6/20 WILTW Child Welfare, Confidentiality, Contraception, Commencement, Conti...

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Specializes in Pediatrics/Developmental Pediatrics/Research/psych.

Hi all! I am so honored to be writing the WILTW for ixchel. It is sometimes hard to believe that I have been a member for more that 4 years.

Anyway down to what I learned this week (or month, or year-days have a way of fading into each other).

Child Welfare

I have been at my new job for over a month and every day I learn something new. My new job is a great combination of my past experiences as a psych nurse and a school nurse. I am now working as a nurse in a child welfare agency that caters to medically fragile and complicated cases. I am lucky enough to live in a state that has a decent child welfare system with many features in place to ensure safety of children and families.

I had the opportunity to sit in family court for a day. I learned that family court runs very differently than criminal court. For one, in order to maintain safety of children, it is not expected that neglect or abuse and other charges be proven beyond a reasonable doubt. Only a preponderance of evidence is expected. As such, a child can be granted visitation with a parent from who she was removed due to findings of sexual assault because said parent was not found guilty in criminal court and is not a registered sex offender.

The judge also provided a lot of insight regarding how nursing documentation and the reports submitted by mandated reporters are used. He also explained some of the thought process behind the court decisions. I was so excited to hear that he recognized that fallibility of the system as well as the subjectivity of decisions.

Confidentiality

I learned that contrary to what I had come to recognize as normal in the nursing/healthcare world, in the social service, welfare and social work work HIPAA is not readily used and understood. The explanation that I was given is that many social workers feel that they are already involved in confidential relationships so they haven't been as educated on what HIPAA is and isn't.

This also means that many social workers feel uncomfortable sharing information between staff who are working in the same case. They feel that this violates the client-therapist confidentiality.

In fact, I found out that many social workers in private practice do not even write visit notes. The reason I was given was that if their documentation is subpoenaed by the court they will be breaking their confidentiality and the therapeutic relationship.

Our agency is trying to improve HIPAA compliance, and there is so much confusion between disciplines and departments. There are staff that as having difficulty understanding why they need to have all documents locked, but there are also staff who think that it is unreasonable that HIPAA restrictions don't exist for TPO.

Contraceptives

As I stated, I am lucky to work and live in a state that has regulations to keep children safe and healthy. As part of my role as a foster care pediatric RN, I am expected to provide information and counseling to all tweens and teens regarding reproductive health, contraception and pregnancy. I am in the midst of a 6 session training program in which we learn a variety of items including techniques in sexual reproductive health (SRH) counseling, child and adolescent growth and development, and decision making in contraceptive options.

I relearned information about Adverse Childhood Experiences (ACE) and how they affect health in adults.

I learned really eye-opening information regarding the increased risk that foster children hold when related to pregnancy, STIs and sexual abuse.

The Copper IUD (ParaGard) is the only non hormonal birth control method other than condoms, and it is also extremely effective as emergency contraception.

EllaOne is more effective that Plan B as emergency contraception for women with a BMI over 25 or between days 3-5 following unprotected sex.

DMPA can be used safely in sickle cell anemia patients.

I learned that I am really good at having these discussions with my clients. I was able to discuss SRH, genetics, STIs,BC... with great success.

Commencement

From a non-clinical, and yet still related perspective, I graduated with my BSN summa cum laude. I was selected as valedictorian of the undergraduate students but did not speak at the ceremony due to time constraints. However, my capstone project was mentioned multiple times throughout the ceremony when discussing the accomplishments of the students.

It was such a thrill to walk across the stage and accept the degree. I had never worn a cap and gown ( I attended a very religious school for K-12 and cap and gown were considered very secular. I attended my AAS pinning ceremony, but we wore scrubs), and there was something way more official and thrilling about the ceremony.

I get very frustrated when people bash online RN to BSN programs now. I worked really hard to get there, and what I learned in this program really has been used in my daily practice.

Continuing Education

I am back in school. I am now in a MS PMHNP program. In fact, I started the program prior to graduation. I am seeing even more that my BSN program was exceptionally rigorous. I am so glad to have had that experience.

I also finished an amazing Coursera class, instructional techniques in healthcare education. It was so great for any wannabe nurse educators. Very interesting and multidisciplinary.

Conference

My capstone project was accepted for poster presentation at APNA national conference in October. I am so excited!

What did you learn this week?

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.

Not a whole lotta new learning going on. Just can't wait to not have the stress of living month to month not knowing if we're going to make it or not. Also excited to have real insurance again. I'm thankful we had Medicaid but it has made things a little difficult.

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Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
Not a whole lotta new learning going on. Just can't wait to not have the stress of living month to month not knowing if we're going to make it or not. Also excited to have real insurance again. I'm thankful we had Medicaid but it has made things a little difficult.

My heart goes out to you OC. Some would say you are learning the hardest lessons of all. You know what they say:

Life is the hardest class because you get the tests before the lesson...

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A&Ox6 -- congratulations to your BSN and also to getting into NP school! I had toyed with the idea of a mental health NP masters but was not sure if I really wanted to be a NP... I will graduate with my MSN with concentration in patient safety and quality in spring 2017.

What you write is very interesting - I learned a lot!!!! So cool!

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I learned that life is not fair (again).

One of my elderly clients was declared mentally incompetent by her adult children even though she is alert, oriented times four and has clarity of mind. Her children are doing this for financial reasons.

This elderly lady wants to appoint someone other than her adult child as her power of attorney, but wait...she's been declared incompetent, so she cannot change the POA appointee. This situation is sad.

Life is not fair. Fare is the currency you pay in order to board a plane, train or automobile. But life is not fair.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
My heart goes out to you OC. Some would say you are learning the hardest lessons of all. You know what they say:

Life is the hardest class because you get the tests before the lesson...

Thank you so much. We are so close, we can see the light. We just need to make it through July & then it will all just be but a distant memory.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I learned that life is not fair (again).

One of my elderly clients was declared mentally incompetent by her adult children even though she is alert, oriented times four and has clarity of mind. Her children are doing this for financial reasons.

This elderly lady wants to appoint someone other than her adult child as her power of attorney, but wait...she's been declared incompetent, so she cannot change the POA appointee. This situation is sad.

Life is not fair. Fare is the currency you pay in order to board a plane, train or automobile. But life is not fair.

I am so sorry. *hugs* I really like that saying.

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Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
A&Ox6 -- congratulations to your BSN and also to getting into NP school! I had toyed with the idea of a mental health NP masters but was not sure if I really wanted to be a NP... I will graduate with my MSN with concentration in patient safety and quality in spring 2017.

What you write is very interesting - I learned a lot!!!! So cool!

Thank you so much. Your MSN concentration sounds fascinating.

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Specializes in critical care.

Thank you, A&O!

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Specializes in Pediatrics, Emergency, Trauma.

I've had a very interesting week!

I've learned that there are times where a specific assignment can get to me; it doesn't happen often, and most of the time it's due to fully understanding a huge roadblock in front of me, especially where adults are in the position to make decisions for someone vulnerable and with a straight face attempt to lie and manipulate their position without thinking of the repercussions of life and death; the only saving grace is that the state is involved.

I am pushing through with advancement with my clinical ladder-I have support of my new boss and is in support of my appeal to rescind my write up. Going toe to toe with trying to change the culture has given me MORE courage that I ever thought I had before!

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I learned that life is not fair (again).

One of my elderly clients was declared mentally incompetent by her adult children even though she is alert, oriented times four and has clarity of mind. Her children are doing this for financial reasons.

This elderly lady wants to appoint someone other than her adult child as her power of attorney, but wait...she's been declared incompetent, so she cannot change the POA appointee. This situation is sad.

Life is not fair. Fare is the currency you pay in order to board a plane, train or automobile. But life is not fair.

Was there an MD who signed off on her dementia?

Coukd she get a second opinion from another doctor who can vouch for her mental abilities?

We have residents appoint a POA but it doesn't go into effect until the MD declares them no longer competent.

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Thank you so much. Your MSN concentration sounds fascinating.

Yes, it has been a great program - everything I learned is very relevant.

Not sure how I will utilize my degree ..

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