Latest Comments by MunoRN

Latest Comments by MunoRN

MunoRN (22,290 Views)

Joined Nov 18, '10. Posts: 7,010 (67% Liked) Likes: 15,975

Sorted By Last Comment (Past 5 Years)
  • 0

    We do 1:1 only until extubated, same at a previous place I've worked. I don't really have a problem with that, they're certainly still busy after extubation but no more than any other ICU patient can be. They typically get transferred to the cardiac tele floor the day after surgery where they will be 4:1, so it wouldn't make much sense to keep them 1:1 until then.

  • 12

    Quote from Ruger8mm
    Funny thing is this thread was started to educate my fellow health care workers on non-lethal ways to defend themselves and the anti-gun nuts who think guns are big and scary jumped all over the fact I mentioned a gun in the initial post and turned the conversation in that direction.
    If that was the purpose of your first post then you didn't communicate that very well, it was pretty clearly a complaint about not being able to carry at work, not helped by the fact that you waited one whole post to use the term "scared liberal".

    I consider myself to be a responsible gun owner, and I'm all for a reasoned conversation about the role of guns in different situations, but I find the pushiness and name callingvto be counterproductive in creating more understanding between the gun haves and have nots.

  • 5

    You're certainly not going to see people at their best in the ED, so if they are a jerk on their best day... I try to keep in mind that they are in pain, or that they're having to watch their loved one in pain, and getting inadequate treatment. I usually will explain that the fewer things on my list that I have to do, the quicker I can get to getting them pain medication, and having to deal with a disruptive patient and husband isn't making my list any shorter.

    What sticks out to me though is that the doc is only giving one time pain med orders for a patient with a known kidney stone, I've never known an ED doc to do that and is pretty much guaranteed to inadequately treat the pain. I'd tell the Doc that the patient in bay 12 wants to talk to them about their poor prescribing habits.

  • 12

    I concealed carry at times, but it's not appropriate at work in a hospital, mainly because it's statistically more likely to be used for harm than it is to defend against harm. More often than not, that concealed weapon will turn an otherwise unarmed bad guy into an armed one. Those of us who carry to prevent a bad situation don't carry at work, it's usually just those who carry to feel less inadequate that want to carry at work.

  • 0

    It's not actually a rally for national patient ratios, it's just for ratios within the District of Columbia. I'm all for legally mandated workload limits for nurses, but I don't think simple ratios are the best way to do it. While it's great to be limited to 4 patients to one nurse on a tele unit for instance, it doesn't really help if you have no UC, no CNA's, no housekeeping, you have to prepare the patient's meals, etc.

  • 7
    Rose_Queen, elkpark, RainMom, and 4 others like this.

    Quote from brandy1017
    You're ridiculous! Hand washing won't harm you, won't leave you paralyzed, possibly permanently, possibley may kill you! Flu vaccines can! The worst hand washing can do is leave your hands red, dry and irritated. There is a serious risk with the flu shot so a person should be able to make an informed decision whether they are willing to take that risk and frankly I think it is not worth it when the vaccine is mostly ineffective!

    I think big pharma should be held accountable for the damage it causes and people should be able to sue them, but the govt is in collusion with the corporations against what is right for the American people! It's all about the money! Big pharma bribes many govt officials to get the legislation they want to keep making the profits and people's lives and safety be damned!

    I remember when Gov Perry tried to mandate all female teens receive Gardasil no doubt as a reward for the millions Merck has given to his campaign and the Republican party! In case you don't know like other vaccines there have been serious side effects, even deaths from Gardasil.
    Frequent hand washing can actually have more severe effects than just dryness, but I agree with your general point; comparing something with relatively few risks to something with well established immensely larger risks is ridiculous.

    The flu vaccine is certainly not risk-free, there are a handful of deaths linked to the vaccine every year, but it saves lives in the neighborhood of about 4,500 every year. If you honestly believe that it does more harm than good then you really need to review basic math.

    While there are plenty of reasons to criticize Big Pharma for profiteering, vaccines aren't one of them. You can actually still sue vaccine manufacturers in the US, you just have to file a claim with the 'vaccine court' first. The purpose of this separate liability system is that unlike regular medications where the benefit is for the same person taking the risk, it works different for vaccines where it's a shared benefit and shared risk, which is why there is a separate shared fund for those injured by vaccines. I agree with you that the system should "do what is right for the American people", but I feel that having far fewer people hospitalized and far few people dying from an avoidable illness is what's better.

  • 6

    Quote from nursemeow908
    LOL! Really? That's you rebuttal? It's not my fault the FACTS are that handwashing is the most effective way of to decrease the risk of spreading germs. It's not my FACT that last years flu vaccine was 18% effective... Do you not agree with the CDC? According to the CDC, (2015)"[FONT=Lato, Helvetica Neue, Helvetica, Arial, sans-serif][COLOR=#000000]The updated VE (vaccine effectiveness) estimate against influenza A H3N2 viruses was 18% (95% confidence interval).. BTW if you took a statistics class you would understand that IT IS NOT EFFECTIVE! It's all about $$$ from the GOVT to your hospital... IF X amount of employees are compliant and receive a flu shot the hospital will receive a grant from the hospital.[/COLOR][/FONT]
    Hand washing is a very important part of reducing the incidence of the flu, but it doesn't negate the need for other measures and isn't actually more effective than the flu vaccine at reducing risk. Hand washing has been show to reduce the risk of transmission by as much as 50%, while the flu vaccine has been shown to reduce the risk by more than 70%.

    Vaccine effectiveness (VE) varies by strain and by year, and last year's VE for H3N2 was unusually low at 18%, the overall year to year VE average is 59%, which produces a significant reduction in risk, resulting in about 4,500 lives being saved each year, I doubt any of those 4,500 would agree with your description of the vaccine as being "not effective".

    Hospitals do not get paid for reaching a vaccination rate goal, part of VBP includes vaccine rate reporting, all hospitals have to do is provide their rates to a database to meet the goal, it doesn't matter what those rates are.

  • 1
    SororAKS likes this.

    CMS collects data on CABG mortality rates by hospital, you can look at their data here

  • 0

    There's no general reimbursement requirement that says an MD has to be physically present in the building in order to bill for phlebotomy. Some blood draw clinics are located in the same complex as a hospital facility or physician's clinic, some are not, it has no effect on reimbursement either way. It's also not unusual for phlebotomists to go out into the community to do draws, ours do daily trips to nursing homes for draws, it's covered the same either way.

  • 7

    Quote from nursemeow908
    I cannot believe how many professional nurses are so FOR a flu vaccine. I, like hopefully all of us depend on informed consent. After one learns about the flu vaccine, from reliable sources such as the CDC, why would anyone be up in arms about someone refusing the vaccine? First off, it's a virus. What do virus's do best? They mutate. The CDC states that they vaccinate for 3 strains. Yes, 3. Most of the time the vaccine does not even catch up with the actual strain that is infecting people at the current time. Also, if we are all working with integrity, we will be washing our hands and protecting ours/patients mucus membranes ANYWAY. FACT: Handwashing is the most effective way of spreading illness. So, spare me the drama and lets all just wash our hands the way we should!
    I cannot believe how many professional nurses are so FOR hand washing. Don't you know handwashing can be potentially harmful? Handwashing isn't 100% effective, so what's the point. Nurse's should have the right to chose what they do to their body, right?

  • 3

    Quote from Janey496
    To clarify, you dont have to reveal it to any immediate supervisors. Yes, obviously somebody somewhere needs to know what the disability is that prevents you from being able to work nights, but that information isn't required to be given to your immediate supervisor. All THEY have to know is that the HR people have looked over the paperwork and its legit, and it says that you can't work nights (or whatever your particular accommodation is).
    HR is still part of "your employer", and it doesn't matter if you have paperwork that says you can't work nights, if working nights is part of the job then they don't have to accommodate you.

  • 2

    I don't know that you've reduced the amount of misinformation related to this topic more than you've added to it.

    While you don't have to reveal your medical condition any more than is is required to establish a need for accommodation, you are required to disclose your disability when requesting accommodations, otherwise there is no way of knowing what accommodations you are asking for.

    You don't actually have a right to ask for accommodations that involve no longer have to perform an essential job function, so if the position you've been hired for specifies working at night, then that is an essential job function. The only examples where employees with valid disabilities are able to get around that have been where the employer did not adequately specify that the position involved working nights.

    If your claim is that working nights is unhealthy for you, then you still haven't made a claim that's any different than what any other night shift worker can claim. For everyone that work nights, there is an increased risk of cancer, heart attack, stroke, and diabetes. Common symptoms include weight gain, mood instability, endocrine imbalance, impaired immune system, etc.

    That doesn't mean that an employer won't just decide to give you preferential treatment just avoid the potential hassle you might cause them, but you're still left with the question of whether or not that's a moral thing to do. Everyone who works night shift is essentially sacrificing the extent of their lifespan, which is why there is generally an expectation that this burden is shared to one degree or another. To you really want to work somewhere that you'll be viewed as the nurse who felt someone else should have to cover your fair share of that burden?

  • 0

    I'm not really clear what your role is in this to begin with since you've described yourself as a "community nurse", aka public health nurse, yet you're describing a individual patient care role.

    I think it's totally appropriate for the family, which is who you essentially work for, to confirm that you are competent to care for their child. If anything, this sort of documentation would help protect you in the future since it limits the family's ability to say that you didn't have the basic skills to care for their child if something were to happen.

  • 1

    Quote from Been there,done that
    Some nurses have the cojones to work with, and appreciate an order for TID prn, some do not.
    ? I'm not sure it takes less cajones to point out to a Doc how they could better communicate what they want.

  • 4

    Quote from VANurse2010
    the point of that order is so that you have the latitude to give it without a specific timeframe, based on your assessment and the medication in question. I don't get what's so confusing or difficult to understand about this.
    TID prn can pretty clearly be interpreted inconsistently. If the point of the order is that the nurse can give doses at any interval, just not more than 3 doses per 24 hours, then that would be "1-3 doses q 24 hrs prn____". If the point is that the nurse can give additional doses after reassessing 30 minutes after each dose, then that would be "1 dose q 30 minutes prn _____ not to exceed 3 doses/24 hours".