RN2B2005

My grandmother graduated from nursing school in 1939, at age 17. At that time, hospital nurses had to purchase their own surgical instrument packs; the physicians would then select the nurses he wanted in surgery based on both their skill and their instrument array. Sixty-four years later, my grandmother still has all of those instruments that she bought on her nurse's salary. Even surgical towels and bandages were purchased by the nurses themselves; my grandmother embroidered her initials onto the bandage ends so that when they came off a patient, she'd get them back. Each bandage was washed, boiled, ironed and rolled by the nurse who owned it. When my grandmother retired in 1979 as head OR nurse at a major Southern hospital, she was making a whopping $8.39 an hour.

D.O's aren't chiropractors, they're Doctors of Osteopathy, which is a whole different ballgame. Unlike chiropractors, D.O's go through the same 4-year programme as M.D.'s, and most go through a residency, just like M.D.'s. Their scope of practise is, in most cases, identical to that of an M.D. The difference is primarily in the training--D.O.'s receive a more holistic education and training in stuff like spinal manipulation. Chriropractors receive a "doctorate" from a two or four-year programme; there are even programs that award an undergraduate and a "doctorate" simultaneously. They don't do residencies, or have prescriptive authority, and aren't supposed to do invasive procedures, although some do. Some chiropractors claim that "adjustments" can cure anything from infertility to ear infections. Call me cynical, but I wouldn't waste a thin dime on a chiropractor; I'd go to a massage therapist.

I'm bound to be flamed for this, but my personal opinion is that the entire chiropractic profession is a scam. In radiology, we call x-rays done at chiropractors' offices "radiation therapy", due to the low quality and tendency of chiropractors to do what they call full-body x-rays. Since these exams are very rarely if ever diagnostic quality (meaning that they can't provide any useful information because the technique was so poor), the only justification for these x-rays is financial--the chiropractor could bill insurance for them. I've seen patients with permanent neurological damage from "manipulations", and I've seen patients who were told by their chiropractors that chiropractic could cure headaches that turned out to be originating from subdural hematomas. I believe that chiropractors are a drain on precious healthcare resources and that they should not be licenced as healthcare providers. Flame away.:chair:

My first pelvic was at a Planned Parenthood, when I was 16 (and still a virgin). They were great. Inexpensive, and before I even went into the exam room, they had a counsellor speak to me about how a vag exam worked, how to lie in the stirrups, etc. Some things--like bending your knees--are counterintuitive, and it helped to have things explained before I was naked. The NP who examined me was fabulous, kind and, more importantly, very fast. Jennifer

I had a pre-existing low back injury that really flared up in my second trimester. It worsened because instead of treating it as I usually do, with Robaxin and ibuprofen, I left it untreated because I was worried about taking ibuprofen while preggers. Poor choice, in hindsight. When it got to where I couldn't sit down or walk, I went to see an orthopedic pain specialist, a guy who specialized in non-surgical or minimally invasive procedures. He prescribed physical therapy and a TENS unit in addition to Vicoprofen and Robaxin, to get the spasms under control. It worked--I only had to take the drugs for three days, and only needed four PT visits total (I continued doing the exercises at home). The TENS unit was paid for by my insurance company after much wrangling, and worked fabulously well. I continued to use it off and on throughout my pregnancy and still have it. So, I guess my advice is, don't ignore it. It will get worse. See an orthopedic specialist in addition to your OB, and ask for a prescription for PT.

I used to volunteer with DD kids (6-14 range) and always found the Down's children to be the most pleasant. It is like Peter said, though; Down's can manifest in so many ways and in such differing degrees of severity that no two Down's children are alike. There is a couple living in our apartment complex, the wife is definitely Down's and the husband is either mild Down's or has some other developmental issue. They both work at the hospital in Environmental Services, and they have a beautiful, very normal toddler daughter.

I thought that the problem with exposure to diseases while pregnant was primarily the mother's lowered immune state, and that injury to the foetus was only a secondary concern?

I have some skillbooks from the Nursing Photobook series, published in the early 1980's. Most of the nurses have caps on, but this one nurse has a cap that I swear is defying all known laws of physics. Her hair is in a short bouffant/shag style, and the peaked mob-type cap is pinned to the very edge of the back of her head. As far as I can tell, the cap is hairsprayed into place; the nurse is shown doing various activities from various angles and heck if the cap touches any solid part of her head. Very impressive, if you ask me. On a more practical note, my grandmother reports that Aqua-Net and white bobby pins (both in vast quantities) are the way to go. Kay's Caps probably has some other tricks, too--they're on the Web, if you want to check them out. :roll

Man, anyone who thinks the nursing shortage--or the unwillingness of hospitals to pay for RN/LPN staff--should read this thread. After having my son (lady partsl delivery, no meds, IV fluids, lots o' tearing) at 2020, I hadn't peed at 0200 d/t fainting every time I tried to stand up to stagger to the bathroom--and being a noncompliant patient, I had tried to walk myself to the potty, ended up with a forehead laceration from THAT brilliant idea. Still, the sweet overworked CNA kept asking me if I wanted to pee. I really couldn't feel ANYTHING...just a big ball of pain south of the navel, but I did want to go clean myself up. Finally a nurse shows up, glares at me, tells me that either I pee in a bed pan or she is going to cath me and--she actually says this--it's going to hurt if she caths me. Fabulous. Long story short, she places a Foley. 1200 cc! Still a ball of pain below the navel, but not quite as bad as before. The kicker was that the nurse didn't document the Foley placement, so I ended up having a very bizarre argument with another nurse the next morning, telling her I had a cath in place and she--without looking--insisting that I didn't have one. Dood! It may be hamburger down there, but I know if there's a garden hose hooked up to the tap or not!

My mother had a spectacular anaphylactic reaction to Taxol in an outpatient setting. She'd had all of the pre-med regimen and had previously had uneventful treatments. Fortunately, she was receiving the tx at a well-respected and well-staffed clinic attached to a major hospital, and she did fine...but the complications, and ensuing problems, were enough to make me think twice about ever administering chemo without LOTS of training. I've read about American patients buying Taxol in Mexico for home use and it gives me the willies. I also worked in an outpatient multispecialty clinic where two oncologists administered chemo, using IV therapy nurses for monitoring...something I didn't think was a problem at the time, but that I wouldn't be comfortable with now.

We had the middle name picked out prior to delivery, but not the first name; the middle name was a family tradition. We had a whole list of possible first names, but the name we ended up with--Samuel--wasn't on the list, and we didn't settle on it until a few hours after he was born. I'm a little superstitious about the whole pregnancy thing, and didn't want to speak my son's name out loud until he was born healthy and safe. Stupid, but that's the way I was. Plus, the second he hatched, he just looked like a Samuel.

Your self-restraint at skipping Wal-Mart is amazing, RNLou. Someplace in week five of my "couch arrest", I decided that since I felt OK, I could just go into work for a few hours to do some paperwork. This can be attributed to either PIH-impaired thinking, or boredom edging on madness, or both. My husband was at his work, and my work is literally across the street from our apartment, so I'd be home and back in jammies before he even knew I'd been anywhere. Unfortunately for me and my 'master plan', I was walking into the hospital and who should pass me but my (very surprised) OB/Gyn!! Suffice to say, I got a lecture, my husband got a phone call, and even my supervisor was called to tell her that if I showed up at work, to send me home. :imbar

From a radiology order form: "CXR r/o Aplat's pneumonia" Should have read: "CXR AP/LAT r/o pneumonia"....we only figured this out after trying to look up "Aplat's pneumonia" in several radiology texts and reference manuals.

My understanding is that you can't refuse to perform your job duties--which means, if the scope of your job responsibility includes AB care, and you refuse to perform that care, then you can legally be terminated. This is not a moral issue--this is job performance issue. If you were a secretary, and refused to type out a letter because you thought it was morally wrong to type, you would be fired--not for your moral stance, but for refusing to do your job. So if you want to work OB/Gyn, choose a Catholic hospital or some other facility that does not provide abortion services. Personally, I consider myself pro-life; I don't believe abortions should be performed after 7 weeks gestation. This is why I support 'medical' abortions--they must be performed before 49 days (7 weeks) gestation; I am in favour of emergency 'morning-after' contraception for the same reason. Nonetheless, when I am working at the radiology clinic, prepping patients for ultrasound exam to determine foetal age (so the patient can go to an abortion clinic), I treat them exactly the same as any other patient. They've made their decision, and if I were to go around proselytizing patients, I wouldn't be employed for long. When I graduate nursing school, I'll go into a specialty where I'm not required to care for AB patients.

I showed this post to my husband, who is a high school assistant principal, and has his B.A. in English, M.Ed. in Education, and M.Sc. in Educational Leadership. He's seen LOTS of teachers burn out in a hurry, so he didn't agree with the idea of going directly into education from nursing. The problem with so-called "need" or "leave-replacement" certification, which is where you go directly into the classroom without receiving your teaching certificate, is that you are pretty much thrown to the wolves. States that permit this sort of certification usually do so b/c of a shortage of teachers in the science and math fields. The burnout rate is extraordinarily high among CERTIFIED first-year teachers, and those teachers have had the training and know what to expect. Our marriage almost didn't survive Tom's first year of teaching; for every hour you spend in school, you spend at least another at home, creating lesson plans, grading papers, and doing other administrative tasks. Tom recommends that you check out your local university for fast-track certification options. In Tom's case, he did a two-year M.Ed. programme, where he earned both his Master's and his teaching certification. The certification gives you both mobility (most states have reciprocal licencing) and the education in the minutiae of teaching--lesson plans, classroom management, etc. One of the teachers at his high school is a former attorney, and another is a former critical-care RN, and both of those teachers completed their certification with their Master's in education and have done very well. On the topic of private schools, you should know that in most cases the pay is lower and the parents more demanding--this is why they accept non-certified teachers. In addition, in most states, experience in a private school classroom does NOT count as classroom hours toward a teaching certificate. Tom interviewed at several private schools prior to his first year of teaching, and was not impressed. Good luck. Jen

It should be called "couch arrest". I had PIH at week 30 with my pregnancy, and spent the next six weeks in bed. My prayers and thoughts are with you, Louise.

I've tried allergy shots twice, once as a very young child and once in my teens. In both cases, after a year or so of uneventful allergen injections, I had an anaphylactic episode. Even though I have an Epi-Pen, know how to use it, know how to monitor myself, etc., I wouldn't give myself or anyone I love an allergy shot. Ever. In both of my anaphylactic episodes, the reaction was so swift and severe that I literally was sitting and reading one second, and waking up with an ET tube in place in the ER the next. In the second anaphylactic episode, I was 17 and actually had an Epi-Pen in my purse...but my airway closed off so quickly (while the IM epinephrine had yet to take effect--I gave it to myself through my jeans) that had I not been intubated, I would likely have died. Epinephrine is invaluable, but I wouldn't trust that alone to bring around ANYONE in an anaphylactic episode, especially a child. And if something did go wrong, and your child died, you would NEVER forgive yourself for having compromised her safety for the sake of convenience or to save a little money. That's my $0.02

It's funny, the clinic I formerly worked at is doing the same thing now....laying off most of their uncertified MA's and replacing them with LPN's and a few RN's. It makes me wonder if the Board of Health didn't issue some new rules or something. In this state, medical assistants are LICENSED through the BOH with the sponsorship of a physician--that physician's name actually appears on the license. The MA does not, however, have to work directly with the sponsoring physician--for instance, the MA against whom I filed a BOH complaint following the staph infection worked as a clinic float, and her sponsoring physician didn't even work in the same building. I'm not sure whether this is entirely legal or not, but that's how this clinic operates. The Board of Nursing has nothing to do with, and no responsibility for, MA's. CERTIFIED MA's are certified through the American Association of Medical Assistants. I would imagine that hospital-based MA's are on the license of the medical director of the hospital in which they're employed. It would still make me nervous, as an RN, if an MA was working with me in hospital setting. When the s**t hits the proverbial fan and some patient sues the hospital, I'd bet that the nurse gets the blame somehow for inadequate supervision of the MA. It's a legal grey area--up until 15 or 20 years ago, most support staff in a hospital or even an outpatient setting were licenced RN's.

In my experience, I've never met a CERTIFIED medical assistant who called themselves a nurse. I have, however, seen physicians and uneducated staff refer to MA's as "nurses"--some patients think every female non-physician in a clinic is a nurse (I've been referred to as a "nurse" while working as a medical secretary) and unfortunately that perception is rarely corrected except by the MA herself. Uncertified MA's seem less likely to correct the mistaken impression of being a nurse, and also seem less proud of their work. The clinic I formerly worked at, an 85-physician multispecialty clinic in downtown Seattle, employed primarily MA's, some well-trained and certified, some not. Some of the MA's actually worked as surgical assistants. Employing MA's in lieu of RN's or even LPN's was a cost-saving measure, since the physicians had decided in the mid-1990's to accept capitated plan patients. They allowed the RN staff to shrink via attrition, and hired MA's to fill what were formerly RN positions. In Washington state, almost anyone can work as a medical assistant, provided that a physician is willing to sponsor them--they work under the physician's licence. There are different licencing levels, called Health Care Assistant classes A-F. I know that Class A is pretty much being a warm body, and then the levels progress in responsibility and duties. I decided NOT to enroll in an MA programme primarily because of the lack of career mobility (each state has different rules for MA's) and because the programme that would allow me to become certified through the national registry was one year long, the same length as an LPN programme. As a patient, I've had primarily good experiences with clinics staffed with MA's, except in two specific instances. The first was when I went to see my physician in the middle of the day, suffering from an acute asthma flare-up complicated by pneumonia. I needed to receive IV Solu-Medrol and Ceftin, but although the clinic was fully staffed, there were no non-physician staff members who could start or monitor an IV (the only RN's employed at the clinic were in the same-day surgery area). So, instead of saving my insurance plan money by avoiding the emergency room, I ended up being transferred by ambulance TO the emergency room just to receive the IV. The second instance was just recently, when a Td vaccine administered to me by an uncertified (but licenced) MA resulted in a skin infection and abscess. Turned out the variety of staph cultured from the skin matched that cultured from under the MA's artificial nails. All in all, though, I have a great deal of respect for MA's who take the time to go to school and keep up on current theory. It's not a career for me, but we all know that physicians will find ways to cut corners, and I'd rather have them employing well-trained MA's than some idiot off the street or worse, no one at all. Good luck in your programme!:)

The Imitrex one cracks me up because there's a little disclaimer in the lower left hand corner of the screen at the start of the commercial: "NURSE DRAMATIZATION". Yah mean the nice lady with the good hair and perfect scrubs isn't a nurse, she's an actress? Really?

Just a little note....the duct tape study used duct tape ONLY on plantar warts--not on warts on the face, hands, etc.

My husband has multiple plantar warts and most recently had some of them frozen off in July. His physician put him on Tagamet (cimetidine) 200 mg BID. So far, he hasn't had any new warts form. Personally, I used the OTC salicylic acid plaster and a scalpel to take off my plantar warts the last time I had them. This is probably not the best method--it's very painful and very bloody, since the wart virus causes a proliferation of blood vessels in the "root" of the wart--but it worked, with no scarring. No warts since then, either (about a year and a half ago).

I recall reading somewhere that SonoSite, the manufacturer of ultra-portable ultrasound units, donated one to "ER" in the hopes of attracting attention. The gambit worked; they're still a little company (based here in Seattle) but they have gotten a few calls from ER docs and hospital managers. I don't watch "ER" very often, but I did watch last night, and I noticed that Littmann stethoscopes are not featured as prominently as they once were. Most of the actors had the diaphragm turned inwards, thus obscuring the "L", and some of them had other stethoscope brands--I saw one DRG, and Noah Wylie had a Sprague-Rappaport type on. Did Littmann not renew their contract with NBC? I can't imagine this is accidental. With "Scrubs", which I think is funny as hell, I suspect their use of all one kind of stethoscope is more an economic decision than anything else. Those gel Sprague-Rappaport types are cheap, and since "Scrubs" wasn't expected to be as successful as it has been, I doubt seriously that they had the clout to attract sponsors. The Pyxis thing I must have missed. I did notice that the guy who plays the hospital chief has a gold-plated Sprague.

In veterinary practise, we almost always used a 1 cc syringe when giving U-100 insulin injections in-house (diabetes is remarkably common in cats). I think it's because the needles were longer than those on the insulin syringes, making it easier to deliver the insulin IM rather than SQ. Not sure, though, and when owners gave at-home insulin, we always instructed them using insulin syringes. Haven't been taught yet how to give insulin to humans, but I'd have to go with everyone else on this one--give the insulin using the insulin syringe, to CYA.

Per my grandmother, who graduated from a diploma school in Ontario in 1939, graduate nurses wear white caps with a single black velvet band across the top. The style of cap (width of brim, one button or two, peaked or not, etc.) varied according to the hospital, but graduate nurses had a single black band and anything else meant that the person was either a student or an LPN. The school you attended was indicated by the pin, worn on either the dress or the cap. She didn't say anything about the black velvet band indicating mourning for Florence Nightengale, but it makes sense, since Nightengale was the first to propose formal (school) training for nurses and the creation of nursing as a profession. I plan to wear my grandmother's cap and school pin if and when I graduate; she wore HER mother's cap and school pin at her graduation.