Latest Comments by KelRN215

KelRN215, BSN, RN 66,751 Views

Joined: Oct 19, '10; Posts: 7,549 (61% Liked) ; Likes: 16,883

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  • 0

    Reading the OP, it seems like you are looking for the opinion of nurses who work exclusively with typically developing, healthy kids. Most pediatric nurses don't. For example, my answers to question #3 (What is one health care complaint or problem that is more prevalent in your practice for children ages 5-12 that visit your office for medical care?) would be, based on my past and current jobs, 1) seizures, 2) leukemia, 3) cystic fibrosis, 4) cerebral palsy.

    Are healthy kids less active today than they were when I was growing up? My mother the teacher would say yes. Most of my patients are quadriplegic/wheelchair bound so they can't be active.

    What could parents do to help their children be healthier? With my patient population, parents could not do drugs while they're pregnant. A large percentage of my patient population were exposed to either narcotics or alcohol in utero.

    ADHD, I only have 1 patient out of my caseload of 26 who has ADHD. The rest of them are probably too developmentally delayed to even be considered for such a diagnosis.

    Socioeconomics- this varies by state. My state's Medicaid is excellent and, I believe, the best insurance in the state. Kids on Medicaid can have better access to care than kids with private insurance. In fact, the children I work with are either in foster care or have been adopted out of foster care. Once they are adopted, CPS continues to provide them with Medicaid until they turn 18. The lead medical social worker in the state actively discourages adoptive parents from adding their children to their private insurance when they qualify for Medicaid because they have to pay a premium for it and it doesn't cover as much as Medicaid does.

    Discipline- as I mentioned, most of my patients are severely developmentally delayed and don't walk or talk so there really isn't much disciplining to be done with them.

  • 0

    Quote from FolksBtrippin

    "Excommunicable offense"


    There is no such thing in the Catholic Church. You can't even excommunicate yourself. Your parents baptize you and you are a catholic forever more. You might be a bad Catholic, but you're still a Catholic according to the church. You might decide you are an atheist or a voodoo priest or a mormon, they don't care. You're a Catholic to them. Period.

    Excommunicated... lol.
    I tried once. I sent an email to the church I was confirmed through and told them I didn't want to be Catholic anymore. They never responded.

    It's been 18 years and my mother and I still fight about the fact that she forced me to get confirmed when I was 16 years old and knew I didn't want to.

  • 0

    I wouldn't spend any money on this. As far as I can tell, based on my facebook newsfeed, "health coaching" is pretty much a MLM scam. I would bet money they'll fade from popularity within a few years.

  • 0

    Quote from heythatsmybike
    Thank you guys so much, this has all been really helpful. Would you guys recommend me reaching out to the nursing manager re: when I should hear back or the HR person? I have tried both in the past, and was wondering which would be more appropriate. I feel that the nursing manager is more personal, but maybe that shouldn't be the routine, I'm really unsure. Any advice is appreciated, thanks!
    Did you send a thank you email after your interview?

  • 0

    Quote from Lil Nel
    Are you talking about MGH?

    I stayed at the Back Bay Sheraton this summer, and it was over $200 a night.
    No, a different Harvard hospital in Boston. I'm not saying there are no hotels in the city that cost over $200/night but saying that "hotels start at $200/night" is untrue.

  • 0

    Quote from AnnieOaklyRN
    Just to clarify the actual physical commute driving, with little to no traffic is 50 minutes which is more then doable. The only time I get this is when its a saturday or sunday shift that starts at 7 am, otherwise its horrendous. I figured it wouldn't be nearly as bad as it is during the off shifts (11a-11p and 7p-7a) but it is unfortunately. I also try and take public transportation to avoid having to sit in the traffic, as I find it a little more relaxing, the problem is is that it takes 2-3 hours going that way. No easy solution

    I have tried to work with the manager, as the traffic is a bit less during off shifts and it takes 1.5 -2 hours instead of more during those times, but she says she cannot do it. I was actually told could work 11a-11 pm during my interview once off orientation, and clearly that was missinformation. I was also told I would do a couple nights per a schedule (it is actually 6 plus a schedule), and that there would only be 2 or so call shifts per an entire schedule (there are usually 1 to 2 a week for each person!).

    Just to reiterate my decision to leave is NOT just based on commute time, its the team dynamics and the job itself, and the schedule which they were not honestly about during my interview. Since I started 5 plus people have left, the team has very poor morale and it isn't getting any better anytime soon.

    The city where this job is, is EXTREMELY EXPENSIVE, as in a 1 bedroom apartment in a slummy part of town cost about 2000.00 a month. A hotel room is 200.00 plus a night, so those are not options. I own a house in the woods and prefer that, and I would never live in any city! I have always wanted to work at this hospital, thus I accepted the job knowing that it may not work out, or it may end up being my dream job. It hasn't worked out, so I am looking for a new one. There are many people in this world who have taken jobs only to realize it was a big mistake... it happens!

    I know your immediate issue was solved but the cost of living you quote here is simply not true. I live in the city you're speaking of and my mortgage for a 3BR house is less than what you say rent is for a 1 BR apartment in "a slummy part of the city." I live in a residential section of the city that is nowhere near slummy. I have friends who own a 2 BR condo in a nice part of a neighborhood you might consider "slummy" and rent it out for ~$1300/month. I lived in an apartment in the city for 4 years before I bought my house (in an area by a lot of colleges) and rent was less than $1000/month. I have stayed at hotels by the airport when I had early morning flights and wanted to maximize my sleep for less than $80/night. We just got married and none of our out-of-town guests paid anywhere close to $200/night for a hotel room. And I just checked Priceline and there's an Express Deal today for the Hilton in Back Bay for $96 as well as a deal for the Park Plaza for $65 for tonight.

    Everyone thinks this hospital is their "dream" employer until they actually work there.

  • 3

    Quote from not.done.yet
    When you consider a CPS report on a child in the school setting, are things like frequent tardies or absences, missing vaccinations, inconsistent school work and poor behavior by the child (inability to cope with the variables of the school setting), childhood obesity etc factors that come into play? I am wondering how neglect or drug use in the home without overt physical abuse is discovered or acted on.
    I currently work with medically complex children in foster care. I have a child on my caseload- a 5 year old who was 130 lbs with severe hypertension when she was removed. She had an open case with CPS for several years because of neglect- missed medical appointments, insufficient food and hygiene, and then there was a new report filed because of concern that the parents were trafficking fentanyl through the home so the children were removed. The office that removed them told me that they couldn't believe that the office that had an open case with them for 2 years (they moved shortly before they were removed) never removed them.

    My patients are in state custody for reasons that vary from born drug exposed, Mom got caught driving drunk with the child in the car, Mom was 14 and incapable of demonstrating her ability to care for her medically complex baby, teenagers with school truancy/medical non-compliance whose parents don't know how to parent them, etc. Mostly it's parental drug use coupled with medical neglect though. I have very few child abuse cases though in the program we do have a few former shaken babies and I have one whose twin was shaken (to the point of being killed). I do also have one who was taken d/t suspected child abuse/because of unexplained fractures but it turned out she has osteogenesis imperfecta so she is home now.

    Medical neglect is usually discovered because of severe failure to thrive, multiple missed medical appointments, undetectable drug levels (for things like anti-epileptic medications or cyclosporine). I have one kid who was taken because his Mom refused to call 911 during a prolonged seizure because Dad was in the home and there was an outstanding warrant for his arrest.

    As far as filing goes, in my state as mandated reports we call the local CPS office to file a report of abuse or neglect. The report is either "screened in" or "screened out." If it's screened out, it means CPS isn't going to investigate at all. If it's "screened in" it can be an emergency response (investigation must begin immediately and be completed within 5 days) or non-emergency response (investigation must begin within 2 days and be completed within 15 days).

    In my state, CPS does not tell parents who filed a report (though they can usually figure it out). A SW in a child's Pediatrician's office and I once filed 4 reports in a 48 hour period over the family tampering with the child's valium. When the state did an emergency response and confiscated the bottle then went to court to get custody, I'm pretty sure they had to share that "the visiting nurse found that the valium bottle had been diluted" and the mother (even though her IQ was actually about 60) knew I was the one who filed the report.

    I would say it's not uncommon for CPS to screen out one report and then respond when they get multiple reports filed on the same child. Sometimes that's the game you have to play with them- you keep filing new reports until they respond. Several years ago there was a high profile case in my state where a child with an open case with CPS was found dead on the side of the road and it was discovered that his CPS worker hadn't been doing her monthly visits. When newspapers were investigating, several places (like schools, MD's office and hospitals) shared what they sometimes had to do to get CPS to act. I specifically remember reading that one school's principal said his school filed 14 reports of sexual abuse before the state even opened an investigation on one of their students.

    People who work for CPS aren't, as someone else mentioned above, the best and brightest. Many of them are just out of college and have very minimal training for what they're doing. About half the time I can't even get ongoing workers to call me back.

  • 1
    Carrie_RN likes this.

    For the patient who you find soiled from head to toe every time you go out to see him- Adult Protective Services needs to be called immediately.

    I don't disbelieve that a doctor told the wife of the IV antibiotic patient that a nurse would come out to administer the medications. I was an infusion liaison for 3 years and the doctors frequently did tell families that. Then the Case Manager and I would have to explain that that's not how it works and if you want to take your child home on IV antibiotics, you need to learn to administer them and care for the PICC.

    Also it sounds like a large number of these patients should have Home Health Aides or PCAs (not sure if your state has that) in addition to the skilled services they are receiving.

  • 2
    Serhilda and xoemmylouox like this.

    I have a question for you all. How do you feel about methotrexate or other drug-based treatment for the termination of ectopic pregnancy?
    It's the least invasive method to terminate a pregnancy that is in no way viable. I don't see how anyone could be against it.

    As someone who was raised with very loose christian beliefs and spent some of my young adult years in the Catholic Church, I'm really intrigued to see how much focus there really is on this topic in the medical community. I work in an OBGYN hospital on the triage floor, and many times have had methotrexate used to terminate ectopic pregnancy in non emergent situations. I have seen patients take this in different ways, varying from complete emotional breakdown to sigh of relief. I see this method as one of the safest ways to handle the situation and find the noninvasive nature of it very appealing, but according to the bylaws of the Catholic Church it is still abortion and an excommunicable offense. I am not certain of how other denominations of christianity or other religions view it, and would be curious to learn.
    The Catholic Church should stick to churching and leave medicine/surgery to those who are professionally trained. An ectopic pregnancy is not viable.

    On that note, a couple of questions for you:
    How do you feel about termination of an ectopic pregnancy by pharmaceutical means?
    See answer to question 1 above. I also support the use of mifepristone + misoprostol for women who are up to 7 weeks pregnant who elect to terminate their pregnancy.

    What religious background are you speaking from?

    How does your denomination/church/religion view this? Are your views in line with theirs, or do you find yourself on the outskirts like me?
    I don't have a religion. I was raised Catholic and left the church as soon as I was 18 because of their views on things like women's rights and gay rights.

    And to better understand your viewpoint, do you identify yourself as pro-life, pro-choice, or undecided?

  • 0

    As one of your fellow Canadians once said, "you miss 100% of the shots you don't take." There is literally nothing to lose by emailing.

  • 0

    Quote from applewhitern
    My son's port was to be used for chemotherapy only, period. The cancer center always stuck him when drawing blood, they never used the port for anything other than chemo infusion. He always got a peripheral IV for everything else. They get infected too easily! He had 3 total.
    Complete opposite at the cancer center where my patients are treated. When I was a visiting nurse, I regularly accessed kids with solid tumors twice/week in the home for labs. For kids with ALL, they got labs drawn on one day and methotrexate the following day if they met criteria. Some of the kids didn't want to stay accessed overnight so they'd get accessed for blood draw day 1 and reaccessed for methotrexate the next day.

    When I was an infusion liaison, if any of these patients had to go home on IV antibiotics for any reason, they went home with the port accessed and their parents were taught to administer IV antibiotics through the port. The visiting nurse or clinic nurse would change the needle weekly.

  • 4

    Surgeon is responsible for surgical consent, Anesthesiologist is responsible for anesthesia consent.

  • 2
    Hoosier_RN and thoughtful21 like this.

    Pay questions should be directed to HR. The hiring manager may not even know. In many hospitals, the rates are standard for new grads and differentials are also standard as well.

    When I was a new grad, HR shared with me the starting salary for new grads when I interviewed. For all positions since, I've been asked what my expected salary is by HR during the initial phone interview and told around what the expected salary would be. (For example for my current job, they asked my salary requirement, I told them I was currently making $91K and wanted to make at least that and they told me the salary would be "around there." It ended up being $95K when they made the offer.) The official salary has never been officially shared until an offer was made.

    Scheduling/on-call questions should be directed to the hiring manager because each manager may run their department differently and HR may have no idea. Every job I've held other than my new grad job has been M-F set schedule but when I interviewed for my new grad job, the nurse manager told me in the interview that the schedule would be day/night rotation with every 3 week weekend requirement.

    2 months is not a horribly long time to be searching for a new grad position, especially if you didn't start applying until after you were licensed. In my area of the country, new grad jobs are usually offered before one graduates for the July and September start dates so if one waits until after graduating/passing NCLEX to apply, there are no new grad positions open until the November or March start dates. And this time of the year is slow for hiring d/t the holidays.

  • 1
    xoemmylouox likes this.

    I've negotiated new jobs honoring trips I've already booked/time off already planned the last 2 new jobs I've received. I would not mention it at the interview but ask about it before accepting an offer. Most likely if you start before the trip and negotiate with them, you will need to take the time off unpaid.

    This is what I've done the last 2 times-

    Last job- got offered a job I didn't even apply for on the spot after the company took me out to lunch to interview me. Received follow-up offer in writing from the office manager later that afternoon. Received an email from the manager after the official offer saying "I really hope you will accept this position." Responded and said "I would love to accept this position; however I have a question. I have an international trip booked in 3 months that I already paid for, can this be honored?" He immediately responded and said "of course, welcome aboard!"

    Current job- received an offer over the phone, asked for the HR lady to send me the benefit information and an offer in writing. Responded to it to ask if the trip I had already booked for 3 weeks from the start date could be honored as well as one day when I already had MLB tickets (a day that's a holiday in MA that was observed by my last job but not my current job). She quickly responded to say "all of that can be worked out" and I accepted the position.

    I would not mention it at the interview because you don't want them to give you a reason to not want to hire you. You don't say where you are located- 4 week long vacations are very rare in the US so a hiring manager might not like hearing this at the interview. My current medical director did ask me when I interviewed for my current position how I deal with working with such difficult cases though (I work with medically complex children in foster care) and I honestly answered that I take regular vacations. I just returned from a 10 day trip to South America, actually, and it's the 3rd vacation I've taken since I started this job 9 months ago.

    In your case, since your trip is coming up in January and your interview isn't until December 10th/there are major holidays coming up in 2-3 weeks which can affect how fast HR moves, it may even be wise to simply ask to start once you return from your trip.

  • 1
    chare likes this.

    Quote from Brithany#1
    I'm still waiting for some "official " letter from the BON ....How do I contact my state rep, any ideas?
    You should be able to find out the information on the state's government website.