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NotReady4PrimeTime RN

NICU, PICU, PCVICU and peds oncology
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NotReady4PrimeTime has 25 years experience as a RN and specializes in NICU, PICU, PCVICU and peds oncology.

certified pediatric critical care nurse and parent of multihandicapped adult son, married to computer geek

NotReady4PrimeTime's Latest Activity

  1. NotReady4PrimeTime

    Nebulizer/MDI for toddlers advice

    Well, nebulized treatments ARE aerosolizing, but not in the same sense intubation, BiPAP and sputum induction are. Medical gas from the wall outlet creates the aerosol in neb treatments, not the patient's cough or airway pressure. So albuterol or steroid nebs wouldn't require an N95 in most instances, unless there's a laboratory confirmed influenza, TB or chicken pox/measles involved. In the same way, PPE would only be required when entering the room of an adult self-administering a neb IF they have a PPE-required infection.
  2. NotReady4PrimeTime

    Youth at Risk - Suicide and Self-Harm

    For me, caring for the family was harder than caring for the patient. Especially when the suicide attempt was *almost* successful. Over the years I was assigned to care for several teenagers who'd attempted suicide by hanging. All of them were left with significant anoxic brain injuries, meaning full-time, ongoing personal care would be required. In some ways, the death of their child would have been the most merciful outcome. Watching as each tiny glimmer of hope was snuffed out and the enormity of the changes the family faced began to sink in was very difficult emotionally and psychologically. Taking part in family conferences took a lot of effort, because I knew none of what was said was truly understood. One such meeting stands out in my memory: there were no signs of brain activity but it was still too early to consider assessing for brain death. The mom was ready to let go, the dad very close to being there, but the physician insisted we wait until 72 hours had elapsed. And in that brief interval, the window slammed shut... spontaneous respiratory effort returned. But that was ALL that returned. This poor family was dragged through 10 years of waiting for the inevitable. They were never able to take their child home and weren't equipped to provide that necessary care and when death finally came, it was within the walls of a long-term care facility. It's heartbreaking. My experience with the child and adolescent mental health system has left me quite jaded. Too many of these young people are returned fairly quickly to the exact situations they were trying to escape, with few real tools to effect change in their coping. Another memory from years past reminds me of a young man so unhappy with his life at the age of 12 that he hanged himself; he was found before he lost his pulse and was revived. A year later, he stole a truck and crashed it into a tree; this time he was left paralyzed from the waist down. His subsequent attempts all involved drug overdoses. The shrink-du-jour would come talk to him, they'd hold him for a few days, then send him home. By the time he aged out of pediatrics he'd made SEVEN attempts to die. I'm not sure that he hasn't succeeded. At what point does the "system" take responsibility for this parade of horror?
  3. NotReady4PrimeTime

    University of Calgary January 2019

    New members cannot use the private messaging system until they've made 15 contributing posts to threads on the site. That's why you weren't able to send one. This particular thread is nearly a year old and it's possible the member you're trying to contact no longer subscribes to the thread. Best of luck!
  4. NotReady4PrimeTime

    Patient to nurse ratio?

    It all depends on where you work. Some units have the so-called CoACT model of care where the RN is in charge of 21 beds and has a 5-patient assignment as well, the LPNs have the remainder of the patients and the aides are divvied up between the RN and LPNs. However, a friend who works on one of the CoACT units has said that the aide vacancies aren't being filled, so I'm not sure who is expected to take on that work... Rural hospitals don't have an average patient:nurse ratio because their census is never predictable.
  5. NotReady4PrimeTime

    CARNA IEN processing times

    CARNA does nothing quickly. In fact, we're required to re-register a full month before our registrations expire to ensure our paperwork has been processed before the actual expiry date. (They also encourage us to re-register even sooner, so they can collect some interest on our ridiculously high annual registration fees. $656.80 for the 2020 registration year...) I would expect your application to take at least 6 weeks to get a response, and then at least that many more weeks once you've submitted the required documentation for them to rule on your suitability for registration. On the positive side, NNAS has already given you a green light so there won't be any further assessment of your education required. However, you might run into a roadblock when it comes to the 225 hours of Alberta experience required for full registration. By the time you get to that stage, I believe there will be very few employment opportunities for nurses here because our new government plans to balance the provincial government by drastically cutting health care spending... I'm hoping they prove me wrong, but I didn't get all this grey hair in the last few months.
  6. NotReady4PrimeTime

    The Health Care Dominoes Have Started to Fall in Alberta

    I know, right? Interesting development late last week: The Alberta Union of Provincial Employees (nursing assistants, unit clerks, porters, dietary aides, laundry workers and others) also have a wage reopener in their current collective agreement with the same timelines as the United Nurses of Alberta's. Alberta Health Services also approached their arbitrators requesting a postponement, which was flatly denied by the chair of that board ... unlike the chair of the UNA arb who rolled over and played dead. AUPE's arbitrator ruled that discussions on the wage reopener would go ahead as previously arranged, beginning June 11. That ruling could have an impact on UNA's emergency labour board hearing later this week.
  7. NotReady4PrimeTime

    New grad pediatric job or adult nurse residency job?

    I do! I might be in the minority here, but if I was in charge of hiring, I'd be looking for any peds experience first, then looking at the 'kind' of experience it was. As I said before, those "soft" skills you pick up from working with kids aren't going to be any less valuable in a more acute setting... in fact, they're probably MORE valuable. You'd already be well-accustomed to weight-based med math, which is a significant benefit. Hands-on skills can be taught.
  8. NotReady4PrimeTime

    New Grad moving from US to Canada

    It IS possible that you'd be evaluated to be equivalent to an LPN and offered the opportunity to write the CPRNE. Just keep in mind that having a permit to practice is no guarantee of a job.
  9. NotReady4PrimeTime

    The Health Care Dominoes Have Started to Fall in Alberta

    Yes, I'm afraid that's what it means. The UCP promised there would be no front-line jobs lost, but the only way to meet their goals is to leave vacancies vacant and then eventually delete the position. They'll reduce costs by attrition. They're required, by the terms of the collective agreement with UNA, to post vacancies, but they're absolutely not required to fill them. Their stated goal is to reduce overall cost of the health care system at the same time they're going to improve access and outcomes. And the only way to make that happen is to make Albertans pay for their care via a parallel private system. The Premier has stated he'll reduce administration costs, not hands-on care, but he fails to realize that Alberta's administration costs are already pared to the bone, the lowest in the country and only a little more than 3% of the overall budget. There are many ways costs can be controlled, but that would require consultation with the pointy end of the spear, not the spear-thrower. I can give him LOTS of ideas of where to minimize waste, only he's never going to ask me. (My facility provides high-acuity care for patients from all four western provinces, sometimes for many weeks or months; are those bills being paid by the patient's province? Or by Alberta?) But Mr Kenney is following Doug Ford's manifesto almost to the letter; whatever is happening in Ontario will soon be happening in Alberta.
  10. As mentioned in other threads, with the election of the United Conservative Party led by Jason Kenney, health care providers are in the government's crosshairs. The UCP is vociferously opposed to organized labour in general, organized public servants in particular. On Monday, May 13, the United Nurses of Alberta and Alberta Health Services bargaining committees were scheduled to meet with an arbitration board to discuss a wage reopener that was written into the UNA collective agreement during negotiations in 2017. UNA agreed to two years of frozen wages while the province battled a recession in exchange for a promise to revisit the issue for the final year of the three-year agreement; this formed the basis for the wage reopener clause. UNA's negotiations were the first completed of the three main health care-related unions in the province and set the tone for the subsequent bargaining of the other two unions. That's the background. On Friday, May 10, Alberta Health Services' bargaining committee approached the chair of the arbitration board with a request to postpone the hearing until such time as the new UCP government had an opportunity to "consult with other public service unions and stakeholders" via a "blue-ribbon consultation panel" as to the direction the discussion should take. The chair of this "blue ribbon panel", Janice McKinnon, made her views clear in a paper she wrote two years ago, wherein she stated all public servants should immediately be rolled back 2%, followed by 2 years of wage freezes. The arbitration board's chair agreed to the postponement, despite a written deadline in the contract AHS signed with UNA that the hearing would be completed no later than June 30, 2019. It doesn't take a crystal ball to see where things are headed. The provincial government is in flagrant violation of provincial labour law and the chair of the arbitration board overstepped his authority in granting AHS' request. The Alberta Labour Relations Code specifically forbids an arbitrator from amending or changing the terms or conditions of the collective agreement, which is exactly what has happened. UNA immediately filed a request for an emergency review by the Alberta Labour Relations Board on the grounds that AHS has been bargaining in bad faith - AHS' bargaining team has idea what's going on and no authority to make ANY decisions in contract negotiations without the government's say-so - and breach of contract. UNA has also asked that the chair of the arbitration board be replaced. This review will take place on May 31; AHS has until May 24 to present their side of the issue. It will be interesting to see where this all goes, but I think I already know most of it. Although the Supreme Court of Canada struck down Alberta's prohibition of strike action by nurses, there has been no finalized essential services agreement put in place. Therefore, if UNA decided to strike or to work to rule, it would be deemed an illegal action and there would be HUGE fines levied. It may yet come to that.... UNA is one of the toughest unions in Canada and their history suggests they're not going to take this lying down.
  11. NotReady4PrimeTime

    Language proficiency for International students

    That's a shame, because I think they're going to tell you to get it before they take your application any further.
  12. NotReady4PrimeTime

    When Nurses Strike: Ohio Hospital Fails to Come to Agreement with Union

    Union representation for nurses by nurses is the gold standard, but there are so many places across the US where nurses aren't able to collectively organize in large enough numbers to lead to a nurses-only union. Those nurses determined enough to become unionized will seek out support from other, hopefully strong, unions like the United Auto Workers. In all ten of Canada's provinces, registered nurses are represented by the provincial nurses' union; LPNs in some provinces are also members, while in others they're represented by the provincial public employees' union. (Under Canada's universal health care system, nurses fall under the heading of public employees along with police, fire, EMS, municipal and others.) In the three northern territories, all health care employees are covered by their public service unions. Alberta's nurses only recently were given the right to strike after the Supreme Court ruled the province's legislation prohibiting strike action was unconstitutional. But in the absence of a negotiated essential services agreement, the ability to actually go on strike is in limbo. Basically, the employer has all the power in this kind of negotiation; they determine who and how many are "essential" (which usually puts more people on the floor than is the usual baseline number!). When the decision to strike is taken and notice provided to the employer, a "strike schedule" is drawn up and each nurse is expected to work the scheduled shifts. No repercussions ensue for the ones who work their published schedule, but anyone picking up overtime to take advantage of the strike will be censured. The nurses who are working are expected to adhere to only providing "nursing" services - no answering phones, passing trays, transcribing or activating orders, delivering specimens to the lab, picking up blood products, emptying garbage and linen bags, restocking, filing chart copies of labs, or any other task that falls under another non-nursing employee's job description. That's a bit of an eye-opener on most units, when they realize how much nurses do that isn't "nursing work", things we do because they need doing, not because they're OUR jobs. Canada doesn't have the same level of agency/travel staff relief that the US does, and in the event of a strike, nursing care is provided by the usual personnel. Does patient care suffer? It probably does, to some extent, simply because nurses are only nursing, so trays will be late, specimens might sit, transfusions might be delayed, needed supplies might not be readily available. But if we don't stand up for ourselves and our coworkers, we get what we deserve.
  13. NotReady4PrimeTime

    Language proficiency for International students

    Do you have IELTS or CELBAN results that are within the required time frame? https://www.nnas.ca/submit-your-language-testing-results/
  14. NotReady4PrimeTime

    OIIQ vs. the NCLEX

    It's true that Québec will not accept the NCLEX, but the Rest of Canada will accept the OIIQ exam results. I think you should be guided by where you plan to live and work. Will you stay in Québec after graduation, even for a short time? Have you established ties to people or places there? Then write the OIIQ exam. Do you plan to live and work anywhere else in Canada in the foreseeable future, but NOT in Québec? Then write the NCLEX.
  15. NotReady4PrimeTime

    New grad pediatric job or adult nurse residency job?

    This is a toughie. In my opinion, you'll learn so much more about nursing children by working WITH children, even in a rehab setting. There's a lot of overlap between rehab and acute care, despite the seemingly wide gulf. Kids are always kids, and soft skills are huge in pediatrics, no matter where you work. The things you'd learn in the adult world would be worth learning, but most of them won't really translate well in peds. I'm biased, I freely admit... peds is IT for me!
  16. NotReady4PrimeTime

    Sad series of peds hem-onc patient deaths

    Ruby Jane makes some good points. But to put a little perspective on it, when my son was diagnosed in 1985, children with malignancies generally didn't survive. We were given a 5% probability that he'd be alive in a year. Next week, he turns 36 years old. The "system" has learned a lot about his disease, and so many of the others, and that has allowed thousands of kids to live longer with their families, a lot of that life GOOD time! I can relate to your feelings about suffering and futility; it's true that we push the envelope with kids ... because they're kids. Kids are resilient and accepting; they don't think like adults do. What would be intolerable to us isn't necessarily so bad for them. Most parents reach a point where they recognize the advent of diminishing returns and are able to step back to let the disease win, but it's a devastating choice no one should ever have to make. Instead of focusing on your distressing emotions, maybe you could instead think about how what you do for that child and that family might make the horrible-ness of it all just a little more bearable for them. Sometimes it's the simplest of things that mean the most - frequent oral care for the child who no longer can swallow, a gentle but thorough bath and clean gown for the older child whose skin is so fragile, administering analgesia and anti-emetics before they're requested, finding little jobs for the siblings to keep them involved and feel like they're helping, there are so many ways your nursing skills can turn a very awful day into one that isn't so bad. Those parents aren't going to remember much of the last hours or days, but they will remember who was there for them and who gave them those last moments with their child. And you know, sometimes hugs are therapeutic for the hugger too.