Ayrman

10-12??? Are we talking long-term care pts. or actual acutely ill people? LTC is one thing but if this is an actual acute care floor my advise, sincerely offered, is not to walk but run like there is no tomorrow. My hospital has a maximum of 7 pts per nurse on nights, and that is the Med-Surg floor. The ratio only goes down from there, with max 6 on nocs for Telemetry, and 3:1 for ICU if the patients are stable, and 2:1 the norm and 1:1 for unstable ICU pts. Ayrman

Mattress tags = "Do not remove this tag under penalty of law except by the consumer." On every new mattress or pillow sold in the US. Ayrman

Minimal response here at my facility. According to Infection Control regular masks are enough. Plenty of folks test negative on the N95 - myself included - and there are NO Powered Air Purifying Respirator (PAPR) units in the facility. Regular flu shots have been handed out, the H1N1 vaccine has been started but they were depending on weekly shipments and last week's hadn't come in. No one has come to M-S or Tele to offer the shots yet even though there have been a fair number of ER and Urgent Care clinic people refuse them (first in line over everyone else). They aren't taking this too seriously. After all we have negative air pressure rooms for isolation - 3 beds out of 140. A few hospitalized cases, yes, but none on vents I am aware of so they don't see this as anything serious here. I have better PPE at home than we are being supplied with. And I have Tamiflu stocked up as well, for what it's worth. To my knowledge they aren't screening personnel for exposure after confirmation of infection in patients. Ayrman

I believe their sign on bonuses have fallen dramatically to around $8-10K, same with Western Arizona up the road in Bullhead City. A new hospital opening in Kingman has drained some of the available nursing staff away from the area. You will find rents in the Fort Mohave area cheaper than up in Bullhead City. Use an agency - there are a half dozen at least, McGhee Property Management in Bullhead City being a reputable one - for your own peace of mind. Yes, there are some private rentals that are good but the agency should take care of common repairs, etc and shield you from "difficult" landlords (ask me how I know) who otherwise get nosey, etc. Right now there are a plethora of brand new houses for rent in the area, never lived in, rents dropping in a bid just to get some income coming in. Apartments are scarce in the Fort area, plentiful up in Bullhead, but that also means 10 miles of traffic on a highway with nearly daily accidents bad enough to make the paper. VVMC is growing, has added on once since opening in 2005 and is expanding again, patient rooms and procedure rooms alike. The busy season is just starting what with the snowbirds, will last until April. Cheapest gas in the area is always at Maverick, just up the road from the grocery stores. Cheapest groceries are Wal-Mart in BHC but Safeway has better meat and a much better bakery; watch for sales. The best restaurants are across the river in Laughlin, but the buffet at the Avi Casino (across the river from Fort Mohave) is reasonable. Superior Tire is good for most auto repairs, etc, honest, won't take advantage of a single female. There is a uniform shop (Scrubs n' Such) a couple miles north of the hospital. Proprietor has a daughter who works VVMC, is very friendly. Ayrman

Very helpful, and I do thank you sincerely. Very much look forward to another trip to your country sometime in the future, hopefully spending more time there than last. Ayrman

Interesting if telling tidbit from my current employer. We currently have a patient under isolation who will be with us for a while, and has been for a couple of weeks already. Active TB case, no other co-morbidities. The percentage of nurses who basically refuse to accept assignment for this patient - they (the patient) are otherwise a cakewalk - is currently running well in excess of 50%. This is something we all see eventually - TB that is. The patient rarely coughs, is in a reverse air flow room and other than meds, routine vitals and hotel care (food, etc) is quite content to watch TV and veg. Pleasant, cooperative and goes entire shifts without requesting so much as a sandwich or a soda. What do you think the chances are that these same nurses will put themselves at risk during a true pandemic when the number of cases runs into a high percentage of total patient load on the floor? 1 or two reverse airflow rooms, and maybe 10, 15 or 20 active flu cases on the floor, possibly infected with a flu variant with a relatively high case fatality rate? Ayrman

Ludicrous in what way? You say that it is impossible yet which is historically valid, i.e. we have seen it before. The current pandemic is little akin to the historical pandemic of the late 19-teens, i.e. people are not dieing in droves and the overall acuity of the infection remains low, and whether you'd care to admit it or not the values of today's population in general are a far cry from those of nearly 100 years ago. A significant percentage of those who proudly proclaim themselves self-sacrificing and unafraid to report for work in the face of a deadly pandemic strain may find themselves having to eat their words before all is said and done.Ayrman

Officially 7:1 on nocs with an aid for every 11-18 (yes, they staff that tight) patients. Even the Charge may have 7:1, and I have seen 6:1 for 2 nurses with no aid or secretary. This is a CHS facility for anyone who cares. Ayrman

Anti-aircraft shell, 37 mm IIRC. Live round, too. You can look it up on the net. The guy had been using it for years to alleviate a dangling hemmorhoid, when his dog ran in on him and caused him to fall on it. End of story the shell was removed and deactivated, the offending dangly repaired and the now dewat shell returned to owner, who had saved it as a souvenir from his days as an ack-ack gunner on the British Isles during WWII. I did not view the x-ray personally but it is available on the net as I say. Somethings are just too weird not to save for posterity. Ayrman

Thanks for the article, Al. Interesting to know that our foreign counterparts have the same misgivings and problems that we contemplate here. Ayrman

Thanks for the article, Al. More food for thought, and it's not just here in the US that staffing may be a problem. Ayrman

140th (?) Case for Indonesia AVIAN INFLUENZA, HUMAN (81): INDONESIA, SUSPECTED ************************************************* Date: Wed 17 Dec 2008 Source: Antara News [edited] Suspected birdflu patient dies ------------------------------ A suspected birdflu patient of Bintaro, Tangerang, Banten, known by her initials as Su (24) died on Tuesday [16 Dec 2008]. Su's aunt said before she died her niece was intensively treated at Sari Asih hospital in Ciledug, Tangerang. She said Su initially had breathing problems, cough and a high fever and as her condition worsened her family then took her to the nearest hospital. "However she finally died after being treated in the hospital for 3 days," she said. Su's body was taken to Punggelan in Banjarnegara, Central Java, for burial. The head of the Tangerang health service, Hari Heryanto, said his office could not as yet confirm if the cause of Su's death was birdflu virus. "Her blood sample is still being examined and the result of laboratory tests is needed to confirm if the cause is really the [avian influenza] virus," he said. The district of Tangerang which is located west of capital city Jakarta has been known as an endemic area and has recorded the highest number of bird flu cases so far, totalling 17 that led to 15 deaths. ---- This would be the 140th "official" case for Indonesia if confirmed. How many have been missed one may only speculate. No matter what they claim the Indonesian authorities are not aggressively fighting this disease. Earlier this year they tossed the NAMRU (Naval Medical Research Unit) out of the country that has served there for a good number of years, because they were afraid they (NAMRU) might share samples of the local virus with the rest of the world, and thus infringe on Indonesia's "proprietary" rights to any vaccine derived from same. In the end that battle will be all about money and have nothing to do with saving lives. Politicians are funny that way. Ayrman

Crunch, H5N1 was first identified in Hong Kong in "97, and saw a 2/3's mortality rate. That was 11 years ago, and all we are seeing is a slow but determined spread. As cliche as it may seem it remains not a matter of if but instead of when. Ayrman

Not only the teeming numbers but the fact that there is a LOT of migration to/from from there with family vistations, business trips, etc. Much more so than we see even with a commercially up-and-coming Indonesia. Then too the modern, commercial Indonesia is much farther removed from the affected areas than we are likely to see with India where the barriers can be as little as the width of a street. Ayrman

You'd have to split the hairs very finely to be able to say that you "could" have given more than the 1 mg ordered. The other responses are correct. You mixed the med in saline and gave half which by all rights should have figured out to a 1 mg dose. Glad to see I'm not the only one who dilutes. At a concentration of 2 mg in 1 ml solution (here any way) it's extremely difficult to make a slow controlled push when your syringe plunger only travels a fraction of an inch (3 ml syringe is the smallest we have without a pre-attached needle, and of course we use needleless access ports). I dilute all my controlled meds for that reason, regardless of the concentration, and much to the dismay of many a tweeker I refuse to "slam" the push just so they can get a quick fix. Slow and safe or not at all. Ayrman

I heartily agree. Considering the time delay these days with regards confirmation kudos are indeed called for. The citation of the SARS incident is an excellent cae-in-point. Ayrman

My attention is going to be focused on the 73 complainants rather than the hospitalized cases. Granted 13 possible infections is no small sum, especially given that they believe the 3 dead - who are in addition to the 13 - represents a VERY large cluster [new record here for human cluster size?]. But the 13 (+3) would pale in comparison to the 70-odd further possible infections, assuming there isn't a modest dose of communal hysteria playing out here. I've been watching bird flu since the first human cases in Hong Kong in "97, and despite all the naysayers who keep pronouncing it to be much ado about nothing or that it has finally run its course and we can all relax now it keeps rearing its ugly head in ways we feared to imagine. Assume for a moment that the 3 deceased did indeed die of H5N1, and that 1/2 of the other 13 cases (call it 6) are positive for H5N1. Now assume that only 1/4 of the other 70-odd cases - call it another 17 - are legitimately infected with H5N1, and you now have reason for panic. Using the modest numbers I have we'd still have more cases than could possibly be accounted for by strictly bird-to-human transmission, given the modest size of the community and the very short time period for infection - apparently all occurring within days rather than weeks or months. Ayrman

How many hospitals use acuity-based staffing for their "general" floors such as medical-surgical, etc? I know that most states have mandated maximum patient to nurse ratios for ICU, CCU, etc, but how many have staffing ratios for other areas? And how many hospitals adhere to those ratios? This has become an issue where I work because of a recent State visit in which they expressed more than a little concern (a warning attitude perhaps?) that staffing on the general acute care floors was bases strictly on gross ratios rather than patient acuity levels was unacceptable. On Med-Surg the ratio is 6:1 Days and 7:1 Nocs. They seemed to be particularly dismayed to hear that the Charge Nurses were expected to - and more often than not do - carry up to a full patient load, the same as the staff they are supposed to be overseeing and assisting as needed. The Acuity model may call for a staffing of 3 - 5 nurses but the staffing grid we are stuck with calls for much larger ratios regardless of patient acuity levels. 2 nurses can carry 14 patients on Nocs, 3 can carry 21, etc. The Charge Nurse is included in these numbers, BTW. I'm interested in seeing how wide-spread this practice is. Especially when ancillary personnel such as Unit Clerks and Aides are cut back to as few as 1 aide for 18 patients, and perhaps not a Clerk at all. Ayrman

As you yourself said "I know nothing at all about medicine. Social science? Bring it on... In any event my first class starts in a month.. A & P. Time to get 1000 3 x 5's I guess." https://allnurses.com/forums/f224/if-i-can-t-handle-medical-am-i-weak-318509.html#post2977403 Some of us do remember the swine flu scare and the vaccination fiasco that came with it. However, we did not have hundreds of deaths across a dozen-and-a-half countries directly attributable to swine flu as we do with avian flu. The first instance is an example of panic without root in good reason. The second instance is an example mankind ignoring the thunder in the distance because the people that live over in that region are thought to be beneath (the modern version of untermenschen?) those in the present locality. You call the bird flu problem a hoax without an basic understanding of what a true pandemic really is or means. The threat is real; your moral smugness is of no use in defense against it. Ayrman

Sure you could supply your own PPE but do you have any idea of the cost? I keep PPE here at the house equivalent to haz-mat Level B protection - strictly emergency get-outa-Dodge use because we are talking a cost of around $120/person for a max. 8 hours of protection before the mask filters become ineffective and need to be changed. I also keep medical PPE as well. Much better quality than what I am supplied with at work; PPE I would pretty much bet my life on - the stuff we are provided with at work I will not. It is thin, ill-fitting and undersized for someone 6' 2" like me. If it doesn't say Kappler or similar (quality-wise) I don't trust it. Granted, I have a minor background in haz-mat, one reason I am fussy about my gear. But as an EMS director I supplied my people with much better stuff for encephalitis cases than what we have in the hospital. I wasn't willing to put the lives of my people at risk just to save a few dozens of bux over the course of a year's budget. Ayrman

The ball is indeed, as they say, in our court. My wife suffers from an innumo-compromised condition that has the past few months caused her health problems. Looking ahead to what may lay in the future we've begun to stockpile her medications in earnest, including Tamiflu. An interruption in the supply system would open the door for opportunistic infection, and we have already seen what that means in her case. No thank you, I will not sit idly by and wait for the lines to form and prices to react to increased demand along with shortages caused as much by the inability to move the supplies to the areas of highest demand as any actual production shortfalls. Ayrman

Flygirl, not questioning your veracity but this is news to me and I am certain others as well. In the past all I personally have seen were general reports of HCW's becoming infected, with no long-term reports such as this. Interesting news indeed. Ayrman

Someone asked what I do with all the food, etc the lovely bride and I have stored when a few years passes and we haven't used all of it. No secret there, after a time we can do less grocery shopping and use what we have stored and bring the older stocks down. Another option we exercise from time to time is to donate some goods to a local food pantry or food drive. Aside from foods which have been specially prepared for long-term storage (freeze-dried or dehydrated in most cases, and in a few instances retort pouch foods similar to military MRE's) most canned goods last years on the shelf with only some loss in nutritional status. We aren't so snobbish that minor alterations in taste turn us off. When making casserole or other mixed dishes you'd need a very discerning palate to notice any difference. Our food and other stores allow us to be choosy when it comes to staying and working or relocating somewhere safer. My lovely bride's health has changed drastically over the past few months, so much so that I seriously have to factor in her health when making any decision about working for my present employer, for instance, vs. another potential employer who is willing to invest in proper PPE and to appropriately limit case loads in order to allow the time for changing PPE, etc between patients. I can't risk carrying something into the house that will infect her. With H5N1 the risk is airborne, because while I can change my clothes, shower, etc before ever stepping foot inside the house I can't do anything about a but I pick up because of a lack of proper PPE. A slip-up in routine is one thing as far as creating a break in protection the bug can exploit, but a complete lack of proper PPE has nothing to do with routine or skill in use. Ayrman

Norovirus has broken out in my hospital, apparently brought in by a patient admitted for an non-related complaint. Since then the virus has spread to other areas of the hospital and all staff have been strongly advised to stay away from work for a minimum of 48 hours after symptoms subside, and to leave even if in the middle of a shift if they experience onset of nausea, vomiting and diarrhea. The medical-surgical floor is believed to the the start point for the outbreak. Rather than close the floor they continue to pack it with as any many patients as they can find beds for, even if it means unsafe staffing levels. Other than cautioning staff the only other active precaution is implementing a policy of terminal cleaning of infected bed areas, and even that is questionable as to how well it is being done, with at least one housekeeper refusing to carry out a full terminal clean "because they aren't doing it in the ER." I should add that half the beds on the affected floor are in double rooms, with only a curtain seperating the patients. The presumptive index case was in such a room with another patient, who apparently was also infected during their stay. In checking the net for reports of other Norovirus outbreaks in the US I find that a common response is to close the floor, restaraunt or even summer camp as in one case, so that comprehensive cleaning can take place. As pointed out above they did not close the floor but instead continued to pack it with every patient they could find in an attempt to make up for a census load that hasn't reached this high for over a year. As a consequence one nurse (from another floor no less!) was hospitalized, and another nurse had to leave the floor in the middle of her shift because of the debilitating nature of her illness. Also affected was a CNA who likewise had to leave during her shift, and a unit secretary who normally does not come into contact with patients nor visit their rooms. Staffing levels during this time were below safe levels, with nurses on day shift assigned as many as 8 patients across the board - including the Charge. If this is an example of how my particular facility handles in infectious disease outbreak that spreads to staff and patients alike can anyone be blamed if they would refuse to work during a real pandemic such as we are discussing?

Inquiring minds wish to know, now that time has passed: how is YRMC? Ayrman