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  1. KatieMI

    "LPNs are glorified CNAs"

    LPNs are in the same sense glorified CNAs as NPs are "just glorified nurses who know nothing but thick too much about themselves". The last I heard more times than I can count. From pretty much everybody, including those who should know better. So? You, like everybody else, got only one life. It is not wise to spend a moment of it musing about words of some blockhead. Or nincompoop, if you so prefer (yes, there is such word in English).
  2. KatieMI

    Managment is TERRIBLE

    You (and all your colleagues working there) probably should consider showing your new DON that each of you just happens to get two legs on which to walk out of there. Resignation en masse with doctor's note for the remaining 2 weeks (can be obtained in any urgent care - just complain on something stress-related like constant headache and insomnia and make sure to mention "intolerable stress" at work) usually takes care of the business. Yes, you might feel that doing so would be bad for your clients... but you got life too, and health as well. Overall, JUST RUN.
  3. KatieMI

    Whiskey peg tube flush?

    Actually, had to do it quite a few times. Acute withdrawal, for one reason or another no IV benzos can be used, PO are either similarly "allergic" to (many alcoholics have paradoxical agitation up to full blown panic attacks on benzos, the shorter acting, the worse) or refused due to psycho/paranoyal behavior. ICU, things are getting worse... ETOH, either 30 cc of liquor (cheap vodka or Jack Daniels) or 8 to 12 oz of beer (Budweiser) PO/PT Q4, slow wean by time, then by amount. It was always a great ceremony of at least 2 nurses walking down to cafeteria and receiving the said medication in a brown paper bag under both person's signature as per policy. As if none of us wouldn't prefer something better Back in my country, IV ETOH is still used in the same situation. D5NS 2,5 to 5% ETOH, start IV 100 cc/h, decrease slow. People were used to tell great lies in order to get that treatment - they told me that there was nothing in the World making them feeling so great.
  4. I once crossed lifeways with a place which was strictly Catholic and so educated and hired a lot of students and grads from nearby university, similarly as strictly Catholic as it is possible nowadays. The university offers courses level BSN and up. BSN is about $80000 tuition, MSN is accordingly more, both with notably lax academic admission standards but picky about everything else. They still wanted to know church affiliation status of applicants, still shun (unofficially, of course, but it is well-known anyway) immigrants unless they come with some kind of Catholic mission, etc. It seemed to me that over the half of nurses there graduated from that place because their moms/grands/ets. did the same and because their parents would rather kill them than to let them get exposed to sinful life of a normal university campus. In addition, I'd heard that those with proven strong affiliation with Catholic church had scholarships which covered a lot of their tuition. There were also those accepted there for $45000 "refresher" after failing NCLEX numerous times and many dropouts from another local university school known for being exceptionally strict academically. The students in that Catholic university had it sweet and cushy, taking courses like "spirituality in nursing" and "life transitions (theory)". NCLEX passing rate first attempt was 80 or so - not terrible, but not impressive either. The hospital was a mess of spectacular proportions in all senses, not the ladt due to awful quality of nursing overall.
  5. In fact, it was precisely she who made the first "nursing diagnoses" among many other things. Soldiers in Scutari was dying in droves not as much as of wounds but of infections and malnutrition. That was the time when infections were mostly not yet accepted as such, and the Lords of Admiralty would have kinda hard time explaining where money for army's rations and uniforms suddenly went to. Flo threw on the table just classic stat tables, not unlike ones still used in base-level descriptive statistics, and 80+% of losses were attributed to three conditions which were not even medical diagnoses at that time: malnutrition (including scurvy and everything else), "flux" (acute diarrhea and dehydration) and "unsavory conditions" (dirt and what it implies, typhus, frostbite, etc). If you would like, they were nursing diagnoses all right. If you happen to be in London, UK, take a few hours and go to St. Thomas hospital. It houses great museum of Flo and nursing in general. You'll have fun there, I promise. Only info about those legendary rounds with the lamp worth's the trip (the rounds were indeed done nightly, only with the purpose to catch and eliminate any forbidden alcohol and women from wounded' quarters. And the lamp was needed for navigation in that long and very heavy (for the sake of protection against said men) skirt among spectacular mess that was there)
  6. KatieMI

    Nurse Charged With Homicide

    It looks just like trying to convict someone of homicide after accidentally hitting and killing a man while speeding 25 miles over speed limit. Yes, it is a tragedy. Yes, someone had died. Yes, there was spectacular level of stupidity demonstrated by more than one person. But, no, it was not a cold-bloody murder. It was, that is to say, a reckless driving. Stupid and tragic, but just... stupid, after all. And, BTW, things look like the doc who ordered a definitely gray-zone drug (as it was discussed on this very forum already, Versed is neither common, nor, actually, directly indicated for symptomatic treatment of claustrophobia alone as opposed to monitored intra-procedural sedation) got dry out of deep and hot water.
  7. KatieMI

    Should employers check titers periodically?

    It may be good idea, but it wouldn't be cost effective. We do not know, actually, which titer is how much protective, and to whom, and in which situation. Titers are "that second" measures, and they are relative. Furthermore, they do not predict IG M=> G=> A "surge" should the patient gets exposed to virulent agent. Pregnancy, recent flu, that recent pack of Medrol (yeah, you know it was not that needed but you had to work with that sinusitis) - all can affect them, in poorly predictable way. And, if they run low, you are going to get a shot (not a big deal, but still $$) and then more titers =>> see above. On the other hand, for example, MMR induces "protective" titers for measles in about 95% of healthy recipients. We do not actually know what happens with remaining 5%. Everything we do know is that they are "serologic non-responders". Statistically, only like 10 to 25% get clinically sick if exposed. What happens with the rest is not exactly known except that they do not get clinically sick while not developing protective antibodies of the class(es) we look for if exposed to "wild" virus. We cannot do anything with this facts, and the numbers stay the same for decades. This is the reason why workers in areas of "very high risk" exposure (like vets and military) are just mandatory vaccinated without too much hassle with titers.
  8. KatieMI

    Head hunters be like...

    Oh, yeah. One smartie from there was absolutely sure that "rare and elite" (he used these words) position of regional CNO for the worst chain of nursing homes I'd known so far would be wonderful match for me. For meretricious compensation of $45000/year before taxes. And they were even ready to compensate my moving expenses in some place in the real middle of nowhere 3 states across in generous amount of $5000. Gosh, I rather go back to Los Alamos. At least there will be plenty of well-educated people around.
  9. KatieMI

    Advice please I’m torn.

    1). You go to your boss right now and tell him/her in clear and simple English that you won't set your foot in that house from now on, period. 2). You call every single home care nurse in your agency to do the same ASAP. 3). Dust off your resume and start looking for another job STAT. If you can afford it, bring your good bye note today and take doctor's note for any remaining time. 4) . Keep copy of everything. I mean EVERYTHING. Picture on your phone with transfer as soon as possible on memory stick which you keep hidden and secure. If your boss(es) suggest a "meeting", do not go there alone. Please protect YOURSELF FIRST. This situation is dangerous beyond all means for you. In-house lawyers won't protect you, they are there to cover your bosses. Honestly, I would look for a TAANA lawyer right now. But the first and foremost action is to quit all contacts with that family
  10. KatieMI

    Is It Possible to Never Make an Error? The Perfect Nurse Fallacy

    I actually know one guy from upper nursing management who boasts wide and loud that he never made a mistake and therefore nobody else ever should. The truth was, he was removed from 3 units after just a few shifts in each before he used his chance to kill someone. How he made it from there to upper chairs, I do not know but there he still is, living his wonderful career in rosy and rainbowy world of policies and schmolicies. He is a true incarnation of manager from hell, BTW.
  11. KatieMI

    Please help

    You are supposed to get out of there ASAP. It is like that little dry cough when flu is about to start. Today they named re-initialing MAR for a person who did not know about it "MAR etiquette". Tomorrow it will be re-initialing in narcs journal. One day after tomorrow, someone will know that X Norco pills disappeared to nowhere and there is a signature of him or her in journal, and he or she was not even working that day. Been there, saw that. Playing with signatures is a dangerous symptom of corners which must be left as they are being cut. Document, then run. Run for your life.
  12. KatieMI

    How to publish a clinical case?

    Recently, in my forever pursuit of all things that are new, stimulating and medical, I caught a real diagnostic zebra. I cannot write the Dx here due to HIPAA, but it is likely to be considered medical diagnosis of at least 70th level out of 80. And I figured it out totally on my own. So, now I'd like to make it into case report and get it published. There are case reports about this condition, but not that many of them, published in big medical journals. The problem is, I am "just a Nurse Practitioner". I am not even a staff in that ordinary regional medical center. I have privileges there through private practice I work for. And I was totally alone in the process, as the practice allows me like 98.5% autonomy (the rest being paperwork which has to be signed by someone with M.D.) but otherwise they cannot care less as long as the daily clinical work is done. The place where it all is going on is connected with 4th tier medical school, and that's about it in terms of academy. In addition, since I had plenty and then some of my ideas blatantly stolen and used by physicians, I am wary about asking a consultant to be my "guide". It was work done by me, alone (and maybe some lab guys in Mayo Clinic who did the key diagnostic test). I want my name being first. I went through several NP journals and their publishing guidelines. The problem with them is that they, understandibly want all things "nursing" and there is absolutely nothing "nursing" in the situation. The diagnosis is not "nursing" one. The diagnostic approach had nothing specifically "nursing". And I will have trouble to find any references that somehow belong to anything "nursing". So, does anybody have experience of publishing clinical case while being a "nurse"? Pearls and tips will be warmly appreciated!
  13. KatieMI

    Site looks weird? Found a bug? Share...

    I was kind of disappointed by total "likes" disappearance. I mean, we were told that the amount can "change" but several thousands of them going to zero... it is a big one. Do not know why or how does it matters it irks me some very wrong way.
  14. KatieMI

    Are We Too PC?

    Then the opposite must be the truth as well. And if that is so, we surely must live in paradise itself. Just look at all those wonderful works of language - the Bible, the Quran, the Torah, the Constitution of the USA, etc., etc. How much they REALLY change thoughts? How about billions of people being killed in their holy names for centuries? As a person who lived for quite a while in Orwellian society, I can tell you that the language can corrupt you only as much as you allow it to happen. Don't allow it - aka use your brains as intended - and you'll be just fine.
  15. KatieMI

    Are We Too PC?

    My opinion might be unpopular, but I still feel I got right to voice it. - If YOU are the one thrown from two jobs in a row for speaking with (apparently) easily understandable accent.... - If YOU are the one whose job suffers from disgusting questions like "is your husband is still the man you hooked up to come here?" (yep, that's what I was asked in my face. The so-called "professional nurse" who spread all over my personal info gave me so-called rationale of "they just wanted to know to whom you are married with"... - if YOU are maligned just because you happen to be born in certain place, with certain skin color, wear certain clothes, have certain beliefs, have sex with certain people (continue as you please)... - if YOU are living through discrimination EVERY DAY OF YOUR LIFE in the country where individual freedom is the highest national pride and glory... - if YOU were even once forced into intimacy against your will because that's what so-called "society" expected from you... Then, sorry, but YOU will understand people offended by Christmas song. It is still a bit too much for me, but I get it fully and completely. BTW, I am absolutely not PC and known for speaking and acting VERY directly when situation demands such actions. But I still get how people get offended by this song. I was, and is, in their shoes - although about different issues. It is a different world now. It is not how it was 25 years ago. It never will be the same, whether one wants it so or not. Learn how to live in this new world - or there are plenty of countries where things seem to run good old ways.