Latest Comments by Jolie

Jolie 33,186 Views

Joined: Oct 17, '01; Posts: 9,619 (48% Liked) ; Likes: 14,059

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  • 0

    Can anyone recommend a practical drug reference guide (website, app or hard-copy book) for home use?

    I am new to case management and often field questions about diluting or crushing meds to be given via g-tube. I have no trouble finding sources that indicate whether or not it is safe to do so. What I can't find is a practical guide on how best to dissolve those meds to prevent clogging the tube. I have referred patients to their pharmacists, only to learn that many won't offer that kind of "off the record" advice.

    Insurance companies won't pay for liquid meds, and pharmacists can't or won't offer practical advice on how to safely get crushed meds thru tubes, so we're paying to replace tubes instead.

    I'm certain this information exists. Does anyone know where I can find it?

  • 13
    PotatoRN, evastone, Mini2544, and 10 others like this.

    Thanks, Kyrshamarks for opening a realistic conversation about the topic of government controlled healthcare.

    Alfie's case (nor the other little boy earlier this year, whose name I can't recall) was NOT about preventing a slow painful death, or even about allocating money to patients most likely to benefit from treatment (at the expense of those not likely to benefit). If it had been about either of these things, there would have been no objection to the parents taking Alfie out of the country at their own expense for evaluation and possible treatment elsewhere. But that was not allowed. They weren't even allowed to take him home.

    This. was. all. about. control. And if we allow our government to fully fund and dictate healthcare, it will happen here.

    This next statement is not meant as a slam to the British. It is meant as a warning to us: I find it utterly inexplicable the extent to which people will willingly relinquish control of decisions pertaining to their own health, safety and well-being in exchange for the mistaken notion that they are not responsible for payment for the goods and services they receive. I am also dumbstruck by the number and seeming intelligence of people who think that because a bill does not arrive in their mailbox, they are receiving something for free.

    God rest that precious soul. And the next. And the next after him.........

  • 3

    Quote from Nurse Beth
    I've seen this done at Cedar Sinai with a doctor present at all times. The clinic is run like an efficient, safe outpatient surgery clinic. Consents are signed, NPO prior is confirmed, allergies checked. IVs are started on patients for sedation and emergency access. Discharge instructions are given. A crash cart is nearby as are ACLS trained staff.

    I'm just surprised at what you are describing.
    Beth, might you be confusing TMS with ECT?

    What you are describing is typical of out-patient ECT, where an efficient, well-run clinic can admit, treat, recover, and discharge an experienced patient about 1-1/2 or 2 hours.

    TMS does not require a patient to be npo, there is no IV or sedation, and no recovery time. Most patients drive themselves to and from treatment, often before or after work, or even possibly on a lunch hour. Max time in the chair is about 40 minutes.

    I have become familiar with this procedure recently, accompanying a family member. The clinic is part of a multi-specialty psychiatric practice, with MDs, NPs, therapists, RNs and psych. techs.

    The initial mapping of each patient is conducted in 2 steps, first by the RN and tech working in tandem. Once they determine the ideal coordinates, the procedure is repeated by the physician, and then results are compared to those generated by the machine itself. The first treatment is conducted by the physician. Mapping is repeated approximately 1/2 way thru the course of treatment.

    Each session is conducted by either the RN or psych tech, with a second professional present in the office. The person conducting the treatment uses the time to converse with the patient, present educational information, etc. This isn't a therapy session, but is useful in assessing the client's mood, activity level, motivation, behavioral plan, side effects, etc. It is not acceptable in this practice to plug in earphones and "chill" during the treatment.

    To Curious MD, As a business owner myself, I understand the challenge of starting up a new business and realize that personnel represent the biggest expense, by far. Though it may be tempting to cut corners to save on this expense, I implore you NOT to do so. Give up your own salary first. (Like many entrepreneurs, we went for a few years without paying ourselves.) It is necessary, and will pay dividends down the line when your business thrives because of the quality and commitment of the front-line people interacting with your patients.

    Best of luck to you.

  • 0
  • 0

    Are hospital acquired surgical site infections reportable (by mandate) to any government or regulatory agency?

    Is there a means for a patient to self-report a hospital acquired surgical site infection, like a website or hotline, similar to the reporting system for vaccine reactions?

    Thanks for your expertise!

  • 1
    KelRN215 likes this.

    I'm sorry you didn't get the job you wanted, but I believe you are over-stating things just a bit.

    You said you were not interested in rotating shifts. That is a far cry from disclosing a disability. Plenty of nurses reject rotating shifts for plenty of reasons: they don't want to mess up their sleeping habits, they need to accommodate spouse's or children's schedules, they take public transportation which doesn't run 24/7, they want to be able to maintain other commitments like school, second jobs, volunteer positions, etc.....

    As a hiring manager, I would tend to assume a candidate was declining a rotating shift job for one of these reasons, not because of a disability.

    So please, rest assured you can move on with your confidential information. I doubt anyone in HR gave it a second thought.

  • 2
    kbrn2002 and NutmeggeRN like this.

    What is a "nut aware" school?

    I can think of a couple of working definitions that have nothing to do with food consumption.

  • 8

    Quote from BiscuitRN
    My 90-year-old little Irish grandmother swears that a Hot Toddy will cure any illness. She claims that once my grandfather had a fever, and when he drank a Hot Toddy steam came off of his head then his fever was gone. I just smile and nod because she's a sweet old lady.
    This little Irish woman agrees with your grandmother! And my hubby's name is Todd. So "Hot Toddy" just makes me giggle, whiskey or not

  • 12
    Meriwhen, rn1965, squishyfish, and 9 others like this.

    The first thing I noticed about this post was: "Patient is 21 years old tells the psychiatrist she has OCD."

    My thought: Starting off an initial visit with a new healthcare provider by informing the provider what one's diagnosis should be will probably not end the way the patient had planned.

    Secondly: Young adult psychiatric patients are often poor historians. I'm not being judgmental, just stating an observation. Including the patient's mother in the discussion was necessary for the physician to gain information as well as perspective. As a legal adult, the patient did not have to allow this, but without the mother's information, the physician may have chosen not to treat the patient, rather than attempt to do so with inadequate information.

    Thirdly: I find psychiatrists who don't automatically reach for prescription pads to be worth their weight in gold.

  • 5

    Please correct me if I'm wrong, but I understand that the OP chose to transfer care to the clinic where her former friend is employed after knowing that the former friend shared news of her pregnancy, yet wants to report the former friend for a non-existent HIPAA violation.

    If I were the manager of this clinic and the OP came to me with this story, I would respectfully decline to accept this patient. In the real world, there are clients who are simply not worth the trouble they bring to a business. This is one of those instances.

  • 0

    Quote from FolksBtrippin
    No such thing as "abuse" of your paid time off. You're not an abuser if you don't want to see a doctor.

    Take care of yourself.

    I agree that taking care of yourself is the key, and don't believe that seeing a doctor is the only way to accomplish that.

    What I do believe is that calling out (typically on short notice, when one is taking a mental health day) IS abusive if nothing is done to address the source of mental distress.

    So if you're staying home from work using sick time to sleep in, down a six pack, and watch Netflix, that's a different story than researching support groups, taking yoga, getting a massage or seeing a therapist.

  • 10
    Howej1, rn1965, VivaLasViejas, and 7 others like this.

    If your physical or mental condition prevents you from performing your job duties, then it is appropriate to call out sick. However, just as you would consult a healthcare provider for a physical illness, it is your responsibility to seek appropriate care for your mental health. If you fail to do so, you are just taking time off, which is an abuse of your sick time.

  • 0

    Please accept my answer in the spirit it is intended: as a practical response, not a harsh one.

    It doesn't matter a whit which rotation you do first. Not a single patient, faculty member or future employer will ever ask or care. Please don't stress yourself out over this non-issue, when there are so many real concerns in life.

    Good luck to you.

  • 6

    It sounds to me like neither the family nor agency are bothering to address a problem that is not yours.

    I have worked NICU in a number of different cities and was responsible for planning discharges. That often involved setting up homecare, including equipment and staffing. I don't ever recall a situation where we were unable to make arrangements in advance for designated parking, coordination with EMS, and guarantee of utility service for families with medically fragile children.

    If this isn't happening, I believe it is because someone isn't bothering to request it.

  • 0

    You need to contact the MD BON to clarify their requirement.

    Does the practice requirement begin upon graduation or upon receiving your initial license? Since you just passed NCLEX and received your first license, the continuing practice requirement may just be beginning, in which case you would be eligible for a MD license, providing everything else is in order.

    Or do they go back to your graduation date and begin the continuing practice requirement then, in which case, although your license is new, you have not met the requirement.

    If MD says that you do not meet the continuing practice requirement, you can either take a refresher course, or find a state in which you are eligible to practice and get 1000 hours under your belt before moving to MD.


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