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MunoRN 54,537 Views

Joined Nov 18, '10. MunoRN is a Critical Care. She has '10' year(s) of experience. Posts: 8,530 (70% Liked) Likes: 22,350

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  • Jan 10

    Why call them chucks? Because Charles is too formal.

  • Dec 7 '17

    Well.... How do we know the pt didn't sign a POLST under duress? How do we know it wasn't forged or altered in some way? How do we know the pt didn't change his mind ten seconds before arresting -- even with a proper POLST?

    Generally tattoo artists limit their inking to what a client requests. Considering the Ockham's razor principle, that tattoo's presence is more simply explained by "this man commissioned this tattoo," vs "the tattoo artist drugged the man and acted without consent, having been paid off by a murderous wife who wants to collect his life insurance and move to Fiji with her young Latin lover."

    One acting in a feduciary capacity is supposed to make the decisions that to the best of their knowledge is what the PATIENT would want.

    I can see "DNR" might be problematic, since it could mean "Daffodils 'N Roses" or "Dine Nightly on Ribs" or could be a loved one's initials strategically placed near the heart. But "do not resuscitate" with a signature? In the absence of other information, that sounds pretty clear.

  • Nov 26 '17

    This is not exactly a 12 hour shift issue. The issue is really.. working nights. You are forced to try to change your circadian rhythm throughout the week.
    I myself.. cannot do it. I bow to anyone that can work nights, period.

    Get on 12 hours, day shift and THAT is a nice gig.

    Best wishes.

  • Oct 26 '17

    Quote from FolksBtrippin
    The anti-vaxxers get upset because there is a question of whether or not we ought to force them to comply. Forcing people to do things they don't want to do, especially with regards to what goes in their bodies absolutely sucks for us morally and we should avoid it whenever we can.

    Force takes many forms. Threatening to cut off a person's employment or income counts as force. As does prohibiting school.

    Using force is justified only when you are very certain that it will benefit the community and also very certain that it will not cause harm to the individual. Then you have moral grounds with which to use force.

    My problem with using force on the flu shot is that we don't know what getting it 80 times over the course of a lifetime will do to people and we do know that flu doesn't usually kill healthy people. It does kill sick people, so maybe it is justifiable to use force for healthcare workers-- as in take your shot or don't come to work, don't get paid.

    But for folks not working in healthcare I don't think force is justified with regards to the flu shot. It's a vaccine people are expected to get every year. We don't know what effect, if any that has over a lifetime yet.

    In 100 years when we have evidence that giving flu shots to a person every year from ages 3 to 100 did not cause undue harm to that person, then we will have moral grounds to use force.

    I think gardasil is also one where using force is not justified for similar reasons. It hasn't been around long enough. Gardasil is a weaker case against force then the flu shot, because we aren't expected to get it every year.

    With proven, older vaccines that prevent devastating illness like polio, I think we are justified in straight up forcing people to comply. Not like, hold a person down and put a needle in him, but definitely keeping kids out of school, and maybe even cutting off income.

    And I say that as a quasi-anarchist who vaccinates her children and gets her required annual flu shot. And also as a psych nurse, who sometimes really does have to hold people down and give them a needle. It breaks my heart every time and I don't do it unless it is really, really necessary.
    The only significant way that has been found to improve vaccine rates is to make them mandatory. You can see this in states with mandatory vaccine laws versus states without strict mandatory vaccine laws.

    Actually, we have a pretty good idea what mandatory flu vaccines and other vaccines do when given over 80 years. It makes people live longer. The flu vaccine has been around for 80 years. The flu vacccine has an extremely high safety profile just like most vaccines. Your analogy of waiting 100 years to mandate vaccines is ridiculous. That is equilavent of saying lets not give ACE Inhibitors as a first line drug treatment until we have a 100 years of studies. It already takes almost 2 decades for research to come into practice. The flu vaccine outside of the military wasn't even mandatory for several decades well after the safety profile was well established with long term studies, cohort studies, retrospective studies etc.

    The HPV vacccine can be 100% effective against most HPV strains that cause cervical cancer. It has been around for 11 years now, and every asinine antivaxxer complaint about its safety or that its going to cause promiscuiity has been debunked. In the USA men on average have 7 sexual partners and women 4 in their lifetimes. It makes sense to have a vaccine that can essentially get rid of most HPV infections, prevent the majority of cervical cancers, eliminate HCPs and infants accidental HPV exposure. The question is why wouldn't there be a mandatory HPV vaccine for girls and boys knowing that the safety profile is consistent with the literature and it has all these health benefits.

  • Oct 18 '17

    Quote from MunoRN
    As of 2009, just over half of ADN students were second career students, often with previous degrees, this comes from research put together for a 2009 committee on making BSN the entry to practice, it says I'm not supposed to "re-publish" any of it, I'll see if that is still the case.
    I would be very interested in that data. The last published data I saw on a similar topic was from 2014 and showed that about 40% of ADN students were over the age of 30 compared to only 18% of BSN students.

    Second degree ADN nurses were not addressed in any of these studies that I am aware of. There are a few interesting potential consequences to this: 1. second degree ADNs would be assumed to be less likely to benefit from a bridge program, 2. they are falsely increasing the ADN outcomes, 3. they potentially, if separated, may help in teasing out some potential and previously inseparable confounders.

    Quote from MunoRN
    I agree that the research has shown different levels of education in programs a couple of decades ago resulted in differing outcomes. There was no delineation of what exactly these outcomes resulted from, but the best guess seems to be that it was the differing content and curriculum, it could be due to other factors are less obvious but seem unlikely, for instance it could be because BSN students are more likely to live in a dorm, I tend to doubt that having ASN students live in a dorm for a year would necessarily improve the outcomes of their patients down the road.
    This is one of my biggest problems with the studies: the authors seem to conclude that having more ADNs bridge to BSN would improve outcomes but I don't see any data to really support that. All we know is that hospitals with larger percentages of BSNs have better outcomes when other factors are controlled for. Scientifically it is as likely to be dorms or learning at a younger age or schooling full time or any random confounder that the authors couldn't control for. You can add all the same exact coursework but that may not change the results, that's the problem for me, we don't know what exactly works.-

  • Oct 10 '17

    Quote from hherrn
    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.
    In the community in which your hypothetical ice cream shop is located, many other minimum wage employees of other local employers would also be making higher wages, and would hypothetically feel financially flush enough to get ice cream out more often. Hypothetically, the ice cream shop owner would have to pay his employees more, but would also see his business increase.

    Moreover, your hypothetical ice cream shop probably doesn't just employ high school kids who work for pocket money. That's an argument that is always made in discussions about raising the minimum wage, but the reality is that around half of minimum-wage workers are at least 25 years old. Those are not kids working for spending money. Many of them are attempting to support families.

    Minimum-wage workers are older than they used to be. Their average age is 35, and 88 percent are at least 20 years old. Half are older than 30, and about a third are at least 40 ... Many have kids. About one-quarter (27 percent) of these low-wage workers are parents, compared with 34 percent of all workers. In all, 19 percent of children in the United States have a parent who would benefit from the increase ... Their earnings are a big part of their family budgets. The average worker in this group brings home half of his or her household's earnings; 19 percent of those who would get the raise are sole earners. Parents who would benefit from the increase bring home an even larger share of their families' earnings: 60 percent ...
    Minimum Wage: Who Makes It? - The New York Times

    Undisputed facts about the minimum wage | PBS NewsHour

    The average minimum wage worker today is not who you think | MSNBC

  • Sep 30 '17

    I Googled it, I guess subcutaneous infusion make sense?

    I am sure some nurses would make a big fuss over this.

    So the patient was previously transferred from another facility. I think the facility who transferred the patient should have clarified with the doctor if he/she wanted the subcutaneous infusion discontinued at the time of discharge.

    The patient came to your facility with the subcutaneous infusion running and it was not caught that there was no order (by the same doctor? or a different doctor?) to continue it. No one realized it hadn't been reordered.

    What was it infusing? Pain medication? Insulin? Chemotherapy agents? Heparin? Nitroglycerin? Normal Saline? Dopamine? Anyway personally I wouldn't make a big deal out of it. Unless it was some potent powerful drug. Simply call the admitting doctor, ask if he/she wanted the subcutaneous infusion stopped or continued.

    My imagination was going a little overboard. Can you imagine dopamine subcutaneous....YIKES.

  • Sep 3 '17
  • Jul 8 '17

    Does that seem like a weird category title to anyone else? Isn't it kind of like opposite meanings? Is it like 'Miscellaneous"? Or am I misreading it?
    It's not important, really, but I'm just curious.

  • Jul 6 '17

    Quote from josierickson
    Try working in EMS for 15 years and nursing for 7; you'll get it then....
    Sorry, there are people with way more experience than that who don't think that's ok outside a private conversation. A person's concerns has nothing to do with the number of years they work. Neither does aquisition of professionalism.

  • Jul 6 '17

    Quote from Luckyyou
    I think it's funny. But I'm actually a nurse, and you're.... not?
    What does being a nurse have to do with her concern? Would a doctor wear a t-shirt with that on it? Or think that was ok to say outside a small circle? Dark humor is used by some to cope, but not publicly. As health care providers, we must maintain a sense of public decency. Frustration and stress does not give license to say and do whatever we want. I've worked in a unit where dark humor was used all the time, but never out in public.

  • Jun 16 '17

    Quote from LovingLife123
    They were probably already declared dead. Brain death and cardiac death are two different things. If the organ team was involved, that child was probably declared dead a long time before extubation. The child was being kept alive while the organ procurement team was getting all their ducks in a row, which can take days. But in those instances, death is declared after a brain flow study has shown no activity. With an anoxic injury, that often happens.

    That's why I'm saying there is more to this and the coroner screwed up by not understanding the process. We all need to not place judgement unless we were there and know the details of the case.
    You clearly did not read the article. This was a donation after cardiac death case.
    Physicians at UCLA's pediatric intensive care unit told Cole's family that the child was not brain-dead but "would never recover normal neuro function and ... could never awaken," according to an entry in his medical chart.

  • May 9 '17

    Quote from elli3
    Hi, im a nursing student so forgive me if this question is a bit elementry.

    If a patient has 2 separate orders for Norco that read:

    Norco 5/325 1 tab PO Q4hr PRN Pain (4-6)
    Norco 10/325 1 tab PO Q4hr PRN Pain (7-10)

    Is it ok to give a patient a 5/325 2 hours after giving them Norco 10/325 if the patients pain is still in the (4-6) range. Do the orders stand alone or not?
    You have every reason to be perplexed by these orders. They are confusing and will be interpreted differently by different nurses which makes them unacceptable.

    I could easily rationalize giving Norco 5/325 then two hours later give 5mg hydrocodone (if the patient's pain had gotten worse) and "restart" the 4 hour time as if I had given the Norco 10/325.

    I could also see a scenario where you assess the patient's pain every 4 hours and give one or the other Norco then wait 4 hours to assess and decide again. Thus giving the Norco 10/325 every 4 hours would result in the patient receiving 1,950mg of acetaminophen and 60 mg of oxycodone in a 24 hour period.

    If these orders were to "stand alone" , the patient could receive 3,900mg of acetaminophen and 90mg of oxycodone in a 24 hour period.

  • May 2 '17

    No, you aren't a moron. The morons don't ask.
    Welcome to AN!

  • Apr 30 '17

    Why are travelers not an option? The difficulty with your suggestions is, it's really not the staff's job to cover the floor by picking up extra hours. Working their agreed upon FTE is.

    Call-in/pickup bonuses could help, since it would then benefit the employee to work extra.