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dallasmiss MSN, APRN

Emergency Psychiatry
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dallasmiss has 6 years experience as a MSN, APRN and specializes in Emergency Psychiatry.

dallasmiss's Latest Activity

  1. dallasmiss

    New Nurse having trouble finding job in Dallas

    Psych Hospitals/Outpatient Programs to Apply to: -Parkland Dallas Psych ER, inpatient/outpatient services, correctional health, partial hospitalization -JPS Fort Worth Psych ER, hospital, partial hospitalization, outpatient programs, Correctional Health -Green Oaks- Psych ER and Hospital Dallas -Hickory Trail -Dallas Behavioral -Glen Oaks (Greenville TX) -Millwood Hospital, Excel Center Partial Hospitalization Program -Springstone Inc hires new/less than 2 years exp I know for sure: Carrolton Springs, Mesa Springs, Innovations Partial Hospitalization Programs, Changes Partial Hospitalization programs (locations Carrolton, Plano, Frisco, Fort Worth, Arlington, Keller) -Perimeter Hospital- Arlington and Dallas (adolescent/children's psych) -Mind Above Matter- Keller, Arlington, Burleson -UBH/Mayhill Denton -THR Springwood Bedford -THR Arlington Memorial -THR Dallas, also has an eating disorder unit -Cook Children's- PHP, inpatient for 11 years and younger -Children's Dallas , PHP, outpatient, inpatient, eating disorders -UT Southwestern Psych -Garland Behavioral Hospital -Haven Behavioral Health Frisco -Wellbridge Fort Worth-primarily geriatric -Wellbridge Healthcare Greater Dallas (Plano) -Innovations 360 (outpatient, some home healthcare) -TMC Behavioral Health (Sherman TX) -Medical City Behavioral Health Mckinney (McKinney TX, small psych) -Methodist Richardson Adult inpatient hospitalization/PHP -Oceans Behavioral Health Abilene TX -RUSK STATE HOSPITAL for the brave- they have dorms for the staff so you can travel out of metropolitan areas for your shifts and return home for your 4 days off. -TERRELL STATE HOSPITAL also for the brave- closer to DFW and features ECT. This does not include rehab facilities.
  2. dallasmiss

    New Nurse having trouble finding job in Dallas

    Dallas County's community mental health system is Metrocare and Tarrant County is MHMR. As other posters have said, most hospitals are currently on a hiring freeze. Try urgent care clinics, freestanding ERs to get your foot in the door (CareNow, CompleteCare, TheEmergencyCenter, SignatureCareEmergencyCenter, TrustedER, ERNearMe, CityHospital, ExceptionalEmergencyCenter, iCareEmergency). These Urgent Care and Freestanding Emergency Rooms are EVERYWHERE. We also have the Federal Medical Center (prison) in Fort Worth that is a good place to look for a job and another federal prison in Seagoville. As for the hospital systems, Baylor and HCA pay nurses the least however Baylor has high nurse satisfaction rates. THR is middle of the road with pay, people seem to be very happy with their pay and benefits packages at the county hospitals (Parkland/JPS). It is very difficult to get hired as someone who is not a new grad with less than 2 years of experience in a hospital in DFW.
  3. dallasmiss

    Age vs Years Nursing

    Age 28, RN for 6 years and Nurse Practitioner for the past year
  4. dallasmiss

    Quitting HCA after 5 months

    I don't know what part of the country you are in, but HCA is notorious for using GROUP ONE Background Checks to Blackball nurses. When you fill out an employment application, you authorize the employer to complete a "credit report" which is giving them permission to run a report in Group One. This practice is most prominent in Texas Hospitals (DFW specifically) but it has been used in HCA systems in other parts of the country. Group One was started by HCA/Baylor executives in the DFW area. The website: https://gp1.com You can search through our boards and find a variety of things people have been blackballed through Group One for... leaving a contract early, not giving 2 weeks notice, a manager leaving a nasty review on Group One whether it is valid or not. I would do research into whether or not your area hospitals use Group One then don't look back and run.
  5. dallasmiss

    PHMNP to aesthetic nursing

    That's out of my scope of practice...the training of psychiatric mental health nurse practitioners does not include aesthetics. You can go to additional classes and get certified but I'm not sure that I would ever want to. You would have to have a delegating physician for example with expertise in what you are practicing in so he/she can provide appropriate guidance. If you were to open up an aesthetics shop as a PMHNP who would be your delegating physician? Would you also be doing work as a mental health nurse practitioner as well? If you chose a doctor to be your delegating who specializes in family medicine- how much experience does he/she have in aesthetics? How much experience does he/she have in psychiatry? Are you allowed to have multiple delegating physicians per your states rules-one for your aesthetics practice and another who specializes in psychiatry? Think about the practicality of this endeavor.
  6. dallasmiss

    PMHNP Fall 2019

    I'm a graduate but the first 2 semesters were 100% in person. The nursing theory class was 7 hours every other week. The pathophysiology class was a night class- Tuesday/Thursday. The Pharm class was similar the next semester. After that some classes were every other week or once a month. Once you are in clinical (3 classes) you meet once a month. Some people drove in from Houston, Oklahoma, other places and managed but stayed with family in the DFW area or a hotel the night before class.
  7. I touch base with my doc once a month and review some charts. Last legislative session a group of Texas Nurse Practitioners introduced an independent practice bill to a Texas business/commerce committee (and I can't remember if it was the Texas Senate or House, I apologize). It did not make it to the docket last legislative session. In the past there was a Doctor very active with the AMA on these committees and the Nurse Practitioners who went to the hearings for independent practice told me it went well and there was positive feedback. Just did not get moved out of the committee this session. I'll be the first one to let you know when random non-nursing guy is right!
  8. dallasmiss

    Lithium and Dehydration

    Everyone is on track! You can have a dehydration with hyponatremia or hypernatremia. Lithium is an element in the same group of the periodic table as sodium. Sodium is involved in so many processes in the body that to this day we continue to not know exactly how Lithium helps with mood and behavior...we give it because "it just works." Lithium accumulates in the collecting tubules and interferes with ADH's ability to increase water permeability. With long term use of lithium this decreases the kidney's ability to concentrate urine. If this person was not drinking enough water as the cause for dehydration, it is "extra renal" -a non kidney- cause of the dehydration. We have to get in there, assess the patient, and do the lab work to find out the cause. If it's from decreased drinking, the patient could present with euvolemic hypernatremia. If the patient has N/V/D or chronic bleeding somewhere it could be hypovolemic hypo or hypernatremia. Check out this guideline, I think you would find it helpful: https://www.aafp.org/afp/2015/0301/p299.html If the patient isn't drinking enough water, the lithium toxicity is mild, I would hold the lithium, observe them, and the treatment would be oral rehydration/IV fluids if unable to tolerate oral.
  9. dallasmiss

    Psychedelic Nursing

    Hello, I know this is an old post but I'm just now seeing it. I haven't logged in to allnurses in a long time. I'm a PMHNP and the FDA has granted Breakthrough Therapy designation for MAPS in their study of MDMA for PTSD. I believe it is in Phase 3 for FDA approval. This is not the same thing as ecstasy/molly sold on the streets- the majority of molly pills have been found to be cut with meth and other substances (up to 85%). When pure MDMA produced with consistency in a lab, MDMA has been found to not be neurotoxic. MAPS is also looking into MDMA as a treatment for other conditions. How it works: 3 experimental sessions total with a primary objective of lowering CAPS 5 Total Severity score, secondary goal of improving functional impairment as measured by the Sheehan Disability Score. The dosing in the First Session is 80 mg with the option for a 40 mg supplemental dose. In the Second Session doses range from 80-180 mg, in the third session doses range from 80-180 mg. After three sessions, previous trials have shown little to no risk of MDMA dependence and a reduction in symptom severity. Many patients no longer meet DSM criteria for PTSD after the three sessions. If you would like to read the protocol for the Phase 3 trial that is currently happening you can read more here: https://mapscontent.s3-us-west-1.amazonaws.com/research-archive/mdma/mapp1/MAPS-2018-02-26-MDMA-MAPP1-Public-Blinded-Protocol-A1V1-26FEB2018.pdf It is thought that the treatment will be FDA approved by 2022 but it is very very expensive. For each experimental session a therapist has to sit with the patient for 8 hours and OVERNIGHT. It is mostly just comforting and answering any questions that just come up. Anyone that is going to do this type of work has to be very passionate about it.
  10. dallasmiss


    In Texas we have something called SAFE HARBOR which protects your license in unsafe/inappropriate staffing situations and makes you not have to be an absolute (insert words here) to your coworkers. Look up the laws in your state, there is likely something like Safe Harbor where you are. If you feel as though you are being assigned an inappropriate patient population to you or staffing is so unsafe that it risks your license, BEFORE accepting your patient load notify your supervisor that you would like to declare Safe Harbor. This protects your license should something happen during your shift and you made every reasonable effort with the situation you were given. Declaring Safe Harbor triggers a process all the way up to administration/corporate depending on where you work. Haven't seen it happen a lot but when it does, magical things happen like DONs/supervisors working the floor, administration showing up. They will do a lot of things to avoid Safe Harbor. Absolutely what you did was unprofessional and inappropriate. Declaring your state's version of Safe Harbor would have been the appropriate response. You deserve to be fired. Think of the horrible day your coworker... and your patients... had that day. Even if you aren't fired get another job. No one in that facility will be able to let go of what just happened. Reputations in nursing are everything and yours will follow you. I hope you are able to successfully get a fresh start somewhere else. Good luck to you.
  11. dallasmiss

    UTA FNP online Spring 2018

    Log into Facebook | Facebook Once you get your acceptance to the program, join this Facebook group. The moderators will ask for some kind of proof of acceptance into the program. We offer advice for specific classes, study tips, working with different professors we know, and studying for boards. Anyone that starts a class specific Facebook group will also post their group here.
  12. dallasmiss

    UTA FNP online Spring 2018

    I'm a little late but I just found this post. I'm not in the FNP, but the PMHNP full time. I just started clinicals but have done the entire track full time while working full time. I am not married and have no children so this has been possible for me. If you work full time and have children I would recommend taking the program part time. If you are single full time work full time classwork is entirely possible. HOWEVER, big however: Once you start clinicals it is not possible to work full time and take more than one clinical at a time. Each clinical requires 180 hours and the last clinical requires 360 hours. You have to make a choice between full time work or dropping to one clinical at a time. Good luck and I hope this helps y'all plan for the future!
  13. dallasmiss

    Am I too old to start?

    You are not too old! In fact you will likely have a different outlook and maturity that many who went to school ages 18-22 didn't have. I work with someone who didn't go to RN school until she was in her late 50s and she is an amazing nurse. A woman in my NP class is in her 60s. It's never too late to make a decision that will make you happy. If you don't go back to school you may look back on that decision with regret!
  14. dallasmiss

    Psych RN salary?

    In DFW the starting salary for new grads in psych is on average $4/hour more than medical/surgical nursing as it is a specialty area. New grads flock to the medical hospital but not necessarily psychiatry. After 2 years of experience in psych inpatient that jumps to $30/hr, 4 years of experience $33-35/hr. That's in DFW, on an inpatient floor. Intake pays lower as you are doing assessments and not managing patients on the floor, up to 10-25% lower. There is so much to know in psych, definitely a learning curve but I hope that gives you an idea of what to ask for.
  15. dallasmiss

    UT arlington PMHNP Fall 2016

    Hello Enilec. The post-master's certificate degree plan is made with your advisor based on your prior degree and courses needed. Here is the link to the full Psychiatric Nurse Practitioner degree plan. Psychiatric/Mental Health Nurse Practitioner MSN - College of Nursing and Health Innovation - The University of Texas at Arlington Candidates with another NP degree typically have the quickest path through the program. The advisors will evaluate course by course the equivalence to UTA's courses. I'm sure you had a Theory, Research, Evidence Based Practice course that will qualify. Depending on what school you went through Advanced Patho, Pharmacology, Assessment, Roles may be able to be skipped or repeated. Apply and talk with an advisor! You will be given the option of full time or part time study. Some of the classes are 2 hours, some 3-4 hours. Full time study is 6-8 hours at a time, part time no more than 3-4 hours at a time or one class at a time.
  16. dallasmiss

    Oops I sat on the patient

    I'm sitting here, 1:20 in the morning in Texas laughing out loud actually and my non-medical family member thinks I've lost my mind. Read him the story...all he said was "Okay?" :)

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