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.

Didn’t look at the link yet... (I hate reading Wikipedia on my phone.) but what you described re: the dancing is known as muscle memory... it’s also behind the concept of never forgetting how to ride a bike.

Or just a second X chromosome.... ? Otherwise, after a hysterectomy, we’d lose our superpower....

To student: “Well, guess what... you’re gonna be fine, sweetie— student-grade flutes aren’t made of silver.... “ (at least not pure silver anyway. Most likely it’s a nickel alloy. ) But, I suppose in fairness, if it’s a new dx’ed allergy, there could be a reaction... good news, though— there are ‘pads’ that can be adhered to the part of the flute that rests against the lip. They’re designed to protect the finish, but they’d also serve as a protection to the player.... if there’s evidence of an allergic reaction, perhaps this could be suggested.

I don’t have disdain really— I have ... I don’t know what to call it, actually.... confusion, I guess. I don’t know. There have to be strings attached— by your own argument, we support people until they can get back to a functional place in life.... so the strings are that they are going to cooperate and work toward that goal of self-sufficiency, or at least minimally-supported-sufficiency (for those with limiting disabilities) So what do you do for those people who will not cooperate??? They have *no desire* to change their circumstances, and will not live within the programs that are being offered. You can’t enroll someone into a sheltered rehab program, but still allow them to do drugs and engage in illicit activity within their provided housing..... they have to be willing to live by the rules. They have to work their way up that hierarchy. They can’t be dragged. Those people, who through misfortune, or bad luck, or sudden illness, etc., end up in bad situations — either through no real fault of their own, or through ignorance and poor choices that are later regretted— those people are the ones who could—and do— benefit from the supported welfare-type programs that exist.... They don’t want to be homeless, jobless, *hopeless*, etc. They want to pull themselves up out of the gutter, and they’re grateful for the hand that reaches out to help pull them to a place of safety, security, and self-reliance. Unfortunately, those people are in the minority, in many places. And more unfortunately, the programs that are offered are often structured in ways that hinder access by the very people who would benefit. My own sister was denied welfare and food stamps when she got breast cancer, had a double mastectomy, went through radiation and chemo, and reconstructive surgeries, all while raising her disabled grandson. She was unable to work for over a year... but the state of AZ refused her benefits because she couldn’t attend the job-readiness classes they required of welfare enrollees. She explained, in vain, that she *had* a job, & she was off on long-term disability, but that it only paid ~30% of her pre-illness wages, which were meager to start with. After six months or so she was able to get SSDI (and SSI for her grandson), but the state still refused any benefits because, according to them she was “non-compliant” with the job training programs. Even letters from her doctors stating that the classes were unnecessary, and inappropriate given her medical needs, made no difference. She nearly lost her house, and car— we paid her car payment and mortgage on more than one occasion, which meant we had to juggle our own payments and got our credit dinged... but the point is that even people who *want* the help, often can’t get it because the programs are one-size-fits-all and are designed to force people into compliance with rules that may not even be appropriate for their situation. If people who want help, and genuinely need it, can’t get it... how on earth can anyone expect to help people who don’t want assistance??

Well, presumably a consult summary letter/report should be sent back to the PCP detailing the problems found or, conversely, ruled out... and the specialist’s recommendations going forward.... that is, if the parent listed the PCP on the intake forms, or if there was a referral to the specialist. Now, whether the PCP reads the letter, and chooses to integrate the findings into their own knowledge and practice.... well, I’ve seen it go both ways— the PCP blows it off with a ‘whatever, that specialist has their opinion, but I don’t agree’ .... or they say ‘hmm, really... learned something new.... I’m gonna make the effort to read/educate myself more on [that topic]’ — it really just depends on the provider’s personality and mindset.

The bolded statement above is especially relevant in Seattle. The homeless population is going up & up... and the main cause isn’t Amazon, believe it or not— it’s that vagrant persons are coming to Seattle from other places! Imagine moving somewhere else to be homeless there.... it boggles the mind, yet it’s happening. And I’ve gone past many of the “tent cities” (although honestly, they’ll pitch their tents anywhere, including the median, under a stoplight, in a crosswalk, in a handicapped-designated curb parking area, blocking the curb-cut...) but let me tell you, many of the tents are nicer than anything my “upper-middle class” family could afford, many expensive, REI and similar tents... and larger than we ever used for our family of six. I can’t say how many people are living in those huge tents, but I *can* say— they aren’t the type of tent you roll up and move with on a whim. They aren’t strapping these to their backpacks and hitching a ride someplace else when the mood hits them.... Furthermore, Seattle has tried several times to provide “transitional housing” — for example, building hundreds of “tiny houses” as part of a pilot program— so people could have a secure living space, with an address, which they need to apply for jobs and access social services like vocational rehab, etc. But there were rules for living in them— shocking, I know— and last I heard, they had to discontinue them, because they were used for prostitution and drug dealing, and the few people not engaging in illegal activity were targeted and robbed or worse. So if you have a population of people, who refuse to live within basic societal rules, and won’t rise above their circumstance of living on the street and eating garbage— what do you do? You can’t help people who don’t want help....

Seems simple enough.... why do so many young adults (and a few older ones, too) have so much trouble understanding this?

I had two complicated kids with chronic issues that had to be “excused” by their pediatrician— Kid #1 B. was one of those kids who just “ran hot”... never had a documented temp under 99.5 — and more often than not his “resting” temp (meaning he was just chilling indoors, not just coming in from playing outside, or PE or recess...) was over 100... ?. Doc said it was because he had a high metabolism (definitely true— keeping weight on that kid was a nightmare... and on top of it he was an extraordinarily picky eater, even requiring tube feeding for nearly 2 years fron age 2-4! Crazy, I know...). He was also a Bigfoot vomiter (learned that one here on AN ?)... I think he was nauseated a lot, and somehow figured out “I feel sick to my stomach” doesn’t get the same reaction as “I got sick to my stomach”, and started saying he puked anytime his stomach was bothering him. He was dx’ed with several GI issues in late elem. & middle school. Anyway, doc wrote a letter that was essentially a “vomiting action plan” — so if he went to the nurse saying he vomited, there were meds to be given, and only if he had a witnessed vomit after the action plan was followed did he get sent home. Or if he had a fever— which the pedi defined as above 101.5, taken after at least 1/2 hour in air conditioned space, and drinking at least 8 oz of cold water (we lived in Tucson at the time). Actually the pedi said two temps of >101.5 taken after 1/2 hour in cool room and taken 1/2 hour apart. So the nurse usually sent him back to class in between with a cool compress [frozen paper towel] for his head/neck (if he came for something not GI) and most of the time he never came back for the re-take of his temp. I think he got headaches and even some of his GI complaints from overheating, and the sx went away when his temp came down... my evidence: I got a call from SN telling me B. was there and his temp was 102.5 and he was flushed and stated severe headache and nausea after immediately following lunch and recess. I said I’d come get him ASAP, but I was about 30-40 mins away... by the time I got there, his temp was 100.x and his headache and nausea had vanished— of course, he still wanted to come home... but meanie mom that I am, I made him stay... This sort of thing happened more than once — thus the ‘two temps 1/2 hour apart’ rule given by the doc. Kid #2 N. wasn’t nearly as complicated as B., but he did need a variance from the usual policy for vomiting— or he would never have been in school... This kid puked at least 4-5 times a week. After keeping a vomiting journal, (something I *never* thought I’d have to do.... ?) we figured out he rarely puked on weekends. He was dx’ed with school anxiety and a “nervous stomach”. He was put on Prilosec and a small dose of reglan (to be given prior to high-stress occasions, like benchmark or state testing, etc.) He was also allowed to carry up to 10 tums with him (as young as 3rd grade) and we took him to a therapist to learn guided imagery/biofeedback/ self-hypnosis -type techniques to calm himself and overcome his body’s stress reaction (churning out too much stomach acid, and regurgitating it’s contents). He did take something for anxiety, but I can’t remember what it was— just that the SN could give him a small “rescue” dose during the school day if needed. So basically, N. had a “vomiting action plan” of his own, along with an “anxiety action plan” (and because of a bee/wasp/hornet allergy he also had an allergy/anaphylaxis action plan, and an epi-pen) ———————————————- Sorry this got so long.... My point is that kids who have documented issues *can* be accommodated, if the doctor is willing to write the letter stating what the child needs to be able to stay in school. Even if the kid has unusual or uncommon issues. In my experience, pediatricians know very well that a child belongs in school— and they want to help kids and parents with whatever is necessary for that child to get back to school successfully. And schools have a vested interest in keeping kids in school— boiled down: more kids = more $$.... They need as many enrolled students with butts in seats as possible every day, in order to pay the teachers and parapro’s and staff and, oh yeah, the nurses. So (again IME) a school will work with parents to help get a student’s needs met so they can be in class and be successful. (at least as far as mandated testing shows, ? But that’s a different topic, entirely)

There’s something wrong with the story .... even if the wrong-sided stenting somehow caused irreparable damage to that ureter.... which would be *really* unlikely— how on earth would this mean that the woman would require dialysis for life??? Maybe she *might* need temporary dialysis *if* her other kidney weren’t functional.... but if that were the case it wouldn’t have needed stenting in the first place. *If* the error happened as reported— that a stent (called mesh tube in the story) was placed in the wrong ureter, and damaged it (which is ironically what the stent is supposed to be helping avoid...), then the error could be remedied with a ureteroplasty of the damaged ureter and then stenting of both sides— the side that was originally supposed to be done, and a stent to allow healing of the rebuilt ureter. Until such time as that could be accomplished, a nephrostomy tube could be placed (by an interventional radiologist— wouldn’t even need a trip to the OR) which would allow urinary drainage, preventing renal damage. Worst case as I see it, (based on what was reported) if for some reason a ureteroplasty isn’t an option, then the patient has to live with a permanent nephrostomy/urostomy. Not dialysis. Not as long as even one of their kidneys are functioning.... i.e. the one that originally needed the stent. Like I said.... something doesn’t add up with this story as reported.

Funny— I was under the impression that virtually all OTC items/meds were disallowed on FSA’s now. When I use our FSA debit card at the pharmacy, virtually the only thing it lets me pay for is the rx’s. If I’ve got bandaids, or cold medicine that I’m getting at the same time, the FSA-allowable potion is deducted and paid, and then the new total is told to me so I can pay for that with cash or another card. As a matter of fact, recently even the mag. citrate and fleets we had to get before dh’s colonoscopy wasn’t being allowed and the pharmacist recommended we call dh’s doc and ask them to rx a “prep kit”, which I guess would’ve been covered, but dh didn’t want the hassle. Plus, 2/3 of the times I use the FSA card, a couple weeks later we get a letter asking for the individual rx receipts or the dr’s office superbill showing what we paid.... as if it was that easy to pay for anything and everything . smh. I know if I could figure out how, donating supplies would be something I’d be willing to consider doing if we had funds left to use... last year we lost about $100 or so, even after I ordered a new pair of glasses and had a new bridge made. This year, we decided to reduce how much we’re contributing....