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tnbutterfly BSN, RN

Content/Community Director

As the Content & Community Director, I'm here to help make your time here enjoyable. Please contact me if I can help you. I'd love to hear from you.

Reputation Activity by tnbutterfly

Reactions Given

Like 275
Thanks 2
Haha 5

Reactions Received

Like 224
Thanks 14
Haha 6

  1. Like
    tnbutterfly, BSN, RN got a reaction from BarrelOfMonkeys, BSN, RN in Trigger Warning!   
    Sounds like a good opportunity for someone to sell Trigger Warning T-shirts.  

     
  2. Like
    tnbutterfly, BSN, RN got a reaction from BarrelOfMonkeys, BSN, RN in Trigger Warning!   
    Sounds like a good opportunity for someone to sell Trigger Warning T-shirts.  

     
  3. Like
    tnbutterfly, BSN, RN got a reaction from BarrelOfMonkeys, BSN, RN in Trigger Warning!   
    Sounds like a good opportunity for someone to sell Trigger Warning T-shirts.  

     
  4. Like
    tnbutterfly, BSN, RN got a reaction from BarrelOfMonkeys, BSN, RN in Trigger Warning!   
    Sounds like a good opportunity for someone to sell Trigger Warning T-shirts.  

     
  5. Like
    tnbutterfly, BSN, RN got a reaction from BarrelOfMonkeys, BSN, RN in Trigger Warning!   
    Sounds like a good opportunity for someone to sell Trigger Warning T-shirts.  

     
  6. Like
    tnbutterfly, BSN, RN got a reaction from BarrelOfMonkeys, BSN, RN in Trigger Warning!   
    Sounds like a good opportunity for someone to sell Trigger Warning T-shirts.  

     
  7. Like
    tnbutterfly, BSN, RN reacted to J.Adderton in Atrial Fibrillation, Strokes and the WATCHMAN Implant   
    Thanks for sharing your story.  There are probably many who read this and can relate to your experience.  
  8. Like
    tnbutterfly, BSN, RN reacted to prmenrs in I have decided to retire!   
    I remember walking into work one morning, feeling like the timer on the turkey had popped out. I was done. 
    Retirement rocks. Have fun! Go new places, play with your family, find new hobbies. Sleep late. Take naps. Read. 
    And, know that the job is well done. 
  9. Like
    tnbutterfly, BSN, RN got a reaction from Horseshoe in Atrial Fibrillation, Strokes and the WATCHMAN Implant   
    I was very excited to hear about this product from a friend/nurse at my church who works with Boston Scientific.  I was diagnosed with Paroxysmal A-fib when I was in my 30's.  It took a while for a diagnosis since I was back in sinus rhythm before they could catch it on EKG.   
    I experience this so infrequently and have always converted in the hospital without cardioversion...except for once.  I have been on Flecainide and ASA for years.  My cardiologist wanted me on Coumadin, however, I was very reluctant to do that since I also was diagnosed with mild Von Willebrand disease and have experienced marathon nosebleeds and bruising. 
    I tried it for a few months, but the INR window for me was so narrow and I was anxious the entire time.  Finally, after much thought, I told the cardiologist that I was stopping the Coumadin as I felt the risk for bleeding outweighed the benefit of anticoagulation and since my episodes were so infrequent.  I can always tell when I am in A-fib.  The last episode was 6 years ago.
    I know I may not always know when I am in A-fib unless it is extended in duration and am at higher risk for stroke.  But I still am concerned about taking an anticoagulant.  So hearing about this product gives me hope that this may be an alternative for me.   At least I will explore this option.
  10. Like
    tnbutterfly, BSN, RN reacted to Horseshoe in Atrial Fibrillation, Strokes and the WATCHMAN Implant   
    This is a timely article for me. My Dad was visiting me for Thanksgiving this year and had a severe stroke. He has been on Coumadin for 25 years, and was very compliant with his regime. His INR was therapeutic, yet he still developed an enormous blood clot in his carotid artery. Because of his INR, he was not eligible for TPA; he had to be care flighted to a facility that could do a thrombectomy. We lost valuable time for that transfer. Dad is progressing in his recovery, but will probably not ever be completely back to normal.
     One of the cardiologists mentioned that we might want to check out this procedure down the line. I had not yet taken the time to fully research this procedure. 
    Thanks for posting.
  11. Like
    tnbutterfly, BSN, RN reacted to Horseshoe in Nurses Call the Governor of Tennessee   
    I wish every unit had my nurse manager (she's retired now) from my old ICU unit. She was exacting-you better know your stuff and practice at a high level. But respected us-self schedule and don't make me have to get involved or you might not like the schedule. She went to battle for us vs. no matter who or what position they held if we were in the right and she never lost. I saw her put a top jerk surgeon in his place when he abused one of our nurses-she had him groveling and apologizing within a couple of minutes. She jumped into patient care if we were sinking in order to help and in order to keep her skills up. She came in for an entire shift occasionally if she couldn't get an agency nurse in. She NEVER asked us to go over the established ICU and stepdown accepted ratios. Not once ever.  She provided an environment that made you want to be the best nurse ever, not just because the patients deserved it, but because you didn't want to let her down. Docs fought to get their patients in our unit because they knew about that culture of excellence and the positive outcomes that kind of environment produces. Medication errors were dealt with not punitively, but with an eye to figuring out what factors contributed to it.
    I wish there were a million of her out there...
  12. Like
    tnbutterfly, BSN, RN reacted to BarrelOfMonkeys, BSN, RN in Nurses Call the Governor of Tennessee   
    I must say with all the passion, professionalism, experience, and thought provided on this topic - thank you!
    It’s been eye opening, thought provoking, and making me question how I perceive things. You’ve all contributed such value to this profession. It’s because of your passion for nursing that this is so polarizing and clearly why you’re all in the right field.  To make changes and provide better outcomes for our patients. I don’t doubt for a moment you all want that same thing. 
    I hope with this case changes will be made that we can all stand behind. 
  13. Like
  14. Like
    tnbutterfly, BSN, RN reacted to Wuzzie in Nurses Call the Governor of Tennessee   
    Guys I know this is a hot topic and our passion can make our tempers flare but could you just "take it outside"? I'd hate for this thread to be shut down because of in-fighting. It's too important.
  15. Like
    tnbutterfly, BSN, RN reacted to Tracy Saunders in Tips for Returning to Nursing After a Gap   
    There's a saying that goes: "Once a nurse, always a nurse." If you trained as a nurse, left to have children and now wish to return to the clinical setting, the good news is, you are in demand. There are many opportunities for nurses today, as well as a shortage of skilled professionals. The USA will see 500,000 experienced nurses retire by 20242 and anticipates a workforce shortage of 1.1 million posts according to the U.S Bureau of Labor Statistics. There is a lot of choice out there and your skills are in demand. Since you have been gone there have been many changes in the field as well. Here's how you can return to a nursing job after a career gap.
    Update Your Skills
    Whether you have had a gap of a year or 10, you'll find that things have changed. The health sector is constantly changing, even for those who have continuously worked in the nursing profession. No matter how long your time away, you'll find that things are different from the last time you worked in a hospital. Don't be discouraged, and take each day as it comes. One of the big things you'll notice is the amount of technology in use, from tablets to online records. You can prepare for these changes by taking a free online course in basic computer skills. Your employer will train you in the use of equipment and technologies that are new to you as well. Another thing you'll notice is the complexity of patients' conditions in hospitals. Due to the increase in life span, you'll likely find more older people with multiple long-term health concerns. Most hospitals offer a return-to-nursing program for nurses reintegrating into the clinical environment. Such programs will help you adapt to challenging, yet potentially rewarding, developments such as these.
    Get Work Experience
    If you are thinking of returning to nursing, you'll need to demonstrate some recent work experience. Return-to-nursing programs can help you gain experience and supervision from a qualified professional. You might also be thinking about changing to a new clinical specialty or environment. Spending a day shadowing someone in a new field or different setting will give you an idea of what their work is like. Don't forget that there are also jobs in research and clinical areas that will be different from your previous work.
    Think Transferable Skills
    It can be daunting to return to nursing, especially when you find that many senior staff are younger than you. Don't let that dissuade you.You'll have that gift of practical experience from your days on the wards. When you are compiling your resume or looking for interview tips, take some time to think about the skills you do bring. Good communication skills, empathy and compassion will always be needed. If you once led a project, you'll have change-management skills. Once you have been in a department or a ward for even a day, you'll be surprised how much you recall from your previous career.
    Think Work-Life Balance
    When you are planning a return to nursing, don't forget to negotiate your hours with your new employer. You may want to work part-time so you have more hours for your family. Some employers allow staff to work during school-term time only due to family needs. And above all, be sure to make time for yourself once you have a job, as you'll need to have a healthy work-life balance too.
    Focus on the Right Job for You
    With so much change in nursing today there are lots of different areas to work in from pediatrics to emergency care and research. Take time to look at several specialties and the type of work you'll be doing. Think carefully about your hours, the intensity of the work and the team you'll be working with when you work there. Check out new areas as well as those you think you'll enjoy.
    Returning to a nursing job is easier than you think. There are many choices and resources available for nurses who want to get back to their career.
    American Nursing Association
  16. Haha
    tnbutterfly, BSN, RN reacted to NurseCard, ADN in Nurses with Attitude   
    I am proud to say that I am ALWAYS a "Nurse B".  Mary Sunshine, that's me. 🤣
    Just kidding.  
  17. Like
    tnbutterfly, BSN, RN reacted to jeastridge in Nurses with Attitude   
    I appreciate your response. Nursing is a tough job, for sure. Thank you for working hard to be a great nurse!
  18. Like
    tnbutterfly, BSN, RN reacted to jeastridge in Nurses with Attitude   
    Haha. Yep, rarely does anyone fit either description all the time. But we can inspire one another to do better, right?
  19. Like
    tnbutterfly, BSN, RN reacted to jeastridge in Nurses with Attitude   
    I agree. It was embarrassing to hear.
  20. Like
    tnbutterfly, BSN, RN reacted to jrbl77 in Nurses with Attitude   
    I was brought up as a nurse tonever discuss staffing issues or other problems with patients or family members. I would often hear others going on about staffing and other issues. To me it is like airing your dirty laundry in public.
  21. Like
    tnbutterfly, BSN, RN reacted to J.Adderton in Atrial Fibrillation, Strokes and the WATCHMAN Implant   
    For individuals diagnosed with AFib, the risk of stroke is very real.  In fact, a person with Afib is 5x more likely to suffer a stroke than someone with a regular heart rhythm.  In order to order to understand how the implant works, you must first be familiar with the basics of Afib.  In Afib, the heart’s atria flutter and send erradic electrical signal to the ventricles.  As a result, blood pools and clots in the heart’s left atrial appendage (LAA).  In non-valvular Afib, more than 90% of blood clots resulting in a stroke are formed in the LAA.  A stroke occurs when these clots travel to the brain and prevent adequate blood flow.  Afib is more common after age 50 and often occurs without symptoms.
    Watch an animation of Afib from the American Heart Association

    The goal of Afib treatment is to prevent clots from forming, control pulse rate and restore normal heart rhythm.  Anticoagulants (warfarin, others) are given to prevent blood clots and reduce the risk of stroke.  There are individuals that require blood thinners long-term.  The risk of bleeding is higher when taking blood thinners.  The Watchman implant is an alternative to long-term anticoagulant therapy for stroke prevention when the risk of bleeding outweighs the medication’s benefit.
    The WATCHMAN device is for people meeting the following criteria:
    Diagnosed with Afib not caused by a heart valve problem Diagnosed with Afib and physician is recommending blood thinners Are able to take warfarin but need an alternative ***Individuals may need an alternative to warfarin for the following:
    History of serious bleeding while taking blood thinners Are at risk for major bleeding to due lifestyle, occupation or physical condition Take warfarin but have difficulty maintaining therapeutic PT/INR, have difficulty getting regular blood tests or cannot take a different type of anticoagulant The WATCHMAN device is not for patients:
    Who are unable to take warfarin, aspirin or clopidogrel Who should not or cannot have a heart catheterization Allergic to the device materials With a LAA that is too large or small for the device to fit appropriately Doing well and expect to continue doing well on anticoagulants. "Ed is a 74-year-old patient with a long history of Afib.  Over the years, Ed has undergone multiple cardioversions and cardiac ablations.  Due to Ed’s high stroke risk, he was placed on warfarin and has been taking for several years.   Ed has had multiple falls and remains a high fall risk secondary to vertigo.  When Ed visits his cardiologist, he expresses fear of causing a major bleed because of his falls.  However, he wants to continue to be active with his grandchildren and occasionally golf.  The cardiologist explains the WATCHMAN procedure to Ed as an alternative to warfarin."
    How It Works
    The actual Watchman implant is about the size of a quarter and fits directly into the LAA. The implant permanently closes the LAA- preventing clots from leaving the heart and entering into the bloodstream.  Since the implant is permanent, placed once and does not have to be replaced. 
    The Watchman procedure is minimally invasive and typically performed in a heart catheterization lab.  The procedure is monitored by the medical team and utilizes imaging to visually guide the device in place.  A thin catheter is inserted through a vein in the groin and guided into the heart’s right atrium. A second puncture is made in the muscle wall between the right and left atrium.  The catheter is then advanced into the left atrium.  The physician uses imaging to advance a smaller inner catheter, with the compressed device enclosed, into the LAA.  Once the implant is in the right place, the implant will open- much like an umbrella.  Within 45 days, a thin layer of tissue will grow over the implant. 
     
     
    Always a Risk
    Any medical procedure carries risks and the Watchman is no exception.  Review common risks here.
    Clinical Studies and Evidence
    The Food and Drug Administration approved the Watchman implant in 2016 based on long-term data from clinical trials.  The trials ( PREVAIL study, PROTECT AF study and CAP Registry) included over 2400 patients and >8000 patient-years of follow-up.  Data from the trials supporting FDA approval include:
    Device successfully implanted in 95% of patients 45 days after implantation, 92% of patients were no longer taking blood thinners >99% were no longer taking blood thinners by 1 year Significant decrease in disabling and fatal strokes (largely due to the reduction in hemorrhagic stroke) Demonstrated similar ischemic stroke reduction when compared to warfarin Reduced major bleeding events vs warfarin by 72% at 6 months In addition to clinical trials, the Watchman procedure has been performed over 20,000 times worldwide.  It is the only device of its kind approved by the U.S. Food and Drug Administration. 
    What new and emerging advances in stroke prevention have you seen in your area of practice?
    For additional information, visit www.watchman.com
  22. Like
    tnbutterfly, BSN, RN reacted to OldDude in Nurse on a Mission Trip to Belize   
    I think this paragraph encapsulates, to the core, and exemplifies all that is "good" in humans. You went over with the intentions of doing good, helping those less fortunate than you, and you did that...but, you likely came back having "received" more than you gave and, YES, that change and bigger vision you speak of will continue to grow through you going forward. So, your "mission trip" only began in Belize but will have limitless effects and will never really end. "Good" on you!!
  23. Like
    tnbutterfly, BSN, RN got a reaction from not.done.yet, MSN, RN in Nurses Call the Governor of Tennessee   
    FYI...allnurses published a short Press Release this past Thursday about this story and the resulting discussion occurring on allnurses.  Feel free to share this press release.
    Breaking Coverage of Nurse Indicted on Charges of Reckless Homicide
    While we may not all agree on the exact punishment that the nurse should receive, I am so glad that all who have posted on allnurses about this topic have been very respectful in engaging in a conversation that should be shared with the public.  There are many possible underlying mitigating circumstances that definitely need to be discussed. And there is much to learn from this devastating case.  
  24. Like
    tnbutterfly, BSN, RN reacted to Nursing America in Advanced Practice Registered Nurses: Overcoming Practice Barriers to Increase Access   
    The number of people over the age of 65 in America is projected to reach 98 million by 2060. This is more than double of this population today. An aging population taxes healthcare resources. It’s no secret that nurses are in demand, but you might be surprised to learn that physicians are another group of healthcare professionals experiencing a shortage. The Association of American Medical Colleges estimates that the shortage of physicians in the United States could reach 120,000 vacancies by 2030. The healthcare industry has turned to nurses in advanced practice roles to strengthen the workforce and deliver comprehensive, direct patient care.
    However, the care delivery system varies from one state to the next, leaving care gaps that impact the access to care for some patients. As nurses continue to step up to the plate to offer an innovative solution to cost-effective care, we must embrace the issues and rally together as nurses of various education levels to support this unique group of nursing professionals.  
    Advanced Practice Roles Explained
    APRNs are registered nurses who have gone back to school to receive additional training. They work as nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), nurse midwives, and clinical nurse specialists. Nurses in these roles hold a master’s or doctorate degrees and are trained to be independent practitioners.
    Many people consider these roles to be a modern advancement of the nursing profession. However, the role of the nurse anesthetist dates back to the 19th century during the Civil War when nurses were called upon to administer anesthetics. The first credential CRNA was established in 1956. Certified Nurse Specialists were the next APRNs to arrive on the scene in the 19th century when nursing specialists were needed. Midwives started with home deliveries in the 20th century and began assisting with hospital births during the baby boom. The first NP program began in 1965 at the University of Colorado, as Medicare and Medicaid expanded their coverage to patients of all ages who met income requirements or had specific disabilities.
    According to the American Association of Nurse Practitioners, there are over 248,000 NPs licensed to practice in the U.S. today. NPs work in primary care or specialty practices caring for patients across the age spectrum. They are permitted to diagnose and treat acute and chronic conditions. CRNAs deliver anesthesia before, during, and after diagnostic, surgical, and obstetrical procedures. Nurse midwives provide primary care services to women such as gynecological exams, prenatal care, labor and delivery, and family planning services. Clinical nurse specialists work in specialties such as critical care, women's health, or wound care services delivering advanced care and expert advice.
    Scope of Practice Issues
    Because APRNs fill a variety of roles, the issues around their scope of practice are just as varied. Some states provide a structure that gives APRNs autonomy, while others mandate direct relationships with physicians that range from supervision to collaboration. All APRNs collaborate or consult with physicians regardless of the state in which they practice. The difference is where they can practice without mandated oversight.
    According to the National Council of State Boards of Nursing 22 states and the District of Columbia allow NPs to diagnose and treat without physician involvement. However, 24 states require a formal, in-writing relationship between all NPs and a physician. Other issues around the scope of practice pertain to prescriptive authorities, with only 13 states allowing NPs to prescribe medications without the direct involvement of a doctor.
    This issue is similar for nurse midwives, with only 18 states allowing them to diagnose and treat without physician oversight. CRNAs are provided the ability to practice without direct supervision of a physician due to the autonomous role they must play in the operating room. Because the role of the clinical nurse specialist spans a wide range of activities, there isn’t a unified scope of practice.
    Improving Access to Care
    In 2008, the APRN Consensus Work Group developed The Consensus Model to standardize regulations. The model, which included education, certification, licensure, and accreditation was endorsed by 48 regulatory and professional groups. It allowed for increased access to care by increasing state-to-state mobility for practitioners and culminated in 23 states removing practice barriers and implementing this model. However more than half of all states continue to have practice barriers for APRNs to deliver a full range of primary care services.
    APRNs and the Patient
    These care limitations don’t just affect the APRN practitioner. Limiting the scope of practice for clinicians trained to be autonomous deeply impacts the ability of patients to access needed care. Several literature reviews have drawn support for giving APRNs the ability to work to their full practice authority. Multiple studies have shown care outcomes between APRNs and physicians to be similar, and some APRN measures are superior. One study examined patient satisfaction in the critical care setting and found that nurses performed better in categories such as listening, teaching, pain management, and answering questions when compared with physicians.
    At their core, APRNs are nurses. It’s not surprising that nurses continue to top the list as the most trusted profession in America. It seems that when innovative, comprehensive care is needed, the industry turns to nurses to fill care gaps. APRNs are in a unique position to increase access and minimize disparities in care over the next few decades. Where do you see the role of the APRN in 20 or 30 years?
  25. Like
    tnbutterfly, BSN, RN got a reaction from not.done.yet, MSN, RN in Nurses Call the Governor of Tennessee   
    FYI...allnurses published a short Press Release this past Thursday about this story and the resulting discussion occurring on allnurses.  Feel free to share this press release.
    Breaking Coverage of Nurse Indicted on Charges of Reckless Homicide
    While we may not all agree on the exact punishment that the nurse should receive, I am so glad that all who have posted on allnurses about this topic have been very respectful in engaging in a conversation that should be shared with the public.  There are many possible underlying mitigating circumstances that definitely need to be discussed. And there is much to learn from this devastating case.  
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