Learning about Policy & Politics in a PMHNP Program

The education for becoming a psychiatric-mental health nurse practitioner is not limited to the obvious role of the ARNP. Last fall, I completed a health policy, economics, and politics course at UI. It was really great timing for the course, with the election process happening. And my education was enhanced at the APNA conference where the keynote presentations included information about policies related to the mental health field, and I met some ARNPs who have been very politically involved. When I entered the PMHNP program, I did not realize the importance of being active in understanding and participating in policy shaping and politics like I am coming to appreciate. 

(Iowa State Capitol in Des Moines in August 2009)

The reason I bring up this topic is that I will be spending tomorrow in Des Moines with many of the nurse practitioners from across Iowa for a Legislative Day. I anticipate this will be a great opportunity to learn about current local & national legislative issues and about lobbying. In the afternoon, I will join Iowa ARNPs in meeting with legislators at the State Capitol building. Being from a family where politics were not discussed, I've got an awfully steep learning curve, and I am hopeful that the more I am exposed, the easier it will come!

I am curious to hear from you - how have you been politically active in nursing and mental health? What do you see as our role as psych/mental health nurses?

Cheers!

~Bonnie

Back from the Other Side of the World

I'm back now from a wonderful month India and am adjusting to the cold midwest winter. Aside from enjoying my husband's side of the family and soaking in India's amazing culture, I was on the look-out for issues related to mental health while I was on the other side of the world. I'd heard that mental health & illness are not really talked about much in Indian culture; however, I saw a few things that make me think the information is out there. Perhaps it's just not a topic people talk about much. I did see some newspaper articles about suicides in Mumbai while I was there and, in response, some psychiatry med students making a group "no suicide" contract. I don't recall reading news articles in the USA that describe how a person died by suicide.

I wasn't sure what to expect with being in Mumbai so shortly after the 26/11 attacks. I thought I may read or hear something about people dealing with post-trauma responses. I was surprised that I did not. However, when visiting the Gateway of India, right next to the Taj Hotel, I saw this sign: 

The psych nurse in me just had to have a photo. I was tempted to call the number to inquire about how these services were being utilized. I remain curious...

Oh, how the days disappear...

I'm taking a short break tonight from what is becoming my heaviest academic semester. I keep reminding myself that I really do love this type of stress - finishing clinical practicum hours, papers, group projects, and all those other great parts of being in a PMHNP-graduate program! Despite the heavy load, I have taken some time to enjoy a couple extra-curricular things that I'd like to share with you.

I had the opportunity to attend a presentation here in Iowa City in mid-November that was truly moving - Jerry Friedman, a photographer and author, discussed his book "Earth's Elders: The Wisdom of the World's Oldest People." Friedman has travelled around the world, listening to the stories of dozens of supercentenarians, people who have lived over 110 years. It was fascinating to hear him describe some of the experiences of these individuals - their humor, faith, optimism, and the importance of their families. I feel honored to share my time with any elder, particularly those I have seen in the nursing homes this semester. And I got the sense that Friedman feels the same way about these supercentenarians! Have you seen this book? Or heard Friedman speak? I'd like to hear :)

Another neat thing that has happened since my first post is that I prepared and presented two lectures for nursing students in the Psychiatric/Mental Health Nursing course at UI. Before doing this as part of my Teaching Assistant role, I don't think I fully appreciated the time and energy that a professor dedicates to this component of the job! I loved sharing some of my knowledge and experiences with the class, and I was thankful for the insightful questions the students asked. My excitement and enjoyment in teaching just these two classes has me thinking more and more that I'd like to continue doing these types of things!

It is nearly every day that I consider something I learned or experienced at the APNA Conference... Today, my thoughts turned to how thankful I am to have had the opportunity to attend the Conference. As I am swamped with classes (and packing my bags for India), I think of all the psychiatric/mental health nurses I met and of all the hard work they have done. And I hope I'm on a similar path to becoming one of those great leaders.

Cheers!

~Bonnie

Hi! My name is...

With an introduction like that, how could I decline this opportunity to try my hand at joining my passion for psych/mental health nursing with blogging? Especially considering the impact the 22nd Annual APNA Conference had on me, something I certainly intend to share with you in coming posts.

So, who the heck am I, that graduate student in Iowa referred to in the previous post? My name is Bonnie D'Souza, and I'm enrolled in the Psychiatric-Mental Health Nurse Practitioner program at the University of Iowa. While I've been a nurse for just over 3 years now, my heart has been in psych nursing for much longer than that. I went into my BSN program at Lewis University with a strong suspicion of my future specialty and am intensely satisfied with how my interest has grown. My particular interests lie in geropsychiatric nursing, end-of-life and bereavement, and research.

Thinking in true Wheel-of-Fortune-style introductions... :) I've been with a wonderful man for 6+ years and married him 2 1/2 years ago. He grew up in India, and we're planning to travel there this winter. We don't have children yet but are hopeful to someday. When I'm not glued to my text books and computer for classes, I love to spend my time baking, drinking coffee, reading, wandering bookstores & libraries, and playing photographer.

(The graduate student APNA-Janssen Scholars - Thanks to Pat for taking this!)

I am one of the 30 individuals honored this year with being selected as an APNA-Janssen Scholar. Hopefully, you will be hearing from a couple of them on this blog throughout the year! A large part of that award was having the opportunity to attend the APNA 22nd Annual Conference in Minneapolis a few weeks ago. This was truly a wonderful experience, one that allowed me to meet and spend time with some of the leaders in psychiatric/mental health nursing. I'm not just referring to the keynote speakers and those who gave presentations or had posters, but all those nurses I met in the elevator or sat next to at the concurrent sessions. And how can I not mention the other APNA-Janssen Scholars? This group of nurses and future nurses, my peers, who are so bright, interesting, and talented. I have no doubt that our generation will continue to bring these qualities to psych/mental health!

I am looking forward to blogging over the coming year. I hope to share with you some of my experiences, thoughts, and questions as a young nurse in the PMHNP program. But it doesn't stop there - I also want to hear from you. What are your experiences and insights? What do you wonder about? It's in the coming together that we can accomplish powerful things!

You can begin by commenting on this first post - how neat is it that two of the people who comment on the first post will be selected to receive a book! That's great! I'd do it!!

Cheers!

~Bonnie

New Year, New Blogger & some Blog Candy

We've just wrapped up the APNA 22nd Annual Conference. This was our most successful conference to date with over 1,000 attendees. We are working on convincing a graduate student in Iowa to take over the blog for the year. Her enthusiasm is infectious and her insight into psych nursing and the world around her is eye-opening.

Hopefully, we will see her first post soon. Please welcome her and subscribe so you can get her latest posts. Also, don't forget to leave comments. We will randomly pick 2 people who comment on her first post to received the new book Carved in Sand.

Last Blog

My blogging for APNA is at an end. Hopefully the tradition can continue. Each year more and more nurses join APNA, increasing the ratio of members that are used to and familiar with online resources such as this blog. So this kind of thing should have a future. But without member participation it is quite difficult. This lack of participation is normal in the first year of any endevour though.

In the last year, especially the last 6 months, I have been adding to my fund of knowledge more then ever before in psych. nursing. But sometimes it get's lonely in the office. And belonging to an organisation like APNA becomes essential.

I go now to the first pre-conference session here in the Twin Cities. I hope I will see you at the conference. Thank you for sticking with me the last year.

Peace, Gisli

APNA Conference in 10 days

Hope everybody is fired up for our convention. I am getting excited.

as we all know, it is not easy to get a psych nurse excited...

Plan to go to the sleep workshop. I find I am giving out Trazodone, Seroquel and other agents for sleep quite frequntly. I review the sleep hygiene points but sometimes the few minutes I spend on it seem to fall on deaf ears. Sometimes I probably don't spend enough time on sleep hygiene with clients. It is way easier to just write out a script, at least for me, in the short term.

I am hoping this seminar will keep me alert and on track.

See you there.

Fear

I am getting somewhat used to practicing on this new level I find myself on. Still there is fear. Fear of failure, fear of not knowing enough, fear of harming others through my negligence, fear of litigation, loss of reputaton, etc.,etc.

The solution to my fears is simple, but not easy, at least not for me.

I accept what can happen can happen, although it as not as likely as the script writer of the acopalypse that sometimes occupies my brain makes it out to be, in his finer moments. By fully accepting the worst case scenario I am released from my fear.

Then I simply do my best one day at a time.

Most good ideas are simple, in my experience, at least to the person having them...

Benzo's, what are they good for, uhh.......

I guess I am a bit biased when it comes to the blessed benzo's. Cynical after my CD inpatient experience. Detoxing of heroin is a walk in the park compared to getting off long term benzo use. I have heard suggestions from psychiatrists I respect that it takes up to two years to detox properly from them. I have not found any research that supports this claim though.

I guess they can be helpful, short term, e.g. post trauma or prn occasionally, for people with no substance abuse history. But too many good people are being left too long on them. They become physically, and more importantly, psychologically, dependent on them. They are convinced "nothing else is going too work".

Being trigger happy with this drug category is a dangerous game. Usually other psychotropics can be found that serve the same purpose. Not to mention non-pharmacological approaches.It is frustrating to see people left on these meds. for years, with limited or no attempts to find other avenues to address the target symptoms.

My final analysis: Useful in certain circumstances, but should be prescribed with caution. Can solve provider/pt. short term dilemma's only to create much bigger ones in the future

Yibbiiii

Good news, at least for me...

Took and passed my certification test last Wednesday. Good to be able to find out right away like that, reduces anxiety, I am sure everybody around me is glad too.

Was unsure how I was doing when I was taking it. Had to answer 175 questions in 3,5 hours. Had 15 minutes left to review questions. A long test. A lot of questions.

Guess you had to have grad school work to pass it. Not a lot of facts, more focus on understanding. This is good. As graduate education, at least the high quality one, should not be testing our cognitive functions and memory. A MMSE is sufficient for that. Graduate education is supposed to help create a mind capable of critical thinking. So we can make the right decisions with the most current and reliable information available. After all information is always changing.

If any of you out there have yet to take the Adult PMHCNS exam and are about to this fall, do not hesitate to post questions here or send me an email at gislik@gmail.com.

I did feel though that ANCC takes too long sending out the Authorisation to test number. What is the hold up? This is not a government agency, the services are relatively expensive. They can't afford hiring one more person? Is the lack of competition making them complacent? Maybe there is a reason for this I am not seeing?

Other services from ANCC were excellent, but the delay remains strange.

I am back

I plan to post 1-2 times a week from now on. Summer vacation is over: playtime is over;)

I am now working as a mental health professional. Will hopefully be fully credentialled soon. Pressure is mounting at work as I am feebly building up trying to assume my future expected case load.

I must say I feel a bit rusty after my time off. I am trying to be tolerant towards myself. Allow my self to feel overwhelmed and anxious for now: "This is normal, for a while at least..."

Psychiatry is no easy business, as we all know all too well.

Staying focused on today and the present moment, and the client in the moment really is helpful.

I do admit that I spend way too much time in the court room, mentally that is. Maybe it is because I am a foreigner, not used to a litigious society. Maybe just because I am a new practitioner. Or maybe just because I am a "nervous Nelly"?.

I know it is quite useless fretting about the future, but I give it a shot regulalry just for the heck of it...;)

The true civilized world

Aðalvík


For those of you who read this blog, my apologies. Will be in the good company of mountains and the sea here in Iceland for a while.

I am boldly going now to a place I know well, no phones, no internet. Just seagulls, high mountain passes and the occasional pissed off polar bear.

Will post again next week as I return to, what we sometimes, for obsucure reasons, refer to as civilization.

Summer

Hope you have some vacation time coming...

Until the next time, enjoy the weather

APNA conference

The 22nd APNA annual conference will be in my beautiful home town of Minneapolis the days October 15-18, 2008 at the Hyatt Regency Minneapolis

Minneapolis is beautiful in the fall. Not too cold, not too hot. All the leaves turning yellow and gold. A nice peaceful spirit over the city. You won't regret coming here.

Be in touch if you want any "insiders tips" on what to do here. Although I have only been here for two years there are certain things I am catching up on.


See the this link or the link on the right for more info

Sign up now

See you there!

Self Care

Just got back from a weekend long stay at a hermitage. Observed the caged monkey (my mind)jump around a little bit. Took walks, worked out, slept.

This is one form of self care. A kind that works for me, among various other things of course.

Other things work for other people.

General self care approaches are things like adequate sleep, exercise, spending time with family and friends, dancing, spiritual practices like prayer and meditation, healthy eating habits, tolerance towards own imperfections, etc.

We who work in this business have, I feel, a moral duty to take good care of ourselves. After all, we are the tools we work with, and our work will only be as good as our condition allows it to be.

That does not mean, I feel, that we should be perfect. It just means that we owe it to our clients to do our best to keep "fit" both spiritually and mentally. That we try, in our beautiful flawed human way to be sharp and well polished instruments.

Self care is not self-ish. What is selfish is neglecting self-care. It not only precipitates rust-out and burn out, it also hinders us to be of service to those we wish to serve.

What works for you?

Have you done that lately?

If no, why not?

working guy

These are strange days.I have graduated from my program and have started working.

I am not yet certified in my field so I cannot prescribe meds yet.

I can however work as an APRN for six months after I graduate while in this delightful process of being certified. See the Minnesota Board of Nursing website

What that means for what I can do is unclear though. It seems I can legally perform as a P/MH CNS minus the prescribing. But nobody is willing to reimburse my employer until I am certified, and credentialed.

I naively thought this clause was put in the statute so we could practice right after we graduated...

If anyone out there has experience practicing in this strange twilight zone any feedback would be appreciated.

Mental health and scandals

Two scandals regarding mental health related facilities have been revealed in the media recently in Iceland.

One is regarding a Christian based substance abuse facility, where the "minister" and head of the facility was convicted for having sexual relations with a number of his clients. Sexual relations of the sort that would be deemed highly unorthodox by most. This facility was run, in large part, on government contributions which make this horrendous betrayal of trust even more serious, if possible.

The other scandal involves the chief physician at the only long term psychiatric forensic facility in Iceland. He has been issuing scripts for stimulants on names of patients who have never received such medicine, and then had an accomplish retrieve them from various pharmacies. This offense is further exacerbated by the fact that these false scripts were written out for some of the most vulnerable individuals in our society e.g. convicts.

Could this happen in any other field of health care?

Perhaps.

But the fact remains that these things seem to happen more frequently in our field than other fields of health care.

Are the standards for mental health care lower? Is there less regulation for these kinds of facilities? Could it be that there is still stigma in the community, and that is reflected in this lack of oversight?

Mental health services in Iceland

"Kleppsspitali", the biggest long term mental health care facility in Iceland, his role is changing, perhaps too slowly?



We enjoy universal health care coverage in Iceland. We have one of the lowest infant mortality rates and the highest life expectancy rates in the world. But we still have a lot of problems in our health care system, like anywhere else in the world.

This is especially true for our mental health care system. Talk of moving the bulk of the services into the community is common, but practical action is slow to take place. We have started taking some action. Experience from countries like Denmark and the UK help, and user groups make a strong lobby group with increasing numbers of celebrities and politicians stepping up to the plate and talking openly about their struggle with mental illness. This helps reduce stigma in the community and is empoering for other users.

Still we have a long way to go. There is hope. We see how we have built up a powerful substance abuse treatment field and attitudes towards substance abuse in the communiuty are rather healthy, I would think. That is a field were the users of the system took the initiative.

Perhaps that is the key for other areas of psychiatry as well?

No place like home

I am currently back in the "old country". Minnesota has a lot of cool things, but it does not have any mountains and it does not have an ocean near by. Both of which Iceland has in abundance.

I like mountains. They are good for looking at and walking on.
Here is one of my favourites.







I will tell you a little bit about nursing in Iceland later this week.

Graduation

Great things will occur in this building today



Today I graduate from the Graduate school of the University of Minnesota with an advanced practice degree in Psychiatric/Mental health nursing.

This is excillerating and scary at the same time.

My main goal for my first year of practice is not to seriously harm anybody.

I will wait until my second year of practice to start changing the whole treatment paradigm of psychiatry... ;)