Content That MunoRN Likes

Content That MunoRN Likes

MunoRN (22,482 Views)

Joined Nov 18, '10. Posts: 7,023 (67% Liked) Likes: 16,032

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  • Jan 31

    Opiates can cause itching relieved by antihistamine . Any opiate--oxycodone, morphine, hydromorphone, codeine, hydrocodone can cause itching it's a common side effect. Many providers standing order Benadryl or Allegra for itching as long as no signs of anaphylaxis.

  • Jan 27

    Quote from MunoRN
    I'm not sure what you mean by "perceived problem". Is there any other way to define misery other than how it's perceived?
    Perhaps offlabel is saying that the suffering individual might perceive her/his situation as misery, but offlabel disagrees, so it's not really a problem ...

  • Jan 24

    Are you kidding me? Where do you work....Stepford General? Why is it any of your business if a nurse chooses to have a buzz cut? I've been in nursing a long time and I've never see a slovenly nurse. As long as dress policy is adhered to...not a problem. Not everyone is the same or has the same fashion ideals as you. I guess everyone is far too busy working to worry about what they look like. I'd absolutely hate to be at work and know you were looking me up and down with a sneer on your face. Wow.

  • Jan 21

    Quote from MunoRN
    There's a variety of evidence to choose from as to why communication is the hot topic these days when it comes to patient safety, take your pick from IHI, AHRQ, or other industries. "Why hospitals should fly" by John Nance is worthwhile read.

    I can tell you first hand why interactive communication is important. I worked at a facility where we trialed a faxed report. A patient came into the ED with CP, was on revatio for PH so was not given nitro in the ED. Of course there was no checkbox on the form for "didn't give nitro because patient was on revatio." The fact that the patient was on revatio was available to the receiving nurse in the EMR, although she was unfamiliar with the med and didn't make the connection to nitro. The patient coded after the nitro and couldn't be revived. When the nurse who had the patient in the ED, who was unaware at the time that the patient had died, was asked what they remembered of the patient the nurses first description of the patient was "the one who had CP but couldn't have nitro because they were on revatio". While this could have been avoided if the nurse had written this somewhere on the form, that's not the only way this information gets passed on, it often gets passed on because the receiving nurse is able to ask "why didn't they get nitro?"
    I can see something like this occurring in some facilities where medications given in ED may not show on the floors charting system or if the ED often doesn't have med administration charted at all. If a CP patient came up from ED with current CP I would probably have begun to follow our protocol and administered nitro without taking time to find med lists which may or may not be up to date.

    I also liked to know if I needed to order a specialty bed or mattress (wounds or bariatric) and it's nice to know of any important family dynamics.

    Let us also not forget some facilities have ED charting systems that do not communicate with floor systems.

    Again solving most issues will require admin to increase staffing throughout facility and that means instead of fighting each other we need to come together and demand appropriate staffing and charting systems that make sense.

  • Jan 6

    It means the check cleared. Nothing more, nothing less.

  • Dec 22 '15

    Pausing tube feedings is one of the stupidest things that nurses do religiously... nothing like saving a patient from potentially aspirating on 4.8cc's of additional TF.

  • Dec 7 '15

    Quote from PinayUSA
    In Texas if you buy at gun show from private seller you just exchange cash for gun.

    Last two used handguns I purchased one was from a garage sale (great deal) and one from a individual (good deal) selling on a forum, Just negotiate best price and take possession.
    And this is a very easy way for someone who can't legally buy a gun to obtain one. Explain how it's not.

  • Dec 2 '15

    Quote from SentinelTruth
    Just my number, but surely, how much do you think it'll cost? It can't just be a few percentage points... if a lot of people are paying hundreds of dollars a month, upto a thousand a month for family insurance under obamacare, and if you figure they make $4-5k a month, then bam 20-25% of their income to pay for it.
    But our current system siphons large amounts of that insurance premium money off the top as profits going into shareholders' pockets, which would not be happening in a single-payer, non-profit system. Most of the people who have actually crunched the numbers realistically have found nothing near that amount, and the increase in taxes would be significantly less than what most people are now paying for insurance premiums.

    Single Payer System Cost? | Physicians for a National Health Program

    "Single payer could be financed with existing sources of taxpayer funding for health care (including subsidies from the ACA) combined with an average 7.2 percent effective payroll tax on employers, a 3 percent income tax on family adjusted gross income, and cigarette ($1.00/pack) and alcohol taxes (5 cents per drink)."

    How will single-payer health care affect taxes?

    "A high income Vermont taxpayer currently faces a top state marginal income tax rate of 8.95 percent and an average tax rate of at least 6 percent. If my estimates are correct, or even close, if these taxes are enacted high income Vermonters will be paying about 15 percent of their income to the state and face a marginal tax rate in the high teens. No other state even comes close to those levels."

    (Please note that this article is by someone arguing against a state single-payer system, noting that the tax increase on the highest-earning Vermonters from 6 - 9% up to 15% is too onerous.)

    Health Care How Much Does Single Payer National Health Care Cost?

    "June, 1998, The Economic Policy Institute

    In the model presented in this paper, it is assumed that in the first year
    after implementing a universal, single-payer plan, total national health
    expenditures are unchanged from baseline. If expenditures were higher than
    baseline in the first few years, then additional revenues above those described
    here would be needed. However, these higher costs would be more than offset by
    savings which would accrue within the first decade of the program.

    Universal coverage could be financed with a 7 percent payroll tax, a 2
    percent income tax
    , and current federal payments for Medicare, Medicaid, and other state and federal government insurance programs. A 2 percent income tax would offset all other out-of-pocket health spending for individuals. "For the typical, middle income household, taxes would rise by $731 annually. For fully 60% of households, the increase would average less than $1,000. For another 20%, the increase would average about $1,600...costs would be redistributed from the sick to the healthy, from the low and middle-income households to those with higher incomes, and from businesses currently providing health benefits to those that do not."

    And keep in mind that those small amounts of additional taxes would be more than offset by most of us no longer paying huge premiums to insurance companies.

  • Dec 2 '15

    Quote from SentinelTruth
    Also, look at Europe... they pay through the nose....
    Europeans pay more in taxes than we do, but they get a great deal more in public services than we do, and they do not pay more for healthcare than we do -- in fact, they pay a great deal less than we do, and have significantly better morbidity and mortality statistics to show for it.

  • Nov 27 '15

    Quote from applesxoranges
    Most hospitals have a policy against smoking 100% legal substances like cigarettes or using chewing tobacco. They drug test us in the beginning and reserve the right to drug test us. They add the nicotine drug test on too (it looks like a pregnancy test).

    Drinking and working isn't allowed at any hospital I know of either.

    Unfortunately, people don't presume that a nurse who drinks alcohol on off time reports to work while impaired while they assume that the nurse who smokes pot does. Yep, recreational drinking doesn't make one an alcoholic in the eyes of others but recreational marijuana use automatically qualifies the user as a "pothead" or "loser" to scores of people who have lived a life time of hearing lies and misrepresentations about cannabis. We won't even talk about how nurses who might utilize cannabis to treat anxiety or insomnia or other things like nausea must live with the ongoing judgement from their peers. Our society would much rather, for some reason, that those people purchase a pharmaceutical to treat those things (and deal with the side effects of those drugs).

    We will get the laws relative to cannabis changed but it has already been too long for some who have suffered and died while waiting.

  • Nov 3 '15

    I'm sure a lawyer will be happy to take your money to essentially double your monetary obligation in the contract. I can guarantee "doesn't like job" is not covered can as a bona fide reason to legally dissolve the contract.

    It's going to cost a lot of money in penalties and fees.

  • Oct 18 '15

    Few positions are immediately available. Reference checks, drug screens, employee health clearances, etc. can take 2 weeks or longer to complete.

    As a hiring manager, if you told me that you would quit your current employer without notice and start my job immediately, I would not make an offer. I don't want to be on the other end of a "quick exit" when your next best job comes along.

  • Oct 1 '15

    Quote from 1edwood79
    So what the Libertarian Party is advocating is a return to the golden (healthcare) age of the 1960s; HSAs, which work great for people who have enough money that they don't have to worry about healthcare costs but not so great for people who don't; eliminating states' abilities to set standards and protect their citizens from abuses of for-profit insurance companies; and eliminating the FDA (because the "free market" can do a better job of bringing medications to the market? Are the leaders of the Libertarian Party familiar with the history of how the FDA came to be in the first place??)?

    Sounds like uptopia to me!! What could possibly go wrong? Sign me up!!

    Y'know, my 90 yo mother (former RN) was ranting on the telephone the other night about how much healthcare costs nowadays and went on and on about how healthcare used to cost a lot less before we started using all these disposable items, and, back in her day, they used to rinse out IV tubing and reuse it, and wash and reuse gloves, and if we only went back to doing things like that, we could probably make healthcare a lot less expensive. Maybe the Libertarians would like to include that proposal in their platform.

  • Sep 20 '15

    This guy sums up how I feel. There's some rather spicy language so if you're easily offended you might want to skip it.

  • Sep 18 '15

    Making sure that core measures are completed is not outside the scope of practice for a nurse. Writing the order yourself for VTE prophylaxis or the ACE-I for a CHF patient is another story, but I doubt you are being "coerced" into doing that. Core measures are evidence-based best practices for patient care. Yes, most of them require a physician's order. However, I have seen plenty of situations where core measures were missed, and it was the fault of the nurse. (M.D. orders SCDs, but the nurse never documents that they were applied or refused. There is an order to remove a foley on POD #2, but it isn't done. Discharge instructions are not complete or documented properly. Things like that..)

    It is probably a huge hassle for some quality nurse or your nurse manager to be crawling up and down your back to make sure that things get done. I promise that there is some hospital finance person or CEO who is crawling all over them about it too, because of the impact that it has on facility reimbursement from Medicare. Most non-profit hospitals run on extremely tight margins, and they rely on getting every single penny of reimbursement that they can in order to survive. With value based purchasing, there is a financial incentive for the hospitals to make sure that their core measure scores are high. Unfortunately, historically there has not been any sort of similar financial incentive that impacts the doctors, but that is changing.

    So... Take a deep breath, and ask the dang doctor for the order or the needed documentation. Even tho it doesn't feel like it sometimes, the measures really are important, and they are EVERYONE's responsibility.