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Emergency nursing

Content by TXTraumaRN

  1. TXTraumaRN

    tb skin test after being vaccinated with bcg

    You can still have a TB skin test after BCG vaccination, just know that it can cause a false positive reaction. I have seen numerous cases where there was a history of BCG vaccination but the skin test was negative. One thing to consider about the blood testing is the cost. It is significantly more expensive than a skin test and you will have to see if your insurance will cover it. I know at my last facility, we charge $15 for a TB skin test and $75 for Quantiferon. The way I presented it to my patients was this: You can do the $15 test, just know that there is a possibility that you will end up needing the $75 if you have a positive reaction to the skin test. As far as adverse reactions, the most common reaction to a TB skin test is localized swelling, redness, itching at the injection site. Remember, that the result is determined by the size of the induration, not just redness. This is why they tell you not to scratch the injection site or cover it with a bandaid.
  2. TXTraumaRN

    tb skin test after being vaccinated with bcg

    BCG vaccination can cause a false positive reaction to a TB skin test (TST). The gold standard for a positive TST used to be a chest x-ray, then sputum cultures if indicated clinically. The drawback of using a CXR alone, is that the CXR cannot determine latent TB status. It will show evidence of active disease or damage from previous disease. Mycobacterium tuberculosis can remain dormant for a significant period before a person shows signs of an infection clinically. This is a latent TB infection (LTBI). In the last 5 years, two different blood tests have been developed that are being used to better determine a person's LTBI status. They have been shown to be more specific than a TST and can detect a LTBI. These two blood tests are Quantiferon TB Gold and the T-spot TB Test. A person who has a positive Quantiferon TB Gold or T-spot TB Test is considered to have a LTBI if there are no other clinical signs of TB present (including a negative CXR). Because of the specificity of the the two tests, a false positive is rare and is usually the result of improper draw technique, processing time, etc. Essentially, if you have a positive TST, but a negative Quantiferon or T-spot, it is safe to say that you are negative for TB. On college and university campuses where there is large scale TB testing for incoming international students, many have gone to using these blood tests, either exclusively or in conjunction with skin testing. However, I haven't seen as many healthcare facilities using it until recently. Before going back to the ER recently, I worked for the last 3 years in college health as the nurse manager for the student health center at a major university that did a significant amount of TB testing. We used both the skin test and the blood test in conjunction.
  3. TXTraumaRN

    Why do you like Emergency Department Nursing?

    Like every post before this, I thrive on the variety of patients. I like having new patients every shift. I really like the problem solving involved with trauma patients. To put is simply, I like to fix people's broken bodies.
  4. TXTraumaRN

    School Nurse Job Interview

    I worked in a Level 1 trauma center straight out of nursing school and loved it. After a few years, my family situation changed significantly and I felt I needed a more regular schedule. I interviewed with the student health center at the local university and accepted a position as a staff nurse; I am now the nursing supervisor. I have been there 2 years now and while I still miss the ER, working in college health has allowed me to expand my nursing experience and interact with a different kind of patient. I firmly believe that my experience as an ER nurse has made me a better clinic nurse because of the critical thinking and time management skills I developed in the ER. You are correct that the pay will be less but I find that the other benefits outweigh the pay difference. If you are interviewing with a public school, ask about benefits. Because I work for a state university, I am considered a state employee and therefore eligible for the teacher's retirement program in my state as well as significant contribution from the school towards medical benefits. One of the other things to consider is that you will probably be working the school year, meaning you will have time off in the summer and on holidays. You may also be able to work PRN at the ER to keep up with your clinical skills. I agree with the previous poster who recommended at least going to the interview to feel it out, but also see your orientation through. You don't want to burn bridges that you may have to cross again later.
  5. TXTraumaRN

    Scott & White

    Not only have I been a Scott and White patient since birth, I used to work in the ER a few years ago. It's a great teaching hospital and the nurses I worked with that came out of the internship program liked it. They remodeled/added onto the hospital right before I left 2 years ago and have a very nice new ER as well as critical care units. With 2 local nursing schools (Temple College and University of Mary Hardin-Baylor), you'll also have lots of interaction with nursing students.
  6. Come to Texas. There's definately a shortage here. I currently have 3 open nursing positions that have been open for 2 months that I can't fill.
  7. TXTraumaRN

    Good Nursing Fiction

    When I was in nursing school, I had to take a nursing history class; my project focused on WWII era nursing. One of the books I used for my research was an excellent pleasure read. The title of the book is We Band of Angels by Elizabeth M. Norman. The author interviewed Army and Navy nurses who served in the Philippines on the islands of Bataan and Corregidor; they were subsequently taken as prisoners by the Japanese. If you like historical reading, this is an excellent book! She also wrote a book that chronicles 50 Army nurses who served in Vietnam; I haven't read this one yet, but I want to.
  8. TXTraumaRN

    Transfer at change of shift?

    From my own personal experience working in very busy Level 1 ERs, I called report as soon as I had a bed. I wanted that patient gone because there were 5 more that needed that ER bed. I can guarantee that most ER nurses do not purposefully hold patients in the ER. Getting a bed to even call report for is a joyous occasion in the ER.
  9. TXTraumaRN

    MCC Waco

    I graduated from the ADN program at MCC in 2005; I came in as a transfer student from another nursing school. They have a pretty good program and the faculty are very friendly. If you have any questions just ask.