either directly or by ommission, I have no problem. I'm going to use whatever works. I can spend the night trying to comfort someone or I can spend the night trying to convince them their mother is dead. I may win the war but I sure lost the battle. Am I lazy? PLEASE! Our dementia patients are 1:1. I work hard! I am always open to suggestions. May I just say I know nothing about working in the NICU. If I'm getting advice from a NICU nurse, I'm going to believe (and respect) she know's what she's talking about. There have been many great posts. Love the milking the cows thing! God over the intercom was brilliant. Can't wait to tell my coworkers about that!
  16. medpsychRN

    Psych Nurse ="not a REAL nurse"?

    I've heard this many times. It also goes along with "the night nurses don't do anything". I work nights...LOL. I really don't know what prompts people to say such awful things. I just remind folks where and when you work is a choice and they are welcome to join me anytime!