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SecobarbSundae BSN, RN

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  1. Yet another PMHNP applicant that hasn't worked a single day in psychiatric nursing. Sorry to be harsh, but I agree with the above poster. And why is it that you want to become a PMHNP?
  2. SecobarbSundae

    No More TB Tests?

    If you look at the background prevalence of active TB per 100,000 in the U.S., it makes sense that facilities are moving away from scheduled testing.
  3. SecobarbSundae

    Pre nursing student has a question for current RNs

    Exactly. Look, I'm not going to sit here at my keyboard and tell anyone what's ultimately right for them. I just think taking some pause is necessary. I don't think it helps the OP to have people that are still in school telling her that psych nursing is full of tangible and satisfying results. Yes, it can be like that some of the time. But it is often back breakingly and soul crushingly hard with little result to show for it. And, yes, although relatively rare, it can be dangerous. You will see patients stabilize and walk off the unit with support systems in place. You will also discharge homeless patients to room and board knowing they'll be down at the river in a few months. You will see the same patients with bipolar and BPD admitted over and over again. You will deal with "providers" that barely know their patients and prescribe meds off-label like they're candy. Yes, it's hard. Yes, you will get the chance to go home at the end of the day feeling like you did some good. Hppy, thank you for being so candid about both the good and the bad.
  4. SecobarbSundae

    Pre nursing student has a question for current RNs

    How old are you? Go to medical school and become a medical examiner or pathologist if you love science and anatomy. ER nursing or OR nursing might also not be a bad fit. I would not suggest psych nursing if your sense of satisfaction is tied to tangible results. You say nothing phases you, but have you ever sat on a 1:1 in a psych facility and had things thrown at you all night by someone suffering their first psychotic break?
  5. SecobarbSundae

    What if/Is it possible?

    This is the problem with setting the NCLEX up as the ultimate litmus test of a nurse. You see somewhat desperate responses here in defense of the difficulty of the NCLEX and how it supposedly reflects clinical competency. Because if the NCLEX means you're a competent nurse, and someone who never went to nursing school could actually pass it, then what does that mean about all the time you spent in nursing school? I'm not burdened by that delusion and don't feel the need to defend the NCLEX. Becoming a nurse is more of a gestalt. The NCLEX is a standardized test that tests, among other things, your ability to take tests. There is a reason there are prep courses that focus less on specific content and more on critical approach and algorithms. The NCLEX is largely a rite of passage into a professional and bureaucratic culture.
  6. SecobarbSundae

    Any Pmhnps here??

    Get a job in psych nursing or in a psych setting. Do you have any idea at all what it's like to deal with an acutely psychotic pt? I'm not a big fan of the direct entry NP stuff. There is a reason why PA schools require clinical hours prior to admission. This whole direct entry thing is not good for the profession. I notice the one thing you don't mention at all is that you actually care about psychiatry. At least go to nursing school and figure out if you like your psych rotations. There are a lot of sick people in a lot of dire need in psychiatry and they don't need "providers" who are in it for the cash or a cush position. Not saying you are one of these, but it sounds like you need a bit of a reality check.
  7. SecobarbSundae

    Therapist or PMHNP?

    I'm just going to be frank. When I was in my BSN program w/o any RN experience, my view of direct-entry programs was a lot more favorable. I had a similar attitude toward floor nursing. However, having now worked as a psych RN for some time, I wouldn't recommend entering a PMHNP program without at least some floor experience (preferably in psych). Is it possible to be a "well-trained clinician" without RN experience. I'm not here to say it's impossible. But, when someone calls you up in the middle of the night asking for authorization to give chemical restraints to a patient, do you really think you know what it is you're ordering without having been on the floor and seen many patients that need to be restrained and been hands-on involved in the restraint process? Let me give a simpler example. Many of the psychiatrists at my current facility are in the habit of ordering ODT tabs such as Zydis for psychotic patients. Theoretical wisdom says that ODTs are often better because they prevent cheeking and promote rapid absorption. The trouble is that many of my patients are A) So confused and disorganized that they cannot be instructed to let a tablet dissolve on their tongue so they swallow it anyway and B) The tabs dissolve too slowly because they don't drink enough water throughout the day. It would be much simpler to just prescribe a standard tab form and have the nurses check for cheeking. Why do the psychiatrists continue to prescribe the ODT forms so often? My sense is because they don't actually know what's happening on the floor. If there is one advantage advanced practice nurses should have over physicians (new physicians in particular) it should be experiential or phenomenological knowledge of the patient and health care world gained through experience as an RN. As for a glut. I won't really answer that. But, I will say that the more programs there are that have low entry barriers with no experience required the higher the chance that there will be a glut. And worse, there's a chance that it could ruin the reputation of the profession in general.
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