BSN_DEC_2006

Any insight into what to take into consideration as a new grad PMHNP? Inpt psych hospital or outpt private practice psych clinic (as an employee)?

I too, administer the IM Haldol & Ativan together while giving the IM Benadryl separate. It's only because of the drugbook i have says that the Benadryl and Haldol are not compatible.

If a physician ever orders IM haldol/benadryl/ativan, how do you typically administer it? Do you mix them all together or separate syringes. I've read that benadryl isn't compatible with many things. Thanks.

Am currently in a Psych/MH NP program and will finish in a year. I hope this last year goes by fast because the program is busy and intense. I miss the travel RN life.

I strongly suggest that you get some type of med/surg, ER, or ICU experience as a new grad before going in to psych nursing, even if it's only for a few months. I started out in the ICU before going in to psych, which helped tremendously with my physical assessment skills. Psych pts have medical problems, too, especially the geriatric psych population. A nurse needs to be able to physically assess a patient to help decide whether or not they need to be sent out to the ER for an eval. I don't think u need years of medical experience, though. Six months to a year should be good enough to develop a reasonable level of physical assessment and medication administration experience. All inpatient psych pts get medically cleared when they're admitted to the unit; however, a lot can happen within that inpatient stay, and it would be beneficial for u to be able to identify any non-psych (medical) issues.

Just curious, What sort of things do u do on your inpatient adult psych unit to promote good sleep hygiene (excluding sleep meds)?

I'm currently in a psych/mental health NP program, and am currently paying everything out of pocket. I managed to save a significant amount of $ while doing travel nursing 2 years ago. This was when travel companies were paying good $, and nearly all hospitals were utilizing large amounts of travelers. This is not the case anymore. I'm only able to pay out of pocket because i guess i don't have as many bills as the average adult my age. I lucked out because my former coworker is letting me stay at his house during school with very, very cheap rent. My vehicle has been paid off for quite some time, and I have no other dependents to support. I'm still employed full-time at work, and luckily, my hours fit just right with my school schedule. It hasn't been easy though. I've had to seriously budget my spending. I dont' do much of anything at all with the little free time i have. However, i think it'll pay off significantly, as I will not have any loans as soon as I'm done, and 100% of my first paycheck will go to me, instead of loans.

Thanks for the responses. I tried to do a brief literature research regarding this "scrubs" policy that we have for patients on suicide precautions, but i couldn't find anything. We use paper scrubs on every new admit we get, and the patients always complain about them and it seems to make matters worse. I'm trying to get that policy changed at our facility because i hate explaining to them why it's necessary. Plus, it makes our patients visibly stand out among the others. Roughly half of our population would be in blue paper scrubs, and the other half in their street clothes. The doctors have to write an order to d/c the scrubs.

Just curious.... Does your institution require that patients be placed in scrubs if they are on suicide precautions, or any other type of visible identifier for that matter? Our psych facility does, but I'm not a big fan of the policy. How does your facility handle these type of precautions.

Well, to answer your question jcmoore2007... I think both technical and interpersonal communication skills are equally important and necessary in any specialty of nursing. I think both of these skills can be learned and mastered over time. Of course, some may learn the technical skills faster than the communications skills, or vice versa. Keep in mind, communication skills not only apply between you and your patient, but also between you and and the ENTIRE HEALTHCARE TEAM (i.e. doctors, RNs, CNAs, physical/occupational therapists, unit secretaries, pharmacists, NPs/PAs, social workers, case managers, supervisors etc...). Best way to find out about nursing or nursing school is to talk to or shadow these people and get as many opinions as you can from a variety of them. That should give u a general idea if you're cut out for this profession or a particular specialty.

Psych nursing can definitely have its moments where it can be considered easy. But, so can any other specialty. I have been working as a mental health RN for nearly 6 months now. Prior to this I had been and ICU/ER RN for the past 4 years. In my opinion, the hardest specialty to work is the Emergency Room because you see anything and everything that walks through the door. I started out primarily as an ICU nurse, but was required to float to the ER on numerous occasions. So, do i think psych nursing is easy? Well, sometimes, yes... but i also thought that ICU nursing was easy too. I mean, in the ICU, the majority of the time i only took care of 2 patients, sometimes 1, and on rare occasions 3 (that was definitely not easy). I say this because i was really interested in these 2 specialties: critical care and mental health. So, the more interested i was in these 2 particular specialties, the higher my job satisfaction was. I absolutely hated getting floated to med/surg and telemetry. I liked the ER, but always found it the most difficult for me. Pediatrics and L&D are two specialties that i will never be interested in working. So, as far as which specialty is the easiest, i think it depends on which interests u the most.

No, i don't believe everyone needs to spend time on the the med/surg floors before starting in the ICU. Yes, there are some new grad RN's who start in the ICU who can't handle it, but i blame that on the Directors that are hiring them. These new grads need to be given an accurate picture of what the ICU is really like, and what it really takes to work in that environment. Just like in any other job in any field, the ones that are doing the hiring need to screen the applicants to see which are a right fit for the unit.

I was with Cirrus all of last year as an ICU travel RN. My recruiter was great and treated me well. I was satisfied with the housing they provided for me on each assignment i was on. I've since stopped traveling because of graduate school, but i would recommend Cirrus to anyone interested in traveling. The only downside is that they are probably not the highest paying company to work for. There's probably a few others that can offer better rates. Nevertheless, it was still good enough for me, and i'm actually paying for grad school with the money i made while i was working for them, so no student loans, for now anyway.

I started travel nursing after only 15 months working as an ICU nurse. The good thing about the ICU i started in was that it was a relatively big hospital for a medium-sized city. Our unit had 16 ICU beds and 8 Step-down beds. Sometimes we would use the 8-bed step-down unit to house ICU patients. Most importantly, we did not have a separate Cardiac, Med-surg, or Neuro ICU unit. All of those different cases came to us, which gave every ICU nurse at our hospital really good experience in working with a variety of patients. Most of the bigger cities have a separate cardiac ICU, Med-surg ICU, and Neuro ICU; and from my travel experiences, those nurses in the specialty units weren't as proficient when they were floated to different specialty ICU's. I was really comfortable in working in each of those units when I was on assignment at a big hospital in the bigger cities. Unfortunately, when the recession hit pretty late last year and earlier this year, travelers were being used less and contracts were pretty difficult to get. So, I had to give up the travel RN thing and started grad school. I really miss it a lot. You learn a lot more traveling, too. Docs, RN's, and RT's from different hospitals may treat a pt with sepsis totally different than what you're used to. I learned that there's a lot of different ways to treat patients with the same illness. If you feel confident and proficient in the unit you currentlywork in, then I say go for it. Don't listen to those people that say you need a few years under your belt before you start traveling. Not everyone is on the same learning curve. I went straight into ICU right out of nursing school when other people were telling me that "you need X amount of years or experience as a med-surg nurse before you go to ICU or ER or any other specialty." I don't agree with that at all. However, i do think you probably need about a year's experience in the same specialty you plan on doing your travel nursing. Plus, most, if not all, travel companies require at least a year experience in your particular specialty before they even consider you for a travel assignment. Good luck.

I'm in the exact same boat as you, with similar credentials, but only 2.5 yrs as an RN. But i'm in the Southwestern United States. Have submitted a few applications to psych facilities thus far... no bites as of yet, but it's only been about 8 days.