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verene MSN

mental health / psychiatic nursing
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verene is a MSN and specializes in mental health / psychiatic nursing.

verene's Latest Activity

  1. verene

    NP/PMHNP Work Culture

    Unfortunately I think this is part of the variability of training and of school acceptances. Some school strongly screen applicants (for both direct-entry and for RN to MSN/DNP) and some don't and there is also variation in rigor of programs as well, and what those programs focus on preparing students for. For my own cohort all of us went out into practice following graduation and are currently spread across FQHC/community mental health, substance use treatment, acute inpatient, forensic inpatient, step-down/residential, and private practice locations. All of us were employed in field with in 6 months of graduation and all of us remain in the field.
  2. verene

    Psych NPs - What do you do when you get this patient?

    Thank you for making that distinction, I'm probably a little salty from having been around a few too many NPs who are SUPER judgmental about patients on ANY controlled substances or anything other than low dosing and really straightforward medication combinations recently. I've heard a few state that they won't prescribe stimulants to patients with well documented ADHD (even if no contraindications and no other medications to interact with) because they "don't want to deal with stimulant seekers" or who make fun of and/or won't accept patients with personality disorders because they are "too much work and such drama queens" and the like of think any medication/med combo for depression or anxiety (even if refractory) that isn't an SSRI is somehow irresponsible and enabling and it's gotten to me a bit. I apologize for responding to your post with those comments still in my head and thus passing my own judgement on what you were asking and making an incorrect assumption.
  3. verene

    Psych NPs - What do you do when you get this patient?

    There is potentially an argument for it being okay under coordination of care - but I would think there would still need to be an active referral in place, and the records being sent/reviewed would be only those necessary to make determination for appropriate referral/level of care. Typically patients do sign ROI when a referral is placed allow information to be released to that facility for purposes of referral. This is why it is okay to review the medication list sent as part of a referral packet (or intake packet which may have been filled by patient), but not okay to look at PDMP -- unless as part of your intake process you disclaim that this is routine for your practice and have patients sign an agreement to this as part of the intake. I'd still say declining to take them based on a PDMP because you don't like their medication list is ethically questionable -- I'd personally error on the side of seeing them for an admission/intake assessment and getting a better picture prior to either accepting or referring to an appropriate level of care or clinician which will better be able to meet their needs. I've seen some absolute doozy med lists where the patients have been great to work with and actively desire to clean things up -- and you can't tell that just from their medication list. You get that by interacting with them and having discussion about their goals for treatment. It *is* reasonable to review PDMP at intake appointment and to discuss findings with patient if there are concerns, as it is reasonable to review prior to prescribing controlled substances.
  4. verene

    Protections of civilian nurses from fed. inmates

    I work in forensics and am no stranger to the kind of patient you are describing. Unfortunately you should be very disturbed both at who is let out, and who is kept for a long time, our legal system is far from perfect. Glad RNs are filing incident reports and officers are filing reports at prison. Documentation is critical in these sorts of situations. Is there a behavior plan in place for the patient? If not, get one ASAP. Staff NEED to be setting boundaries with this patient, if there are no interventions in place, the patient is controlling everything and you have a very, very messy situation on your hands. IDT/leadership need to be looking at taking a hard look at resources, interventions, instituting behavior plans, and modification or restriction of privileges, if not modification and restriction of rights (e.g. mail is a right, however staff may need patient to open contents in front of staff, inventory, and have contents locked away if they are contraband for setting). This is a tough place you are in and I sincerely hope it gets better for you soon.
  5. verene

    Protections of civilian nurses from fed. inmates

    The process for how to transfer him back will depend on what his specific jurisdiction is and on why he is hospitalized to begin with. You need an interdisciplinary care consult including unit leadership, and possibly hospital leadership to determine next steps and get this patient moving along. If he is assaulting staff, staff do have the right to press charges. Prison isn't obligated to help you per se, but your hospital should be working to make things safer for those caring for him.
  6. verene

    Are nurses really leaving nursing in droves?

    Nursing has a fairly high turn over rate even in good times - the midst of a global pandemic is far from good times. Many will leave for other jobs in nursing, some will leave for related health jobs, some will go into completely different careers. What I've seen a lot of at my work place is people quitting working altogether to accommodate home-schooling and child care giving needs, I suspect at least some will come back as schools reopen, but others likely won't.
  7. verene

    Suicide Risk Assessment and Care Planning

    The most important thing to do with a patient mentioning SI is to clearly assess -- is this a vauge and passive "wish I don't wake up tomorrow" level of SI or an imminent detailed plan with high lethality means? What are the protective factors that would cause a patient to pause or prevent them from acting on these thoughts? Are there are large number of these protective factors or can the patient not identify a single reason not to die? Appropriate action is based on the severity of risk after assessment. Exact policies on how to follow up will depend on your setting and resources available. In some settings RNs can initiate a mental health hold, in others you would need to call MD/NP or call a crisis line or 911 to get additional assistance. If the patient isn't at imminent risk it is important to make a safety plan (this isn't the same as a contract - contracts for safety don't work and are essentially meaningless). Work through - what are "higher risk" situations - when do they feel most depressed and most likely to act on SI - how can they avoid these situations? What are there reasons not to die? - write them down. If feeling depressed - what are their resources for support and distraction? Are they okay with these resources being brought in an aware of their safety plan? (E.g. "If feel better when I call my mom on the phone - can we let mom know that patient is going through a rough time and their protective factor is to call mom?) Who is the second person to call if that person isn't available? Post the plan (risk situations, how to avoid, reasons to live, coping skills to manage the impulse, and resources for help) and these contact numbers in multiple places - e.g. copy on fridge, copy in car, copy in purse. AND consider giving a copy to 1-2 support individuals for patient. Make sure they also have copies of local crisis resources and know locations/contact of walk-in/urgent care mental health clinics. Also reach out to the mental health team (if involved) and see if the patient can't be moved to more frequent check-ins - potentially including phone check-ins for support and safety. These plans work best when the patient is an active participant in their creation as they need to be personalized and meaningful to the individual. In out patient setting we sometimes would have patients call office daily if we were worried about them, and the patient had agreed that if we didn't hear from them - we would send a welfare check to their home. A lot of the specific details may vary based on your practice setting, community resources, and the individual patient.
  8. verene

    Psychiatrist’s false documentation

    It may be that there are shady practices going down. It may also be that patient presentation is different at different times of day and with different staff - which is not at all uncommon. I've had patients who floor staff think are bright and happy and playful give me detailed suicide plans. I've also had patients who've looked more stable when I've met with them then present totally hypersexual with staff a couple hours later. If you are seeing things completely different from psychiatrist or don't understand their care plan, or have concerns - I'd recommend reaching out to them first - see what their thought process is and what they are basing their decisions on. There is a chance they may appreciate the feedback that nursing is seeing something completely different from what they are in their meetings with patient.
  9. verene

    Short Staffed: An Epidemic

    Oh we are working on morale boosters too and seeing what we can do to get people to stay and to get people who've been out on leave to come back to work. It's not a single prong approach by any means. And fortunately while my unit has had it rough - we still have better morale compared to most and people will chose us over other units for voluntary overtime, and more of our regular staff show up to work. I think having good leadership makes a big difference. You can tell the units/departments that care about their people and the ones that don't right now. Hopefully the ones that are better off can impart some of their leadership and morale boosting strategies to those who are struggling more. I'm confident that we'll turn it around eventually. The hospital has been around for well over 100 years and has been through any number of ups and downs in it's history so while it make take time I'm confident that we'll circle back to better days again. (This is no where close to rock bottom the historical perspective). In my own perspective as much of a dumpster fire as it currently is - it's still one of, if not the best, job I've ever had - so I'm willing to stay to help turn the place around and make sure those new staff coming on are welcomed and given support in hopes they then become well trained and stick around. My confidence in our hospital leadership has yet to be broken (The fact that our CMO and a lot of our other executive leaders will come work the floor -- even on weekend NOCs and other less desirable shifts -- and do whatever needs to be done to meet patient needs with out ego speaks highly to their willingness to lead by example and to put the safety and needs of their staff and patients first).
  10. verene

    Short Staffed: An Epidemic

    COVID policies led to decimated staffing at my hospital. Prior to COVID we had 100% of our positions filled. Yes - we still had sometimes with high call outs, but we even had our float-pool mostly filled so it was manageable. Over a year later we are in dire straights. Nurse staffing is down by more than 50%. Those who are left are burning out from the mix of emergency staffing, voluntary overtime, mandates etc. and injuries are WAY up which in turn contributes to even more staff out on leave or quitting. I don't know how we are going to turn it around because at this point new staff brought on see a hot-fire and thus quit or established staff leave and we are barely filling positions fast enough to keep up with attrition. It's bad. Really, really bad. Management all the way up to DNS and above is working the floor. (even our CMO is working the floor at least shift per week right now.). And we can't be shut down because we are 100% full on beds and have a wait list to take more patients. Hopefully we will get hiring ahead of attrition and get the place back together again. Apparently it's bad everywhere though - other local hospitals are also struggling and even my PCP said that the out patient clinic I go to is running at about 60% of usual staff due to # of call outs and people out on leave and not being able to find staff to back fill positions.
  11. No, you don't need to renew the LPN license. In my experience once you have the higher license level the lower one automatically moves to inactive or expired status as it is superseded by the higher level. If this isn't the case in your state, I'd just let it expire.
  12. verene

    Dress Code - Hair dye

    I work inpatient psych - myself, unit psychologist, social worker, and our RN manager and at least two of the RNs on my unit all have either totally unnatural hair colors or have some fun highlights in unnatural color. Totally fine under hospital policy, and my supervisor's only comment was "love the hair - that's such a cool color!" The most critical comment I got was from a super manic patient who told me I "need to stop going to raves" and that he wanted to speak to my father about my life decisions..... but we worked through it once he was less manic. 😎 Some of the places I did clinicals at though as RN student and NP student though... would not have approved at all of unnatural hair color.
  13. verene

    Mandated reporting outside of work

    As others have said depends on your state. In both WA and OR you are required to report suspected abuse or neglect of child or vulnerable adult even when not in your employed "mandate" role. I've had to make a few reports (all at least tangentially work related) and the process is pretty straightforward. Remember - you don't have to do all the detective work to prove there is abuse/neglect just have reasonable suspicion for it. I've helped patients with the process numerous times - most get screened out eventually, but a few reports have resulted in further investigation and in one case I'm aware of, arrest and pressing of criminal charges against the perpetrator.
  14. Therapy is often individualized based on need -- I've had everything from 1-2x weekly for 60 minutes when things in my life were more intense to 30 minutes every few months to just "touch base" with a therapist. If you need to be doing more intensive work now that can't be done in brief sessions that are far apart, ask your therapist to increase time and/or frequency to better meet the level of support you currently need and the intensity of work you want to be doing now.
  15. verene

    Emergency response team

    I work in a large (600+ bed) inpatient psych hospital. Units try to manage crisis on their own as much as possible and not all acute behaviors (or medical issues) result in a code being called all staff are trained in de-escalation techniques and challenging patients often have specific behavioral plans created to help avoid behaviors becoming code situations. (for example my unit may only call a behavioral code for one out of every 10 behavioral emergencies because we are able to manage the others with out extra staff). If it does move to a seclusion/restraint situation ALL staff are trained in what we call "safe containment" and physical restraint techniques with clearly designated roles. Typically lead RN will lead these situations, but we do allow flexibility such that if another staff has rapport and is primary engaged with patient they lead if need be. We have the ability to directly ask security for a "walk through" (1-2 staff casually walk through the unit) or a "show" (2-4 come prepared to deescalate) if things are escalating and we just want some extra people on the unit to potentially help manage milieu while unit staff are engaged with the emergency but are hopefully not going to escalate to code situation. To call a code you can radio in a code, call security/dispatch on phone for code, or hit a personal monitoring device we each wear -- the prior two are preferable as then you can provided more detail on what is needed, but the monitoring device is good because not only can you activate it by pushing the button, but it also will trigger security if there is sudden change in motion (e.g. if you go from upright to laying down with in a certain number of seconds and then don't move it will also send an alert and security will look a cameras in your area and call code if needed - of if you've just dropped the device will call the unit to confirm no code and not call). Although it is much more rare - if security monitoring cameras sees something that looks dangerous (e.g. patient appearing to charge staff running down the hallway) they will also independently call a code. When a code is called (Green = psych, blue = medical) Program manager, attending psychiatry staff, RN managers from all "sister" units, and at least one staff from each of the program "sister" units respond to other codes in the program along with security staff. (who responds to codes is assigned each shift). For some units/situation the code will be called "Code Green X units and security only" -- this is usually more common for our specialized units (e.g. medical-psych). Code blue summons rapid response team, program manager, RN managers, and medical staff but usually gets a HUGE response because they aren't as common (and if there has been a "code green" followed by a "code blue" people tend to assume the worst and you get more than enough staff to manage both situations). Many times we get almost too many people and it is important for whomever is in charge of the code to direct staff to roles and ask excess staff to leave. You almost never want more than 4-8 people directly involved with the patient for restraint or medical and want the rest being utilized to manage milieu and do things like bring supplies or open doors, make phone calls etc. It can be useful to have some of the responding staff stick around to help staff anteroom and manage milieu while the unit debriefs after the incident.
  16. verene

    NPs and Being On-Call

    It can be highly variable which is part of the challenge. I'm in psych and where I work (inpatient) the NPs don't take call at all, so no overnights or weekends. Which is really nice and can help keep a good work/home balance (there is always someone else responsible for my patients when I'm not there which makes it easier to "let go" and keep work at work.). However in other psych settings - such as the inpatient setting I did my clinical rotations in - NPs not only take call, but may even be contracted specifically for call-shifts (aka all nights or all weekends) only. (Though there was also option for regular day-shift NPs to take voluntary call for OT pay if they wanted it). Depending on outpatient calls may be directed to a crisis line or dedicated "After hours" number, and there is never call, or you may be "on-call" all the time, and be expected to take emergency calls. I wouldn't let fear of taking call hold you back from exploring different specialties and going for an APRN role. I think the only one that might be challenging is Midwife, but even then there are places where call is not mandatory.