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.

They're great if your facility uses them but not all ICU's carry them. However, nothing beats a really good, focused physical assessment alongside accompanying labs... something that every ICU is capable of doing.

My guess is that they'll send everything out by tomorrow and that we won't hear anything til early next week.

Still have not heard anything yet from NMSU, bummer.

Yeah, i'm in the same boat as you. I applied to one other out of state school and have already received an acceptence from them, but they're way out in the east coast and NMSU was my 1st choice because of work. I've yet to hear anything form them thus far.

Did u end up applying for NMSU's online program? Have u heard anything from them yet?

U may want to also consider traveling 3 hrs south of Albuquerque and applying to New Mexico State's BSN program. I believe your odds of getting in at State are better than at UNM. But, then again, if i had to do it all over again, I probably would have gotten the ADN first and finished the BSN as I was already working as an RN. Honestly, that's probably the best route to getting your BSN, considering our current economic crisis and the large volume of applicants to BSN programs nationwide.

To all current/prospective nursing students at NMSU, Once you graduate from nursing school and meet other RN's that graduated from various nursing schools across the country, you will come to realize that ALL NURSING SCHOOLS ARE BASICALLY THE SAME. The same complaints about NMSU's nursing program are the same ones i've heard dozens of times from many of my coworkers i've worked at various hospitals. I'm currently a traveling RN (and a graduate of NMSU's BSN program), so i've spoken to plenty of nurses within NM and throughout the nation about their experiences through nursing school. It's funny because the same complaints i read on these message boards (e.g. "professors are lousy and can't teach,"; "lab facilities aren't open long enough,"; "too many students at clinical sites or not enough clinical sites/rotations," "endless/pointless care plans," etc...) are the same ones i've heard from other RN's. I even have cousins who went to Medical School and Dental School who had very similar complaints about instructors and clinical rotations. My point is, nursing school isn't easy anywhere you go. There are dozens of other students who have applied to NMSU's nursing school who were not accepted, but they would love to be in the program still, despite all the complaints/comments made throughout these forums. Regarding the HESI, nearly all nursing schools administer these exams in one form or another. In some schools in Arizona, they have a HESI exam that you have to pass in order to even be accepted into the nursing program. And in Texas, there's a school where you have to pass a HESI exam to get into the program, in addition to another HESI exam you have to pass in order to graduate from the School of Nursing (just like @ NMSU). Taking and passing this exam only helps students in the longrun because it is very similar to the style of questions found on the NCLEX. Nursing students have to realize that they cannot be spoonfed information to them, and they must read/research on their own time in order to digest the information thrown at them. Also, clinicals are the best time for nursing students to learn something. Many get too caught up on writing out careplans or filling out their pre-clinical paperwork and miss the big picture on what's going on with their patients. Lastly, i think success in nursing school also depends a lot upon your classmates, too. My graduating class had our fair share of complaints each semester and we even butted heads with each other frequently. But all of us helped each other out every semester no matter what. It was like that with the semester ahead of us and with the class graduating after us. So, i thought that every cohort of nursing students would be like that, but judging from some of the comments made throughout these message boards, it seems that some classes may not be as cohesive as others. Overall, NMSU's nursing program is a great program, and every nurse i know that graduated from there are exceptional nurses. Many of them have already made their way up to heads of their departments. So, just stick with it and suck it up... you'll know what i'm talking about once you've graduated and done your time in the nursing world.

I started traveling in the summer of 2008, and I was only picky about my 1st assignment (didn't want to be too far away from home). But back then, nearly every traveler could be picky because of the numerous contracts that were available throughout the country. After that 1st assignment ended (which i loved), I told my recruiter that i wasn't picky and that i was willing to relocate anywhere throughout the country (this was around October 2008) . My 2nd contract wasn't very difficult to come by either at that time. But towards the end of that contract (end of Dec and early Jan), I wasn't hearing from any of the hospitals my recruiter was submitting me for, so i decided to extend for a little while longer. I'm currently still here and my recruiter has already tried shopping me around for numerous hospitals and haven't gotten any bites. So, i'm probably going to end of extending here again, even though i'm willing to take an assignment anywhere. I'm not very optimistic that i'll be able to land another contract as soon as this one finishes. I work in the ICU and even those positions are hard to come by apparently.

Looks like travel assignments are still slim pickens, well with my agency anyway. My 1st contract here in Texas ended the first week of January and I extended til the beginning of March. My recruiter emails me about potential assignments and as soon as i reply only a day later, she says that those same assignments have just been filled. I'm glad they still have a need for me here at my current hospital. I went in to travel nursing because I wanted to travel and see the country and also see how other hospitals compare to my previous staff position. So far I've only had 2 different travel locations since i started last summer.... bummer

I was required to take this exam for one of the Texas Health Resources (THR) hospitals in the Dallas/Ft. Worth area. They make all travelers take it in the THR system. I passed, but thought it was a pretty long exam. For the most part it wasn't very difficult to identify the medical diagnosis (which you are required to do), but from what i hear,... they like for your to be very detailed on what you should do (i.e. nursing interventions) and your rationale for those nursing interventions. In my opinion, this is what made the test difficulty for me. It was a good thing I can type really fast because the test is timed. To me, it felt like for each video/case scenario, you had to type out a pretty lengthy care plan... very similar to the ones i did for my clinicals in nursing school. I think there were like 4 or 5 video scenarios... so, imagine trying to fill out 4 or 5 lengthy/detailed care plans, and that's what the PBDS test is like. There are other parts of the exam where they give you a video scenario (e.g. an infiltrated iv site), and they ask you for a brief description of what you should do (e.g. d/c IV)... but that part of the exam is pretty easy and straight forward. I think it's the video scenarios where you're expected to make the medical dx and appropriate nursing interventions section where most nurses have difficulty. I took the PBDS designated for ICU nurses, and i believe there are separate ones for med/surg and peds, etc... I've also heard that each ICU exam is the same and each med/surg exam is the same, etc... I wouldn't mind taking another travel assignment that would require the PBDS, but i would definitely study beforehand and not underestimate it!!!!