Morgan314

YES !!! One of my clients has reported knots/lumps in her arms since starting IS over a year ago.The client has taken my hand and guided my fingers over these areas and there are at least 2 or 3 small hard knots/lumps in both arms. Of course we rotate sites, and it's not the kind of lump that goes away. They have been there for months.

I've never given more than 3ml in any injection. I had a patient on Haldol Dec 350mg IM and I gave it in 2 doses of 1.5cc each.

A patient called our office asking to refill a medication that I had never heard of. I questionied the patient about her med request and asked her to get the empty bottle so she could call her pharmacy, but she insisted that calling the pharmacy would do no good because the bottle said "no refills." I asked her to spell the name of the med. Med labels contain so much info, it is hard for folks to read everything listed, but she was finally able to spell the name of the med. I explained that the med was for a condition that one of her other doctors is treating and asked her to call the other doctor, but she said she did not know which doctor prescribed it. Again I referred her to the bottle label but she said the doctor's name was not there. I told her the doctor's name is on the label somewhere and she says "Oh, here it is, but I can't pronounce her name." I asked her to spell it to me, and I wrote down each letter as she read it. It only took a few letters for me to realize this was not her doctor's name, but I let her continue and I kept on writing the letters as she read them. This is what I had written: DR M-U-S-T A-U-T-H-O-R-I-Z-E

Those of us stuggling with ADHD also have the gift of creativity which we have had to develop to compensate for our difficulty staying focussed and staying on task, so tell us the things you have already tried doing to get your charting done on time. I knew from an early age that there was something "wrong" with me because in class, everyone else seemed to know what was going on, but I didn't. I honestly don't know how I made it through nsg school, but that was over 20 yrs ago and before computers. I remember keeping a folded paper towel in my pocket to jot notes that I would need for charting. Time has always been a problem for me, so I would note the time and what I did on my paper towel to use for reference when I wrote my notes. For the past 12 years, I have been on meds that help tremendously. I notice sometimes it takes me longer to write the note then it did to actually perform the task because of having to recall what I did and process it into written word. Also with ADHD we tend to be perfectionists and procrastinators, so you will need to motivate yourself to get things done with minimal distractions. Do you have a quiet place to do your charting? Every little thing can be a distraction when it comes charting time, so maybe you could talk with your supervisor about your need for a space with less stimuli where you could get your charting done.

Hope you have better success at getting prints than I did. My prints don't show up, and the police officer grumbled the whole time about how nurses are the hardest people to get good prints from because of our use of alcohol based hand cleaner (I rarely use the stuff, preferring soap/water instead) and frequent handwashing.

Will you be providing the community support service, or are you just to identify pts in need of referral to a community support provider? In the area where I live, a facility has to have approval from the "powers that be" to provide this service, and once approved to provide the service, the provider has to complete a 12 page "person centered plan" that details every need, goal, intervention, etc, then the plan has to be approved before the services can be provided. It can take weeks or months for all this to happen and the community support provider spends more time developing and getting the plan approved than providing any services. it's horrible.

Ours is a small town, so when I worked in the hospital psych unit, I had many pts that I had been in school with, or knew from the community. Now that I'm working in an OP clinic, I know many pts from school, church, and community. Some of my distant relatives have come in for treatment. If I am to have contact with a pt I know personally or am related to, I ask the doctor or a clinician to make sure the pt is comfortable having me a part of their tx team beforehand. I always remind the pts of our confidentiality rules and assure them that I will maintain their confidentiality. If the person is someone I am close to, like a former co-worker, friend, or cousin, I limit my contact as much as therapeutically possible, and I limit my reading of the chart to only things I need to know, like meds.

Outpatient mental health. I have education groups to teach patients about the medications and management of symptoms of Schizophrenia, check vital signs before psych evals, individual med teaching, keep up with labs, take phone calls for med refills, and spend lots of time on the phone getting prior auths for medications through Medicare Part D, and lots of paperwork.

It's sad to lose a patient to suicide, but even sadder to lose a co-worker. We experienced that last week. He didn't work for the same agency, but for an agency that contracted with ours and we shared some of the same patients. I'm very angry at him.

I work in a behavioral health clinic and stay late almost every day............paperwork!! Every little call requires documentation. Treatment plans, Medicaid authorizations, etc.

well, since it has been about 10 years ago, it's hard to remember. I borrowed the review book and some other notes from a friend who had taken the test the year before. I thought since I had 7 years of MH nursing and 2 yrs of detox experience, I'd have no trouble, but I didn't do well on the substance abuse part, I remember missing a question describing symptoms of a young male coming into an emergency dept, but the answer suggested he was on PCP. The test and getting certified is well worth the money. When I got certification, the company I was working for gave me a 2% raise. And having certification gives you something to be proud of. You have to get recertified every 5 years and it requires 75 hrs (I think) of continuing ed, plus several hundred dollars. I had the CEUs but not the money to get recertified. I requested to cash in all the unused sick time and vacation time I've accrued to pay for the recert, but I was turned down.

I took the certification exam through ANCC years ago.

I work really hard to provide med education with my psych patients, and some try really hard to sound like they've learned something, many times much to my embarrassment. These are some things I've heard: Haldol=hound dog Wellbutrin=welluterine Depakote=Defecate Restoril=restawhile Lexapro=lexicon Seroquel=Sir Rockwell Atarax=anthrax One pts mother wrote me a note saying her son needed a refill on his "klopine" Remeron=ramrod The best one is a pt prescribed generic Xanax, which she calls "altroplasma" (alprazolam).

I worked inpt psych many yrs ago, and our doctor would order valium and also an assortment of vitamins which are important for a person detoxing, but I can't remember why it is crucial for these certain vitamins. my bad.

I had a part-time job as CNA while in nursing school, and one night I had a pt who was worried about a spider in his room. He described its appearance and said it was spinning a web from the top of the window. I never saw it, but when he said it dropped to the floor and ran up under the bed, I got down to look for it. The RN saw me crawling on the floor and called me out of the room and told me the man was being treated for DT's and having hallucinations.

I didn't like med/surge in nsg school. My first job was in a hospital, and it was very different than in nsg school. I couldn't keep up the pace. I liked psych in nsg school, so when the opportunity presented itself, that's where I went. I love it.

I have trouble remembering my own kids' names. Half the time I call them by the other one's name. Sometimes I ask one kid what the other kid's name is!! There are some days I forget my own name!!! And just to be safe, I always call my husband "Honey."

I agree with onc. You are gaining a lot of experience, but I understand what you mean about the work you are doing. There is a lot of clerical work and tasks that do not require the skills you have, but consider what you mean to the patients. They need someone with your education and knowledge to explain things that MA's don't know. Another thing to consider is your work hours. Where else would you work? In the area where I live, there are few positions for LPN, and most LPN's work in long-term care facilities. Most OP facilities operate M-F 8-5. Is this important to you? Most other nurse jobs require you to rotate shifts, work weekends, holidays, and maybe even be on call. Think about what matters most to you.

My daughters' pediatrician is encouraging all female patients to receive this vaccine. I have mixed feelings about this. I do not want my girls to get cervical cancer from HPV, but in 15 yrs from now, what if we find out that there are long-term problems associated with the vaccine? Why are males not targeted for this vaccine? I am interested in hearing from nurse/mothers who have or have not gotten their daughters vaccinated and why.

Thank you. My understanding is that it counteracts the effects of ETOH, but does not control the cravings. The injection came with its own needles. It is very thick and took longer to mix up than the instructions suggested. Do you give it often?

I work in the most disorganized and inefficient office ever. It seems no one is in charge and no one knows what they are doing. Our computer system is mostly to blame, but there is so much more to it than that. There are just so many little things that just add to the daily stress. For instance today, several adult patients decided to go outside to smoke instead of waiting in the lobby. This is an ongoing problem because when I go to the lobby to get the patient, it takes up a lot of time having to go find them outside, wait for them to take that one last drag of the cigarette, and then have to walk in the smog that follows them. To make things worse, today the patients who went outside to smoke left their unruly children in our lobby. They were so loud and rambunctous that our front desk staff had to call them down. I suggested the front desk staff let the practice manager handle the situation, but she was not in the office today. The site director was in meeting, so there was no one with any authority to do anything about it. And another thing that bugs me is our lack of housekeeping. I think someone comes in during the night to empty trash and I hope they clean the toilets, but I see little evidence of anything else being done. The place is filthy. I've always worked in hospitals or nursing facilities with fulltime housekeeping, and I cannot get used to working in a struggling private practice that cannot afford good housekeeping services. We see approximately 100 patients a day (2 doctors and 8 therapists) but we only have 2 people working medical records and 3 front desk staff.

Thank you for the reminder of the importance of appeciating our health. You are so right, nursing does rob us of our health eventually. I've seen it so often. You describe a very unfair and unfortunate situation, but I appreciate you bringing this to our attention because most of us would never think about the need for "pre-auth" when a doctor orders something. Why is it that insurance companies always look for any little reason not to pay for something? A friend of mine had to be seen by a specialist because of a hormone imbalance, but her insurance refused to pay because her diagnosis was coded as "infertility" instead of "amenorhea." She was able to talk to the doctor who corrected the code and eventually the insurance did pay, but by that time, my friend had already gone through the humiliation of having to get on a payment plan with the billing office and had paid for the service out of pocket. I think you should not be penalized for someone else's mistake. The doctor's office should cover the expense of their mistake.

When I interviewed for my job over 10 years ago, I was apprehensive about the questions I would be asked too. My concerns were the same as yours. They did ask basic psych questions and situational questions, but the most challenging questions they asked related to how I personally cope with stress, how I relax, and how I take care of myself. I hadn't prepared for this and it made me stop and think. At that time, I had a 6 month old baby and when I was asked what I do to relax, all I could think of to say was "rocking my baby." I felt stupid after I said it, but the interviewers accepted it. When you are working in mental health, it is so important to have good leisure activities and interests that help you recharge your own batteries because this line of work can be mentally and physically draining.

In all my years of psych nursing, this "therapy" is new to me. What is the therapeutic benefit of this? What was it to accomplish? It sounds like abuse.

These workbooks are what I use for patient education. They may be a bit simplistic for you, but I have learned a lot from them: http://www.treatmentteam.com info below copied from here: http://www.treatmentteam.com/pdf/treatment_prevention/UnderstandingIllness.pdf Positive Symptoms Positive symptoms do not refer to symptoms that are “good.” They refer to symptoms such as thoughts, beliefs, and sensations that you may experience, but which are not real. You might experience sounds, voices, or images that other people say they don’t experience. These are called hallucinations. Noises may seem louder than usual. So it might be hard for you to focus on a conversation or to understand what other people are saying. Colors may seem brighter than usual or you might see shadows. Delusions (believing things that others say are not true) are another type of positive symptom. You might feel afraid of being followed, harmed, or killed and not know why. These are all types of positive symptoms. Negative Symptoms Negative symptoms may be described as lack of energy or motivation— you don’t feel like doing the things you used to do when you were well. They are symptoms that may be hard to explain to other people. Some examples include: • You don’t feel like talking to other people • You don’t have much energy to do things • You don’t care much about how you look Cognitive Symptoms Cognitive symptoms refer to problems with learning and concentration. It may be harder for you to concentrate on things like reading a book or watching TV. Also, you may find it hard to learn new information the first time—like getting directions to go someplace new. You may find it hard to focus on what someone else is saying. Or it may be hard for you to get your thoughts together to explain how you feel.