Ex130Load

Regarding, "I think it can be too convenient to throw up the race card, etc." Regardless of the causes of racism, it's alive and well here--subtle and otherwise. Cabot, among the fastest growing cities in AR has a culture historically based on racism. Check its demographics; it's nearly pure white. I know of many military personnel who check out the local Jacksonville, Sherwood, and North Little Rock schools (the larger towns around Little Rock AFB north of metropolitan Little Rock), their racial percentages, and purposely opt for Cabot. The Democrat Gazette has the following to say regarding white flight occurring to this day in one of the three school districts within Pulaski County that incorporates Little Rock and its surrounding environs. For interested folk, feel free to read the entire article by going to the web address after the excerpt. "As a result of a decades-old pattern, more than 48 percent of the city's white students in kindergarten through 12th grade attended private school in 2000, according to an Arkansas Democrat-Gazette analysis of census data. Among blacks, 4 percent did. Since 2000, the school district has lost 600 more white students, making it probable that the majority of white students in Little Rock are now in private schools. No other major city in Arkansas had a higher percentage of its white students in private schools in 2000. Only eight major cities in the United States did. The shift has pulled the Little Rock School District into a downward spiral that's hard to escape: the diversion of millions of state dollars, diminished hopes for millage increases, and uneven teaching experience and parental involvement among schools. "It's a constant, sloping trend," said Baker Kurrus, a five-year member of the Little Rock School Board. State school funding is tied to enrollment. For every child who leaves the Little Rock School District, the district loses about $4,700 in state funding, according to Don Stewart, chief financial officer for the district." Friday, March 06, 2009 9:19:05 pm http://www.ardemgaz.com/ShowStoryprev.asp?Path=ArDemocrat/2003/10/28&ID=Ar00102&Section=National Regarding UAMS' first time NCLEX pass rates, my stats were current in 2007 when I originally posted my response. This is now 2009... Things change. "...But I took the time of comparing UAMS to ALL THREE programs and took the average of all 5 years posted on the Arkansas State Board of Nursing website. Of the diploma program, only 40% had higher scores than UAMS. Of the Associate's only 45% had higher scores than UAMS. and of the other baccalaurette schools; a whopping 32.5% had higher scores. As you can see UAMS has scored higher than more than half of the schools in all three programs in the last 5 years. AND combining the averages of all 3 programs in the last 5 years only 39% had higher scores than UAMS. UAMS had higher scores than 61% of all schools in all 3 programs in the past 5 years. So, I think it's self explanatory....In closing, UAMS is NOT "among the lower pass rates of four-year, two-year and certificate program." Where to start??? Again, when I originally posted, my info was accurate. Again, this is 2009. I personally find it statistically significant that "Of the diploma program, only 40% had higher scores than UAMS" or "Of the Associate's only 45% had higher scores than UAMS. and of the other baccalaurette schools; a whopping 32.5% had higher scores." 40%, 45%, and 32.5%--small insignificant numbers??? Back in 2007, UAMS was among the lower pass rates for four-year, two-year, and certificate programs. "Beating the dead horse," I reiterate things can change... I'm a person of perspective. For those with the inclination, perhaps someone could track down the on-time graduation rates for Henderson/Hendrix in Searcy, UCA in Conway, Baptist in Little Rock, UAMS in Little Rock, and U of A Little Rock. I seem to remember about 113 showing up day-one for class for the four-year degree program (having entered the program with 60 hours or so undergrad/prerequisite work) at UAMS and graduating about 68 two years later--about 60%. That's a lot of attrition. Are the other schools like that? For the record... If I come across as personally attacking anyone, that is not my intention. I also apologize if I seem overly "gung ho" or "appear to be going for the throat." Again, that honestly wasn't my intention. Respectfully, Ex130Load

My post doesn’t address the OP’s question, but addresses high morphine doses. A sister-in-law (SIS) elected to receive hospice care in a local hospital due to family convenience. Staff nurses engaged in, for them, non-routine care by tending to a terminal cancer PT. The non-routine aspect regarded the “out of the ballpark” morphine doses that became routine over the final 14 days. New nurses to the case often initially balked at bumping up dosing when they first noticed infusion rates on the pump and consulted the MD or charge nurse for confirmation. One PM nurse refused to bump doses because she hadn’t personally observed symptoms warranting an increase. She stuck to her guns despite me destroying her logic, “…and a PT won’t have pain or express it in your absence?” I understood her reluctance, but her approach wasn’t providing the most effective possible. Sometimes, ya gotta trust PT’s family and in this case, I wasn’t “just a family member”off the street, but a BSN RN graduate. I called in the charge nurse with whom I’d developed a relationship and who bumped the dosage. In the AM, I related the situation to the MD who was POed and in turn further clarified his orders to help prevent further repeats. Again, I can understand reluctance regarding previously never seen before morphine dosing. So, what constitutes a high morphine dose? I think for many or most floor RNs in most hospital practices, a high dose might constitute 10-40 mg. In the hospice environment, over 400mg isn’t unheard. In my SIS’s case, when she expired, she was at 244 mg and passed quietly and comfortably to all the family’s knowledge. Prior to really getting into heavy morphine dosing, I led a tearful family discussion on what the SIS wanted, that to control pain, morphine would need boosting which eventually would cause a decreasing level of awareness. She wanted to be comfortable. That meant, whatever family wanted to say in way of final words had to be done sooner rather than later as the SIS would become progressively quieter with less responsiveness. The family learned to read pain from grimacing, flinching, increased resp and BP, muted groans, etc. Family input was vital to pain control as nurses couldn’t possibly sit bedside for the level of time we did. I think we, family and nursing, did a good job of giving the SIS what she wanted. Back to high morphine doses, one of RNs said she’d seen higher dosing in a cancer ward elsewhere. A 14 YO teenager played Nintendo and beat siblings in scores…

Grab 100 smokers and 100 non-smokers off the street. Focusing solely on smoking as a discriminator, the smokers are more expensive because they lose productivity attributed to missing work due to a host smoking related illnesses. Treating those illnesses incurs additional expenses absent in non-smokers. Someone pays for lost work and treatments. Insurance companies are gamblers. They make money based upon statistical likelihood of paying out money versus money received. Smokers are gonna cost more, all other factors equal. Insurance companies’ rates reflect those realities which are passed to coverage buyers like employers. If an individual insists on engaging in a well documented deleterious activity like smoking, is it wrong to charge him/her more for that choice? Medical coverage is a headache and drag for businesses. I suggest the only reason most companies offer subsidized insurance is to remain competitive with others doing the same. If they all stop providing coverage… Altruism and compassion is waning as companies shoulder heavier financial burdens providing coverage. Fat people and those with high cholesterol aren’t quite the same as smokers. There are diseases and genetic influences that can cause being overweight and elevated cholesterol levels. Tests can mostly identify things like hormone deficiency, water retention, etc. After factoring out influences of which people have no control, is it wrong to charge fat/overweight people more for medial coverage who are in the condition they are because they loiter at never-ending buffets? Here too, for most overweight people, they make a free choice to be the way they are. There are costs to their choices. Who should pay for these choices? Hypertensive? Is that person fat? Who should pay for treatment after tests rule out liver, kidney, adrenal, pituitary, etc. disorders? The fat person is fat because of overeating which causes HPTN and diabetes, which cause congestive heart failure and lower extremity edema, which causes decreased ADLs, which causes premature death. Dogs—to my knowledge, there is no statistically significant cause and effect or direct relationship between owning pets and increase medical costs, not yet at least. If one is discovered in forthcoming years and owning pets increases likelihood of diseases like asthma, bronchitis, etc., who should bear the increased costs because people insist on engaging in another deleterious activity by choice? Look, I’m not trying to pick fights, but trying to heighten awareness that some free choices have definite consequences. Who should pay for our decisions? Smokers and most fat people aren’t the same as non-smokers and those of normal weight by choice. Why should their choices be subsidized? Remember this, companies to my knowledge aside from union labor concessions, recent legislative advances, and the sort don’t have to offer medical insurance. Medical insurance and pension plans cost companies plenty making them less competitive, especially on the world stage. American cars are made over seas, same for fabrics. Phone calls are routed to India for answering. Most offshore companies don’t provide medical and pension plans lowering costs driving US companies out of business and leaving US workers increasingly jobless. So, the smoker insists on smoking and pays more than I for medical coverage. I suggest he/she shuts up, stands back, takes a serious look at “the big picture,” and hopefully realizes how much worse the picture could be. Only five measly dollars more per paycheck or whatever? Complaints???? Just more examples of “people picking on me” syndrome and failing to accept/recognize personal responsibility… Sadly, so common today.

jaylynn67--You threw me regarding your suggestion to check spelling. Your response contained a quote and I thought a spelling error was hidden within it. I back-tracked and noticed "habbits' misspelled by the original poster. Depending on your learning style, listing related items collectively may ease learning, like arrhythmias. For me, it was it easier to learn some things by listing on flip charts or drawing tablets. Arrhythmias went down the left side in a column. Across the top, left to right, also going down in columns, I listed in blocks things that differentiated each arrhythmia—symptoms, drugs used, appearance on EKGs, heart rates, treatable by shocking, etc. Note cards listing discriminators can all look the same and rely solely on rote memory for learning/recall. When set up in a graph fashion, the brain may better remember some things because of their positions on the graph. A fine subtlety perhaps, but a key difference for some folks likes me. Within the graph, you can further accentuate some things. For example, some arrhythmias may be treated by the same drugs. However, if only one or two of those seemingly related arrhythmias (in that column) is treated with amiodarone, you may highlight that discriminator with color. You don’t want to overdo highlighting or excessively use one color as it could become a “blur” to the brain decreasing effectiveness. If you have a “block” on learning, say, ventricular tachycardia (v tach), perhaps it’ll help by highlighting v tach’s entry in the far left column, just something to make it standout from entries above and below it. Flip charts and drawing tablets typically are bigger than regular paper. Don't be cheap with pen or pencil. Write big enough so as to easily read info blocks. Can’t get all items on one sheet of paper? Tape several together and make a “mega sheet” where everything is gathered in one location. Some folk can easily assimilate info from several pages of text in a book; not me. It is sometimes easier to extract pertinent tidbits from those pages and place in a “central, consolidated” location. I made bold lines separating each entry into blocks. Some blocks may be empty further aiding learning because the brain will remember “holes” among other text-filled blocks. This stuff may seem juvenile, but not everyone learns best in the same fashion. I learned this painfully late in life and nearly washed out of nursing school. This method was recommended by a doctorate of education specialist at our university. She was on tap for med, pharm, nursing, radiology tech, dental lab, etc. students. This method was key to me passing a class on the second go. In a subsequent class, it aided learning the different anemias and passing. Food for thought…

Following a PM, I decided to relocate my first posting and review responses and postings. The poster immediately following mine stated much of my original posting is outdated. I made some phone calls, had a few talks, checked the "net," checked some local papers, etc. I will only agree that some(!) things are outdated and have decided to post updates where I feel warranted and of significance. UPDATE--The state legislature is throwing another 100 million dollars to address the dilapidated school system--$200,000,000 or so. This wasn't largess on the state's part, but in response to the state supreme court's rebuke for not complying with its first directive. According to local news media, the legislature tried various actions to get around having to comply with the original court mandate. The court responded by extending its oversight for at least another year to help ensure state compliance. Legislators then mostly resigned themselves there was no way to legislate themselves a fix and appropriated the additional $100 million while the getting was good--a shocking nearly one billion dollar surplus. UPDATE--Racism. It seems to be alive and well in the Cabot area which made the local papers for a possible worsening of relations. If memory serves me, a black Air Force family living in Cabot awoke one morning to find an epithet sprayed on their fence or house... might have been one of their children that actually discovered it on the way out to school, but am unsure. This followed new reports of a neutral fashion commenting how some Katrina evacuees were placed in the Cabot. As I sometimes work in the construction industry in Cabot, the evacuees' arrival was a topic of conversation within the trade and among reality agents I met--nothing negative, but... it was discussed. I was told by an active duty Air Force member that the race relations folk were "dialed-in" to Cabot and closely watching the town. STATUS QUO--Personal property (which includes autos) and income tax rates remain about the same. UPDATE--Bible belt. The religious governor is out of office and running for US president. The governor's records stands and may partially explain his dismal standings among party candidates. UPDATE--College scholarships. Up slightly proportionately according to a friend who works for ASU-Beebe. Good deal! The kid I mentioned having a Mohawk and ridiculed by some locals graduated with two baccalaureate degrees... within four years. Good for him! RazorbackRN, I would agree with you if you stated discrimination occurs in all states. I will not agree with you that it is not worse than anywhere according to my experience. Things may be improving though. The state police (state troopers?) recently was removed from federal oversight for overt and systemic racial discrimination in hiring and promotions. In my 45 years or so of military experience and living in many different locales, the only place that comes close to comparing with AR's racial climate is the New York City area of which we read periodically. UPDATE--Attitudes towards sports and Hog/Razorbacks. No change on the legislative front regarding increased transparency of public schools over how tax dollars are spent support sports, notably football and basketball. Of note according a local high school teacher is that her school's soccer team was demoted to a club. What does that matter? No tax dollars support clubs... which leaves more money to the "big" sports--football, basketball, and baseball in particular. Arkansas sports, especially the "Hogs" football team of whom many seem rabid--I expect them to possibly do better. Two years ago, the USC Trojans stomped the Hogs... 75ish or so to 14? Last year, the Hogs improved significantly; USC only beat'em 40-something to 20s? Next year, I'll bet USC won't beat the Hogs... because the Hogs aren't scheduled to play USC for the first time in several if not in many years. This will occur despite the fact the Hog's much ballyhooed quarterback (a native Arkansan) quit after one year and transferred. Maybe he knows or finally realized something. UPDATE--Baptist Hospital (Little Rock) Unionization. The federal court finally helped resolve the labor dispute. I think I remember reading hospital management was found trying to rig the union vote in violation of federal law and other violations. They're union which is good or bad depending on your perspective. UPDATE--Corrupt public and government officials. It was the mayor, police chief, chief's wife, two bailiffs/bondsmen, and other assorted folks who where charged with a cornucopia of wrongdoings... from Lonoke correct? The chief and wife have been convicted are in the pokey. Did I get all the characters correct? I could go back and double check MSNBC... or CNN--cannot remember which media covered the story, perhaps both. Maybe Huckabee would pardon'em if he still was in the governor's mansion. UPDATE--Arkansas education. If Bryant's schools have improved, my hat's off to the community and to the others as well. My connected ASU friend maintains that state still ranks among the worst with the number of four-year degrees awarded within five years and the number of students needing remedial course upon entering four-year institutions. Arkansas also was among states cheating on achievement tests mandated by No Child Left Behind. Practices included ensuring some of the worst students were absent on test dates and that races were not accurately reflected. Again, Arkansas wasn't the only one doing these actions and No Child Left Behind is a practically unachievable as currently written and funded for those aware of the details. STATUS QUO--Still in the bible belt. Two more churches going up in my neighborhood. Man, where does the money come from? The Pentecostal monstrosity in North Little Rock at the junction of I-30 and I-40--A friend of mine inquired about joining with this particular church and stated the church wanted a copy of his tax returns for the preceding year return and demanded payroll deduction. I googled quickly for bookstores in Searcy. Three popped up--Harding University Book Store (religious affiliation), Church Data Services, and Bible House Inc. The last two are listed as having the same address and phone number. Somehow I don't envision a Barnes and Noble, Books A Million, etc. opening there anytime soon. Publicly funded healthcare providers--I can't see Searcy's population receiving the best community healthcare possible in such a religious sodden atmosphere. I wonder how much is mentioned about abortion, birth control, pre-marital sex, sex education, etc. other than to say "no" to extramarital sex which according to a study I read of yesterday was completely worthless. The preached to "no" kids engaged in sex as often as those preached to "no" and offered sexual education. The feds gives millions to preach abstention and cut back on abortion, birth control clinics, etc. Like RazorbackRN, I don't mean to start a religious debate, only mention facts and share observations. Potential settlers should individually decide if the religious atmosphere is to their liking. STATUS QUO-UPDATE--I agree that Arkansas still is it a beautiful state with two of the top hospitals in the country. UAMS and Arkansas Children's Hospital are second to none in research, technology and medical breakthroughs. They have been ranked by US News and World Report as top facilities in the world. But if you are considering applying to UAMS for nursing school, consider its first time NCLEX pass rate--86%. I think cross-town competitors Baptist and UALR were in the high 90s. Call the AR Board of Nursing. UAMS had among the lower pass rates of four-year, two-year, and certificate programs. STATUS QUO--Catfish, Bar B-Q, a sweetened iced tea are to die for. Despite writing what some will view as a diatribe about Arkansas, I recommend coming to Arkansas and buying a home as long you do it with both eyes open. I think the Latin expression "caveat emptor" can easily apply in some situations. Please excuse typos, punctuation errors, etc. If I am significantly wrong on claims/statements, please give specifics as to how I erred. Another please, don't just say, "Some of what you have said is true, however, much of it is outdated information." That is profoundly vague and useless to me and other readers. I depended much on memories/recollections and little on notes, recordings, etc.

CAMeadors, Some folks advocate schools for various reasons, some of which don't hold up to objective scrutiny. They same can be said of athletic programs; there's hoopla and reality. Little Rock has three programs off the top of my head. Searcy has Harding U which has a religious affiliation if that is to your liking and is north of Cabot which means you shouldn't be fighting traffic during commutes. I'm telling some folks to contact the AR board of nursing for school's first time NCLEX pass rate. If you're spending time and money, I think it's wise to attend a school that's shown a recent trend with a high percentile first-time testing NCLEX passage rate so as to maximize the likelihood of passing. Each test is $200ish. Just my opinion...

If memory serves me, UAMS had a better first time NCLEX pass rate as fairly recently posted in AR Board of Nursing's magazine. Fayettville may have been in the mid-70s--yikes. But UAMS' first time pass rate has dropped significantly compare to my year group--mid-90s down to upper middle-80s. UALR was in the mid-90s. Call the board of nursing.

From what I remember, 850 is about the "break even" score that if you get it, you are statistically expected to probably (though only slightly so) pass NCLEX. But, the "wind" could blow you either way on your particular test day. Getting 900 or better significantly raises the statistical likelihood of you passing NCLEX. Check HESI's website to see if my info is still correct. Possibly a bigger factor in you passing NCLEX may be the school from which you graduate. UALR in Little Rock, a two-year school, last year/this year had a first time pass rate in the mid-90s percentile while UAMS, a four-year school had a mid-80s percentile. The pass rates came from the AR Board of Nursing's magazine. One thing to remember or to ask prior to testing is if all question scenarios assume you have a standing order allowing execution of all answer choices. It is pounded in students heads they cannot do anything without orders. Our group's proctor didn't mention that detail to us and we had a larger number of failures partly due to that omission. In other words, you may be offered choices that requires an MD's prescription/directive but the question scenario will/may not mention you are assumed to have a standing prescript or directive. Hope this makes sense. If you are sitting on the dividing line for failing/passing, you will not want something like this detail pushing you on the line's bad side. I mention failing because my school mandated passing HESI to matriculate to senior status and after graduation to be eligible to sit for NCLEX--two HESI test. Good luck.

Finding a client in possession of a loaded weapon would unnerve me initially, but not necessarily enough so that I'd insist on contacting security or law enforcement unless it was hospital policy. If your facility doesn't have a policy regarding weapons, I think it would be good idea to discuss it. A loaded clip is less dangerous than the three inch or bigger knife many men carry for cutting this-es and that-s or as part of their profession. I'm intrigued with the original poster's statement "... And said the Pt.s family was to pick up the car/gun and we kept the ammo & locked it up seperate and will not give to family." Legalities could be an issue. The facility has confiscated property that I suspect is legally permissible and won't return it to the owner or relatives for whatever duration. To my knowledge, law enforcement agencies and governments are the only ones permitted confiscation powers with due cause. If I was legally permitted to possess a loaded clip and someone confiscated it without allowing family or friends to remove it from hospital property, the issue would be far from dead. I'm getting way off topic... HIPPA? What is the connection between HIPPA and a loaded clip? Like one poster mentioned, some states have large populations legally carrying weapons. Many of them are concealed. I've yet to hear of a problem in my state within anyone acting non-judiciously or inappropriately with a concealed firearm who was permitted to legally carry one. This population profoundly avoids publicity as it counters the usual purpose of having a concealed weapon. I'm emphasizing legally permitted and responsible use of loaded firearms, concealed or otherwise. On many federal properties, it is illegal to possess a loaded weapon, especially concealed. At other sites, that isn't so except for the "concealed" part. A weapon, loaded or otherwise, can be bad idea, especially with mind altering meds or pathologies. I'm sure some facilities don't have a weapons policy because it hasn't been a problem. I wouldn't necessarily be quick to contact the police. Perhaps in another situation, the client is an off-duty or retired law enforcement officer. Then too, maybe the person is a business man/woman who often carries large sums of money or valuables and routinely carries a weapon for protection. Many of these folks carry a weapon out of habit. I habitually carry my wallet, finger nail clippers, and a comb when leaving the house. Thus, I wouldn't find it necessarily unusual to discover a person carrying only a clip or an unloaded weapon as some facilities and businesses expressly prohibit them. The owner often will separate a weapon from ammo to be in compliance. Me personally, if possible, I'll retain the weapon as I don't want it stolen in case my parked car is burglarized, but I'm getting way off track again... Just some ideas to consider.

Am a retiree in the Little Rock area. Yeah, there are a lot of nice things to be said of AR. Same's true of other things too. Have kids? This is considered one of the most backward states regarding education. There's a raging debate going on about how to meet the constitutional mandate of providing an "adequate education" for all and which has been reviewed by the courts mandating another 100(?) million towards remedies. Another review is shaping to see if the first millions adequately address educational short comings--poor teacher salaries, dilapidated structures, etc. Little Rock schools and surrounding county schools are still under federal oversight for discrimination. Racism can be alive and well here, though probably less overt. When I PCSed in '99, the social actions folks at Little Rock AFB(LRAFB) asked us to inform them if discrimination was still on-going in Cabot, 9 miles northeast, and a hotbed for housing growth. They seem to discriminate in the loan process, realtors don't do follow-ups, your name's not given to realtors, realtors are too busy, etc. or so I've been told. The town has almost no black residents. Jacksonville, immediately outside of Little Rock AFB is about 40%(?) black. Several long-term residents tell me how Cabot in the '70s had a sign/billboard stating "don't let the sun go down on your black @$$ here" or very similiar to that. A Cabot resident and acquaintance commented how everyone in his neighborhood "knows of the local KKK muck-a-muck around the corner." Cars are taxed yearly. I guess they're not excessive compared to the NE or CA. I don't consider the income rate tax excessive. You're in the bible belt. Searcy, 35+ miles north or LRAFB had a book store close several years ago because it carried books dealing with homosexuality. The current governor, a Baptist minister(?) had drawn a lot of negative attention to the state for pardoning numerous murderers, rapists, etc. He seems to better know inmates than the parole board. If memory serves, he's paroled more criminals than maybe seven (more?) previous governors. Allegedly, more have been paroled than all surrounding states, maybe for several years. A neighbor kid received many negative comments for his Mohawk haircut, even had a couple of guys try to beat up him and a friend if he would step out of the Taco Bell. He declined the invite. This "bad seed" got a mostly free 4-year ride to a state school due to ACT scores. To the state's credit, it seems to give a lot of scholarships of varying amounts. We have among the larger number of two-year schools per capita. Sports are a big thing here, especially the "Hogs" and football. Several progressive thinkers have tried to introduce legislative measures to more better account for money going to public athletic accounts--all failed to my knowledge. Remember my observation regarding dilapidated school structures... ? Baptist Hospital(?) in Little Rock has/had a labor relations dispute simmering for several years. I think the nurses voted pro-union, but management used every "shuck and jive" measure, dirty trick, etc. to avoid complying with the vote/contract. A complaint was filed with the federal labor relations board. Not sure how that was all settled. It seems we read monthly about another politician accused of crimes or about to serve jail time. We have a least one not too distant governor serving jail time, same for legislators. Remember the check bouncing scandal in Congress 15(?) years ago. I believe among the worst of'em was the fairly recently former Pulaski County sheriff Tommy Robinson. An often heard comparison is that, whatever the category, at least Arkansas is not last... this year maybe. We're very competitive with Mississippi, Louisiana, and South Carolina. I stand by the above statements and observations. They can generally be easily verified though I may be off on some numbers, dates, etc. Not too flattering a picture of AR and likely to upset some. The truth is what it is. Having said those things, depending on where you live in PA, $200,000 often will buy a lot of house, land, or a combo. They do wonders with catfish and bar bq pork down here. Ice tea can be sweet enough to stand a spoon. If you like hunting and fishing, there's a lot to do. They don't salt roads often, if ever. Ice storms and snow aren't common, but hot, sticky summers (100F+) are and tornados can be. People can be very friendly, if you look like them. I have a newer 1800 SF house, heated and air-conditioned., 2250-SQ total. Electricity ran me $60 (Dec), $90 (Aug), and $140 (Sep). Gas cost $132 (Jan), $72 (Feb), and $18.36 (Aug-Sep). Water runs $30-$95 depending on how much I water the lawn.

Years ago in another life, a co-workers' heavy southern accent was held against him before even showing up for his first day of work. The label of being a "loser" was assigned when the individual called several weeks prior just to check-in with his new work section to be, he never recovered. My boss at the time told me he was personally put-off when the guy stated, with a very heavy and slow drawl, "Hi, this is XXX and I'm just calling to see how things are going over there..." I mentioned to my boss that accents have nothing to do with job performance; my boss (and friend) remained non-committal. Unfortunately, when the individual reported for work, opinions went further down hill. I tried to insulate the co-worker/subordinate and educate others about wrongful biases. The guy was short, heavy set, and looked terrible in uniform which wasn't completely his fault. Jump suits more tailored for his physique were nearly impossible to attain. His appearance exacerbated adverse opinions. My point is this, even though the guy was at least an adequate worker, many around and above me were prejudiced and couldn't be swayed otherwise. In the healthcare field, we are cautioned against using our culture's values to judge others. When I became boss, I had to constantly advocate for this guy when it came to handing out assignments, advanced schooling, and performance ratings. Most are aware that bias exists for race, gender, and age. Don't forget it can also exist for how one speaks.

Some other gee-wiz to consider, ran across the following article from MedPage. I did a cut and paste as the link wouldn't open for friend to whom I tried to forward the article. MedPage Today Action Points *Explain to interested patients that this study suggests that the presence of one or more cats in the home of an infant is associated with an increased risk for eczema among the children of mothers who do not themselves have the condition. *Reassure concerned patients that eczema is not a serious disease, can be controlled with topical medications, and may be transient. *These studies were published as abstracts and presented as a poster at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication. Review Esmeralda Morales, M.D. U. of Arizona, Tucson SAN DIEGO, May 22-Children who are exposed to cats and their allergens soon after birth have a significantly elevated risk for developing eczema at one year, according to research reported here. In a study of 486 children followed since birth, more than 25% of those with cats in the household had eczema by age one year, compared with less than 20% of children from feline-free households, reported Esmeralda Morales, M.D., a pediatric pulmonary fellow at the University of Arizona in Tucson. Interestingly, having two or more dogs at home seemed to offer a slight but not statistically significant protective effect against atopy, Dr. Morales said at the American Thoracic Society meeting. According to the so-called hygiene hypothesis, exposure in early life to endotoxins such as those associated with cats, dogs, and other animals may skew the immune system away from the allergic Th2 phenotype to a more tolerant Th1 phenotype. "Some studies have shown that exposure to dogs and cats in infancy is associated with protection from allergic conditions, but others find no relations," Dr. Morales and colleagues noted. The investigators looked at the relationship of pet exposure to eczema in kids who were part of the infant immune study, a prospective birth cohort of 488 unselected healthy infants. Data on the presence in the household of either cats or dogs was ascertained by questionnaire shortly after birth. The investigators used a Pearson chi-square test to assess the relationship between doctor-diagnosed eczema and exposure to either cats or dogs for the group as a whole and for a subset of children whose mothers have eczema. In all, 134 of the 486 children studied had cats in their households, and of these, 27.6% had eczema by age one, compared with 17.8% of those without cats. When the data were stratified by maternal asthma, they found that the effect of cat exposure was significant only for those children whose mothers did not have eczema, the authors found. "We're not exactly sure why this came out in our data set," Dr. Morales said in an interview. "Is it something underlying in the population, or is there some sort of gene-environment interaction that's driving it? And that's one of the directions we have to go with our analysis with the genetic and blood data that we have, to try and see if there's any correlation there." Whatever it is about cats that seems to increase risk for eczema, it's not a lot of endotoxins--at least not in midwestern homes, reported investigators from the Medical College of Georgia in Augusta, in a separate poster presentation. They conducted a study of homes with newborns children to assess whether the presence of cats or dogs would be associated with increased endotoxin levels in the child's or mother's bed, child's or mother's bedroom floors, and the living room or family room floor. "Our hypothesis was that the presence of either cats or dogs in homes could increase the levels of endotoxin in all areas of the home, but would have a greater influence on floor endotoxin concentrations," wrote Dennis R. Ownby, M.D., and colleagues of the Henry Ford Health System in Detroit. They found that endotoxin concentrations were lowest in the child's bed, and higher in the floors than in either the child's or the mother's bed. But they also found that endotoxin concentrations did not vary, regardless of whether there were no dogs or cats in the house, or whether there were two or more. "We conclude that the presence of cats and dogs in homes from urban and suburban area of the midwest are not associated with increased concentrations of endotoxin," they wrote.

Really like the flow of this thread. Dusting off a lot of cobwebs. Just sittin' back, watchin', thinking, and sucking it up like a dry sponge...

Beach Nurse, The topic of transitioning to NP PhDs came up during my senior year. Several classmates considering follow-ons to NPs commented that if they were gonna become NPs, they were gonna do it before PhDs became the norm. Like me, they wondered how many folks would go to the extra hassle and time for the advanced degree and questionable financial return. RNs of whatever degree are in short supply. I can't see mandating an advanced degree for the title will be an attractant to NPing. I also think it will add another dimension to the education required to be nurse conundrum/controversy--certificate, AA, or BSN. If schools universally phase out masters level NPs, I feel there won't be any significant discussion or backlash until or if the number of practicing NPs drops. Wiser heads in the RN controversy with true "big picture perspective" know that if BSN RNs are mandated, the RN supply will only further decrease. With all the money required of schools to run a program (especially properly credentialed faculty), I find it hard to believe schools would have both masters and PhD NP programs except for closing out masters programs as my university system when it transitioned over to pharm PhDs from baccalaureates. It'll be interesting.

I've read the National Council of Nursing or some other body is advocating NPs become PhDs so that they can more effectively integrate with other healthcare providers. Those aren't the exact words, but pretty close. That rationale is also part of why many pharm schools are now PhD level. Had also read that the NP PhD conversion date was supposed to start 2010 or so.

Weak links--I too suspect my college uses HESI as a way to weed out the weaker students... especially after my university received mention in Time or Newsweek magazine for having one of the best schools in the nation. I think they're helping to protect their newfound reputation though none in a position of authority have stated so. I'm convinced the school uses it as a tool to keep the Board of Nursing off its back regarding minimum first attempt NCLEX rates. On the other hand, I think the school is being a bit altruistic in helping weaker students face reality sooner. I'm sure it's a motivator to some which is good in the long run. Fail HESI in the junior year, the student is removed. Fail it at the end of school, will the student pass NCLEX? Are weaker students better served, less time and money earlier wasted than if they were allowed to continue? Put the suffering out of their misery? To my school's credit, it mandates a review course like Kaplan's upon failure during the senior year prior to graduation. I think our first time NCLEX passage rate is in the mid 90s. I've been told that another local/regional school uses HESI as diagnostic tool. If students fail, they're given or must seek given. I suspect failures must remediate to a certain level of performance or competency, but don't know for a fact. I was profoundly relieved when I passed HESI on my last shot, third time during my junior year. I was equally relieved when I passed on the first round near graduation. Word at my school was that 25-30% failed the senior test, unusual compared to previous years. I understand all the reasons why my school may use HESI though I don't necessarily agree with each. I most definitely hated the additional angst it caused. Course work and clinicals were enough for me by their lonesomes. To all those staring at HESI, I understand the pain and emotion. Been there. As a possible way to help regain control of the situation, perhaps a HESI study guide may be of benefit. It was for me. I "pounded" one of the more expensive versions available from HESI--read, highlighted, flashcards, review questions, practice tests, etc. until I was intimately familiar with the information. Spent two weeks in the process. For juniors or those with another year to go, maybe that might be something to mull over as an option during X-mas or spring break of the senior/last year. Good luck to all.

Several responders have mentioned test-taking skills, an important area for examinees. There are peculiarities/idiosyncrasies/etc. related to HESI that are equally important, especially to borderline students like me. Not having complete information set me up for three rounds of testing taking required to attain "senior" status. My group's proctor, nor any other faculty for that matter, didn't mention that it was was a "given" that nurses had standing orders to administer any intervention offered from among answer choices. For example, one question that I answered incorrectly offered choices like administer O2, administer a med, call the MD, or take another vital sign reading. I selected "take another vital sign" because the first two choices require an MD's order, nothing said I was allowed to provide those interventions, and I knew definitely that calling the MD was incorrect. Administer O2 was the correct choice. I missed at least four questions like that. Knowing that piece of critical information would have made difference when I scored an 84.? and 85 was the minimum passing score a few years ago. HESI seems to be the norm in my area. Most schools allow three attempts. My schools allows graduation without HESI, but won't send your name to the Board of Nursing as one having completed requisite course work and thus renders a student/graduate ineligible to undergo NCLEX. It's part of a process to ensure schools graduate students likely to attain the 75% mininimum first-round NCLEX passage rate. I heard that prior to HESI, some schools had passage rates down in the 60s percentile. To receive less than 75% NCLEX passage now jeopardizes a school's accreditation. I think we lost 2 out of 85(?) during my junior year. I agree that test two was more difficult, but that's a subjective assessment. Still, classmates agreed with me. Savvy test takers heeded the assistant dean's message that test three would would include re-cycled questions... I can appreciate all perspectives regarding HES--its accuracy/worth as a predictor of NCLEX success, a school changing the rules midstream, curriculum that may not match test areas, stress/anxiety, etc. How would/should a graduate feel if he/she graduated from a nursing program and couldn't pass NCLEX. I've been told that some states, LA(?), only allow a limited number of NCLEX attempts, 3(?). I'm one of those who believes "the glass is half full," that all isn't lost by graduating but being unable to undergo NCLEX. Ya still have a degree, especially for the four-year folks. Many folks know that nursing school generally is tough compared to many other programs. I firmly believe a degree, any degree, is generally better than no degree when it comes to seeking employment, even in a non-medical field. Knowledgable employers know the average nursing graduate: is academically capable; can communicate orally, verbally, and perhaps use multi-media; and has developed problem-solving skills--desired attributes in any career field. That may be poor consolation to many, but it's still something positive from what I found to be a difficult and long path. I too was glad to pass my final HESI.

I used to work for a university at a military base. We saw many students, maybe half, that used CLEPs and DANTES for credits. They're not for everyone. Some folks lack the discipline to self-study--they need to have an authority figure (teacher) "cracking the whip", giving quizzes to ensure assignment are read, etc. I tend to be or used to be one of those types. If you're in a time crunch and are counting on scoring high enough to receive credit at your school, that's a bit of gamble. I have seen folks with those expectations, score too low, and then didn't meet pre-reqs of their conditional acceptances--had to wait the following year to re-apply. The Air Force offers it's own associate degree programs and excepts recommended minimum scores. Many university have higher cut-offs. Of those pursing AF degrees, I'm guessing maybe 25% didn't receive minimum scores. Those exams are free to military personnel. The base library stocked commercial study guides for many subjects and many military folks passed personal copies among each other. Military have minimal to lose in this situation. Civilian have costs to gauge. If you don't "test" well, maybe it would be better if you go ahead and take the class. The cost for the class at a community college can be significantly lower than at a 4-year college though possibly much more expensive than the exam route. I think my AA college is charging $65 per credit hour. Study guides go for $35+(?) and CLEPs and DANTES exams $45ish or used to at military sites. What do the exams cost in the civilian world? Some colleges offer the exams and charge students their going rate per hour of exam credit. A 3-hour credit exam could be $450 or more. The only possible incentive in that case would be a time saving. Is one study guide better than another is? From what I've seen, they all, as of several years ago, cover the same general material in a "survey" form. They don't go into detail because the exams are only attempting to gauge your general knowledge if you were an average "C" student. If you know of someone who used a particular company, if that person studies about the same way as you, if that person possesses about the same intellect/cognitive abilities as you and passed, then by all means try the book he/she used. Otherwise, I don't think you'd go terribly wrong with any company's product. I bring up all this stuff so that folks will make more informed decisions regarding credit by examination. It's not for everyone. If you're not military, it's not without its own price. I only want to help minimize disappointment and loss of time and money. I hope the insights offered are beneficial to those considering CLEPS and DANTES.

In the early stages of my diagnosis, the docs said most often it's gone or significantly reduced within two years. That held true for me, but I've had a minor relapse over the last five months. I couldn't make rhyme or reason as to events that would exacerbate or precipitate it. The docs also said deteriorating lumbar disks, which I possess, could be a contributing factor. Never tried different shoes as my symptoms seemed mostly related to bending at the hip and taking long walking strides. I minimized those actions and made it through ok. Good luck

Chip's statement was sweeping and all-inclusive. I can understand why some would take offence I would have said, from first-hand observations and conversations with friends/ acquaintances in unions or who supervise union workers that unions tend to foster mediocrity and protect the lazy and incompetent.

I re-read the original question and want to retract my first response. I see the question appears more directed to graduate school and thus I tend to agree with the first responder. If applying to RN nursing school, my first response is valid.

GPAs are the primary filter to get into my school. I suggest you inquire with the schools you're considering as to how they determine acceptance. I know firsthand of 3.0 GPAs that didn't get accepted at mine.

I think a lot of good advice has been offered. Will the kids suffer long-term effects from not playing t-ball a year? Don't think so. Rice and ramen are cheap. Ramen usually has a surprising amount of fat... Don't forget spaghetti/pasta! The three foods are cheap, easy, and tasty. Loans--I joke that loans are a god-given American right. If you're gonna do loans, education is a good reason for them. House looking like a tornado has been through it? Look into house cleaning services. Several of my neighbors have ladies from their nearby churches do weekly visits. If you do the washing and drying, could a cleaning lady do the folding? House cleaning/services may go a long way towards preserving sanity and reducing stress. Is the 4-YO in a kindergarten? I think(!?) they go down to that age level. The couple of hours a day 3-5 days a week can be a blessing. Fifteen months is a ways to go, but then, the light at the end of the tunnel is starting to become brighter and more enveloping.

The real world ain't always pretty or fair. Behavior of this sort isn't confined to nursing. Nepotism, cronyism, and the good ol' buddy network seem to be rampant in AR. At least outsiders could get that impression from the seemingly never ending articles on the subject in the local newspapers.

If I remember correctly, the local VA rep advertised the valor program as an externship program akin to civilian hospitals. If true, you should be matched up with a preceptor or preceptors. An acquaintance of mine was accepted into the program. He told me you weren't independently "just" assigned patients all by our lonesome. You practiced skills, developed proficiency, and gradually took over more and more tasks based upon personal abilities. The RNs' licenses are on the line; they won't turn over tasks over to you until you win their confidences. If you were selected, my hat's of to ya. I think any externship program is a good deal, much better than any of the various student patient care tech jobs I heard classmates mostly speak of derisively.