celery_juice

JustKeepDriving - I found your post really helpful in understanding when it is appropriate to set limits and try other methods. Thanks so much!

He did receive the prn as ordered, I did not withhold it. I came here seeking advice on whether or not it would have been an appropriate circumstance to withhold and get into that "pissing match" you spoke of and see if maybe there were any other interventions I could have implemented. Instead of looking at me in a negative light maybe I came here for justification of not withholding it? Because I often do feel like im too "soft" with the patients in my care. From the responses, Ive gathered that I did the right thing by being cautious and giving the prn. I've said in the past that Im new to this site and I also have limited experience and little to no guidance on my unit, so when I come here and ask things it really is coming from a place of genuine interest and a desire to work with this population and do right by them. Had I been with an experienced nurse that day, I would have been able to just talk to them. But I wasnt and so I came here. Thanks for taking the time to reply to me, I do appreciate the insight

I do understand this and should have given more objective information in my original post. So to generalize, am I to go along with any behavior regardless of whether it seems genuine based on observed behavior and assessments, because to question its "genuineness" would be judgemental and subjective?

This is what we were doing to a T. In this specific instance he was being observed without knowing and while doing so he was found to have zero tremor or symptoms, was eating and drinking perfectly fine, but upon entering the room he was suddenly so tremulous he could not sit still long enough for a blood pressure check. With that being said, I do always err to the side of caution because etoh withdrawal can be dangerous, so he WAS being medicated according to Md orders.

Wondering what everyone's strategies are when dealing with manipulative behavior in a patient. I'm talking specifically about a situation I had recently where a pt was very obviously faking ETOH w/d tremors for their prescribed PRN ativan. In situations like this, do you call out the behavior? I never know how to handle it.

I took it last September and prepared in a similar way. I read the ANCC book cover-to-cover a handful of times, and researched anything I wasn't sure on more in-depth. I also purchased the additional practice questions from ANCC. I didn't use any other study materials. As other people have posted, I found it similar to NCLEX. It was challenging but you seem as if you're preparing well. Good luck!

I checked yesterday and was not accepted to the psych program. I thought I had a strong application, but maybe this wasn't in the cards for me right now. Congratulations to you and best of luck!!

I don't know why, but I never got any notifications that this thread had any comments! I just caught up, and I appreciate all of the feedback, however I just checked my portal and I was not accepted. I am disappointed. I wish they gave feedback as to what your application was lacking so I can improve it and reapply in the future. Good luck to everyone else~!

yes! this! thank you!~

Glad I found this thread. I am also awaiting a decision for Fall 2015! I have 5 yrs experience split between med/surg and psych.

""Bottom Line: "You have Two Options- One: Make a Commitment to Safety, do Nothing in Word or Gesture that could be Interpreted as a Threat of Harm to Yourself or Anyone Else, or Two: Be Restricted of Your Right to Freely Move About.""" thank you! thats more along the linea of what i was looking for.

Thank you for your response. I think I didn't articulate my question right...I know that threatening restraints is assault, so if it has gotten to the point where restraints are imminent how do you tell the patient without it becoming an ultimatum/threat/assault?

Experienced Psych Nurses.... Especially in a crisis unit, there comes a time when a patient is being a danger to themselves or others, and the need for restraint is necessary. For a psychotic person, I will typically say something like "I am going to put you in restraints right now to keep everyone safe and help you stay in control until the medicine starts working." Is this appropriate? Now, for someone who is more aware of their actions, say, a behavioral group home adolescent or a medication seeker or personality disordered patient, how do you set limits and expectations without directly threatening them? It would not be therapeutic nor appropriate (or, I'm guessing, legal) to storm in the room with security and scream "STOP THIS NONSENSE RIGHT NOW OR I'M PUTTING YOU IN RESTRAINTS" ... so, how would I say it? Always looking for ways to improve my communication skills so any input is appreciated!

When I worked med/surg and wore them, they were 30-40mm hg. While definitely snug, I did not find them to be too tight, and they did their job quite well. I know they are expensive, but if you are that concerned with them being too tight, get a lower pressure and see if they help.

Hmm. I'd be interested to hear an update if you get the position!

I feel as if I work in a psych ED. I mean technically, it is the psychiatric wing of a medical hospitals emergency room. Is there something different altogether you're talking about?

I have applied and I'm just waiting for the decision. If I am accepted I'd love to find more people to talk to about Drexel. I have no idea what their program is like or what to expect.

No but I applied to the Psych NP program!

I work full time in a crisis unit as a staff RN. Where I live, we also have "screeners" that are not RNs - they have a background in either psychology or sociology and are masters-level, and they are the ones who evaluate patients and make the determination along with the psychiatrist. So as the nurse, my role involves direct care of the patient and crisis stabilization/management while they are waiting for their evaluation and disposition. If a person is already on the unit when I walk in, what I do is minimal. Meds, vitals, any type of therapeutic interactions or deescalations, then once they are dispositioned I will prepare them for transfer, give report, and fill out necessary paperwork. Throughout the day, patients will come in either voluntarily through triage, referred by the ER, or brought in from the community in various ways - either by police or as the result of a mobile evaluation. When someone arrives, they are wanded by security, then changed into a gown and socks in front of me. I document any skin abnormalities while checking or contraband. Vitals, blood work, and urines are obtained. They have an exam by the ER physician for medical clearance. Once medically cleared, they are on the list for a screening. Everyboy is on a q15m watch for safety. My unit has 9 beds and staffing will be either 1 RN with 1 MHA or 2 RNs with no MHA. What I described above doesn't sound so bad when its written out, but the thing about psych is that your day is never predictable nor consistent. I place much more value on acuity than volume. Keep in mind that a unit packed to the brim with patients may be your easiest day, but a unit with only 2 patients who are psychotic and violent, or cognitively impaired, or demented and need constant redirection could turn challenging very quickly. Patients also do not come in one at a time, and they rarely come in voluntarily. You really hone your skills with regard to deescalation and milieu management, because things would go south fast. Also, because it is a crisis unit, we see EVERYONE. I have had a 4 year old. I have had a 102 year old. I have seen every DSM diagnosis walk through those doors. I could have an autistic 8 year old in one bed, a combative dementia patient climbing out of another, while a med-seeker is punching walls because he has learned its a great way to get IMs, the chronic schizophrenic is disrobed in the doorway and the voluntary depressed 20-something is cowering in her room wondering what the heck was she thinking by coming here. At the same time, two patients have transfer times and the ambulances are on their way, and was that the doorbell? yup, police are here with a handcuffed and floridly psychotic man who just burned his house down. Depending on volume and acuity, your day will either be spent in the hallway running ragged putting out fires, or you will spend it doing paperwork. Some days a mix of the two, but where I work, its either clear skies or a hurricane. Another thing I need to mention is that we are a direct extension of the ER, so your medical knowledge needs to be there. (I hate seeing all the threads asking if we lose our skills!!! If anything, my skills are BETTER now than when I worked med/surg, because everything presents so much differently or more subtly or is masked by an altered mental status.) I frequently have patients who are not as "medically cleared" as originally thought, and are brought to the main ER for medical attention or are admitted to the medical floor. I cannot do any type of medical treatment on my unit for safety purposes - no oxygen, tubes, IVs, you get the point. Anybody who requires oxygen is held in the main ER. So to summarize, at my job, the screeners will evaluate/disposition/make recommendations and the nursing staff does everything before, after, and in-between :) Sorry for the long reply but I loooove my job. I hope this helped!

i read the ANCC book cover to cover a few times, and then researched more in-depth any topic i wasn't 100% about. i thought the exam was very challenging and really tested your knowledge, but the ANCC book prepared me well. good luck!

Hey all - I am currently awaiting my decision for the fall 2015 semester at Drexel for their PMHNP program. The more I think about it, the more questions I have. I have read all of the threads on allnurses pertaining to Drexel but I can't find any supplemental information anywhere else. Any past/current students willing to provide me information would be greatly appreciated. I have the following questions/concerns (so far) - and thanks in advance! Drexel is a b&m school but all of their MSN degrees are offered online. I was initially hesitant to apply to an online-based school because of my previous experience with online classes being comprised of mostly "busy work" and group discussions. How does Drexel compare to a b&m school in terms of class structure and work load? Did you feel like you learned as much as you would have by sitting in a real lecture? How about testing? I chose Drexel due to its flexibility, cost, and seemingly good reputation but don't get me wrong, I am looking for a good school and I am looking for a challenge. Do you feel that you were as prepared as a student who went to a traditional, classroom-based school? I have read a thread where an NP's practice stopped accepting students from online schools, because their knowledge and preparation was not up to par. That is my worst nightmare. Becoming a nurse practitioner is a huge deal that carries a lot of responsibility, and it is important that I receive a quality education. Lastly, the big doozy, PRECEPTORSHIP. I'm already having anxiety from all of the horrible "I can't find a preceptor!" posts I am seeing online. Assuming I find a preceptor, what does the actual preceptorship process entail and where will I have to precept (e.g. all specialty areas, or just within psych?) Thanks again to anyone taking the time to read this and respond. I realize I could ask faculty these questions but it is always better imo to hear from people who have been there & done that as opposed to someone who might not necessarily have my best interests in mind.