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ElvishDNP

ElvishDNP

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Content by ElvishDNP

  1. ElvishDNP

    Physical exam form question

    Is there a spot on the school form to indicate? If not, then don't chart more than you have to. On school/work PE forms, I fill out what's asked and no more. Of the occupations/schools a) that require a PE form be filled out, and b) where a person's circumcision status matters, I don't think the Venn diagram circles overlap too much. On our EMR, there is a spot for intact foreskin vs. circumcised. I chart there, just like I'd chart if I saw Mongolian spots on a baby's butt. It's an observation, nothing more.
  2. ElvishDNP

    Mandatory co-author?

    At my school/for my project, we were not required to list them as co-authors of the actual project manuscript write-up/dissertation/whatever your school calls it. That was ours and ours alone, although to be fair our (or at least my) project chairs were hands-off about actual editing parts; my chair reviewed my work periodically to make sure it was going in a good direction, and made helpful suggestions here and there, but we were not required to list them as co-authors of the dissertation (DNP degree here). However, had we submitted the project to a peer-reviewed journal, they did require that we list our chair as a co-author. So, TL/DR - yes.
  3. ElvishDNP

    NAS babies

    Cluster your cares. Swaddle, white noise, dim the lights/cover isolette/crib with a blanket if you can do so safely. Pacifiers are your best friend. Anything you can do to decrease your baby's exposure to stimuli will help. Do you have something that smells like mom (an old tshirt, a nursing pad, anything at all, if it doesn't smell like cigarettes use it) that can be put close to baby so s/he can smell mom? Sometimes those kids are hard to console and you have to do whatever works. What scheduled/PRNs do you have at your disposal? USE THEM. If they don't have any, advocate for some. At my old job we used methadone, phenobarb, and clonidine and that worked for most of the kids.
  4. ElvishDNP

    Wearing gloves with HIV positive patients

    I would also highly recommend How to Survive a Plague by David France. It's mostly patient centered, and focuses on people with HIV/AIDS and how much of what we know now, and many of the medicines we use to treat HIV, we have because people in those early days did not stop demanding better from government and medicine, even as they were literally dying on the FDA's doorstep. It's riveting....and heartbreaking.
  5. I don't think there's anything wrong with keeping your social media life and your work life separate, and I wouldn't be offended if a coworker told me they do this. I do think it's probably better for workplace relationships if you tell why, though. I'm starting a new job tomorrow and this will definitely be my plan.
  6. ElvishDNP

    How do you discuss gender issues with adolescents?

    Thanks for the clarification. So, if a kid is questioning their sexuality, they're probably not going to be on hormones unless they're also certain their gender identity differs from their assigned sex, and sometimes not even then until they're a certain age. Sexuality is who they're attracted to. Gender identity is who they are. Everyone, us posting here included, gets one from category A, one from category B. I have found this resource to be extremely helpful with regard to trans health issues, and some of the questions you've got will be answered. I spent hours one night reading through most of this stuff and it was riveting. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People: Fertility options for transgender persons
  7. ElvishDNP

    Wearing gloves with HIV positive patients

    If you don't want to contract HIV from your patients, don't have sex with them, share tattoo or IV drug needles with them, or transfuse yourself with their blood. If you don't do those things, you will be fine. Furthermore, the CDC's most recent statement suggests that if the pt's viral load is undetectable, then they really can't transmit HIV. Years ago, when I was a brand new nurse, I had a pt whose AV fistula had abscessed. He was HIV+. His fistula ruptured on my shift, and I ran into his room and instinctively slammed my bare hand down on top of the artery shooting blood shooting out of his arm onto the walls and ceiling. He yelled at me to grab gloves, but I wasn't moving my hand, and at that point my hand was already covered in his blood. If I didn't get HIV from that, there is no way you will get HIV from a pt interview. The nurse that told you to wear gloves is stupid and wrong, and reeks to me of the phobia we dealt with in the 80s.
  8. ElvishDNP

    How do you discuss gender issues with adolescents?

    I do think it's important for primary care providers to discuss this with adolescents at office visits, and I agree with the member who said we mostly need to be listening. But if we don't ask we risk not uncovering what may be a source of great anxiety. "Some teenagers have questions about their gender identity/whether their assigned birth sex matches what their brain tells them/[whatever phrase you want to use], and that's perfectly normal as they're trying to figure out their place in the world. Any questions about it that I can answer for you?" (Or, "Does this sound like you or anyone you know?" might work. Teens sometimes like to ask about 'a friend' when they're seeking info for themselves.) A 12- or 13-yo is not going to be surgically transitioning, but they may take GnRH blockers to delay the onset of puberty while transitioning socially. Hormones come a little later in adolescence. A lot of trans therapy is close monitoring while weighing risks/benefits; hormones aren't risk-free, but neither is forcing a trans adolescent to live in a body that they don't want. (Let me say now: I fully understand that not every trans person wants to surgically transition, and that decision should be respected in either direction.) There is a high incidence of mental health issues in transpeople, but it's not because they're defective, it's due to shame and stigma. THAT'S wrong. If a care provider told my kid (trans or otherwise) to honor the body they were given, I would interpret that as them being told that dysphoria's is not legitimate, and that's inappropriate. Trans kids, especially, are so so vulnerable, and they are almost assuredly going to have a lot of adults in their lives telling them what to do. They're going to need a soft place to land. Based on what we know about sex, gender, and development, it's scientifically sound that we be that for them.
  9. This. Just like the ADN, BSN, whatever is the degree you hold and the RN is the license, it's very similar with NP certifications. The DNP (or MSN, whatever) is the degree one holds, and NP is the certification. There are a ton of different NP certs. I wasn't married to the idea of getting my doctorate, but now that I'm done with it I love the idea of never having to go back to school if I don't want to. (And right now, I don't!) A new grad NP is a new grad NP. It doesn't make much of a difference in your clinical skills starting out, although I did do a residency before graduating, but there are some leadership and research hours that aren't part of a MSN.
  10. ElvishDNP

    Dangers of teaching kids they can be boys or girls

    Identifying obvious bias, calling out poor-quality evidence, and outing unreliable (i.e. clearly flawed and/or unreproducible) research qualifies as neither bigotry nor an attack. Darling, please. Christians are not under attack in this country. This Mennonite asks you to take that baloney elsewhere.
  11. ElvishDNP

    Dangers of teaching kids they can be boys or girls

    OMG, something similar happened in our house when our son (4 at the time, now 13) asked for a Tinkerbell tea set and tree house. My husband flipped his lid and said his son wasn't gonna be playing with girl toys. I asked the husband what he would do the day his daughter (with whom I was pregnant) wanted to play with a dumptruck. Somehow that was 'different' lol. (My mom invoked Grandma privilege and Santa brought the Tinkerbell stuff to her house and it somehow found its way to our house. He played with it for like 3 weeks then decided to leave it for his sister to play with when she's older.) This idea that toys and clothes etc. are for boys or girls is just absurd. As the trans comedian Eddie Izzard once famously said, "I don't wear women's dresses. I wear my dresses. They're mine, I bought them. Women wear what they like, and so do I."
  12. ElvishDNP

    National Walkout Day March 14 at 10am

    A lot of people don't know this, but it's possible to care about more than one thing. Your post reeks of, "I can't logically refute their actions, so I'll deflect to other stuff and attack their appearance."
  13. ElvishDNP

    National Walkout Day March 14 at 10am

    Two completely different discussions. Yes, kids should be kind to those in their midst who might be lonely. But that's not going to help with the issue of legislators in bed with the NRA and refuse to do ANYthing to help them be safer in school.
  14. ElvishDNP

    National Walkout Day March 14 at 10am

    They're kids. They're doing a hell of a lot more meaningful stuff than I did at 13. They don't hold a lot of political power, so they're doing the best they can with what they have. I'll cut them some slack for stopping off at the school nurse. They're still kids. My 13yo came home upset that about half the walker-outers acted stupid during the walkout at his school and just used as an excuse to get out of class. And he talked about the cold, but he said that people in Michigan were doing it (we're in the South), so if Michigan can deal with it so could he.
  15. ElvishDNP

    National Walkout Day March 14 at 10am

    My kid's school district supported any kids who wanted to walk out. At his middle school they're having a voluntary 'walkout' assembly today where they could talk about what they think needs to happen for school shootings to stop, and if they want to make posters there will be stuff there so they can, or so he told me. All with the blessing of teachers. I asked him if there was any group of parents to come sign the kids out so they can actually leave the campus, because if there is, even if we just walk across the street for 17 minutes, I'd have done it. His response: "God, Mom, no. Don't show up at my school any more than you absolutely have to." He's still 13 and I'm still Mom and I still embarrass the hell out of him. (Just one more free service I offer.) I do admire these kids and fully support them. They're way more politically aware and far more ballsy than I was at that age.
  16. ElvishDNP

    Dangers of teaching kids they can be boys or girls

    Pal, I am not the one who started an entire thread bemoaning my personal experiences. You did. I have little children. My daughter is in first grade. She is totally ok with the fact that some people like boys and some people like girls, and some people like both. She also knows that there are some people who know that they're boys and some people who know that they're girls, and some people who know that they don't fit into either category - the same way she knows she loves cats, no one had to tell her to, she just does - even though their body may present differently than their brain tells them. It doesn't bother her at all to know any of this, and it occupies an infinitesimally small portion of her daily brainpower to think about it. If kids have hangups about these things, it's only a reflection of what the adults around them are doing. As I said once before, the beginner-level knowledge you'd apparently need imparted to you about the spectrum of sex and gender, before we could even begin to cover things such as the rich historical tradition of trans, nonbinary, and two-spirited people across the globe and since the dawn of civilzation, would cost thousands if coming from a university, even a public one. I'm not about to hand it to you for free. Do your own heavy lifting. Just don't think you're going to get away with posting nonsense on a public forum and not get called out for it.
  17. ElvishDNP

    Dangers of teaching kids they can be boys or girls

    The basic information needed to impart to the OP would costs thousands of dollars if it came from a university. I don't get paid enough. But what I will say is that a friend of mine has a trans teenage daughter who just this week had multiple vile things said about her. Lucky for her, she's got supportive parents who are about go to beastmode on a school and some parents who tolerate this crap. My own kid cut for about a year before he came out to us. He's only cut once since then (2 years ago). The bigotry my friend's child faces on an almost-daily basis, combined with the nonsense written in the OP is why I'm committed to caring for queer teens and being a safe space for them as a FNP. And it's the reason why, if you're going to mess with queer teens in my presence, you will have to do it over my cold dead body.
  18. ElvishDNP

    What would you be in another life?

    Librarian. Mmmmmmm, boooooooks.
  19. ElvishDNP

    Meyers Brigg, Have you done it?

    Solid INFJ. Every single time I've taken it. OB/neonatal and soon starting to work as public health FNP. INFJ - The Advocate
  20. ElvishDNP

    Mission Trips

    I have been on several mission trips (mostly secular) and agree with the notion that it is extremely important to examine your motives. I understand that you're not interested in a 'missional vacation,' and that's a good start. Wanting to give back is a far better reason to want to go on mission trips. The first trip I went on was one to Haiti when I was 18, and while I went wanting to help I'm not sure I did any good at all. I learned a lot and my perspective on a lot of things changed drastically, but in retrospect I was more of a burden to the people around me than a help. I didn't do anything stupid like get drunk and act like a fool, or crash any motor vehicles, but I didn't contribute anything useful to the people around me, either. So I've tried to do better and be better since then. Partnering with 'boots on the ground' so to speak is a far better idea than a group that goes down from outside once or twice a year and expects the host country to do things the way the outsiders want. People who live and work in an area are going to have a far better idea of people's actual needs and what interventions will actually work. I would also highly recommend reading the book 'Toxic Charity' by Robert Lupton before embarking on any sort of mission trip. I didn't read before I went, but wish I had. Finally, wherever you do end up going, it's important to know where you're going. It's good to know culture, yes, but history is also important. Is the place a former colony whose people and/or resources were exploited by the colonizers? There might be some (understandable) resentment/resistance toward foreigners coming in ostensibly to help. Recent wars or conflicts? Were there outside governments meddling? (ex. USA/USSR in Afghanistan and Nicaragua) Realize that you might not be welcomed with open arms. (*alternately, you might be humbled by people's kindness to you despite the sins of your government. That works both ways.*) I don't mean to sound like I'm discouraging you from going. I'm not. There are wonderful people doing wonderful work all around the world, and expanding our own horizons almost always makes us better people. I just think it's v important to go for the right reasons, to respect the dignity of the people you're going to be serving, and be a responsible steward of the privilege you're given as a guest in someone else's country.
  21. ElvishDNP

    Are you doing these things on your L&D floor?

    UDS: It's a default on our EHR screen, but most of the providers will uncheck it unless there's an abruption, no PNC, or a history of drug use. Nubain: Haven't seen it in a very long time. Not only is it bad for withdrawal, our newborns would forget to breathe for several hours post birth. U/S on admit: Only there's a hx unstable lie or prior u/s was breech. (we're a teaching hospital, so sometimes residents aren't always sure what they're feeling, or need practice with the U/S so they'll do it in that case, but by no means everyone.) Pit: It goes off completely with late decels. Late decels = uteroplacental insufficiency. Baby needs a break, as do uterine receptors. Cord gases: Only if there was a bad strip and/or an unexpected NICU admit. My thing is, if you're not going to do anything with the information, why run it just because?
  22. ElvishDNP

    Clonidine...

    It isn't the only thing we use, but it helps with those kids that are just losing their minds. We use it as an adjunct with methadone and phenobarb. I can't remember exactly when we started using it but it's been at least a couple years.
  23. ElvishDNP

    Clonidine...

    My patients are significantly below school age, but just throwing it out there that we also use clonidine po q6h for our opiate withdrawal newborns. It helps A LOT with their sleep. And when they sleep better they do everything else better (grow, eat, not freak out from withdrawal).
  24. ElvishDNP

    East Carolina University Online Program

    Neonatal is a small world, and I have worked with several of the professors/former professors in that program. They're good people and excellent colleagues. I finished my DNP-FNP there last year and am getting ready to start my job after a 6mo break to exhale. The ECU CON professors really do want to help people succeed but they won't baby you. Be prepared to do a lot of self-teaching and if you go to them with questions, be prepared to show them what you've already done/what resources you've already used to help yourself. Best wishes on your journey. You'll graduate a different person than you were when you started.
  25. I'll throw my $.02 in with everyone else and say you did the best you could with the situation and resources in front of you, and I don't want you to spend one more second beating yourself up about it. Microchips weighing 500gm need a 00 blade, and we don't even stock those on the L&D warmers in our unit. (We have a separate neonatal resus room where the teeny tinies go at delivery, and that's where we keep the 00s.) There is so much unknown from this delivery. How long the baby was down, exactly how many weeks s/he was, and at that stage of the game, a week in either direction can make a HUGE difference. Please please please know that you did what you could and gave this baby your best. (For what it's worth, I made up my mind years ago after seeing a ~23 weeker being resuscitated that I would opt out of that if ever in that situation with a baby of my own. To be resus-ed and later poked, prodded, intubated, jerked around by an oscillator, overstimulated all the time, and still iffy chances on a good outcome, no thank you. Every situation is unique but it's ok to let these teeny tinies go gracefully back to where they came from, too. It sounds like that's what you and your colleagues did.)
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