RNcashy89

Thanks guys. Anyway, Ill just have to satisfy the requirements for general registration prior to looking for a job.

In Australia - international nurses with a psychiatric background can received registration to practice only within a mental health setting. Hence my query.

Let me start with a huge preemptive thank you to anyone who can provide insight on this matter, it has been causing me a lot of stress. My wife has been offerred a job to commence in Toronto in Aug/September 2015. I am an Australian Registered Nurse, with a background entirely within acute psychiatric settings. I have noted that many of the districts in Canada have specific certification of psychiatric nurses, but Ontario does not. Does this mean that I will need to write a general NCLEX examination to work within a psychiatric setting in Toronto? Preparing for such an examination, with a background solely as a mental health practitioner is a daunting concept and it seems strange to asses my competence to work in a surgical/ICU setting if I am a mental health nurse. Again, thanks for ANY input.

Hahaha I think you have nailed it!

I am aware of rare cases of adverse interaction between Haldol and Lithium which can lead to an encephalopathic syndrome which could be categorized by weakness, lethargy, tremulousness, EPSE, confused state, you need to monitor patients who are receiving Haldol and Lithium closely for any indication of neurological toxicity. Regarding the injection, what gauge needle did you use and how obese is the patient? There is a risk of of abscess, fat necrosis, ulceration, pain and swelling if a lot of the solution was administered into the subcutaneous tissue.

Not sure if this will be directly helpful to you. If I interpret what you are feeling correctly, its a form of performance anxiety. In my graduate year I was giving probably my 10000th IMI one day when one of the more intimidating psychiatrists came into the patient's room and decided to wait and watch while I administered the drug. I turned into MR Bean! And that was just a standard, voluntary depot admin - so don't feel bad, its natural. What I realized was that I was insecure about my administration technique. Insecurity, as you know, doesn't necessarily spawn from any factual deficiency - it grows from a belief you have, about yourself. You clearly have some questions - so get a senior, respected colleague to scrutinize your knowledge and technique in a non-emergent situation where you can pause, evaluate, question, etc etc. I tell people all the time to stop fearing scrutiny! Its the best tool in the box for personal development. So at that time I asked a senior staff member to go through an injection with me - not only was I doing everything perfectly, I was able to teach the CN a thing or two! It was such a confidence boost that now, regardless of the pandemonium or drama, I am confident enough to execute that procedure.

General med/surgical trained nurse on a psych ward (generally) = as useless as a psych trained nurse on a general med/surgical ward (generally). AS mentioned, the knowledge practice gap is just as evident. Furthermore, I will always argue that a higher percentage of your success as a psych nurse will depend on your interpersonal and communication skills, self awareness, and intuitive aptitude for psych nursing. Also, every psych nurse is reading that post, evaluating it and wondering, "you got the job but you are still annoyed that the manager asked the most GENERALIZED employment question in history". Hmmmmm

Exactly. Reason #1 : high potential and likelihood of misuse. By demented patients, developmentally challenged patients, hypomanic patients etc. Not to mention that it is FIXED to the counter, so it can not be removed or silenced at any time.

Recently, in their vast wisdom and without consulting clinical staff, management have screwed a hotel-style reception bell to the desk of the nurses station within my psych unit. I want to hear from experienced psych nurses; is it as obvious to you, as it is to me, why this is a profoundly foolish strategy to implement within an acute psychiatric ward? I can think god at least 20 reasons, I'd like to hear your input...

You have some options/techniques as far as redirection and deescalation of acutely psychotic or hypo manic patients - however, ultimately their level of receptiveness will depend on their own capacity for emotional regulation and rationalisation. Many who are acutely unwell, do not possess this capacity, and simply can not be reasoned with or redirected. Unfortunately, management in said instance will require containment and often involuntary assessment and treatment. To answer your question; yes - the manner in which your facility is dealing with this patient is profoundly lacking - mainly due to the fact that you are not equipped with the facilities, resources, or staff to treat patients who are this unwell.

My dear god, this sounds like a bad dream. It is phenomenally inappropriate for such an individual to be treated within the facility you describe. I'm very ignorant re: international health care law, but in my neck of the woods said individual is a certain candidate for involuntary assessment, and would almost certainly be contained and medicated regardless of his consent - he sounds like he is a danger to himself and others.

Indeed. I too find swearing to be remarkably therapeutic :)

If this is the individual's genuine presentation, it would almost certainly be due to ortho hypo - if anything related to actual position change. +1 for Mandychelle. I feel grossly uneducated to comment on the gas exchange factor :) - but the above comment seems viable also.

Psych nursing is different, not easy. Certainly there is less task orientation than in a med/surg ward. I work with a lot of task oriented individuals - often they are the ones swanning around a psych ward waxing lyrical about how quiet and lovely it is. Equally as often they find themselves poorly equipped to handle some of the more challenging aspects of psych nursing.

By definition, the context you have addressed was form of manipulation. You were manipulating your own pain - please don't see the word "manipulate" as having any particular connotation (negative or otherwise). Furthermore, I clearly stated that "not all self harm is the product of emotional distress" - ie; self harm CAN be the product of extreme emotional distress - as it has been in your historical experience. I am convinced that you understand that self-harm is a complex phenomena. So certainly, self-harm is not necessarily a behaviour utilised to manipulate others, however, it most certainly CAN be a behaviour utilised to manipulate others. Similarly, self harm is not always utilised to "get a reaction or some sort of sympathy", but sometimes it is (or as revenge, or to generate chaos/drama, or to elicit the 'rescue' response). I hope this clarifies my previous comments somewhat.