Spurse32

I'm in PMHNP school and happen to be learning about lithium so this is good. According to the FDA, people are often maintained on a dose of 600 TID which is only half of what your patient is taking. This makes me think you need to just titrate up until you reach a therapeutic level between 0.6-1.2, being cautious of any new side effects as you increase the dose. From what I can see, the dosage is not based on weight, as its excreted primarily by the kidneys. So as long as your patient has adequate kidney function, they should be able to handle a higher dose. The only things that jumps out at me is the lab level on 05/05/2020. That makes me think that he didn't take his dose the day before or something weird happened. But again I'm only a student so I don't have a lot of experience with lithium lab draws and analyzing the results. Those are just my thoughts :)

It definitely can't hurt. I volunteered at a hospital and opened the door for the ICU. They had a door that could only be opened from the inside or by a button next to a desk. I didn't really spend much time in the ICU, but I did peek in every now and then. It helped reaffirm my desire to be a nurse. Also, on my resume, it read "ICU volunteer" so it looked good

I think I'm saying this for the third time now but yes, I agree with all you seasoned experienced nurses, I should have been more creative in finding tasks to do. But there's nothing on my evaluation from about "creative task finding". If I was told this during my time there by either my preceptor or faculty to go find more tasks and do more research, I absolutely would have. But at this point, I'm done playing the blame game and I'm moving on, learning from this and looking towards solutions, not problems. Also, I retract my comment about "being set up to fail". This is a victim, egotistical statement and I was upset at the time and still in victim mode. I love what someone just said about having the mindset of, what do they expect from me? Other than, what do I expect from them? That's good stuff and I will carry that with me. At this point, I'm not even claiming I should have passed or failed. I'm not appealing the grade, I'm actually going through a different process and requesting that I am able to walk after next weeks ATI review, work with my clinical director to find me a new preceptorship, get evaluated properly via the proper university guidelines, pass and receive my degree. I'm fairly confident they will allow this. If they don't, I will deal with it then. Thank you all for your comments and feedback. Without the experienced nurses who are willing to give feedback and help us newbies, we would suffer and our patients would suffer. I think I'm going to be a great nurse because I'm willing to mess up and move on. And most importantly because I do genuinely care about the welfare of those under my care. Wish me luck on my next preceptorship, or don't, I think I will be fine. Thanks for those who encouraged me and those who gave me constructive feedback. Maybe I will come back and post about how my next preceptorship goes.

Geeze no one is taking my side! lol This is all good stuff guys thank you. I'm going to have to appeal this and I appreciate the perspective. I also want to learn from this. I know I'm accountable and responsible. There were times in the morning when it wasn't slow. From about 7:30-9, before the clients had morning group. It was also hectic during that particular morning, there was like 5 discharges on top of meds. My nurse said that there was no point to train me on the discharges because it was mostly just computer stuff. I said ok and I just got vitals for all three of the nurses. She then called me into the med room to count the patients' meds. I don't know why it happened, it just did. I wasn't paying enough attention I suppose, I was trying to count 1000 pills with people cramed all around me. I got super anxious. I should just grabbed his meds, found a clearer spot to work, took a deep breathe and been more careful. It was bad and unsafe. Like I said, I could have found more things to do. I get it. But again, my mindset was centered around "being the nurse" and "doing what the nurses do" And a lot of the times, they weren't doing anything and were just talking and waiting to give meds. Thats why I pushed so hard the first day to get computer access. I talked to a lot of the patients. When I got a chance to lead group, afterwards we started a volleyball game. I got to interact and talk with a lot of them. Once I walked outside where they were smoking and just checked in on people. I heard their stories and asked people how they were. But whenever I left, I was thinking I should be back at the nurses station, being with the nurses.

I perform better with a steady work flow, with more things to do and more tasks to accomplish. I'm more engaged. But like I said, I could have been more creative in finding things to do. Still, I did whatever she asked me to do and more. I could have done research also. I'm not lazy, I'd rather be busy. When pts needed ppds, I asked if I could do them or practice drawing up the meds. There wasn't a whole lot of "procedures" going on. Patients were walking, talking, oriented. There was nothing in the evaluation about me not utilizing spare time or being lazy. I don't think I can request a passing grade in good conscious because I didn't get what I needed to match the outcomes of this course. This is MY FAULT for not discussing this earlier with my clinical director. Could I have been more safe? Absolutely. And I think I would have if I was given the chance to work in a more traditional setting, with more opportunities to learn, fix and improve on my mistakes. If anyone out there is a student nurse and is in a preceptorship that you don't think will offer you chances to learn and build toward your future, SPEAK UP. Learn from my mistakes. It never hurts to communicate with the powers that be.

I wanted to respond to NurseStorm, I didn't see your post till after I responded again. Yes you're right, I could have done all those things. I suppose my mindset was more of an application perspective and that I wanted to be near the nurses station, ready to give meds. I didn't walk around doing nothing for hours and I did talk to ALOT of people, including the patients. But thank you, I appreciate your thoughts. I should have been more creative in finding tasks to do. I even brought a NCLEX practice book but never got around to working on it. I just didn't want to seem like I was checked out.

I know it was highly specialized and interesting, that's why I stayed. I actually volunteered myself for a lot of things. For instance, if a patient needed to be walked downstairs for an appointment, I volunteered. I volunteered to lead groups and that was one of things they said I was good at. The nurses were on their phones, chatting, watching youtube, etc. I'm not making this up, it was a slow unit and there wasn't things for me to do. And I didn't want to leave the nurses station always because if someone needed PRN or afternoon meds, I wanted to practice doing it. It might sound crazy but if I had more things to do, like being on a med-surg or ER floor, I would have been WAY more focused and more energetic. When I get bored I tend to get uneasy and zone out. I love being busy and running around helping people, it's a challenge and keeps me engaged. That's my fault for not speaking up though and requesting a new site. I always, always achknowledge people when they speak to me. I hate being ignored. I'm actually a very nice person. There is a chance though in the heat of the moment, I didn't, only because I was distracted and so new at doing the med process. But I honestly don't remember. There was no MAR in the pixus, we had write everything down before going to the med room. I think if the insulin thing hadn't happened, I probably would have passed. It was bad, I know. And yes I was very nervous. The med room is the size of a bathroom and it was hectic with us trying to do discharges and pass meds. My nurse pulled the pts meds down and placed his bin of home meds next to the insulin, called me over, pulled out one bottle and a plastic pill counter thing and told me to count them. I never saw the insulin laying by itself. I only saw it next to all the meds. If I would have done that task from start to finish, that would HAVE never happened because the first thing I would have done is look at his MAR. But it did and if that patient went home and for some reason injected himself with insulin and got injured, I would be accountable and I understand that. My clinical director somewhat empathized with me and said I can come back and finish in January and we would work together to find me a site that fits, I'm probably going to do that.

So I failed out of my last class, my senior practicum, preceptorship. I'm just looking for a little perspective. I'm gonna try and make it brief as possible so bare with me. I love psych but also like ER and all the medical side of things. I decided to go for psych because I thought I would enjoy it over med-surg. I discussed this with my clinical director and we decided on gero psych. I ended up an inpatient, drug rehab facility. It's a nice facility that incoporates detox and a longer stay unit. I thought what the hell, It's not my first choice but I'll make the best of it. My first day was very slow. They couldn't get me in the computer system to chart or give meds so all I did was take BP and HR. I was getting along good with the patients but I knew RIGHT away that choosing psych to start was a mistake. Weirdly enough, one of the first patient interactions was someone with pneumonia. Right then, I knew I needed the medical background first but I didn't mention this this to anyone and I carried on. I had only 7 shifts left and I wanted to stick it out. Finally I got to pass meds. I think the second person I gave meds to had like 13 meds. I immediately felt overwhelmed. I got his vitals first. I saw that he was taking dig so my preceptor said make sure to get an apical pulse. I went to the med room first though to start collecting his meds. While I was in there she said get an apical pulse. I thought she was just reminding me but I think she meant like NOW. Finally she goes, "for the third time, get an apical pulse". I said ok...do you want me to get go do it now? She said no, just finish getting the pills. I got his apical pulse before giving the dig. It was 85. I gave him all his meds. This was one incident that was brought up at evaluation. I would have known next time to check the apical BEFORE grabbing the pill but I didn't get another chance to do that persons meds. Another incident was someone who had cirrhosis and major fluid overload but no respiratory symptoms like crackles or SOB. My preceptor was doing his meds and asked me to get a O2 sat for him. I put it on him and it read 91% so I told her. She said to leave it on longer and have him take a deep breathe and sit down. It went up to like 93, 94. I was supposed to know to leave it on longer. But again, didn't get a chance to do O2 on a critical patient. Or critical for that unit I should say. My preceptor wasn't around and a patient came up complaining of anxiety. I looked at his chart and gave him PRN 1mg ativan. I told my preceptor what I did when she got back. She asked me if I got his BP first. I didn't. I forgot or was thinking that we took his morning vitals and that was all we needed. I said, damn, I was just about to and I didnt. I told her I would check it next time I saw him, just to be safe. She said don't bother it's over, now you know, you won't do it again. That was the first and last PRN narc I gave. I asked her sometime last week for feedback. She said I was good with groups, good with the patients, a big talker. Nothing negative. But last night, the second to last of my shifts at the end of my shift, I got my "mid-term eval". She started going over some incidents but that I could do better on my last shift but that she would never do anything to jeopardize me not graduating. She mentioned those previous incidents but also something about not taking the pulse ox on the side of a BP cuff inflating. She said it can cut off circulation and change the reading. I said ok. She also said I have poor body language and no "eagerness" to do vitals when a patient needs it. On my last shift today, right when I was supposed to shine and improve, I messed up big. Preceptor told me to count pills for a discharge and note it. She put the meds down and said go fast b/c we were busy with discharges. Well she put the meds right down next to an insulin vial someone left out, probably from night shift. Before though, the patient had lisinopril that wasn't on the sheet that listed his meds. I asked my nurse about it and she said it was added later, go ahead and add it. Well, I applied the same logic to the insulin vial. The patient doesn't take insulin. I gave her the whole bag and said I was done. She said...what's this insulin doin in here?? Opps. I still can't believe I did that. I'm sure there were other mistakes that I made but that is what was brought up. I don't think I did any other "major" mistakes. My evaluation today was that I'm not safe. A lot of the nurses don't want to work with me because of safety, I have poor critical thinking, poor assessment, and I dont' apply knowledge that I know. I'm probably going to appeal but I think I'm going to lose. I did a lot of things good but the workflow is so slow, I don't think there was enough to prove myself, only enough to make mistakes, which are my fault, I know. I was so bored there. It was supposed to be my preceptorship and me "being the nurse" but it just wasn't like that. On average, I probably did about 1 or 2 hours of actual work, if that. The rest was sitting around doing nothing or walking around aimlessly. And trust me, there was NOTHING to do. I feel like I was set up to fail for sure. Why wasn't this stuff brought up to me earlier? But I also get soo anxious, especially if I make mistakes. I live in them. If I don't do good at first, I sometimes get anxiety to the point where I can't think at all. It's like I can feel my IQ just plummet. So here I am, wondering where the hell to go from here.

It was just a question based on general curiosity. Why are people so god damn touchy on this website? It's like they take crap at work, then come home to vent to people they can't see in person. You're not informing me of anything, I'm well aware that men make more than women across the board in this country and probably in most other countries as well. I've heard that SOME people give men an advantage in some floors because of their ability to lift, that's all. Again, it was just a question. All I'm saying is that I've heard that and was wondering if it's true. Salary should be based on your experience and ability to perform your duties. I'm aware that's not always the case though so I was asking about the gender factor when hiring someone.

Hello. I am a nursing student about to approach my preceptorship experience. I have always been drawn to psych and I'm pretty sure I want to be a PMHNP so I'm trying to do my preceptorship in acute psych in a ER. I really like workning nights so I requested to work nights. I guess my question is: Is acute psych a little too much for a precepting student to take on? Or if I do night shift, would it be not enough? I was on night shift in the ER during my clinicals and it seemed very slow in the psych bay. It seemed like all the patients were asleep. I could do mental health in a large mental health hospital but we are "bound to a facility" so if I wanted to go somewhere else I couldn't, I would be stuck with mental health for the remainder of my preceptorship. Has anyone ever precepted someone in the acute psych center in the ER? When it's slow, did you allow your students to float and take on other patients in the ER? I want to do psych but I also don't want to neglect the medical side of things and I want to improve my skills. Yes, yes, I know this subject has been wrote about many many times on these forums but I'm just curious what you guys think. I love the pathophys of medical surgical/acute care/ER but I also love brain psychiatry and I just have a feeling I would be good at mental health. My second and third options were psych in a mental health only facility and IMC. I haven't done peds clinicals yet so I might really like that. Any feedback or suggestions is much appreciated...muchas gracias.

Here's how it works in ABSN cohorts: You take the midterm and pass, you move on to the final. If you take the final and pass, you move on to clinicals. You usually get a few days off before clinicals because people have to super remediate and they will have to do a review for the super remediation the day before. If you don't pass the midterm, you have to remediate. If you pass the remediation you move on to the final. If you fail the remediation, you have to super-remediate, regardless of how you do on the final. The super-remediation is comprehensive covering material from the midterm and the final. If you don't pass the final and you fail the remediation, you have to super-remediate. If you fail super remediation you are dismissed from the program and you have to either do something else or reapply to the cohort that is behind you(something like 3 months behind or something). We're almost to the end and only one person has failed out of didactic and one person failed because of clinicals. Good day :)

The ABSN program is different. Personally, I'd rather go to school online and be in the comfort of my own home doing it at my own pace, which is what I do. The material is the same and we all take the same NCLEX. Just so yall know, Roseman's nursing program no longer issues "4.0" GPAs. Everyone gets straight Ps on their transcript. They ended they As right when my cohort started...horray timing! If you wish to apply to graduate school following Roseman, there's no guarntee that your desired program will accept this grading style. However, Roseman does issue a letter attached to your transcript stating how the P=A. We're all unsure of how this is going to play out for our future as students and nurses. A lot of my students are discouraged at the fact that they changed it back. Oh well. I contacted UNLV out of curiousity and asked their nursing grad program if they would accept the "P" system. They said they would with the letter. Roseman is still fully accredited so I'm hoping for the best. Just thought yall might want to know that.

Psychguy, are you in private practice, hospitalist or both? Can you tell me how you got your start and how you got to that kind of salary?

Yah, scope of practice. And no, I wouldn't expect them to have the same knowledge as a MD. I guess I just imagined that with the right background and enough education, an NP could be on the same playing field as a MD or DO. I guess I was wrong. But I suppose in a speciality like cancer, where the docs there have certs in oncology and hematology, that would be pretty hard to compete with. What about PMHNP, could they ever be ever be equal to or close to equal to a psychiatrist? As far as skills/knowledge base is concerned. I suppose not. That's why I was liking the PO to DO option.

I love this thread. I'm an ABSN student about to graduate in October. I'm doing my community health rotation in an outpatient cancer center. There's an oncological NP who works with three other doctors and a surgeon. She said she had 15 years of RN experience in oncology before she got her APRN. She seems smart as hell and if god forbid I had cancer, I would put my faith in her. However, she doesn't have full autonomy. She said she's not able to "design" the treatment plan for her patients. I took that as, she cannot read a scan and decide which course of chemo to give. She's constantly asking the doctors questions. I'm not saying that's bad but it just makes me wonder: How much more autonomy would she have if she was a PA? I'm kind of leaning more towards PA. They have more clinical hours and seem to be taken a little more seriously than NPs. And I like the PA to DO option. Does anyone know the differences in power between, in Nevada, for a PA vs a NP?