Hey all! So I'm a BSN RN (Bachelor of Science in Nursing) that I obtained from UT Health Science Center in San Antonio and also an LCDC (Licensed Chemical Dependency Counselor) which in Texas only requires an Associates/60 credits, and a pretty rigorous internship.. about 50 weeks working 40 hours a week. I did it in between my sophomore and junior year of university. I went to UTSA (University of Texas at San Antonio) for my pre reqs and then did my LCDC, then got my BSN, which I was able to use some of my residency hours being both an LCDC and nurse, and now I live in Austin and work as a nurse at the ER/ICU at one of only two level one trauma centers here, and work as an LCDC/nurse (well, just administering injections and giving pills) at a mental health hospital/rehab. I work 3 days a week at the ICU, 12 hour shifts, and then 3 days at the mental health hospital, one 12 hour and two 8 hour shifts.
Where I work, our ICU appoints one BSN or higher nurse per two patients at all times, and sometimes a nurse per patient in more extreme cases, and sometimes a whole team. Once I delivered a baby to a woman in the ICU who came in from a critical wreck. She had two surgeries and was recovering, she was on IV Diauloded .4mg/15 minutes (which is a lot, yes... but we usually do .6/10 mins!) and she was stable. We did have to reluctantly give her some Lorazepam so she was about sedated. Due to her injuries, she didn't have cramps or anything. Suddenly she's yelling and saying "this baby comin out I swear check it up" (exact words lol) and I ran, and that baby was coming quick. Grabbed a blanket to catch it, caught it, let the mother cut her own embelical cord, and the doc and other nurses sent baby to maternity area for awhile. We then temporarily gave her a one-time 18mg Morphine IM and then every 2 hours an 8mg as she was injured in that area as it was. Plus she had her Diauloded.
I love my job at the ICU. I've seen multiple people die, including completely randomly, I've had gang members in there who we had to lock and they'd go nuts, I've seen many car wrecks, etc. But despite some of the cruel things I've seen, (children dying in front of their mothers, someone dying naturally and can't breathe and just dies, husbands with their wives who have broken bones everywhere and are hard to look at, children seeing parents without being able to touch the bed because they just had reconstructive surgery, even once a brutal rape that was also a beating and a woman whose eyes were so sore, was crying, wanted to bathe and felt ashamed, it's hard. But there's so much good too. The teenager who gets in a car wreck and look horrible. You find out 6 months later that they are healed. Someone who went into cardiac arrest, we find out their heart is under control, the person who had seizures sporadically, they found out what it was, the woman who is told she has a week to live, thinks she is dying as she gets really sick, and lol and behold, a night later she's out. We learn months later she actually beat the cancer!
At the mental hospital... let's just say that the only reason I work there is because I have a heart. It's very understaffed especially in the medical division. We have plenty of counselors there during the day, enough specialists and psychiatrists, enough "security" aka folks who will hold you still when you become enraged, but at night, which is when I work, we have only one therapist... who has to deal with all kinds of sudden events as well as admissions. An RN Nurse must work admissions and nurses are constantly having to do admin work and billing. In fact, when I'm working, I'm the only LCDC there and at least for the night, I'm in charge of getting to know why someone went to detox, the doctor comes in and I tell doc what's going on, then doc tells patient hi, and we start detoxing if one has withdrawals, and if anyone has a question from detox, since I'm the LCDC, I usually take care of that while the therapist takes care of MHMR. I also usually advise a taper plan with the doc lmao! I have gotten to know routine. After that process, I usually have to administer nightly meds to MHMR and help them with anything. Usually another nurse will be in MHMR while I'm
In detox but when I'm finished with detox, I run MHMR too. As a mental hospital, I'd say at least 4 times a night we have to sedate someone for going crazy. I always keep 2 shots of Versed on me.
I am really happy about this mental hospitals new benzo tapering program though! It's basically the Ashton Manual. After leaving rehab, they still have to taper. But they go to their pharmacy every 3 days and get meds. They come once a week to facility, twice a week probably every 3 times for random drug test, but we check on them, drug test whether random or not, and we let them taper comfortably. I love this policy.
So that's my work! I may have to cut back on hours because I've had chronic pain for 7 years but now it's getting too bad, but time will tell.
As for why I went into nursing, I did so because I'd like to be a nurse practitioner and still want to be! I just don't know if I want to be a family NP or specialist. I love the medical field and I love helping others.
As for why an LCDC? Well, I took my prereqs but for school I was taking lots of loans. The LCDC program internship was *paid!* Only $25k/year but still. I also was a drug addict and knew I could understand better. So I got licensed for that and worked at Methodist Transplant in San Antonio while I was getting my nursing degree. Now for the Masters!
I graduated university in 2014. Started working in the ER for a prominent hospital here. Eventually moved primarily to ICU. Chose to work at mental hospital as it just opened a detox center and I wanted to engage in that. In a way, the ICU keeps me so busy that at the mental hospital I'm chilling, but at the same time, the opposite often occurs! In the ICU I'll admin meds to someone every 4 hours, I'll check vitals, but both folks I'm watching in ICU are sleeping. Then at mental hospital, mom brings in hysterical meth addicted 15 year old who will not be silent and whom I can only put in isolation because mother was there when we spoke of sedating and mother says no. So I have to go talk the whole time. They are on meth.. I'm talking a lot!
I'm probably going to leave the mental hospital and go to another one as we don't offer methadone as a solution at our rehab and for alcohol abuse we just use Valium. We used to taper folks off benzos in ways I hated so much I almost lost my job over it. As one who has tried getting off benzos 6 times, only one from cold turkey, who spent 8 months tapering and still had a seizure, had a seizure every time I tried to get off, suffered horribly, I think tapering from benzos is not something we should even decide on how big the cut or when, just as long as something is happening. They're starting to give out Gabapentin as if it's a benzo and it's harming our patients, with me having to hear others suffer. We never have patients leave with more than a qty 20 supply of a benzo with only one refill - in 2 months. We should however expect that in the setting we are in, these folks are experiencing critical times, and may need benzos-and justifiable!Theres no other anxiolytic like benzos so sorry, but reality is that we must use them. You can't talk about changing pain management prescribing habits without talking about your alternative plans to help - same with anxiety!
ANY OTHER FOLKS IN MY FIELD HERE?!
Where I work, our ICU appoints one BSN or higher nurse per two patients at all times, and sometimes a nurse per patient in more extreme cases, and sometimes a whole team. Once I delivered a baby to a woman in the ICU who came in from a critical wreck. She had two surgeries and was recovering, she was on IV Diauloded .4mg/15 minutes (which is a lot, yes... but we usually do .6/10 mins!) and she was stable. We did have to reluctantly give her some Lorazepam so she was about sedated. Due to her injuries, she didn't have cramps or anything. Suddenly she's yelling and saying "this baby comin out I swear check it up" (exact words lol) and I ran, and that baby was coming quick. Grabbed a blanket to catch it, caught it, let the mother cut her own embelical cord, and the doc and other nurses sent baby to maternity area for awhile. We then temporarily gave her a one-time 18mg Morphine IM and then every 2 hours an 8mg as she was injured in that area as it was. Plus she had her Diauloded.
I love my job at the ICU. I've seen multiple people die, including completely randomly, I've had gang members in there who we had to lock and they'd go nuts, I've seen many car wrecks, etc. But despite some of the cruel things I've seen, (children dying in front of their mothers, someone dying naturally and can't breathe and just dies, husbands with their wives who have broken bones everywhere and are hard to look at, children seeing parents without being able to touch the bed because they just had reconstructive surgery, even once a brutal rape that was also a beating and a woman whose eyes were so sore, was crying, wanted to bathe and felt ashamed, it's hard. But there's so much good too. The teenager who gets in a car wreck and look horrible. You find out 6 months later that they are healed. Someone who went into cardiac arrest, we find out their heart is under control, the person who had seizures sporadically, they found out what it was, the woman who is told she has a week to live, thinks she is dying as she gets really sick, and lol and behold, a night later she's out. We learn months later she actually beat the cancer!
At the mental hospital... let's just say that the only reason I work there is because I have a heart. It's very understaffed especially in the medical division. We have plenty of counselors there during the day, enough specialists and psychiatrists, enough "security" aka folks who will hold you still when you become enraged, but at night, which is when I work, we have only one therapist... who has to deal with all kinds of sudden events as well as admissions. An RN Nurse must work admissions and nurses are constantly having to do admin work and billing. In fact, when I'm working, I'm the only LCDC there and at least for the night, I'm in charge of getting to know why someone went to detox, the doctor comes in and I tell doc what's going on, then doc tells patient hi, and we start detoxing if one has withdrawals, and if anyone has a question from detox, since I'm the LCDC, I usually take care of that while the therapist takes care of MHMR. I also usually advise a taper plan with the doc lmao! I have gotten to know routine. After that process, I usually have to administer nightly meds to MHMR and help them with anything. Usually another nurse will be in MHMR while I'm
In detox but when I'm finished with detox, I run MHMR too. As a mental hospital, I'd say at least 4 times a night we have to sedate someone for going crazy. I always keep 2 shots of Versed on me.
I am really happy about this mental hospitals new benzo tapering program though! It's basically the Ashton Manual. After leaving rehab, they still have to taper. But they go to their pharmacy every 3 days and get meds. They come once a week to facility, twice a week probably every 3 times for random drug test, but we check on them, drug test whether random or not, and we let them taper comfortably. I love this policy.
So that's my work! I may have to cut back on hours because I've had chronic pain for 7 years but now it's getting too bad, but time will tell.
As for why I went into nursing, I did so because I'd like to be a nurse practitioner and still want to be! I just don't know if I want to be a family NP or specialist. I love the medical field and I love helping others.
As for why an LCDC? Well, I took my prereqs but for school I was taking lots of loans. The LCDC program internship was *paid!* Only $25k/year but still. I also was a drug addict and knew I could understand better. So I got licensed for that and worked at Methodist Transplant in San Antonio while I was getting my nursing degree. Now for the Masters!
I graduated university in 2014. Started working in the ER for a prominent hospital here. Eventually moved primarily to ICU. Chose to work at mental hospital as it just opened a detox center and I wanted to engage in that. In a way, the ICU keeps me so busy that at the mental hospital I'm chilling, but at the same time, the opposite often occurs! In the ICU I'll admin meds to someone every 4 hours, I'll check vitals, but both folks I'm watching in ICU are sleeping. Then at mental hospital, mom brings in hysterical meth addicted 15 year old who will not be silent and whom I can only put in isolation because mother was there when we spoke of sedating and mother says no. So I have to go talk the whole time. They are on meth.. I'm talking a lot!
I'm probably going to leave the mental hospital and go to another one as we don't offer methadone as a solution at our rehab and for alcohol abuse we just use Valium. We used to taper folks off benzos in ways I hated so much I almost lost my job over it. As one who has tried getting off benzos 6 times, only one from cold turkey, who spent 8 months tapering and still had a seizure, had a seizure every time I tried to get off, suffered horribly, I think tapering from benzos is not something we should even decide on how big the cut or when, just as long as something is happening. They're starting to give out Gabapentin as if it's a benzo and it's harming our patients, with me having to hear others suffer. We never have patients leave with more than a qty 20 supply of a benzo with only one refill - in 2 months. We should however expect that in the setting we are in, these folks are experiencing critical times, and may need benzos-and justifiable!Theres no other anxiolytic like benzos so sorry, but reality is that we must use them. You can't talk about changing pain management prescribing habits without talking about your alternative plans to help - same with anxiety!
ANY OTHER FOLKS IN MY FIELD HERE?!
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