Latest Comments by hherrn

hherrn 12,655 Views

Joined Jun 13, '07. Posts: 980 (69% Liked) Likes: 3,344

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  • 0

    Quote from RunnerNurse09
    So then the doctor you refer to is letting his patients make the decision based on risk benefit...isnt that what a provider is supposed to do ethically, isnt that what patient centered care is? When you listen to the drug commercials on television and they list the possible side effects to medications, do you think it makes patients more or less inclined to ask for them? Informed consent is one thing, scare tactics are another. I am not sure which you are speaking.
    I never, ever said I thought the flu shot was harmful, and I dont know how words are being twisted.
    1) the flu shot can be, and is, beneficial. I personally do not feel it is effective enough based on what the CDC states for me personally to get it UNLESS i am required to do so. THAT is my choice.
    2) I would never talk a patient out if getting vaccinated, or any other treatment. If a patient directly asked me the statistics on the flu shot, I would show them the stats from the CDC, and advise them as per the CDC is it highly recommended. Period. I would never advise otherwise unless the recommendations changed.
    No doctor or any provider should be hiding information on the risk vs. benefit of a procedure.

    "The flu vaccine effectiveness is usually under 50%, and the powers that be push it like its eradicating the flu altogether."

    So, would you be showing them that statistic? I would also like to see it, as it is very different from my understanding. I could have it wrong.

    I think that the reaction you are getting comes from how you are presenting this. You refer to "the powers that be". Who are these powers? Medical experts?

    Or, "Show me the statistics that say the flu vaccine is 100% effective." I don't think anybody claimed this. Or that it is even relevant.

    And, your emphasis on the importance of beliefs and opinions is similar to those who don't rely on science.

    Oddly, I think you do rely on science. And, I think that your conclusion about your risk/benefit ratio actually makes sense. As to whether it is technically, statistically a correct conclusion I am not sure. But is is certainly not out there as far as the risk/benefit to you personally getting the flu.

    From my reading, I determined: Like anything, there is a risk benefit ratio to a flu shot. and that ratio differs by the individual. The risks of the shot seem to be fairly similar, despite demographics. In other words, I am just as likely, (or unlikely) to get guillain barre syndrome as somebody older or not as healthy. So, we have about the same level of risk. But, an older, less healthy individual is far more likely to die from the flu, so gets a greater benefit from X% immunity.

    Just because the risk benefit of the flu shot is favorable to the general public, does not mean it is favorable to me. Or you, given your screen name. I actually tried to look for studies that stratified risk benefit by overall health and fitness, but didn't come up with anything. So, you and I appeared to be lumped into the same group as sedentary obese smokers, despite the fact that they have more to gain, and less to lose.

    My impression was that I might actually be better off without the flu shot. The chance of me dying from the flu is minute. Possibly less than the chance of guillain barre syndrome. But, more important is this: Symptoms start 1 to 4 days after the virus enters the body. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Some people can be infected with the flu virus but have no symptoms.

    As a nurse, it is irresponsible for me to not reduce the chance of infecting others. I got the flu a few years ago. Left in the middle of my third shift in a row after measuring a fever. I could have infected patients before leaving, or on earlier shifts. But, at least I had done due diligence in reducing those odds.

  • 4
    JulesOb, 37changes, mudd68, and 1 other like this.

    Despite huge amounts of preparations, most people don't understand the test design.

    You feel terrible because you got a huge amount of questions wrong. Around half. Of the half you got right, some were lucky wild guesses, some were the result of ruling out one or two answers and using good test taking strategy. So, the percentage of questions you were able to confidently answer correctly is pretty small.
    An excerpt from this discussion.

    Jul 24, '07 by rn/writer
    Everyone will finish with approximately 50% of their answers correct and 50% of their answers incorrect. What determines whether you passed or not was the level of difficulty at which you reached that 50% rate.

    If question levels were rated 1-10 (just hypothetical here), you might start with a level 5 question. Pass it, and you'll get a level 6 question. Pass that one, and you get a level 7. Oops, now you missed. Back to level 6. And so on.

    If you start with a 5 and miss, you'd go to level 4. Miss that, and now you're down to level 3. Miss that one, and you slip to level 2.

    Up and down you go until the program determines the level at which you consistently find yourself. You can miss 50% of higher level questions and still qualify. But let's say that you keep missing easy questions. At some point, the program is going to determine that you are not well-equpped enough to handle the basics and it will shut off.

    It isn't the number of questions you get right--as I said, that will be somewhere around 50% for everyone--it's the level of difficulty of the questions that you get right. If you don't do well on the foundational kinds of questions, the program deduces that you are not ready to be licensed.

    Everyone walks out of testing feeling somewhat beat up. How can you feel otherwise when, by the very design of the test, you missed 50% of the questions. The determining factor, then, is how high did your proficiency level go before you reached that 50% failure rate.

    It's like giving people pages of math problems. Some will get half right at a seventh grade math level. Others will get half right at the level of a junior in high school. Everyone is getting 50%, but the difficulty of the problems decides who are the more adept students.

    Hope that makes sense.

  • 0

    Quote from RunnerNurse09
    And I respect YOUR views, opinion, beliefs. Aren't nurses supposed to respect the autonomy of others? So shouldn't you respect mine?
    Respecting an individual's autonomy and respecting their views are completely unrelated. I would hope that you could think of some views and opinions that are simply not worthy of respect.

    Your understanding of the science behind a given procedure or medication are absolutely critical in the patient care you will deliver as a Nurse Practitioner. What you understand, or believe, will absolutely effect how your patients will make decisions.

    For example- One of the docs in my ER has concerns over the hazards of TPA- more so than the other docs. When he is done explaining the risks/benefits of TPA, a lower percentage of his patients get TPA than with other docs. As it happens, he was ahead of the trend in reducing use of TPA, and most of the others have caught up.

    The point is that his research led him down a certain path, and it affect the choices of his patients.

    As an NP, you will have huge impact on the decisions of your patients. Your "views" will guide your advice to them.

  • 1
    brownbook likes this.

    Quote from Texasholdem
    I know that many vaccines work, but I also know that many do not. You can discredit the flu shot with research from the CDC. However, I still get the flu shot every year (mainly because I'm forced to at work).

    People tend to take an extreme perspective on every issue. With vaccines you have one group that swears all vaccines are effective while another group wouldn't take the shot if their life depended on it (which sometimes it does). My advice would be to take all of the old school vaccines and do a lot of research before you let someone inject you with a vaccine that has been on the market for less than ten years.
    While you mentioned that you are required to get the shot, you don't mention whether you are a nurse. Or more to the point, whether you are in any position to influence anybody's healthcare choices.



    "A lot of research" is done, by trained scientists before these vaccines are approved. This is not to be confused with a Google search, which can be done by anybody with two fingers. If the result of your research is that "You can discredit the flu shot with research from the CDC. ", then I am going to take a wild guess you are not in the first category.

  • 7
    Horseshoe, brownbook, lpndeb, and 4 others like this.

    Folks- The OP is not real.
    Many of the posts on this forum are trolls. The good ones are clever and engaging, like some kind of new twist on nurses eating their young by a first time poster.
    This one is just ridiculous.
    OP- I call BS. You blew it with "medical license". I have never heard a nurse think they have a medical license. See you on your next troll with a new screen name.

  • 12

    politely, professionally, and firmly.

  • 0

    Quote from HalfBoiled
    Because there aren't any.
    Like you, I am in favor of raising the minimum wage.

    But, of course there are downsides, or dangers, as you put it.
    And, there are studies that support this.


    How hard did you look? It took me around a minute, and I am old.

  • 1
    sevensonnets likes this.

    I am not sure I understand the question.

    It sounds like what you have in the syringe is a mixture of urine and water.

    Is that what you are thinking of testing?

  • 3
    nehneh14, LibraSunCNM, and elkpark like this.

    Quote from Mini2544
    Sounds like you would enjoy living under a socialist regime. Let me know how that works out for you.
    When did butterfly suggest that?

    What was mentioned in the post were economic structures very common in countries with a higher standard of living than the US.

    If you don't believe me, ask Doctor Google who has a higher standard of living than the US, and have a look at their social and economic policies.

    Those countries really don't meet any reasonable definition of "socialist regime".

  • 0

    Quote from HalfBoiled
    I would love to read research studies about the dangers of raising minimum wage.
    Why don't you?

  • 3

    Quote from AceOfHearts<3
    I use the brand name of IV acetaminophen with some patients instead of telling them it's IV Tylenol. I want them to give it a chance to work instead of automatically assuming it won't work. If it doesn't work then we'll try something else. I also don't lie if they ask if it's Tylenol.
    How timely.
    I just made that decision a few days ago.
    I had a PT get 3.6 MG dilaudid in 2 hrs with no relief. Another nurse suggested IV Tylenol, for which I got an order. I have given it in the past, and had decent results. The PT expressed some skepticism, but I gave it a good sell job having read the research on the drug, and my experience with it.
    Complete resolution of pain. Then all that dilaudid caught up, but that's a different story.

    I realized that by calling it Tylenol, I was giving correct information, but misleading the patient. I had developed some rapport and trust, nonetheless, what the PT heard was "I am giving you a drug you know to be ineffective against the type of pain you have."

    Despite my success in that instance, I am done giving IV Tylenol. In fact, I don't think I will be giving any IV acetaminophen. I will be giving Ofirmev. It's a drug not frequently used here, but has been proven to treat the kind of pain you are having.

  • 3

    Quote from Colleenj19
    Right now I am in school for nursing and I am doing my preceptorship in an Emergency Department. I've noticed that lots of people come in for non emergent things, like a stubbed toe or vomiting one time, things like this. I'm wondering why these people aren't going to quick care, is this coming from being uninformed about what is an emergent situation or is insurance covering these trips? Maybe it has something to do with medicaid? I'm curious why the ER is the first place people are thinking to come for these things. I've had one ER visit in my whole life and a nurse told me that she knows someone who has had at least 70 ER visits in 6 months! That is crazy to me!
    2 issues:

    For the most part, decision making is very similar to how you might make a decision. Given a range of choices, you would pick the least expensive and the most convenient. For most of the folks you are talking about, the ER is free. Whether it is from their insurance, or the fact that they simply don't pay, they get world class care for free.
    As far as convenience- well hard to beat our hours.
    Perfectly reasonable decision from that perspective.


    The next question is why people seek help of any kind for certain issues. For example- my son crashed his bicycle, and I just wanted him checked out. The kid has a few scrapes, all his limbs move. This type of assessment used to be a part of parenting. But, a certain number of folks are unable to deal with things that you or I might find simple. And, it's free.

  • 4
    Meerkats, Ullikummi, LibraSunCNM, and 1 other like this.

    Quote from FolksBtrippin
    It may sound naive, but it is still true.

    Don't take my word for it though.

    Look at what happened to our economy when minimum wage was enough for a decent living. FDR was all about this. What happened to our economy when the minimum wage was a living wage, not a wage for pocket change?

    We did all benefit.

    A lot of people think that the economy of a nation runs the same way as personal finance. The idea is that every time you put money one place, it is taken from another place. That is the way personal finance works.

    But that is not the way a national economy works. Economists have proven this, but since it is a political idea about which we all vote, and some people even become morally attached to their ideas, we don't make the best decisions for our economy.

    Everyone benefits when money flows, rather than staying stagnant. Minimum wage as the wage of a decent living, fuels the flow of the economy.

    I agree 100% with 90% of what you say.

    Minimum wage should be raised. But not because everybody will benefit. As a civilized society, we have a responsibility to protect those with less power. And, once one accepts that the concept of a minimum wage is reasonable, (most do), the only question is the number. The current number is pretty indefensible. In reality, the only thing that makes any sense is to decide on a number, and then devise a plan on how that number will adjust along with the cost of living.

    I agree that the national economy is not like personal finance- it is more like an ecosystem. And much like an ecosystem, even small changes in one area can cause multiple larger changes. And much like an ecosystem, some will benefit, and some will pay.

    The thing is, I don't have to believe that a raise in minimum wage will benefit everybody in order to support it. In fact, I don't even have to believe it will benefit me. I frequently vote for policies knowing it will take money out of my pocket. For example, when I go back to paying my own health insurance, it would save me personally a bundle to be in a pool with other healthy people, yet I still believe that sick people deserve health care, and am willing to pay for it. (Though I would really prefer a plan that makes really rich people shoulder more of the burden, and allow my wife and me a bit more money for retirement.)

    The way you explain it is so simple, you would think it would be understood by accountants whose job it is to help other people make money. By your reasoning, those math guys are unable to do the math because of pre existing political bias.

    While you and I are probably on the same side on many economic issues, including this one, your argument of trickle up economics sounds very similar to the debunked trickle down argument that is being recycled right now. There are some very wealthy people suggesting that they should get a huge tax cut. They are offering me a small tax cut in the hopes that I will support their plan. And they are downplaying their benefit, and focusing not only how good it will be for me, but how it will help those who need it even more than me. Because they know I care about that.

    This is kind of a side track to the original question of how it will affect nursing wages.
    I think many people miss the fact that as nurses, we are essentially a commodity, like electricity or hospital supplies. I often hear nurses express a belief that their wages are tied to how well the institution does financially. In reality, nurses are paid by the same laws of supply and demand that govern the price of electricity or IV tubing. In areas where nurses won't work for under $50 an hour, that is what they get. Where nurses are willing to work for $20 an hour, that is what they get.

    Whether we will get paid more as a result of higher minimum wage is pretty complex and hard to predict. Some here predict that bumping up the bottom will have an upward ripple effect, and more people will be able to afford education. That may add to the supply of nurses. Or, it could reduce the supply. I suspect that given all the changes in healthcare and insurance, there will be far more effect to the demand side of the equation. And I don't think anybody can accurately predict those changes.

    Bottom line is I hope I make more.

  • 7
    Vicki17, Kitiger, not.done.yet, and 4 others like this.

    Quote from FolksBtrippin
    I don't understand your question.
    Well, it was a bit tongue in cheek. The statement I was challenging was "Minimum wage increase benefits everyone." I think that is naive, and is probably not shared by all those actually paying minimum wage.

    Hypothetical ice cream shop that pays minimum wage to high school students. They have no particularly unique or difficult skills. The owner works his tail off and is not wealthy. The kids who work there don't need a living wage, they need some pocket money. Any more that he pays them is money out of his pocket that won't be helping his kids pay for college.

    I don't think he benefits from minimum wage increases. If he did, he would simply raise wages. I am quite sure that there will be some businesses right on the edge of survival that will fold if minimum wage goes up.

    That being said, I agree that minimum wage should be raised. Effectively, minimum wage has gone down hugely.


    It's just that I accept the fact that economic decisions are complex, and very few benefit everybody. They need to be seen in balance.


    This is very much on my mind as a new tax code is being developed. There are people who have made it their life mission to make rich people richer. They are telling me that that with certain changes, everyone, including me, will benefit. While I think it is awesome that they have taken a sudden interest in my well being, I am a bit skeptical.

  • 9

    Quote from FolksBtrippin
    Minimum wage increases cause increases in skilled labor wages as well. Because if you can work at McDs for 15/hour why would you go to school to work for 15/hour? Minimum wage increases also generally improve the economy and increase employment. You have increased employment when minimum wage is enough to afford rent, utilities, food; because it is worth it for people to work.


    This will not create short staffing in hospitals. CNAs will make more, and more people will stay in the job.

    Minimum wage increase benefits everyone.
    How many minimum wage employees do you have?


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