Psychrich

You have to know the states view point on the issue and the facilities stand. Many of the places that I have worked, in multiple states, allow a 18, who is still in school, to be on an adolescent unit. Plus in some of these situations you may have to get the psychiatrist's approval. There are some situations that have occurred, just like elkpark wrote, when a teenager, even as young as 15 years old, have to sign themselves in yet are on a adolescent unit. They have the same rights as an adult when it comes to pt rights and rights of refusal, but the parents have the financial responsibility. With one situation, we had 19 and 20 year olds who were in a adolescent unit because they were still under court orders and would not be relased until there 21st birthday. Good luck to the situation you are contemplating.

Thank you both for your input and directions, but I'm trying not to use pharmicudical companies which will always promote their own drug and their target audience is usually adults or physicians. I'm really looking for a series of videos (10-14 of them dealing with depression, eating disorders, anger management, bipolar disorder) that are made for teenagers or children. I have searched on the internet 4-6 hours and have found little. Most of the companies do a video for one topic or another but rarely have a series. Thanks again for your suggestions, please keep them coming.

Krissy, depending upon who is doing the hiring and what state you will be practicing will determine some of your issues between CNS or NP. Most states the CNS and NP have the same Scope of Practice and are recognized equally, but you still have to check with the individual states. As pertaining to what type of setting and your job duties, there are many jobs out there in long term settings who do well for themselves. A friend of mine currently is a NP and works in a in-patient acute care setting part time and the rest of the time works with geriatric patients in the nursing home settings. She enjoys both because she does not get caught up with issues in one setting too long and she enjoys the change of pace. Another friend works splits her time between an outpatient setting and the nursing homes or you could also work in at a VA where you could be working outpatients and doing substance abuse work. There are many avenues for you to take. Alot has to do with what you feel comfortable with and are you willing to move around. There will always be a setting that suits you, you may just have to move to get it. Another aspect of your degree is the specialty. CNS are certified as Adult Mental Health or Child/Adolescent Mental Health. NP's are certified as Adult or Family, both by the ANCC. There has been a push by the APNA (American Psychiatric Nurses Association) to set up an exam to divide the exams into Geriatric, Adult, and Child/Adolescent, but this will take some time to get approval and validation. I personally can't wait and hope to get some of these issues brought up again at the next conference in Nov. I wish you luck in whatever your decision.

I manage a 38 bed child and adolescent inpatient psychiatric unit and am in need of a good series of patient education tapes on different topics. Most of the video that we have are left from either pharm reps, which are more geared for MD's education of the meds or toward adults, or the tapes are quite dated. I'm hoping to find a company that has a series of different topics, such as depression, eating disorders, mood disorders, substance abuse, that I can use for education for children, but mostly teenagers. If anyone can recommend any, please let me know. I have found companies that have individual topics, but none that seem good for a series. Also, I posted before, if anyone knows of some good competency programs that are age specific for nursing and support staff. Thanks for any help.

Wellbutrin is a Norepinephrine and dopamine reuptake inhibitor, unlike SSRI which inhibit the reuptake of serotonin. It can be used for smoking cessation, depression, ADHD.... Because of its quality to effect dopamine, a neurotransmitter that effects an area that makes you feel euphoric, it can be helpful in decreasing the wants of highly pleasurable activities such as smoking. It can decrease the craving that someone has to smoke. There are many studies that have shown some weight loss while taking the drug and it is given to help with weight gain. Wellbutrin is a very good, multipurpose medication that can be given in different cases. The length of time you take the drug depends upon what it is for. In depression, research states that you should be on the medication for months after you have stopped the depressive symptoms to make sure you do not relapse.

I feel your confusion about the issue and here is what I know. There are some programs out there right now (UNC) that will allow a dual track of CNS and NP at the same time. Some of the course differences are that a NP will have to take advanced pharmacology and Physical assessment. CNS's route will be a little more academic in that their roles can be more in the psych or specialty educator role. NP's are more geared toward direct practitioner and medication prescription role, the physical aspect of the role. Depending upon the state and company, each role can do the basic same job descriptions, but there are those states that are very specific on scope of practice. Many states will allow you to do the CNS program and then take an additional three classes to sit for the NP exam also. Many professionals believe that the CNS role is being phased out or will be obsolete, but their role is as valuable as any and definitely contributes to the value of nursing and in the private sector. When pertaining to private practice, there are many independate, completely NP organized practices out there. I can think of two right now in Cincinnati and in Lexington KY. For some it is just easier to become part of a psychiatric group and have the collaberating psychiatrist there at the office. Plus there are still states that really don't give NP's and CNS's much support or are not recognized as highly as in other states.

I have read the previous entries and they all have good advice. One of things I would add to the last person would be that you also need to look at the scope of practice defined by the state nursing board for NP's. Each state is different and can go as far as the state doesn't allow prescriptive rights to full rights as an completely independant practitioner. I have been an NP for about a year and in many circumstances the employer wanted me to be strictly there for med management, but there are circumstances where they were wanting me to do individual and group therapy. An NP will allow you flexability, but it really depends upon the state you want to work and the type of setting....ie inpatient, outpatient, partial hospitalization. I think as a MSW and a NP your knowledge would be very valuable and well rounded. Good luck.

The first thing I would do would be pull out CMS (Medicare/Medicaid) guidelines and read pages 77-116 on Seclusion and Restraints for medical use and for behavioral health. Their rules are much more specific and black and white. You should also read your state mental health rules also. There can be differences in rules or timeframes and you must use the most restrictive of the rules to be in compliance. When JCAHO comes calling they should know which is the most restrictive and judge you on those criteria. JCAHO standards are a little more up for interpretation as compared to CMS, which we all must follow also.

No I have not received any replies but have been making some more up at work using books that I have and information from NAMI. If I get anything I can let you know. What type of rehab center is it (behavioral, drug and ETOH)? Hi, Just wondering if you received in any info? I am looking for a sample of competencies specific for an RN working in an adolescent rehab center, any suggestions or samples? Thanks -

My first psych job was with residential adol females...25 of them to be exact. Most of them not only had mental health issues but were from inner-city areas where gangs ruled. I somewhat had to learn the hard way, but there are ways to get a broader knowledge. First I would find out where I could get CPI (Crisis Prevention Institute) training (http://www.crisisprevention.com) or PMAB (Preventions and Management of Aggressive Behaviors) training. There are many other institutes out there but these two are some of the more common. This training will give you a better foundation for aggressive behaviors. Second, I would read up on psychiatric medications and disorders. NAMI (National Alliance of Mental Illness) can give you a good start. If you want more info you can continue researching databasis or read review guides for psych clinical specialist or nurse practitioners. It may be a little more indepth than you need, but can help you. GOOD LUCK with your decision.

I have been a psych nurse for 11 years and have worked in 6 different states, usually with children and teens. Staffing ratios are not only different from state to state depending usually upon State Medicaid/Medicare regulations, but also hospital regualtions. I have had ratios as low as 9:1 (Pts:RN/Mental Health tech)to 8:3 (in this case it was federally mandated). I do feel that your ratio was low for the census and the acuity of the the time. As a manager I have always felt that evening shift is the area you should staff up and have your highest staff to patient ratio. This time is when you get most of your admissions and have more behavioral problems. Day shift is where there are usually more ancillary staff to assist. I hope that your trend does not continue. Psych is an area that is easy to get fried.

I graduated 10 years ago and when right into psych. I feel that there are a few times working on a medical-psych unit it was a little tough remembering my skills, but not too bad. If you feel that you will want to work in other areas other than psych, it may not be a bad idea to see if you can pick up some shifts on a medical floor. Good luck with your decission. We need more good nurses to work in the psychiatric field.

I am a manager of a Child and Adol unit and am looking for a site or book that is a good resource for psych and age specific competencies for nurses and for mental health tech. The hospital I work at does most of thier comps. on computer and needs to have the learning material placed on a Power Point presentation with a post quiz. I could go through some of my personal books but am hoping that some information and material is already out there. Thanks for any suggestions