Latest Comments by MunoRN

MunoRN 33,302 Views

Joined Nov 18, '10. Posts: 7,640 (69% Liked) Likes: 18,640

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  • 0

    Quote from smartnurse1982
    What if the nurse asks me and i reply "She is doing well".

    That is still a violation?
    I assume it is.
    That's not actually a HIPAA violation since it doesn't reveal any protected medical information and HIPAA specifically allows for the patient's overall condition to be given out using "general terms", and that would seem pretty general. But as a general rule, I just would ask about former patients.

    Revealing that a patient passed away is also not a HIPAA violation since deaths are publicly available information.

  • 13
    Here.I.Stand, kalycat, KelRN215, and 10 others like this.

    This used to be common, then went away, now is making a comeback. Would you rather deal with a combative, belligerent, paranoid, agitated, seizing DT patient or the hassle of giving someone a drink of whiskey?

  • 3
    Ted, herring_RN, and toomuchbaloney like this.

    Quote from ZASHAGALKA
    Conflating a Republic with democracy has been a neat trick of the media since the 70's. We aren't a democracy and the founders despised the idea. "A tyranny of the majority" is how they viewed democracy. The Constitution is based on the idea that most of your rights come from your Creator and are therefore not subject to the whims and fancies of your neighbors.

    The founders also believed that your Senator was to be chosen by your State leaders, not you. The amendment calling for direct election of Senators is one way we have already moved to PV to decide our representation.

    The founders intended the EC to be offensive to the idea of democracy because they despised that idea.
    This has been a popular meme lately, but the founding fathers including Madison were very clear that they were establishing a republic that utilized at least in part a representative democracy, what Madison said he opposed was a different type of democracy; a "pure" or "direct" democracy.

    The argument that you're either Republic or a Democracy is like arguing you're either from Dallas or from Texas, you can't be from both. A republic is a type of government which by definition uses some form of democracy, most commonly a representative democracy.

    Madison argued for representative democracy in part due to his opposition to a "pure" democracy, where the people draft and vote on laws directly. This is because this was the common form of democracy at the local level at the time, which typically involved chaotic and disorderly town meetings, where he felt the minority views were literally shouted down by the majority, leaving the final decision making process without any incorporation of the views of the minority, which coincidentally has become one of the main criticisms of the EC.

    While Madison's initial preference was to directly elect the President, he went along with the EC compromise based mainly on this explanation:
    There was one difficulty however of a serious nature attending an immediate choice by the people. The right of suffrage was much more diffusive in the Northern than the Southern States; and the latter could have no influence in the election on the score of Negroes. The substitution of electors obviated this difficulty and seemed on the whole to be liable to the fewest objections.
    Looking at his views overall, it appears pretty unlikely that he would attempt to maintain the EC today.

    Quote from ZASHAGALKA
    RE the PV favoring the GOP, think about it this way, if we switch to the PV, the election moves to the top 20 US cities by population. That's where the votes are. It wouldn't be cost effective to spend your time and money anywhere else.

    So. Rural areas get ignored. The Dems made a conscious decision to ignore white working class voters in favor of identity politics and a PV shift would reward that strategy. But. It also more or less locks in the rural vote.

    In a PV election, the GOP starts with rural voters locked in and uncontested. At any point in the equation, it's more cost effective for Dems to attempt to increase urban turnout than contest rural voters.

    By the same token, it then becomes crucial for the GOP to contest urban voters. So. Now the GOP is talking about being better urban managers (all the truly bad innercity areas are Dem controlled), better at infrastructure, school choice for innercity youths, free enterprise zones ala Jack Kemp, welfare reform that rewards marriage and work, etc.

    The GOP message stays the same nationally but also becomes very targeted to urban areas. I would argue that they should be doing this anyway. The GOP ceded innercity voters to the Dems first or the Dems never would have felt comfortable ceding rural white working class voters.

    Politics in a binary system always adjust to a 50-50 proposition. That's Sean Trende's take in "The Lost Majority". If the GOP started losing urban areas by just 10% less, the entire playing field changes.

    And that would mean that in a PV election where the GOP is actively contesting urban voters, the Dems would have to re-engage rural voters to compete. That just wouldn't be cost effective to do. Not ONLY would the Dems have to reach out to rural areas, they'd have to cross check the GOP strategy in urban areas.

    So. The GOP gets to play to urban voters while the Dems are spread thin trying to cover all bases.

    In any case, a PV election would be so fundamentally different than an EC election that the current PV means nothing. HRC didn't beat DJT in the PV because NOBODY ran that race. If they had, the outcome would have been fundamentally different. It's like running a NASCAR race and the second place finisher crying, "But I had more gas left at the finish line, that means I should have won!?"

    That said, since he's so thinned skinned and it obviously bothers him, if I were the loyal opposition, I'd put the PV in DJT's face constantly.

    You're correct, changing to a popular vote would change how candidates run for president, that's the whole point.

    Currently there is little incentive to incorporate the views of minority using an all or nothing state vote, something Madison clearly felt was important to include. There's no benefit in trying to increase your support in a particular state from 20 to 30%, since in the end it just gets changed to zero, which means there is no reason to improve your standing with the minority by accounting for minority views in your policy positions, yet according to Madison that incentive should exist.

  • 4

    Quote from ZASHAGALKA
    I don't think it is disingenuous. They knew by the time the ACA got down to push/shove that they wouldn't get any GOP help. They knew how hard it was to pass a similar bill in MASSACHUSETTS just a few years earlier. It didn't take much to suggest that wouldn't work in more GOP areas.

    They didn't go single payor because too many DEMOCRATS balked at having to explain that to their constituents in more red state areas. Indeed, the idea that Democrats bent over backwards to make the ACA palatable to the GOP is revisionist history. What they actually did is lock the doors to the GOP, sang about how "They won".

    My Congresscritter at the time, Chet Edwards, voted against the ACA even as it was because he knew it would go too far against the wishes and voting nature of his district. And. He was defeated in 2010 anyway, because it DID go too far.

    The problem with the ACA is two-fold. First, it needed bipartisan support to become ingrained into the system and it didn't get it. Most of the consolidated gains in these types of areas, Medicare, SS, Civil Rights, were grand bipartisan gestures. The Democrats figured they could push it through and once operable, the ACA would gain the status of those types of laws as a third rail. Or become so entrenched that it would be impossible to uproot. That was mistaken. The second problem is that the ACA was flawed from the beginning but the Democrats assumed that once passed, the GOP would work with them on tweaking it. The problem with that is that the ACA, via the Tea Party, did in fact become a third rail - working against any GOP member touching it in any way. None of them dare lift a finger to help stabilize the ACA; it is indeed a third rail in GOP politics.

    The ACA is gone. There is no way that the GOP, after overpromising to their base about the ACA for 6 years now, can not make that their top priority. A Senate filibuster cannot save it for two reasons: First, the Senate will just repeal it on a simple majority reconciliation vote, and second, even if a filibuster were to stand, the whole program is run by HHS, which will now be a Trump appointee. The ACA gives enough power to the HHS to run the ACA under a Democrat administation without further legislative support, and enough power to completely eviscerate the ACA under a GOP administration, again without further legislative support.

    What comes next will be interesting to watch. But, to the main point, I disagree that the Billion dollar bailouts were a nod to Republicans. One of the few successful legislative pushbacks against the ACA was Rubio's Bill to eliminate payment for the risk corridors.

    One of my issues with Trump is that he was one of the least likely to make big changes to health insurance reform, not that he was the only republican who's ACA replacement plan was essentially the ACA. If the basic components of the ACA are so completely opposite to what republicans believe then you'd think they would be proposing massive sweeping changes, instead Trump has already signaled that his preference is to just tweak it, and even then he hasn't offered much that he would actually change, with the exceptions of further expanding medicaid which I would argue is the one thing we shouldn't do. What republicans are currently tossing around still involves support for affording insurance using various tax breaks/subsidies/etc, as well the requirement to cover pre-existing conditions which then necessitates the mandate, so at least so far it doesn't look like there will be significant changes for the better.

  • 5

    Quote from ZASHAGALKA
    If the popular vote was determinative, he'd have won that too, running away. Neither candidate played to the popular vote so using that as a standard is moot, worse than apples and oranges.

    The EC is an advantage for Democrats. They start with CA and NY in the bag and 1/3rd of the way to 270 without breaking a sweat. In fact, the only way for a GOP candidate to win was to break a DEMOCRAT firewall. The GOP has no such firewalls in the EC. If Trump had lost NC, FL or OH, any one of them, those firewalls would have been unneeded by the Democrats. The only way for Trump to win the EC was by threading a very small needle. Which, he did.

    The EC favors Democrats by moving the campaign fight on GOP territory. When you're fighting for hearts and minds in the heartland, then Democrats are fighting for rural votes. In fact, had HRC even bothered to campaign in WI, maybe we wouldn't be having this conversation at all.


    Move to the PV and everything changes. The fight moves onto Democrat turf and into the big cities. It would force the GOP to try to be competitive in urban area. Trump at least sounded that he understood this. So, an alternative election where Trump is campaigning in NY, LA, Chicago, Houston, Miami and striking an infrastructure message to urban voters??

    Put another way, the GOP doesn't have to win a majority of urban voters to change the electoral map. If they change the urban vote just 10%, so that they lose areas like Philadelphia by 60% instead of 70%, then the map is fundamentally different and much more challenging for the Democrats.

    HRC didn't need to win the rural vote in WI, MI and OH. She just needed a few more percentages of it. A few campaign rallies worth of attention.

    Fighting the election on urban turf is moving the fight to the Democrats. The GOP would be contesting for urban voters in places where they can easily get out their message to the masses while the Democrats would not only have to check that, but also reach out to rural voters who would then feel even more neglected than they do now.

    The Democrat party, since the 80's, have argued that demographics is destiny. 40 yrs later and they're still waiting for demographics to make competing for votes moot. Sean Trende of RCP argues that both parties will alway adjust to make the electorate very close to a 50-50 proposition in a binary system. As the demographics change, the parties will adjust to the change. In this cycle, the major change was that Democrats ceded the white working class vote and Trump took advantage of it.

    No. Moving to the PV wouldn't be salvation for Democrats. The GOP would adjust and pick off just enough urban voters to remain competitive.

    Neither party contested to win the PV. They both were trying to win the EC. The PV is less than irrelevant to the outcome and changing it would only make winning more challenging for Democrats.

    This is the first argument I've heard for the idea that the EC actually benefits democrats, so I'm curious what your basis is for that, but I'm still not sure what you're basing that on.

    It is true that in winning California and New York can bring a candidate close to a third of the way to winning the EC, but that's because in winning those two states you've won a huge population of people. Yet for republicans to get to the same number of EC votes, they have to win over far fewer people, which is a pretty clear advantage for republicans. For instance, in Wyoming, each electoral vote represents 143,000 people, while in California and New York it's more than 500,000 to each EC vote.

    Basically, EC adds more weight to more rural votes relative to more urban votes, which pretty clearly benefits republicans more than it benefits democrats, as evidenced by 2000 and 2016.

    There's no doubt that candidates would run differently if it was based on the PV instead of the EC, mainly in that republicans would have to make up for what they lose in rural votes becoming equal by seeking more votes from traditionally democratic voters, which would shift their center to the left.

    My main issue that as the son of a statistician I find the EC to be offensive to sound mathematical principles, it's essentially a system with built-in rounding errors and measuring flaws.

  • 1
    toomuchbaloney likes this.

    Quote from SC_RNDude
    I don't disagree with anything you have said.

    However, the justification that the electors should go rogue is based on faulty reasoning. Clinton won the game that no one was playing.
    Quote from SC_RNDude
    You are giving it credibility, which speaks for itself.
    It was actually the founding fathers that gave credibility to the idea of the electoral college electors picking someone different than the voters, they intentionally designed the system that way. There were various reasons argued for doing this, one if which was to prevent the electorate from essentially cutting off it's nose to spite it's face. There was concern that an angry electorate might express their anger by voting in someone that was essentially a critique of what they were mad about, and I can see the comparison made to Trump on this point. So I don't think it's completely accurate that the way the electoral college is set up wasn't intended to override a president elect like Trump.

  • 3
    BCgradnurse, herring_RN, and elkpark like this.

    Quote from pmabraham
    The lies of Obamacare -- the unaffordable healthcare act:
    • You can keep your existing healthcare plan if you like it.
    • You can keep your existing doctor if you like your doctor.
    • You can keep your existing pharmacist if you like your pharmacist.
    • Families will save an average of $2,500 per year on their insurance costs.
    • The mandate is not a tax.

    President Obama and the Democrats, remember Obamacare is 100% partisan, told the American public how evil the insurance companies are, how greedy the CEO's of Insurance companies are and then crafted a bill (with idiot Nancy Pelosi stating it had to be passed in order to know what's in it -- like read the bill in order to know what's in it wasn't an option. Given that they forced the timeline, what would one expect) which made insurance companies part of the winning monopoly as well as jacking up what had to be in the insurance -- who cares if you needed the coverage whatsoever -- to increase the cost so those could afford the higher prices could subsidize those who could not.

    Now, classic Mafia style democrats (look at the history of the democrats on fighting against freeing slaves, fighting against women voting, etc) they claim they are for the poor, but if they wanted to do real wealth distribution, they would have done it with real money vs. what accounted to monopoly money with the subsidies.

    My wife and I have Obamacare, and our plans are cancelled once more. What we did have, was expensive; and the deductible so high we did our best to avoid using it. Obamacare has been and continues to be a disaster.

    Health insurance is not the way and means to increase access to healthcare where in a free country, every single provider has the very right to state - take this insurance and shove it! We don't accept the insurance!

    We need a means whereby the health care providers will accept the form of payment; and that's a cash-based system that puts the patient directly in the relationship with the provider vs. the insurance company being the direct party having the relationship with the provider. Insurance should only be there for catastrophic events, not day to day or month to month healthcare access needs.

    The money put into the Obamacare disaster during the year before inception and two years afterwards could have put between $1,000,000 and $3,000,000 in every LEGAL American Citizen's -- including children -- HSA. And then if you wanted real wealth redistribution, have the rich pay a tax that goes into the HSA's of those in need or otherwise covers the catastrophic insurance of those most prone to need or use it.

    Then you don't have to worry about pre-existing conditions, age (young or old), rationing, etc. After that or during, then work on how to reduce the overall cost of healthcare including making sure Epipens that were sold for $57 a few years ago aren't being sold for $600 to $900 because of lack of competition et al.
    You've complained about how much money people have to pay before insurance kicks in (deductibles), but also complain people should use more of their own money first before insurance kicks in, so which is it?

    HSA's are an important part of how we cover part of our costs and are more common than ever now, but it doesn't work to try and use them for all costs including catastrophic since we'd have to put hundreds of thousands or millions of dollars into everyone's account starting now which is not anywhere near feasible or economically smart.

    And there is no math that puts $1,000,000 to $3,000,000 in everyone's account by dividing up the cost of starting up obamacare. A high end cost estimate for total costs up to now is around $100,000,000. There are 319 million people in the US, $100 billion divided by 319 million is $313.48

  • 0

    Quote from conservativeprof
    Oh my goodness, this thread. The fantasizing on the Electoral College (all the states committing their vote to the winner of the popular vote....really?) making a Clinton presidency reality remains strong.

    The Electoral College winner not having the popular vote has happened .......5 times! It's never been reversed.
    I agree it's pretty silly, which is why it doesn't make much sense for that pathway to even be available.

  • 3

    Quote from azhiker96
    Unfortunately, we don't know the full will of the people. We only know the votes that have been counted, not the votes that were cast. Over a million absentee votes were never counted because they would not sway the particular state's election outcome. Absentee votes tend to favor Republicans over Democrats. It was absentee votes in Florida that gave Bush a 500 vote lead. Without them Florida would have gone to Gore with a 200 vote margin.
    Absentee votes are never not counted, there are many still left to be counted, mostly in Washington, California, and New York which are pretty unlikely to go in favor of Trump, more likely around a 2:1 ration in favor of Clinton.

    Either way it doesn't really matter at this point.

  • 1
    NRSKarenRN likes this.

    As for what to expect going forward, Trump has already stated that plans on keeping key parts of the ACA, including requiring insurers to cover pre-existing conditions, which effectively also requires some variation of a mandate to be covered, and both Trump and Gingrich have consistently called for everyone to be covered.

    Gingrich's plan has been to use tax credits to make insurance cheaper, just like the ACA, but when people opt out of buying insurance and then end up in the hospital they would be placed in high risk pools and their unused tax credits from not buying insurance would be used to cover their costs. The problem with that is these tax credits would only cover a small portion of the healthcare costs of these pools, leaving the need to either just cut off a portion of those people from treatment, or establish a second tier of hospitals and other services that provide a more minimal level of care. One option that's been thrown around is to have non-ICU hospitals to keep costs down for this pool of patients.

  • 4

    Quote from BSNbeDONE
    Nurses who harbor criminals, regardless of the location, are just as guilty as the criminals themselves, as would be any other individual.

    We do not silently aid-and-abet (spelling?) wanted criminals by turning a blind eye. If it is determined that one of our patients is wanted by the law, anyone can make an anonymous phone call to the proper authorities...which is what I would do. This is told to each of us during the onboarding process in employment.

    If it is discovered after the patient has been admitted, notify the manager, who should notify the hospital's security/police department, who should and probably will inform local authorities. The patient care continues, but probably under a (literally) guarded situation until discharge.

    If this is discovered on a day off and we know the patient's (criminal's) location, again, anonymous phone call, phone call to the hospital's security department, and/or call to the supervisor. We have an obligation of safety to all individuals who enter our doors: colleagues, patients, and visitors.

    We are far too busy with sick people. Word is already out that known drug addicts can come to us with subjective complaints and get their quick-fix. We do not want to be known as a safe haven for basic and/or hardened criminals.

    Just my opinion...
    That's actually a pretty clear HIPAA violation as it doesn't abide by the notification of law enforcement requirements, and no, treating someone accused of a crime is not aiding and abetting. Aside from the legal definitions of what exactly is required to notify law enforcement of a patient being in your facility, it's also unethical.

  • 3
    chare, KindaBack, and vanilla bean like this.

    Quote from dream'n
    I assume you mean 'pausing the tube feed' because the HOB is lowered to under 30 degrees to provide care? If so, then yes I do. Would I stop doing it if EBP shows it's not necessary? I doubt it because I don't see the harm in extra airway protection. No, I've never forgotten to restart the feeding when I was done. Heck the machine beeps at you if you don't restart. BTW, I'm an old schooler that still aspirates with IM injections because after all my years of nursing, I have gotten blood return once. And that once was enough for me to believe it's a good idea. Plus the reasoning not to aspirate that I received straight from the mouth of the CDC was ridiculous.
    I've never paused TF because I've never seen the logic in doing so, out of curiosity, what's rationale that pausing provides airway protection?

    If normal gastric volumes can be around 250ml, then how does pausing a TF going at 60ml/hr for 5 minutes provide any benefit, since you're only changing the gastric volume by up to 5mls which isn't really significant given the 250ml or more that might already be in the stomach?

  • 2
    herring_RN and toomuchbaloney like this.

    Quote from chare
    No, but it would require a constitutional amendment.
    The mechanism for changing to direct presidential elections would be a constitutional amendment.

  • 4

    Quote from arizonagirl2016
    I'm hoping something good comes of it. As it stands, the ACA hasn't made healthcare affordable. Premiums just increased dramatically in my state, making it absolutely unaffordable for my husband and I to both be covered. We don't qualify for subsidies, he doesn't have insurance through work and for us both to be covered under my plan from work would be $850 a month which is pretty much most of my paycheck. And that would be just for medical. It doesn't include vision and dental. So at the moment, I'm insured, he isn't. And we're just hoping we won't be in a situation where he needs something until we can get it figured out. Oh, and we're newly married so things are tight money-wise. But right now, we definitely don't have the money for insurance because premiums are ridiculous. Hopefully something can be done about those stupid-high premiums.
    True insurance wasn't really available in the individual market prior to the ACA, the majority of people who declared bankruptcy due to medical bills prior to the ACA had insurance, so it wasn't doing much to keep healthcare sustainably funded.

    Health insurance is now required to actually do what's supposed to and reflect a person's share of healthcare costs, which isn't a bad thing but also isn't cheap.

    For each person that pays less than their share, someone else has to pay more, so we can't just say everyone can pay less, instead there's a necessary cutoff for subsidies. If you and your spouse don't qualify for a subsidy then that means you make more than $64k a year, well above the US average for an entire household. What do you think the cutoff should be?

  • 4
    chare, AJJKRN, AceOfHearts<3, and 1 other like this.

    It's never really as simple as just a number, so given your combination of medications I would guess you're talking about a patient in alcohol withdrawal. The withdrawal symptoms we're treating with benzos typically also drive up blood pressure, so if the patient is hypotensive then that usually also means additional benzos are not indicated. There are certainly exceptions, such as a patient who presents with sepsis and then also goes into withdrawal, in which case I would still treat withdrawal symptoms and prevent seizures with benzos, and then use pressors to treat the sepsis induced hypotension.