oceanblue52

Wow, this seems a little crazy. I work in outpatient Psych so our duties are a bit different (e.g. we just do injections, not anything crazy like post-op or sedation). Will say that we have about 8 docs (some part-time), and we have many of the same obligations:refills, PARS, phone calls, emails from providers. On a bad day we get 30-40 calls a day (and maybe they are a bit worse b/c they are Psych related and require lengthy conversations and follow up?). The only way this chaos works is that we have two MAs and one RN. MAs can pretty much do everything that RNs can do other than dealing with Scheduled meds...and they are of course uncomfortable dealing with difficult clinical scenarios. Don't know if that feedback is of much help since Psych is very different from your setting...but will offer my sympathy and say that you do the best you can (and find another job if it’s too stressful after a time). We were understaffed for awhile at my job and it was horrific. People like to think out patient is easy, but it can be just as crazy and chaotic as inpatient.

Greetings, Outpatient Psych RN here. Had an adverse incident recently where we were giving a client an injection and said client grabbed scissors off the desk and injured himself. 911 was called and client was stabilized. Our outpatient facility is now reviewing protocols to prevent this incident from happening again. Of course the obvious first suggestion is to not leave items that can be used like weapons around in easy reach...in this case it was a human error and of course our staff plans to be more careful with keeping these sorts of items out of reach. Rest assured our staff member feels terrible about leaving a sharp object out and nursing staff is now hyper vigilant about reviewing our environments before client encounters. Honestly though even if obvious sharp objects were tucked away, there were other items the client could have grabbed. Other than controlling the environment better, does anyone working in outpatient use an evidence-based assessment for predicting who might act out/commit assault so better precautions can be put in place? In an outpatient setting it is tricky dealing with patients who are easily agitated because we don’t have security backup in place. Am thinking a risk assessment is a good start to tackling this issue?

Very good summation. Would like to add my own anecdote with strip searching a patient, came in looking pretty put together. A colleague of mine had her remove her underwear and hundreds (literally) of pills came tumbling out, mostly benzos. She was a voluntary patient and still don't quite understand her rationale for coming in. The lesson being...never assume a patient is not hiding something. They are crafty. Have a few other stories but will save them for another time.

RN here that works in outpatient community health, and am interested in becoming an NP. Your statement about trying to cure psychosocial issues via medication is close to heart. Very difficult and takes a lot of skill for a provider to separate the issues and medicate accordingly. Some community health centers do really well with Care Coordination between therapists, case managers, navigation, benefit specialists, nurses, and providers, and crucial to managing this issue. New NPs should inquire about availability of these services before accepting a job.

Right? Sounds like my dream job.

If you are trying to transfer within your hospital, you will likely need 6 months experience before they approve a transfer. A word of warning, it can sometimes be difficult to transition back into acute care after working in Psych; managers tend to think you've "lost your skills." Dumb because those soft skills you gain in Psych are needed in any setting. But I digress. If you are truly miserable, and not just having new grad anxiety, I don't see why you can't apply for jobs more to your liking. Think carefully about what you liked about your Psych rotation. I worked 5 months home health as a new grad and then transitioned to a new one. If you apply and get offers, vet them carefully. If you leave this job early you'll want to stick around the second one at least a year, ideally 2 or 3 to show stability.

Former (non-nursing/medical) researcher here. Consult with the person heading the study, or another supervisor. They should be able to counsel you on the most appropriate action. Like working in a hospital/clinic, you are correct that it is inappropriate to work directly with them as you would have access to their medical records. Sometimes arrangements can be made to accommodate both you and participants.

How had the application process been for PMHNP? Thinking about applying in the Fall...

Perhaps this varies state to state. But I don't understand what a physical license is, and why you would need that to practice nursing. Once you have a number shouldn't you be good to practice? That is all that should be needed to verify that you are licensed.

Can you stick it out another 6 months? A solid 2 years in critical care with Charge RN responsibilities should give you a good foundation on which to market yourself. Are there things you enjoy about your job? What attracts you to Public Health? Every specialty has its stressors; self-assessment can help you avoid getting into another poor workplace environment. What about something like the OR/pre-op? Home health? Is there a specific population you enjoy?

Hard to say what specialty would be a good fit for you...I would recommend going on a comprehensive job search engine such as indeed and then search for various specialties you are interested in. This will give you an idea as to the market and qualifications they are looking for. When I get frustrated at my job I do this, it puts things in perspective and reminds me that the experience I'm gaining will open more doors down the road. Will also add that the Psych experience you are gaining is very valuable. I've been in Psych several years (through nursing school). My favorite clinical instructor liked to remind me that patients with Psychiatric issues exist in ALL specialities and are not just confined to a Psych hospital. It's a valuable experience and will serve you well, and might even help your job search. Good luck finishing the year out, will be over before you know it.

I worked as a Tech in a Psych hospital for a few years and had to make a similar decision. Pharmacology has always fascinated me so that was one reason. Counseling as a field is also quite saturated (way worse than nursing) and the pay almost never commensurate with the education. It's also an arduous process to get licensed. Could argue the same about nursing, but saturation is typically less of an issue within the Psych specialty. Ultimately I feel like Psych nursing offers better pay and other opportunities if I grow tired of it.

It is very difficult, if not impossible to get vaccines waived. Typically it is not the school but the clinical sites that have these requirements. From their perspective, it's puts their patients at risk and sets them up for increased liability. So even if you successfully petition the school, they will have a difficult time finding a placement for you. Clinical sites essentially have the final say, and with placement as competitive as it is I doubt the schools will allow you to matriculate without records. Did you get vaccinated as a child? Some of those records may suffice, with the exception of the flu shot and possibly TDaP. And keep in mind too that this fight will continue to follow you into the workplace. Not trying to be argumentative, just offering my observations.

Probably want to pick a more specific population, but rural populations is a very broad, interesting topic. Vulnerability stands to get worse as more hospitals are forced to close from funding issues. If you are on social media, follow some community health organizations in your state, they might give you some ideas. What sort of nursing are you interested in? Maybe that can help you narrow down a topic?

Work in outpatient Psych, best part is watching clients get stable after trying and failing a bunch of med combos.

To be fair, managing BP to the gold standard of under 160/90 is not always feasible. A family member of mine is allergic to 2 different classes of cardiac drugs for symptom management, and she is maxed out on all other doses. Resting BP is usually around 169/95. The cardiologist didn't have any other suggestions either. Always good to get a history and check for understanding before delving into education.

Take some deep breaths prior to check off. In addition to ignoring the instructor, have a good routine in place that is well reheorificed. Enter the room, address yourself, do safety checks, etc. "Setting the scene" can help you feel less anxious an approach whatever issue more naturally. As an aside, I also got very nervous about check offs. Enjoy the process of learning and realize that *most* instructors are just looking for safety and basic competency. All of us nurses on this site have gotten through something similar, and you can too.

Please take care of yourself. Do you see a therapist and/or doctor for managing your anxiety and depression? It is better to stay on top of these types of things rather than go unchecked. What kind of coping techniques have you used in the past to manage anxiety and mood? If you are needing to talk to someone, you could also try your health and wellness center. Some other tips to recommend: -get a planner if you don't already have one, and pick one that breaks the day down by the hour. Block off time for studying, and also self-care. Sometimes visualizing your day can help things seem less overwhelming. I always recommend paper planners over electronic management, because you can flip back and forth between weeks, and cross off things when you complete them. -some people will probably disagree with me...but I think it is counter productive to do ALL the reading for class. Reading multiple chapters is time consuming and takes away from review. High school does a disservice by teaching students to highlight. It makes you focus on little details, and miss the big picture. When I was in school, I used to skim the text before class for general concepts, pay very close attention in lecture, and then go back and read concepts I didn't understand more carefully. Trying to read and meticulously take notes for all of your textbooks is a lesson in futility. If you have good teachers they will highlight the most important points in lecture. Star essential concepts when your teachers talk about them and focus your studies from that. I also second doing a self assessment in your learning style. Do you learn best by reading? Watching videos? Listening to lectures? Writing out important concepts? What has worked for you in the past? -do you have a classmate you can commiserate with? I never did well with group studying, but even small talk with your seat mates can help manage anxiety. This might be challenging tho if your GAD extends to social settings -IV drips are confusing, and it takes practice to learn how to extrapolate info from questions. Thankfully, there are a limited number of calculations that you will use, and it gets easier with practice. I'd be happy to try and help over PM. There are different ways to solve a problem, and some ways click better than others for people -This is obvious, but make sure you are managing your sleep, eating good food, avoiding screen time late at night, etc. Feeling good physically is really important to maintaining your mental health -for Pharm, there are some good study resources that offer mnemonics and group the meds by class so you are not trying to memorize details about every little drug. I used a little spiral book by Mosby that had lots of cartoons and simplified the info. The costs of these extra study guides add up, but is worth it if you can get some piece of mind -Finally, please stop beating yourself up about a bad test score. Nursing school is notoriously hard, and it takes awhile to get used to the tests. Can you go to office hours and review what you missed? Talk with your professor and see what they advise. The vast majority WANT you to succeed and will do what they can to help. Several of us nurses have had lousy test scores, and managed to get our license. Getting a "D" can be ego deflating, but it is possible to improve. Please do not get discouraged. I wish you the best. Would be happy to explain dosage calc over PM, it's really only learning a few formulas and then plugging in numbers. Maybe I will ask about submitting an article on this in the future since so many students have difficulty.

It really depends on your program. Some do random drug screens, and others might ask you to submit an additional, more updated drug screen later on in your program depending on clinical site requirements. I would say it is rare to be tested during clinical, unless a big error is made and/or you appear impaired. At any rate, if funds are tight for you it would be smart to keep $50-70 set aside so you are not scrambling to get funds together last minute. Regarding your specific program, it's hard to answer your questions. I would just turn the paperwork in and be done with it.

If you have the money, get the cert and start working before school. You will be miles ahead of your classmates in those first clinicals because you'll be comfortable with basic patient care. If money is an issue, some states will also allow you to "challenge" the test once you've passed the Fundamentals of Nursing class. They pay is not usually great, but even 8-12 hours a week can land you good experience and references. Good luck with whatever you choose.

How did you get her email address? If she handed you her business card or directly gave it to you I say go for it. Do keep it short and to the point though, as managers receive crazy amounts of emails. Good luck to you as well!

The gloves they test you with are tricky, so don't be discouraged! Some tips: One you have your first glove on, be very mindful of the thumb on your gloved (sterile) hand. Keep it away from your other fingers, it's easy to forget about it when you are focused on wriggling your non-sterile hand in. Otherwise just take it slow and press the fingers of the non-sterile hand close together (instead of spreading out) such that they make a point. Do you have a pair you can practice with at home? If you pay close attention to how the packaging is put together you can fold it back up and practice at home.

I worked there before becoming an RN, the "support" aspect really seemed floor/manager dependent. Some nurses raved about the residency program, while 2 other people I know left early and paid the financial penalty. My floor was one of "the good ones," but some of the nurses seemed very stressed out. Scrubs for nurses when I were there were a navy blue. Shirts were embroidered and purchased through the hospital, and scrub bottoms could be your own. The floor I worked had lots of employee transfers, this is again probably contingent on your manager's supportiveness. The application process is competitive, are you applying from out of state? Like all teaching hospitals UCH is very big into EBP and continuing education, so that is something to think about when you put your application together. Denver is a great city to live in, rent is crazy here though and UCH pay for new grads lower than some other hospitals. Like other metropolitan areas, Denver has become highly coveted, and wages in the area stay depressed because so many people are moving here. Surrounding area is "questionable," but it all depends on your comfort level. Feel free to PM me if you have other questions.

RTD is reliable even in snow storms, as long as you budget extra time. The neighborhood around UCH is rapidly gentrifying, I drove by it last week and barely recognized it! You will want to do some research though; Denver/Aurora neighborhoods can change drastically within a few blocks. Everyone has their own comfort zones so it's hard to say if you would feel comfortable.

I worked for a hospital with Magnet status and was not happy with the working conditions. I suppose every hospital is different, but I agree with Sour Lemon, I wouldn't make that a deciding factor. If you are wanting to go into critical care, the ER is probably a better option.