Duranie

This is a very astute observation. Elementary, and particularly MS kids can grow 1/4”-1/2" *in a single day*! Imagine waking up at the end of a week, to find: that your pants are all "high waters", and when you try to move the way you always have, your legs suddenly feel like Bambi's did on ice. ? To top it off, your shins, and sometimes femurs ache so much at night that you wake up several times every night in pain.? Now, all of a sudden it really is your "first day (week/month) on those new legs" and you are too tired to see straight.? And lucky you, today is kickball day or tennis day, or god knows what— all are equally horrifying in your mind. ? Welcome to being 8-12 years old (boys even longer— all of my boys were still having growth spurts up to at least age 21-25, and my oldest (who admittedly, started puberty late @ nearly 15 years old) had his last growth spurt at age 28! <he grew 1.5", and is now a bit over 6'2"!! > My hubby was the same way...once, early in our marriage, he accused me of shrinking his work pants when they were suddenly over 1.5" too short. His arms grew too—less, but nevertheless his dress shirt sleeves were all an inch or more too short. Hubby was 22 when that happened. [it was actually kinda funny when I showed him that other than the length, his pants were actually loose in the waist, as his body fat redistributed itself once he was taller.] Anyway, I just wanted to give a little more context for the "kids becoming tall and lanky" description. Girls go through the same growth spurts, but hormones like estrogen & progesterone slow growth down relatively early, while testosterone tends to rev it up. There's other hormones at work too... but the end result is that most girls reach their final height by 14 years of age, typically. Boys however, may still be growing even as they enter college.

Another consideration— does the diabetic student have a 504 plan or IEP? What does their plan state in regards to having nursing care available during the day? Is there any sort of care plan or action plan on file wherein the student's physician has outlined steps to be taken for various scenarios? I'd be surprised if there weren't a written plan in place... otherwise, where are you getting the dosage adjustment parameters that the Dr has approved? Any of the above documents constitute a contract between the school (including you, if nursing care is stipulated, or if there's a specific care plan) and the student's guardian/parent acting on their behalf/in their best interest. If having you float to another campus would interfere with your ability to fulfill your responsibilities under any existing care plan, then the answer would necessarily be that you cannot float, because to do so would put both you and the school in a bad place if there was an issue while you were away from your campus. As an aside— consider drawing up a care plan for any temporarily disabled, injured, or ill students. That will potentially cover you as to your need to stay put at your assigned school, depending of course on what their Dr. actually outlines. Remember that how you write your parts of the care plan, can influence what the physician "orders". Your suggestions or proposals may be what the Dr uses as the outline to write his plan. Good Luck.

It's actually a good idea, Tenebrae. Unfortunately, it will only be effective if every "carer" follows thru on the reports. It needs to be any staff who is interacting with the patient when an incident occurs from lowly ? patient techs to LVN's & RN's. Also OT/PT providers (if any), dining room staff, RT's, etc. The idea is to show a true snapshot of how unsafe it is for: the patient (who isn't receiving appropriate care ? simply because your facility is the wrong placement) the other patients/residents (who are potentially getting injured by the patient) and various ancillary staff [some (most?) of whom are not adequately trained and prepared to manage the patient's behavioral issues] If only OP is making the reports, it's going to look like s/he is a "complainer" rather than being seen as an indication of a need for this patient to be moved to a higher acuity facility. (Or an appropriate acuity facility, however you want to think of it…). But getting everyone else on board to add more work to their day? ? Maybe .... *if* they're convinced that ultimately it will effectively lessen their workload. ?‍♀️

These aren’t run-of-the-mill high schoolers. To succeed in the kind of program that I’m familiar with, these students are driven, ambitious, and extremely smart. They have time-management skills that some experienced nurses would envy. I was in a VocEd program in HS more than 3 decades ago.... it wasn’t nearly as structured as the programs today are (now known as JTED). I could’ve graduated HS in 3 years, credits-wise, but I chose to stay for Sr. year and when I graduated, I had my CNA, MA (front and back office), phlebotomy & lab tech certs— basically all the allied health certs. that were offered except dental assisting. And I did it all with straight A’s. I didn’t necessarily want to do all those things, but I had a strong desire to learn all I could about what was called at that time “medical arts”. I knew from the start it was gonna be difficult and that the bar was set high. I wish I’d been in a program that would’ve given me the opportunity to have been at least partway done with my AAS-N, instead of having so many cert’s that I never used. (I did come out of it with a familiarity with a lot of very basic concepts, plus already knowing medical terminology when I started nursing school. I also already knew how to do blood draws, start IV’s, and give injections. But I didn’t actually get college credit for any of it.) The JTED students know the expectations from the beginning. These are students who are more mature than the average 14-18 year olds. If they aren’t able to keep up with the coursework or if they change their minds, they can transfer to the regular HS at any time. Its not just nursing, either... there are quite a few programs they can pursue— including auto mechanics, software development, machine shop, manufacturing processes, and others that I can’t think of now. Anyway, I think that for these exceptional students, programs like this can allow them to achieve their dreams. Also, I’d imagine that a lot of them would go on to BSN or other bachelor’s-level programs, because like I said, these kids are so driven.

I know there are programs in AZ that in cooperation with the Community college students can graduate from high school with only one year left to get their Associate of Applied Science in Nursing. The way that there is room in the high school curriculum to make this work, is that every course serves 2 purposes: so a pharmacology course might be counted as a general science credit. Senior “English” would instead be replaced with a course on professional communication, with emphasis on writing. A dosage calcs course counts as a math requirement. In addition, under this sort of structure, there are no “electives” as such, because all elective slots are filled with courses that fulfill major requirements. There’s also room in the curriculum because most HS Seniors in AZ actually only attend for a 1/2 day, because they’re only req’d to have 3 yrs of science & math. But in a VocEd program, seniors have a full day, or if they do leave campus, it’s to take courses at the CC.

I disagree with allowing individual states to determine how to implement any sort of socialized medical insurance. A big part of the “appeal” of coverage-for-all plans is that, indeed, everyone is covered for all of their medical needs in the same way. My ability to have my needs met shouldn’t be different depending on where I live—either what is covered, or potential obstacles to accessing the covered services. In my case for example, I’m relatively young— in my late 40’s. However my health needs are more like those of someone at least 20 years older. So let’s say that dh has a great job in the PNW... if WA or OR were allowed to have a plan which favored well-care and made it more difficult to access treatment for some things, or covered DME or HH differently, due to the area’s demographics, that would place a serious hardship on my family— we could be forced to relocate to someplace like FL, and dh could have to find other employment, and in his field, there aren’t the same opportunities there. As it is now, there are already big differences in Medicaid coverage from state-to-state, and even Medicare differs somewhat because each state has different supplemental plans, that extend coverage to different things (like rides to dr visits are available on plans in some states, but not others).

All of them are good for somebody... the trick is finding the one (or ones) that are good *for you*....

Yeah, try some of the other dandruff shampoos our there, and make sure you are actually getting it on your scalp... either use your fingers to dab it around your entire hairline and several places on the rest of your head at the roots, or use a bottle with a nozzle (think Elmer’s glue type of thing) to direct the shampoo right to your skin. Rub at the roots to make lather, concentrating on the areas you tend to scratch most often or that you’ve seen flakes build up.... then let it sit on your hair for 3-5 minutes before you work the lather thru the rest of your hair (if it’s longer) & before you rinse. Also, you may find you need to rotate a few shampoos every few months... Selsun Blue for a couple months, then Nizoral, then something with coal tar as the active ingredient (I use MG217... I get it at Walgreens or Amazon...)— when you start to notice more flaking again, move on to a different product. It can be helpful to try several to see which ones work, that way you aren’t scrambling to find a new one when you need it. You’ll already have and know what works. I went to the Derm. and he told me to try several OTC shampoos before he would rx anything. Eventually he gave me a steroid liquid to put on the worst spots at my temples and behind my ears... but you can’t really use that on your whole head.... Anyway, those are the things that helped me. Maybe it’ll help you figure out your own best options. Ultimately, you may just want to go to the derm. and see what they say. Also, keep in mind that looking down at yourself, you’ll see every. little. speck.... but look at your coworkers— you’ll probably not really notice anything until you get right close to them. It’s typical of dark/black clothing to show every bit of lint etc.... but it’s rare that anyone else sees what we see on ourselves. Good luck

They do ?... so make it a habit right from the start— you do not loan your stethoscope to anyone. Period. Make up a little white lie if you must?: “ I had such a hard time adjusting the angle of the earpieces, and if they are moved even the tiniest bit, it *really* hurts my ears, so I’m sorry, but I can’t.” And if you are ever tempted to deviate from that practice, make sure you follow your ‘scope ... stick like Velcro to whoever is using it and the second it comes out of their ears, stick your hand out to get it back. (Doctors are the *worst* offenders— especially residents— but honestly they never really “outgrow” the stethoscope kleptomania. ?) But seriously, the best thing is to never, ever, ever lay it down, or loan it to anyone. Also, if you are gonna wear it around your neck, get a fabric ‘sleeve’ for the tubing so your skin oils don’t wreck the tubing. You could also get a ‘scope holder for your pocket or waistband. Look on Amazon for “stethoscope holder” and you’ll find lots of different ones. Good luck in school.

Related to anyone in the hospital? With how big Vanderbilt is, I wouldn’t be surprised if she was.... Now if you mean related to someone in Administration? That’s a different question..... I’ve not seen so much as a rumor that she was..... I’m sure by now some investigative journalist (or someone at the DA’s office) would’ve figured it out if that were the case.... And I didn’t see where anyone suggested that “statistics just caught up with her”.... I think what TriciaJ was saying was that it wasn’t a case of everything just coincidentally going wrong at each step in the whole chain of events, with no way of foreseeing that it could all go sideways. *I* read her post to say that perhaps Vandy was aware of other instances of RV practicing in an unsafe or questionable manner.... For instance, had a coworker ever had concerns that they brought to management, formally or informally? If so, was that concern ever properly documented? Or did Vandy cover that up, too?

Liking this just once isn’t nearly enough......

Yes, sometimes it is the records kept by the heath office on the ff kiddos that really help the doc figure out what’s up. If not for the log of sometimes daily temps on my son, we wouldn’t have had such a clear picture of what was happening. It was a crucial piece of the puzzle, even if it was frustrating and patience-trying for the nurse.

Well, unless he knows of another nurse in the dept. who is a rape survivor who ended up being required by management to perform SARS exams after they voiced concerns similar to yours — then I’d say he’s talking out of his sphincter... ‘Go speak to the Nurse manager or whoever you need to in management and explain the situation. Are you still in therapy? If so, ask your therapist for a short letter that states simply that it is not advisable that you conduct or participate in sexual assault forensic exams because due to your own experiences there is potential for you to cause inadvertent harm (psychological, if you freak out mid-exam) to the patient or to cause a break in the chain of custody of forensic evidence if you became unable to complete the exam you had started. You could also make use of your “Employee Assistance Program” to speak a counselor that the hospital provides. (Usually for free.) You should do this because of the psychological stress that came from being in the situation of having to decline performing the exam and then being bullied about it by your charge nurse. This will create a “paper trail” with regard to this specific incident that you can turn to if needed in the future to show that you had concerns and tried to do what was best for yourself and your patients, at this time. For the record, as an SA survivor myself— I think you did the right thing. A patient will pick up on your feelings of anxiety and fear, but because they don’t know why you have that anxiety, they will likely misconstrue that it has something to do with them... which in this case, might make them think that should be ashamed or that they’ve done something wrong, or that you somehow think they shouldn’t be there— any of which could cause them not to go forward with the exam or the report of their assault. Which is, no doubt, the last thing you want to happen. I’m sure what you really want to convey to any SA patient is that they are right where they belong and that they have done nothing wrong and they have nothing to be ashamed of. And that the exam is a necessary part of the SA report they are rightfully pursuing. Be sure to point out to your manager the above risks and that you (and they) surely wouldn’t want to inadvertently cause any further trauma or stress to an already fragile and vulnerable SA patient. I’d be willing to bet that your charge nurse’s threat of “it just doesn’t happen” is empty. It probably hasn’t ever happened, but only because it probably hasn’t ever come up before. This is exactly the kind of thing that has to be handled on a case-by-case basis, because there is no one-size-fits-all policy that could ever cover it. Good luck. Be strong and confident in your knowledge that you did what was best for the patient. You advocated to get that patient the care they needed, even though it wasn’t care you could personally provide. And isn’t that ultimately your job?

Letting them know that you’re moving to be with your fiancé (especially since you can prove his out-of-state job started after your contract began) might make a difference in whether they’ll hold you to the penalty.

I’ve done similar things.... I’ve poured milk into a cup of water sitting next to my bowl of cereal.into a bowl or cup instead of into the measuring cup I meant to.(While making dinner of hamburger helper) directly into the skillet of hamburger instead of the measuring cup. I’ve also poured soda into a glass of water instead of the glass I wanted to. I will say that I’ve never poured anything into my purse or any other place that wasn’t an otherwise normal receptacle. I mean other than accidentally— like knocking a glass over and the contents spill into my purse or whatever.