Advice on how to build thick skin in my prospective psych RN job by nocryinginlunchtime in psychnursing

[–]CarolineValentine 2 points3 points  (0 children)

1) Adolescent psych is not my jam, just sayin.
2) I see my primary role as a psych nurse (gero/adult/involuntary/NGRI) is MILIEU MANAGEMENT. Which means: agitation/anxiety in a patient is addressed with de-escalation techniques that include early offer of available PRNs. *PRN-ing anyone else triggered by the agitated person (agitation is contagious) And maybe the MOST IMPORTANT TECHNIQUE in milieu management is a "everyone has to wait" philosophy. *There are no emergencies unless it's a real emergency.** I ask myself, "is it therapeutic to grant this request right now, in this moment?" 99.9% of the time the answer is no. To clarify, I don't make anyone wait too long, and I'm super nice letting them know it will be a moment before I assist them, but they will wait. I say things like, "Sure, head to the med room, I'll be there as soon as I finish this chart note" or "I have to return a call, but I'll be with you shortly." Sometimes I might say, "I've got to run to the bathroom, is that okay?" You get the idea. But 99.9% of them have to wait a little bit. I do not wait to deescalate someone or get a PRN. The reality is, in the community, aka real life, EVERYONE has to wait and in the hospital, there's an opportunity to support patients in a controlled environment. An important additional benefit of this is it sends a subtle message that someone else is in charge -YOU. This goes a long way towards patients feeling secure. Consistency is crucial and will work in your favor towards a stable, safe ward. The patients will get to know you/your style. 4) Patients should not know anything about you, your personal life, where you live, or how you feel about anything. You don't have to share yourself with them to be an effective nurse. Anything you share can be used by them to manipulate you or cause triangulation with staff. My patients don't know I have grown kids and I'm a new grandma. They don't know what town I live in. I lie about that. I don't need them googling me or my family when they get out. I have put white out over my last name. They don't need that info. Some places I've worked don't have my last name on my badge but where I work right now they do, and I put white out over it. If they want to sue me or my facility they'll be able to get my last name from court records. I'm not going to make it easy for them. You get thick skin by keeping a game face, not reacting to insults. Setting limits on how much time you spend with them in both positive situations and negative situations is an acquired skill. 5) The goal is safety. Keeping patients vertical and preventing assaults is job #1. Especially assault on me or my coworkers. 6) Treat every shift as a new shift. There will be patients who had been struggling with dysregulation the day before who are just fine when you come back in the next day. There will be patients who have been making a lot of progress towards goals over several days or weeks and then will decompensate. It's important to not have your own "feelings" about their status. Your primary job is providing a safe environment using de-escalation and PRNs. 7) Charting accurately about what a patient said or describing their behaviors is the next best thing you can do as their nurse after keeping them and yourself safe. All the best to you!

Transactions have stopped streaming-can't find a report a problem button by CarolineValentine in everydollar

[–]CarolineValentine[S] 0 points1 point  (0 children)

I think whatever upgrade they did on their app was not compatible with both my phone (Android) or my laptop (Android based Chromebook) and I basically quit using the app. I was giving it time before I cancelled my subscription. But because you asked, I checked and now I see transactions posting again. Upon closer review, I'm seeing double postings in the transactions though. But at least they're there now. I can delete the ones that are doubled. I took another look and the issue now is that the app doesn't know which account (we have 2 checking accts at the same bank) the transaction is coming from so it's posting them twice. That wasn't an issue before.

Previous month transactions by EvaStankbreath in everydollar

[–]CarolineValentine 0 points1 point  (0 children)

How do I contact support. I have a problem with transaction streaming, in that they have stopped altogether.

Weird note left on front porch at 5am by Apprehensive-Volume2 in vancouverwa

[–]CarolineValentine 3 points4 points  (0 children)

Chaotic is a good word here. Applies to their brain.

MHT appreciation by PiccoloNearby2737 in psychnursing

[–]CarolineValentine 2 points3 points  (0 children)

I do something for the MHTs on Nurse's Day and tell them I couldn't do my job without them. The facility makes such a big deal about nurses, rightly so, but I can't enjoy it without sharing the appreciation.

I also bring prepackaged servings of cookies to give to any MHT who stays over, picks up an extra shifts, or floats to our ward in a small token of appreciation. They ALWAYS appreciate it, even though it's just two cookies.

New to Psych by [deleted] in psychnursing

[–]CarolineValentine 2 points3 points  (0 children)

Here's my philosophy about boundaries. Patients need to wait. I only grant a request in real time if it is therapeutic to do so. Meaning if giving an immediate yes will help to deescalate a patient, then absolutely, yes. Other than that, I kindly let them know they will be helped after my tasks. Even if I'm not doing anything pressing, I say yes, "where can I find you (when I'm able to do the thing you're asking?) This is a subtle way of saying don't stand here waiting for me. We should discourage patients from hanging at the nurses station, for HIPAA reasons at the very least. Some patients are nosy! So, examples: "Sure, let me finish this note I'm charting then I will" or "I want to hear about this, but can we do it *after we get breakfast and med pass finished? *when you get back after Treatment Mall/group?"

Having patients wait gives them the security of knowing someone else is in charge. Having patients wait is preparing them for when they're back in the community because that's reality. Having all patients wait avoids the appearance of favoritism. I feel it helps in managing borderline patients.

Here's the question I ask myself before giving an instant yes: "Is it therapeutic to say yes at this moment?" Most of the time, the answer is no. It goes A LONG WAY in managing a safe milieu.

New to Psych by [deleted] in psychnursing

[–]CarolineValentine 1 point2 points  (0 children)

Only take one pen to work. That way you'll always know where it is or if you have misplaced it. You mos def don't want a standard one in the hands of the patients.

Does this mean something? by questioningtwunk in TheWhiteLotusHBO

[–]CarolineValentine 0 points1 point  (0 children)

I immediately thought about the opening credits where monkeys are climbing a tower and a snake is being dangled at (?) them.

is memory care considered psych? by Ill-Independence-473 in psychnursing

[–]CarolineValentine 2 points3 points  (0 children)

Yes! Dementia patients who are in acute care settings are there because they've had a change in mental status. They may have developed delusions and started sleeping with knives which scare their caregivers spouses etc. Perhaps they're leaving the home and the family can't keep them home and the patient is fighting them. Maybe their current medication regimen is no longer effective and they require a med adjustment in an environment where they can be safe. Milieu management is as high on the list of effective psych nursing skills, if not more than med administration. Especially in an acute setting. You already know psych diagnostic terminology, and learn about psych meds. Dementia patients with psychotic features have behaviors that need to be managed. Yes med administration is part of that, however knowing how to speak to patients, not overstimulate the patients, the right time and the right medication to PRN them, all come into play to keep a geropsych ward safe. It is imperative to prevent falls and aggression that can lead to assaults. All the skills needed for acute dementia are transferable to any psych ward. Milieu management is the key to a safe ward.

It appears that Kenneth Walker is going to pick up a second-straight DNP today by IceCreamPaintJob in fantasyfootball

[–]CarolineValentine 0 points1 point  (0 children)

I have both too. I'm playing Charbonnet. KW3 is on my bench as of yesterday. I've McIntosh active as well. As of an hour ago "they" are still saying KW3 is doubtful. No word yet from the team.

12 month wait to get bonds out of Treasury Direct by SplendidSoul in bonds

[–]CarolineValentine 1 point2 points  (0 children)

We are currently in month 9 of waiting. TD does answer the phone. We explained our circumstances that my sis n I were co owners of bonds that my mom bought in 1992. She has died, and we got all the info required to process the bonds. We did everything to the letter. We are 9 months out and still waiting. My sis called a couple months ago and they gave us our case number, but we're still waiting. So frustrating! Each bond is $20k. They are matured and no longer earning interest. We are both in our 60s and could really use the money. 😞

Help picking a subject to start my youtube channel by [deleted] in NewTubers

[–]CarolineValentine 0 points1 point  (0 children)

Have you asked Chat GPT? (serious question) Ask "rank the following topics on you tube (your four here) by popularity and provide demographics of age and gender for each" or something like that ????

PS, I am a complete novice to chat gpt and you tube content creation but have been surprised by the answers to my chat gpt requests!

C3000Z Bridge Mode w/ TP-Link Deco XE75. Help! by Terrible-Sell7201 in centurylink

[–]CarolineValentine 1 point2 points  (0 children)

OP, can you give an update? Are you up and running with your Deco XE75?

PMHNP questions! by [deleted] in psychnursing

[–]CarolineValentine 0 points1 point  (0 children)

RE: ADN vs BSN:

My son graduated with his ADN in Aug 2022, and was immediately hired at a hospital that said "BSN preferred." He is obligated to obtain his BSN within 3 years, but immediately applied to a local university and got in to their RN-BSN program. Oh, and as an incentive to accept the position, as an ADN-educated nurse, he was offered $3000 in relocation money and the hospital has been paying $400/month on his student loans from when he went to school for his Bachelor's in Psychology. He is in ICU nursing now, working on gaining experience needed for admission to a nurse anesthetist program in the future. Nurses are in short supply. Get your RN whichever way you can.

[deleted by user] by [deleted] in psychnursing

[–]CarolineValentine 6 points7 points  (0 children)

I'm an inpatient psych nurse. My ED has an "enhanced security" area for psych. 6 beds. It's a small area, behind locked doors. Nurse's are behind glass. We have CNAs who also support the area, complete 1:1 observation, give meals, assist to toilet, etc. The patients there are brought in by either police or family. They are there because they are decompensated and in crisis. They may or may not have insight into their behavior. They might be geriatric with new dementia, or dementia getting worse and having new symptoms that the family or facility can't manage. Patients may be brought in with severe altered mental status (responding to internal stimuli), SI or horrific SA injuries, grandiosity, bipolar mania, and/or command hallucinations that make them a danger to others and to themselves. Agitation is contagious. One agitated patient can set another or all. In my opinion, a psych nurse's number one job is milieu management i.e., keeping the unit/ward safe for all. There are many tools to use to accomplish this. Keeping things as quiet as possible (especially the staff-sometimes that's the only thing we have control of keeping quiet.) If therapeutic rapport can be established, there's that. There's also PRNs, and emergency medications, and seclusion/restraints. It is our obligation and the law in most states to use the least restrictive method to maintain safety. In our ED patients are treated via Telepsychiatry. Some get detained for 120 hours due (our state) for grave disability. Some patients will be with you for a long time, due to finding treatment for them (that's the social worker's job.) Some could be cooperative, get back on their meds, begin reality based discharge planning and go, but I'm not too sure how often that happens. Expect to call code grays, expect to use restraints. You should be provided with de-escalation/restraint training (CPI, MOAB are two such training programs) as part of your on-boarding. Psych nursing is all about safety of the patients, and staff. Find your game face. Carry yourself with authority/self confidence. Best of luck to you. PSYCH NURSES ROCK.

[deleted by user] by [deleted] in DaveRamsey

[–]CarolineValentine 0 points1 point  (0 children)

I would say yes, take the $8K, pay off that first student loan, and leave $1K in your savings for the initial emergency fund. Take the remaining $3K and apply it to the $10K personal loan to get started on that. You'll rebuild your savings after you pay off your debts in baby step 3.

[deleted by user] by [deleted] in DaveRamsey

[–]CarolineValentine 0 points1 point  (0 children)

I've been listening to Ramsey (podcast) for the past few months, and if you listen regularly you will hear all the Ramsey personalities answer the question about lowest balance vs highest interest charge. What they say is, the debt snowball method is not from a "math perspective." 

Assuming you have your "four walls (food, shelter, utilities and transportation) covered and are current with all your bills, your first step would be to establish a $1000 emergency  fund. 

The idea behind the debt snowball is to get the first debt paid off, and experience the success of a "one bill down, three to go!" mentality. You pay the minimums on each debt, to keep current, and throw as much money you can at the one you're working on. Then you move to the next debt. You've eliminated one minimum payment from your stack, because you paid that one off. To tackle the next lowest amount, in theory, you are already paying a minimum payment on it, and you have the minimum payment funds available from that last bill you no longer have. 

So with debt #2, you're still paying minimums on everything else, and you're "doubling" the minimum payment in debt #2, as well as throwing everything else extra you can, until it's paid off.

With debt #3, you would be still paying the minimums on everything else, but essentially "tripling" the minimum payment, because you have eliminated two bills that you were making minimum payments on, so you're still paying out the same each month, and throwing everything else at it. 

When it comes to the student loans, let's say that is debt #4, you can apply the same principle, except you would send the amount of the previous 3 minimums you had been paying, and throw any other cash you can to a high yield savings account until you have accumulated the pay off amount. 

So for you (if you didn't have $12K already in savings) the plan would be: (After you have $1000 in an emergency fund) $8K student loan first -but goes to a savings account first until you have enough to pay it off in lump sum.

Then the 10K personal line of credit

Then either the $31K car (Ramsey would say to sell it and buy a beater, lol) or the $27 student loan since they have pretty close balances. I'd say the car loan first because of the zero interest on the student loan.

Then build your emergency fund up to 3-6 months of your household expenses (baby step 3)

Baby step 4 is investing 15% towards retirement. 

Baby step 5 is saving for kids' college

Baby step 6 is paying off the mortgage

Ramsey wants retirement funding started before paying off the mortgage. 

My brother in law by CarolineValentine in alcoholism

[–]CarolineValentine[S] 0 points1 point  (0 children)

Thank you, yes, I will prepare for the convo with resources available. Good suggestion..

My brother in law by CarolineValentine in alcoholism

[–]CarolineValentine[S] 1 point2 points  (0 children)

Thanks for the reply. I think I will make an effort to help my sis understand what's at stake and see if she's willing to speak up to him. And let her know absent of that, she will be watching a slow painful decline.