Content That MunoRN Likes

MunoRN 59,924 Views

Joined: Nov 18, '10; Posts: 8,946 (71% Liked) ; Likes: 24,131
Critical Care; from US
Specialty: 10 year(s) of experience

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  • Apr 29

    Quote from MunoRN
    Parents don't have "full decision making capabilities in the US", it actually works the same exact way here. Hospitals and their ethics committees can determine that futile care is not appropriate and make the decision to withdraw care against the parents wishes, parents can appeal that decision in court just as the parents of Alfie Owens did. This is not particularly rare in the US, it's been about a month since my hospital had to take legal steps to bring futile and tortuous treatment to end in a child.

    There were no "experimental treatments" offered, no additional treatments were proposed by the Vatican hospital, doctors from the Vatican hospital who travelled to Liverpool to evaluate Alfie agreed that his condition was not curable and other than palliative care they did not suggest different treatments would be available to him in Italy.

    Denial and bargaining are well established steps in the grieving process. Appropriate care does involve helping ensure that the grieving process doesn't result in abuse of the child.
    On reflection, and further research, I will concede the points as you have presented them. I feel I fell victim to the same emotional argument. These situations, as I have experienced them, are always the hardest conversations. My second month in we gave a swaddled bundle to the parents after a 45 min code. 8 months old. Coxsackie virus.
    While i'll still advocate for second opinions and review of symptoms, I do understand the need for the hard truth to prevail.

    It's these conversations I love AN for. Thought provoking and personally challenging.

    Thanks Muno as always.

  • Apr 28

    ecg_preview-2-jpg

    I would call this Sinus Arrhythmia (probably respiratory related) in the setting of sinus bradycardia. There is no "dropped beat" as there is no "p" wave. There is also no AV block as there is no "p" wave to be blocked.

    I see this a lot in PACU. People are just waking up and taking slow breaths with a HR in the 40s and 50s. As they get more awake their rate picks up and the slight variation between beats is not so pronounced. You really need a longer strip with concurrent clinical assessment. (i.e. the thing happens with every inspiration)

    No zebras here, move along.

  • Apr 27

    Who actually read the ANA's position on this? Where do you disagree?

    "To explore the clinical case for the effect of nurse staffing models, we collaborated with health care insight leaders Avalere and a panel of top nurse researchers, thought leaders and managers. The white paper concludes that staffing levels in a value-based health care system should not be fixed, as day-to-day hospital requirements are constantly in flux. "

    Nurse Staffing

  • Apr 26

    I think they were short a CNA and needed the help for 4 hours.

  • Apr 14

    Quote from Double-Helix
    This is exactly what happens when the pharmacy sends a pre-filled medication syringe or bag to an inpatient unit. You didn't see the pharmacist draw up the medication either, but do you go to the nurse manager and refuse to give the medications sent from pharmacy? No. You check the label on the syringe with your order and give the med and sign it out. It's not a violation in practice to give a medication that another trained and licensed professional prepared.
    Agree with this, so long as the medication is properly labelled.

    For those of you making the distinction between meds prepared by an RN, and meds prepared in the pharmacy. You are aware that most of these medications are prepared by a pharmacy technician, and the only time it is seen by a pharmacist is when he or she verifies the information on the label with the order.

    ETA: I find it sad that some of you have so little trust and confidence in your coworkers that you would refuse to administer a medication prepared by one of them.

  • Apr 12

    Is the family member to whom you're referring a POA or a guardian? There's a big difference. And is there actual paperwork documenting the legal status, or are we just talking about next of kin? In the case of someone who holds legal power of attorney for healthcare, the POA only becomes effective when the individual is unable to make decisions for her/himself. Is the client considered sufficiently impaired to lack the mental capacity to make her/his own decisions about eating/drinking?

  • Apr 3

    Who said we are the "only" group that doesn't accept gifts? None of the professionals I know, from a wide variety of healthcare disciplines, would accept gifts from clients. That's a basic professional boundary, in any number of disciplines.

  • Mar 26

    Quote from MunoRN
    As I said in previous post, it's certainly reasonable to avoid these products all together out of worry for one's job, but it's also not as though it's not possible to make a reasoned decision on this based on measurable data rather than the more hysteria based rationale that seems to dominate this topic.
    That certainly is a fair and valid point.

    As someone who has to pee in a cup around twice a week for 4 more years, I shy away from anything that is not FDA approved, however. I live in fear of the herbal supplements I used to take prior to monitoring because they aren't regulated federally and I'm paranoid about illicit fillers or other contamination I've read that has happened. A miniscule risk is still too much of a risk for me, unfortunately. I can only speak about me personally and my choices.

    In my head, I know that a mega brand name herbal supplement is most likely completely safe and as advertised. I know I'm being hysterical. I am most certainly paranoid. It is what it is.

    But, again, having faced the Board and watched 8 hours of other nurses facing the Board in front of me for a variety of reasons, including testing positive for THC, I have made the personal choice to steer clear until more widespread regulations are in place. It's probably the same reason why I prefer to get my meds from my local pharmacy rather than getting them shipped cheaper from India. The comfort of guaranteed ingredient quality control without me having to put in any investigational effort.

    I'm glad to hear the research you bring to the table though. I'm glad to hear that there are safer options for people who could clearly benefit. Marijuana has a hugely medicinal market and I do hope that our country comes around. I like the evidence you discuss and I appreciate it's contribution to the discussion. I learn from seeing another perspective.

    Thank you.

  • Feb 17

    Quote from traumaRUs
    I just changed job and work in a small office part of the time. My cubicle-mate (we are within 3 feet of each other) has a radio on the entire day. I find it very difficult to concentrate let alone talk on the phone (which is part of my job).

    I'm truly ready to quit over the issue.

    When i worked my entire day in the ED, we ran around way too much to listen to music plus there was always something else going on....
    I was told I could play my music at a... reasonable.. level...

    Attachment 26101

  • 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


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