verene

Neuropsych testing is done by a neuropsychologist rather than by nurses. The specific tests and screeners are going to depend on what is being clarified and context of evaluation. (e.g. different screeners may be used if this is a person facing murder charges and there is concerns for malingered cognitive deficits compared to an 11 year old needing evaluation for an individualized education plan and accommodations at school).

Edited post for clarity.

You would likely want to call security/additional staff for help separating patients, managing the rest of your milieu and creating a safer situation. Once separated it would depend on what happens next - can the patient deescalate and accept oral medications? Or are they going straight into restraints after punching security and trying to climb through the ceiling of the seclusion room? You always want to offer least restrictive means and it is NEVER to late to return to less restriction if the patient is able & willing to safely accept. When doing something that takes away patient rights - be it restraint, seclusion, movement restriction, IM meds, etc - the important piece is to document rationale - were less restrictive means offered and unsuccessful? Was the situation too unsafe to use less restrictive means? Particularly with mental health law you want to be familiar with the laws of your specific state (or jurisdiction if you aren't in the U.S.) and your facility policies.

My hospital has a lot of them. Unfortunately with travelers, their contracts may be only 8-12 weeks. Seems we barely get them trained sometimes before they are on to the next assignment. The critical need for travelers right now is actually compounding the staffing issue - we've had a number of our regular staff leave to take travel gigs for the pay. (Seriously I've received recruitment ads to work as an RN where hourly pay is more than I make as an NP..... I can see the draw, particularly when if the assignment is terrible you know you don't have to renew and will be out of that facility in a couple of months). This just adds to the work burden of regular staff and the fewer regular staff the fewer people who are really invested in turning things around for the long-term and being able to tackle those changes to fix the system. In regards to staffing overall, every single specialty and discipline seems to be short-staffed right now from nursing to EVS to social work to medical... and it's not just inpatient, one of our challenges is trying to get patients into outpatient care on discharge, and yet our outpatient partners are also horrifically short-staffed and have no resources. Which in turn means more really ill patients being sent to us, because they can't get care in the community, and then we can't discharge. We are under so much pressure to take more patients in, but we are running out of beds, let alone the staff to care for them. Patient care is definitely suffering. Acuity is way up. Everyone is burning out - no matter the discipline or role and it just tumbles. So many things are falling through the cracks because there isn't some one in the role, the person in the role is untrained and covering, or brand-new with no experienced staff to rely on. Mandates are creeping back up again, and I expect will only get worse as we head into Winter months.

In order to obtain licensure as an APRN you will need to get a graduate degree in the specific specialty area you want to practice in. A generalist masters in nursing may open up opportunities for leadership or teaching sooner than going through an ASN or BSN program, but on graduation you will still be a new-grad RN and there is unlikely to be much of a difference in pay initially. This degree (masters-RN, masters clinical nurse leadership) will not allow you to become an APRN with it alone, you will need to go back for either post-master's certificate or DNP in the clinical specialty area in which you decide you want to practice.

Yes, RNs do have to know a lot of information. However, the most critical thing is to know where to find information. Memorizing every medication and every side effect isn't necessary. Knowing your medication classes and common side effects and rare/life threatening by class is important (and a lot easier to learn than trying to memorize for every single medication you may see). You'll also find that in practice certain medications will be commonly prescribed in your practice setting and you'll want to have a good handle on those, for ones you see less commonly - it's more about the ability to look up the information. Do you know where the drug guide is on your unit and how to quickly look information up? Do you know how to run a medication interaction report in your e-mar? You are not responsible for the Attending making a mistake, or the pharmacist making a mistake, you are responsible for knowing enough to be able to identify obviously life threatening or weird issues and to take a pause and ask questions before it hits the patient. (E.g. when taking meds out of the omnicell if the drawer is stocked with the wrong med this isn't your fault, what would be your fault is if you don't look at the medication package and realize what you are holding doesn't match what is ordered in the MAR). If a patient is asking for more information on a medication it's okay to say "I don't know a lot about this medication, but let me print out one of our information sheets for you" or "Let's look up this information together". (which I've totally done numerous times with patients, and most are totally okay with you not knowing the answer to a specific question so long as you can find it for them. I've found that fact that I'm willing to pull out a drug guide to verify information and show them the page, or print off a patient education hand out, or get a pharmacist on the phone or to come to the unit to walk us both through it actually tends to bolster patient confidence). Yes, it does feel terrifying and overwhelming at times, but in practice you typically get into a good flow and get to know your specialty area well, and as long as your are following the 7 patient rights of medication administration, you are unlikely to get into serious issues. Even as an NP I don't know everything. It's totally normal for me to stop and look up a medication, side effects, dosing rates, run drug-interactions etc particularly for medications I don't prescribe as often. If I have concerns I'll also chat with a pharmacist and have them help me review interactions and/or literature about the medication. If I don't know the answer when a patient is asking me - I'll tell them I need time to research it and will get back to them. So long as I do get back to them, patients are typically able to be patient and recognize I that I'm taking the time to make sure I'm giving them accurate information. No one is expected to know everything, but you are expected to recognize when you don't know something and to know what your resources are for finding our information when you need it.

Vasovagal syncope alone is not reason to be dismissed, however multiple episodes in clinicals is very concerning and they may have concerns about her physical health and ability to care for herself while also caring for patients. Faculty may want to meet with her to discuss option of medical leave until she gets her symptoms under control vs outright dismissal or withdrawal from program. It may help if she is able to identify her triggers and speak to how she will address them to keep them from being an issue going forward (probably don't bring up "boredom" as a trigger though, perhaps something about standing for long periods and, assuming it is true, how she can wiggle her legs or knees, bend knees, etc to get some blood flow with out walking to regain her blood pressure when needing to stand for long periods of time). (As someone with vasovagal syncope, identifying and mitigating my triggers is huge; I rarely have episodes now).

I would be very cautious about disclosing. A family member of mine worked for a nursing school (non-RN/non-nursing capacity) and when one of his nursing coworkers mentioned how hard it was to get students a good foundation in psych he mentioned to them that he had once been hospitalized inpatient and would be willing to share his experience from a patient perspective if it would be helpful to the students to help humanize individuals with mental illness. Long-story short it got around the school faculty that he was "crazy" and "mentally unstable" and (though he had ADA accommodations), he was ultimately fired for being a "safety risk" to the school. Apparently having had been hospitalized over a decade prior meant he was now mentally unsound and a danger to students or something. ? Even worse he'd been employed there for a while, and it was only after this conversation that he went from being well liked to no one trusting him. ? I say this as a cautionary tale, because you never know how an employer will react. I worked for a different location as an RN that specifically incorporated a large number of peer specialists into our treatment team, and I do think this led to a more open culture where it was more okay to mention lived experience. However, it was still our peers (who were specifically trained on how to use their lived experience therapeutically) who were most likely to disclose to our patients, even if other staff also had lived experience. When it comes to interviewing I think your volunteering at the crisis line is excellent to bring in and it is appropriate to say you've had a lot of interest in and exposure to DBT and CBT and done your own independent research into these therapy modalities. I think it is okay to say you have personal connection to someone with mental health/eating disorders and this motivates your interest in this area, but not disclose that this person is yourself.

Does your university not help place students? I'd also reach out to your university alumni network as this can be a great resource for finding placements in your area! (And targets NPs who would be familiar with your program). My employer does accept both NP students and MD students for psychiatry clinical rotations, but unfortunately I'm on the opposite side of the country from you.

It really depends on the corrections facility and the specific role you are working in with in corrections. Do you work a mental health pod? Or mental health clinic with in the corrections setting? For college admissions you can usually use your application essay and/or interview process to clarify your experience and how it relates to whatever you are applying for. As for ANCC their webpage/FAQs state: "Review the certification specialty information page for a description of the certification and to review the test content outline. Use this information to compare with your current practice and responsibilities." For determining if experience is applicable to the certification. If you go to the PMRN certification page it has an outline of test content to review - if this looks like what you do/are familiar with - you probably meet requirements. If the concepts seem completely foreign or not part of your day-to-day work then you may not be eligible.

That sounds horrible. I work inpatient, .8FTE W-2 employee with good benefits. Base salary works out to a little over $80/hr, and the combo of differentials and overtime pay means take home actual pay is usually above base salary. Typical panel size is 12-14, but may be larger temporarily if providing cross-coverage. This may sound small but it's a high acuity/high complexity population, and the workload adds up very quickly, so I do stay late/come in early to work on documentation or care coordination or other tasks at times.

And we have obligation to treat ALL patients who need care. Should it get to a crisis-triage situation then you treat based on survivability as defined by disaster/mass-casualty guidelines. Sometimes belligerent patients are just jerks, many times they are individuals in pain, intoxicated, or in mental health crisis, or otherwise physically unwell --- and can be very reasonable and even likable people when the crisis has passed. Anger and belligerence are not uncommon following a TBI either - so maybe reserve some judgement until you actually know what is going on with the patient and if "being belligerent" is a baseline state or a symptom of the reason why they are seeking care at ED. No one puts patients in an ambulance bay to "sleep it off". Alcohol withdrawals are one of two (commonly abused) substances (the other benzos) where the withdrawal can be FATAL. This is why patients intoxicated on alcohol require monitoring (and would NEVER just be dumped out of sight/out of mind so they don't get "attention".) Alcohol also increases risk for impulsive actions such as suicide in those who are already in mental health crisis or distress. Someone coming in highly intoxicated is in need of help - the ED may not be the appropriate place to get all of what they need, and they may not want or accept the recommended assistance - but if someone is heavily using substances - chances are good the substance use is symptomatic or cooccurring to other issues in their health and life.

Your hospital seriously keeps patients hanging out in an ambulance bay (which is presumable being used by ambulances and thus not a safe place to hang out for anyone) for patients who are detoxing??? I don't buy it. If they are actively detoxing then you need them on detox protocols - if they're well enough they don't need ED care you send them elsewhere - if they they are so belligerent they are a danger to themselves/others they get put in the mental health beds.

I just looked it up -it's a legal requirement in my state-- part of the state regulatory statutes and applies to anyone in healthcare using the title "Doctor" in their healthcare professional practice. In order to be called "Doctor" one must 1) have a doctorate in the field of healthcare in which they are working, 2) be licensed by a professional regulatory board for the area in which they have the degree and 3) if using the title in healthcare practice, must identify the profession in which they hold a doctoral degree.

The ones I will work with will introduce themselves as "Dr. So-and-So, unit psychologist" or "Dr. So-and-so, clinical psychologist" Not sure if this a legal requirement for them like it is for NPs, but most want to make it really clear than they are psychologists and do NOT want the patient to launch into a high level of detail about their bowel movements, weird medical issues, or medication questions, that they will get if they do not (or sometimes even if they do) make it extremely clear what their role is.