Nursing mental and adult
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Woah in no way did I suggest adult nurses were ever "superior". Every branch of nursing are worth their weight in gold and they all have their place. I stated that in an elderly mental health setting where the nurses are MH trained only, they really struggle to grasp the physiology side of nursing and don't understand co-morbidities. It's not all in my imagination, I've had plenty of elderly patients admitted from MH wards come in with trivial matters that could have been managed over there but the MH nurses don't have the knowledge or the skills to manage it. I have also heard accounts from my RGN friend who works on an elderly mental health ward who says the same thing but they also haven't really given her any extra training for the MH side of things.
It's the same on my acute DME ward. Practically all of our patients have dementia and/or delirium with acute medical problems. We are very adept at treating the medical conditions. We are also very good at looking after patients with dementia and managing their challenging behaviours but there is a lot we have got to learn and I think some of the girls would benefit in going on to do modules in mental health to gain a better understanding of how mental health conditions affect the elderly, how the psychiatric medications impact on the elderly and the risks of using them. Not just AP's and benzos increasing risks of falls etc. but things like SSRI's causing chronic low sodium and the effect of lithium on the kidneys etc.
You are also right in saying that adult nurses aren't great in some things. We could be a lot better at non verbal communication, and it's not an excuse but on an acute hospital ward such as mine you don't often get enough time to sit down properly with the patient so we do a lot of anticipation. We can pretty much tell if somebody wants the toilet, is in pain, wants to go to bed, wants something etc. And in all honesty in my nursing career I have only ever come across 1 patient that needed to communicate via sign language and her dementia was so advanced she barely used sign language anyway. We are in the middle of a project to completely overhaul the way we care for our elderly patients which is going to be costly to the trust but it involves changing the environment and hiring staff who will be non clinical (but have clinical backgrounds) to spend time with these patients and their families, stimulating them, running activity groups and physio groups. I also hope they will send some of the nurses on MH related modules. I myself teach a dementia module but I was never given any time off the ward to do this.
There's certainly things I could not do as a nurse. You couldn't just throw me onto a children's ward because I would have no clue what to do. Just like you wouldn't throw a children's or MH nurse straight onto an acute medical ward. There's even specialities within each branch that have specialist training and knowledge. For example you couldn't just throw me into somewhere like CCU or ICU. I wouldn't even know where to start. We have had patients sectioned on the ward to be tube fed and medicated and I felt really out of my depth dealing with it because the MHA is not really in my expertise, but it couldn't be managed on a MH ward because the nurses were not NG trained so it had to be done in the acute hospital.
There are definitely fields of nursing where dual training would definitely be helpful and I think DME and Psych/Geri wards are definitely those areas. From what I understand from some of my children's nurse colleagues they are also getting many young people sectioned under the MHA and end up stuck on acute children's wards for months because there are no paediatric/adolescent beds in the country and they struggle to manage their behaviour at times so that is also another area that could benefit. There are probably other areas too where different specialities cross over. It's not a criticism of any one or any speciality because we all have our strengths and weaknesses, but nursing is changing, our population is changing and we face many more complexities. My ward has changed drastically in the 4 years I have worked there. Yes, we have always had patients with dementia who would wander, become aggressive etc. But it didn't used to be nearly all 28 of them. So I do think there is a need for us to expand our skills and knowledge to give our patients the best possible care.
Btw, we only use pumps on our ward unless we have a solution that needs to be infused carefully as the medicine could potentially be fatal if they infuse too quickly (patient unbends arm and position of arm changes which can speed up the infusion if infusing with gravity). So solutions such as high concentrate potassium, magnesium, phosphate and continuous infusions such as furosemide, GTN, sliding scale insulin, heparin etc. Those types of drugs require pumps so it's not that adult nurses can't work out the drip rates to infuse via gravity it's because the drugs are dangerous and need to infuse through the pump to ensure it is infused safely. We infuse most of our infusions via gravity unless the drug we are infusing is a high risk drug that does require a pump.
It's the same on my acute DME ward. Practically all of our patients have dementia and/or delirium with acute medical problems. We are very adept at treating the medical conditions. We are also very good at looking after patients with dementia and managing their challenging behaviours but there is a lot we have got to learn and I think some of the girls would benefit in going on to do modules in mental health to gain a better understanding of how mental health conditions affect the elderly, how the psychiatric medications impact on the elderly and the risks of using them. Not just AP's and benzos increasing risks of falls etc. but things like SSRI's causing chronic low sodium and the effect of lithium on the kidneys etc.
You are also right in saying that adult nurses aren't great in some things. We could be a lot better at non verbal communication, and it's not an excuse but on an acute hospital ward such as mine you don't often get enough time to sit down properly with the patient so we do a lot of anticipation. We can pretty much tell if somebody wants the toilet, is in pain, wants to go to bed, wants something etc. And in all honesty in my nursing career I have only ever come across 1 patient that needed to communicate via sign language and her dementia was so advanced she barely used sign language anyway. We are in the middle of a project to completely overhaul the way we care for our elderly patients which is going to be costly to the trust but it involves changing the environment and hiring staff who will be non clinical (but have clinical backgrounds) to spend time with these patients and their families, stimulating them, running activity groups and physio groups. I also hope they will send some of the nurses on MH related modules. I myself teach a dementia module but I was never given any time off the ward to do this.
There's certainly things I could not do as a nurse. You couldn't just throw me onto a children's ward because I would have no clue what to do. Just like you wouldn't throw a children's or MH nurse straight onto an acute medical ward. There's even specialities within each branch that have specialist training and knowledge. For example you couldn't just throw me into somewhere like CCU or ICU. I wouldn't even know where to start. We have had patients sectioned on the ward to be tube fed and medicated and I felt really out of my depth dealing with it because the MHA is not really in my expertise, but it couldn't be managed on a MH ward because the nurses were not NG trained so it had to be done in the acute hospital.
There are definitely fields of nursing where dual training would definitely be helpful and I think DME and Psych/Geri wards are definitely those areas. From what I understand from some of my children's nurse colleagues they are also getting many young people sectioned under the MHA and end up stuck on acute children's wards for months because there are no paediatric/adolescent beds in the country and they struggle to manage their behaviour at times so that is also another area that could benefit. There are probably other areas too where different specialities cross over. It's not a criticism of any one or any speciality because we all have our strengths and weaknesses, but nursing is changing, our population is changing and we face many more complexities. My ward has changed drastically in the 4 years I have worked there. Yes, we have always had patients with dementia who would wander, become aggressive etc. But it didn't used to be nearly all 28 of them. So I do think there is a need for us to expand our skills and knowledge to give our patients the best possible care.
Btw, we only use pumps on our ward unless we have a solution that needs to be infused carefully as the medicine could potentially be fatal if they infuse too quickly (patient unbends arm and position of arm changes which can speed up the infusion if infusing with gravity). So solutions such as high concentrate potassium, magnesium, phosphate and continuous infusions such as furosemide, GTN, sliding scale insulin, heparin etc. Those types of drugs require pumps so it's not that adult nurses can't work out the drip rates to infuse via gravity it's because the drugs are dangerous and need to infuse through the pump to ensure it is infused safely. We infuse most of our infusions via gravity unless the drug we are infusing is a high risk drug that does require a pump.
Original post by ButterflyRN
Btw, we only use pumps on our ward unless we have a solution that needs to be infused carefully as the medicine could potentially be fatal if they infuse too quickly (patient unbends arm and position of arm changes which can speed up the infusion if infusing with gravity). So solutions such as high concentrate potassium, magnesium, phosphate and continuous infusions such as furosemide, GTN, sliding scale insulin, heparin etc. Those types of drugs require pumps so it's not that adult nurses can't work out the drip rates to infuse via gravity it's because the drugs are dangerous and need to infuse through the pump to ensure it is infused safely. We infuse most of our infusions via gravity unless the drug we are infusing is a high risk drug that does require a pump.
I calculate drip rates all the time, in some cases it's more cost effective than using a volumetric set.
This is on ITU where we have all our shiny machines and high tech therapies.
Original post by ButterflyRN
From what I understand from some of my children's nurse colleagues they are also getting many young people sectioned under the MHA and end up stuck on acute children's wards for months because there are no paediatric/adolescent beds in the country and they struggle to manage their behaviour at times so that is also another area that could benefit.
From what I understand from some of my children's nurse colleagues they are also getting many young people sectioned under the MHA and end up stuck on acute children's wards for months because there are no paediatric/adolescent beds in the country and they struggle to manage their behaviour at times so that is also another area that could benefit.
I honestly can't even begin to say how big an issue this is!! I've spent time in places in those situations and its honestly awful. For patients and staff. And now some of the nurses are doing their mh top up.
But the staff just don't know how to look after them, but why would they??
Dunno why people would be offended like there's no reason why one branch would know everything that the others do otherwise you'd just have no branches and just generic nursing.
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Original post by moonkatt
I calculate drip rates all the time, in some cases it's more cost effective than using a volumetric set.
This is on ITU where we have all our shiny machines and high tech therapies.
This is on ITU where we have all our shiny machines and high tech therapies.
I agree and I calculate drip rates and use gravity where possible. Most things I run through via gravity such as ABX, paracetamol, blood and most IVI's including potassium (although it is in our trusts policy that if it's a 40KCL bag you need a pump if it's running at a rate faster than 8 hourly). I will also use a pump for things like magnesium and phosphate and other fancy things that I don't come across often. I will use a pump though if the cannula is situated in a precarious position especially as most of my patients are confused and elderly and are not very compliant with keeping their arm still. I am not so bothered about this for ABX and solutions like normal saline, dex saline and 5% dex but for blood and potassium I am because all it takes is for them to change their arm position and it can speed through (it does happen, the elderly and IV's are a bloody nightmare). At least most of your patients will be sedated and don't move which makes gravity a lot easier :P You also get nicer and bigger lines to use haha. Getting a pump in our hospital though is like gold dust :P
Original post by Swagio
I honestly can't even begin to say how big an issue this is!! I've spent time in places in those situations and its honestly awful. For patients and staff. And now some of the nurses are doing their mh top up.
But the staff just don't know how to look after them, but why would they??
Dunno why people would be offended like there's no reason why one branch would know everything that the others do otherwise you'd just have no branches and just generic nursing.
Posted from TSR Mobile
But the staff just don't know how to look after them, but why would they??
Dunno why people would be offended like there's no reason why one branch would know everything that the others do otherwise you'd just have no branches and just generic nursing.
Posted from TSR Mobile
I nearly got sectioned when I was 15. CAMHS wanted to section me but were brutally honest and told my parents that there were no beds and the nearest bed would be 200 miles away which really was not ideal. My parents begged them to take me home and manage with intensive community support and CAMHS reluctantly agreed. But I'm glad they did because I would have been stuck on an acute children's ward for god knows how long. There was no children my age on that ward and no one I could relate to. The staff didn't really bother with me. Not because they were horrible but because they were so busy looking after very sick children and probably didn't really know what to say to me and probably didn't feel skilled enough to even try. They were very nice and pleasant though and I never felt stigmatised by them however, but I understand that this is not always the case.
No single branch of nursing knows everything. I certainly don't and I'm certainly not perfect. I learn something new every day. But as I said before, many areas of nursing need more skilled expertise. I don't think that is a bad thing and not a criticism of those areas. I include my own speciality in this. It just highlights how complex patients are becoming now and that there is a need for further education and development.
From the looks of this discussion, you guys are nurses in the different nursing fields? If so, as someone who is unsure whether to become an adult or child nurse what would you guys recommend?
See I want to become a child nurse but then again being an adult nurse also seems appealing... so is there a chance for me to become an adult nurse and specialise in paediatrics or do I do the dual course?
Many thanks!
See I want to become a child nurse but then again being an adult nurse also seems appealing... so is there a chance for me to become an adult nurse and specialise in paediatrics or do I do the dual course?
Many thanks!
no one can say which is best for you. realisticly can you cope with sick and terminal kids. have you any practical understanding of the roles of rscn or rgn nursing adults is stressful caring for ill kids more so. if you opt for adults then it would be unusual but not impossible to switch specialities. before applying make sure you know what you want. you really must go into interview with a fix idea.
is it possible for someone to come up with pros and cons for both adult and child nursing?
Its really difficult to get the knowledge, there is no one with a helping hand and this is seems to be a better source of information than anywhere else.
Much appreciated
Its really difficult to get the knowledge, there is no one with a helping hand and this is seems to be a better source of information than anywhere else.
Much appreciated
me and the wife we prefer care of the elderly and community. why because its a neglected area. we experienced the work of sick childrens nurses as a number of our kids needed special care just after birth we could never do their work. it really comes down to you. do you like action constant change and challenge then a and e and such front line care is best. if you like to see a person from admission to discharge then none acute medicine maybe best. to learn what you could do go to your nearest hospital and speak to their volunteer department dont worry they will be used to future nurses and doctors looking for work experience a number of folks we know gained experience via the red cross. its a shame you need to pick your specialty at the start.
why do you want to nurse. you must have a reason to nurse. for example a number of mental health nurses have personnel experience of mental conditions its very individual
why do you want to nurse. you must have a reason to nurse. for example a number of mental health nurses have personnel experience of mental conditions its very individual
Original post by tashachelsea13
is it possible for someone to come up with pros and cons for both adult and child nursing?
Its really difficult to get the knowledge, there is no one with a helping hand and this is seems to be a better source of information than anywhere else.
Much appreciated
Its really difficult to get the knowledge, there is no one with a helping hand and this is seems to be a better source of information than anywhere else.
Much appreciated
I personally could not deal with dying/sick children. It's all personal preference. Not saying that dying sick adults aren't hard to deal with. But I have 2 small children. Mentally I just couldn't do children's nursing
Original post by tashachelsea13
is it possible for someone to come up with pros and cons for both adult and child nursing?
Its really difficult to get the knowledge, there is no one with a helping hand and this is seems to be a better source of information than anywhere else.
Much appreciated
Its really difficult to get the knowledge, there is no one with a helping hand and this is seems to be a better source of information than anywhere else.
Much appreciated
For example the girl I did my access with qualified last year as a children's nurse. Just 2 weeks ago she had to look after a 3 year old child and her parents who have just discovered she has terminal cancer. She said they where screaming with hurt and all she could do was cry with them. The story alone made me cry. I admire children's nurses immensely. The strength needed is something else
Thank you guys so much for this, it is much appreciated. This has given me a slight in site and made me consider my choice deeper than I have considered before.
Original post by tashachelsea13
From the looks of this discussion, you guys are nurses in the different nursing fields? If so, as someone who is unsure whether to become an adult or child nurse what would you guys recommend?
See I want to become a child nurse but then again being an adult nurse also seems appealing... so is there a chance for me to become an adult nurse and specialise in paediatrics or do I do the dual course?
Many thanks!
See I want to become a child nurse but then again being an adult nurse also seems appealing... so is there a chance for me to become an adult nurse and specialise in paediatrics or do I do the dual course?
Many thanks!
Just make it easy and become mental health instead 😉 (just kidding though!).
Hope you manage to work it out, although from doing lectures with adult and child as an outsider I can say what they have to learn seems very different and like us children's do a lot of adult stuff then our own area on top.
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hello!coming late to this! I believe colleges in northern ireland offer the 18 month option, if you are registered in one field of nursing you can do 18 months and become registered in 2 firlds! you prob have it done by now!
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