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Occupational Health; Adult ICU
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42pines specializes in Occupational Health; Adult ICU.

Occupational Health Manager at Sysco (sole nurse for 700 employees). Occupational Health Nurse for GE (General Electric Aviation). Occupational Health nurse for Shire Pharmaceuticals. Occupational Health Nurse for GM (General Motors). Former Adult ICU RN.

42pines's Latest Activity

  1. 42pines

    RN Disciplined While Waiting On Covid 19 Result

    I'm union neutral and once worked in a hospital (my first nursing job) where I was in a union and nobody had told me. A supervisor said: "Why are you mopping that floor?" I responded: "I was told to do it to prepare for a new patient." She said: "Stop." I did, and was never asked to mop the floor again. If you don't have union jobs in your area, why not contact a union for nurses and advocate or one. Just an idea. If your hospital opposes you in any way...now there is a great lawsuit.
  2. 42pines

    RN Disciplined While Waiting On Covid 19 Result

    Wuzzie, I'm surprised that there aren't 200 thumbs up. Excellent post and IMO mandatory reading for all working nurses. Summary: Families First Coronavirus Response Act: Employer Paid Leave Requirements https://www.dol.gov/agencies/whd/pandemic/ffcra-employer-paid-leave Read it nurses...know your rights.
  3. 42pines

    RN Disciplined While Waiting On Covid 19 Result

    So very easy to say.
  4. 42pines

    RN Disciplined While Waiting On Covid 19 Result

    Harsh realities: State department of health is unlikely to even answer. State BON is unlikely to answer if queried (I wrote (email) to the NH BON with very specific questions about PPE, many days ago, no answer). Whistleblower lawsuit must be in response to a specific violation such as hiding an OSHA injury or a violation of State or Federal law. There is no specific violation here. Further, if you research whistleblower cases more often than not, the whistleblower gets nothing. Attorney: An attorney will not touch a lawsuit on contingent (no fees) unless they are certain that there is at least $100,000 and preferably > $150,000 in easily proven damages. For instance: Loss of Left eye because surgery was performed on the wrong eye. That's a good contingency case. Minimum retainer for any lawyer these days will be $3,000 but that will very, very quickly grow to $12-15,000 even before any hearings. Bottom line: There is no specific damages here. Much of this is contract law and contract law opposes most people's "common sense" POV. "Common sense," has no place in law, that's a simple fact that most cannot fathom. Harsh but true. IndyRN asks: "Is this fair?" All of us, would respond: "no." A contract lawyer would respond: "pretty much, 'Yes." The word "fair" has no place in war. We are at war.
  5. 42pines

    Nursing homes and Covid-19. Storms a coming

    I'd say you are, indeed, sitting on a ticking time bomb. My last job (a temp job) was as Administrator for a small assisted living facility slated to close. (Now closed) Were I still there I'd advocate for zero visitors, zero family, zero resident excursions. Additionally, I'd ask staff to come and work like they do on an oil rig. This means you come in, stay overnight, day after day, without leaving, perhaps for 4-6 days, then leave. (We had multiple empty rooms). Upon coming in, via a dedicated entrance, each person would shower, change clothes into new clothing, and old clothings would then be laundered or placed in bags. All incoming items would be wiped down including foods, even such items as tomatoes (very simple--spray with 10% bleach, 60 second dwell, rinse/dry. Were I there today and be opposed, they could have my two-week notice. Consider, in my small facility we'd have 11 staff group in/out cycles per day. That's 330 possible virus entries each month. If staff agreed to stay for extended periods such as 5 days, living there, sleeping there, we could have reduced that to 50 possible virus entries. Additionally, dedicated entry with clothing change/showers would go a long way to stopping virus. Doing that once every 5 days is practical--daily, not so likely. Staff would be paid lucratively. I'd have staff wear, at least, surgical type masks in case they were asymptomatic. I suspect we are on the cusp of an enormous crisis within a crisis at LTC and assisted living facilities. One single resident who takes this lightly can be the Typhoid Mary for your facility. Infection will spread from one to resident, to staff to resident, there will be no stopping it, once started. A cursory search shows some bombs detonating right now: Coronavirus Spreads To IL Long-Term Care Facility; Now 66 Cases. See: https://patch.com/illinois/across-il/coronavirus-spreads-il-long-term-care-facility-now-64-cases Oklahoma: "Hardest hit was Grace Skilled Nursing and Therapy in Norman. The Health Department reported 33 residents of the nursing home tested positive for COVID-19 and four of them died. It reported three staff members also tested positive." Texas: "Twelve of the 53 residents of MorningStar, 5355 Centennial Blvd., have tested positive for the virus, spokeswoman Lorna Lee said Thursday. The other long-term care facilities with outbreaks have confirmed 10 or less coronavirus cases." Note: The above cases are like the Diamond Princess cruise ship. These are localized epidemics that are now occurring, NOT ones we are looking back at--each will have more and more victims.
  6. 42pines

    Help I’m allergic to my mask??????

    It's more likely than not that you're experiencing mask contact dermatitis. "Mask contact dermatitis. “. A study by Foo et al40 in Singapore showed that 35.5% of healthcare practitioners in their cohort who used N95 masks regularly during the SARS pandemic developed adverse skin reactions. Of these patients, 59.6% developed acne, 51.4% developed facial itch and 35.8% developed a facial rash.” See: https://www.researchgate.net/publication/323278369_Surgical_mask_contact_dermatitis_and_epidemiology_of_contact_dermatitis_in_healthcare_workers Indications of a true allergy might include swollen eyelids, eye irritation, mouth, throat, or respiratory issues. Still there might be something in the mask that you are allergic to. I'd refer you to an allergist and/or dermatologist. A dermatologist might take a small piece of the mask and put it under a bandaid on your forearm. The resulting reaction or lack of reaction may tell if you're experiencing an allergic response or an irritant response. Try a different type/brand of mask. Ask for a PAPR if one might be available. A dermatologist might give you something such as a cortisone cream to oppose the itchiness. If the reaction is acneic then topical antibiotics might help.
  7. For those nurses who are told not to wear PPE (masks) and not to bring private PPE from home: A definitive, must read announcement by The Joint Commission. The Joint Commission is essentially “God” to hospitals. They outrank (IMO) Federal or State OSHA, CDC and about anyone else (if related to a hospital). Spoiler: Yes, you can choose to wear masks, including ones you brought from home, including ones you have made, as often and as long as you damn well care to. (If you can get your higher-ups to comply--if not complain to Joint Commission!) Interesting bits: “In settings where facemasks are not available, healthcare personnel (HCP) might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option.” “The Joint Commission supports allowing staff to bring their own masks or respirators to wear at work when their healthcare organizations cannot provide them with adequate protection commensurate with the risk of infection to which they are exposed by the nature of their work.” “Based on this information, it is reasonable for staff to want to wear a mask throughout the day. The value of wearing a mask throughout the day will depend upon the number of COVID-19 patients in the hospital and the community. However, for staff who are at higher risk because of their age, underlying health conditions, or caretaking obligations for high-risk family member, even a small risk of contracting COVID-19 from an asymptomatic patient may make them want to err on the side of caution. Staff in emergency departments are at particularly high risk because of the high number of patients they see who may be asymptomatic carriers of the virus and the fact that they may have to emergently intubate patients and would be at significant risk without a respirator to protect against aerosolized virus.” Note: I called NH BON asking about these points many days ago: no answer. Are we surprised? I suggest that this is a MUST-READ in its entirity. Link: https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/infection-prevention-and-hai/covid19/public_statement_on_masks_from_home.pdf
  8. 42pines

    Has anyone left nursing job due to COVID19 virus?

    I agree with all you say. However, actually, there have been instances when military was sent to the front without weapons. When Germany invaded France at the beginning of WWII each truck had two rifles and ten rounds of ammunition and that's for everyone in that truck. France was quickly over-run. (Apocalypse-The Second World War - S01E01 - Aggression) There are numerous other similar war-time scenarios. The problem here is we never signed on as military yet here we are, on the cusp of what is essentially a war-time footing.
  9. 42pines

    Has anyone left nursing job due to COVID19 virus?

    Uh...just how much "time" do you think you have? As a kid, I'd put my ear to the train track and sure enough you could hear the sound of an oncoming freight train as much as five minutes away (going about 40mph). There are no freight rails near me but I can watch the charts at: https://www.worldometers.info/coronavirus/country/us/ I can hear the rumble of an oncoming train full of Covid-19 cases... In some areas it'll be this or next week, in others 3-4 weeks. But that train is a'heading right this way, and moving at quite the steady pace.
  10. 42pines

    Has anyone left nursing job due to COVID19 virus?

    Or....... the hospital's supply of masks will be exhausted in one single day, when 100+ patients show up in a week or two, every day, day after day. Each coughing... "Triage is the process of determining the priority of patients' treatments based on the severity of their condition or likelihood of recovery with and without treatment." While triage usually relates to patient care, it can also relate to the usage of supplies and materials. If one mask is worn for one day, it is supposed to be disposed. If the entire supply of N95 masks consist of 1,000 and no more are available, and 100 nurses use one a day for a week... Do the math. Take your state's exponential infection curve...extrapolate it. Cases often are doubling every 3 days. Got one or two or four cases...extrapolate it out one month (10 iterations). Then fold back in the numerical need for respiratory protection at the end of the month. This may be the reason that the hospital does not want you wearing masks today. It's not really about "we don't want to protect you," I suspect in most cases it's "we're about to be over-run by thousands of enemies and all we have are a few boxes of bullets, so don't hand them out 'till we can see the white's of the enemies eyes.." Admittedly, it seems that there is a universal horrendous lack of transparency and communication. If the above scenario fits the bill......then come out with it. Honesty will reap rewards and courage--dishonesty will reap ruination. The one thing that sickens me most about this whole scenario is the overt obfuscation, to the point of dishonesty. On January 30th I wrote to my two senators asking that protective actions be taken, no answer. I wrote later to my senators and congresswoman, no answer. I for one am disgusted. When nurses lose trust, when we come to believe we are not being told the truth--terrible will be the results.
  11. 42pines

    Thieves! Stealing Supplies During COVID-19 Crisis

    There is one single problem with the very, very pretty Infogram from zerohedge. That is: It is absurdly meaningless. "Oh, look, down there, is that tiny red dot called the Coronavirus. Why, it is so small, not to worry..." Oh, wait… history. Let me see: Yes, the inforgram is titled “History of Pandemics.” COVID-19 is NOT history, it’s NOW, do you, for one second think that the tiny red dot will stay tiny? Take any one of those thorny, scary looking “things,” on that Inforgram and consider. EVERY one started as yes, a tiny dot. Your comment, “infection does not create illness” is a bit odd, but I get your gist and agree. For most, becoming infected does not mean death. Here’s a good definition from thefreedictionary: “The invasion of bodily tissue by pathogenic microorganisms that proliferate, resulting in tissue injury that can progress to disease. You are correct, it does not say: “…that will lead to disease.” However, we’re talking about a response that I wrote to an immuno-compromised RN. I did not respond to an RN who is healthy. Go to https://coronavirus.jhu.edu/map.html and look at the “other locations.” We see an exponential graph. Today, “other cases” hit just about 100,000. “Other cases” have doubled over the past five days. Do the math. Should that continue the number 30 days (5 iterations) from now is about 3,200,000 cases. Don’t do the next 30 days, it’s too scary to think about. Think about that. Sure, it may not happen—it didn’t during the H1N1 pandemic of 2010. Millions of deaths were predicted and a mere 100,000 to 400,00 died. That virus mutated to a more benign form and maybe, just maybe this will too…or just maybe warm weather will halt it. Also, I did not say: “give notice,” today. However, I still adhere to my advice to pixierose, to isolate when “community spread” occurs. Each person must decide their own risk factors and risk tolerance. Therein lays on of the evils of this virus. A 20-year-old, healthy person might have a 1:200 risk of death while an 80-year-old person with COPD might have a 30% risk of dying. She is immuno-compromised, need I say more? You wrote: “banning congregating over 50 people? I work in an 88 bed ER. do the math.” What can I say? Bans relate to concerts, public gatherings—not to hospitals! Was this some attempt at humor that I missed? You wrote: “…why is it that no healthcare workers are dropping and being admitted to the ICU? Here is the answer: Because on the pretty Inforgram, the COVID-19 is a tiny red dot. All epidemics/pandemics start as a tiny red dot. Theoretically they start as patient zero, a single case. Then they grow, eventually the curve flattens and eventually they end. Here, read this from Business Insider and then tell me, do you still want to ask that question? “Nearly 3,400 Chinese healthcare workers have gotten the coronavirus, and 13 have died” See: https://www.businessinsider.com/healthcare-workers-getting-coronavirus-500-infected-2020-2 The correct answer to your question about “…why…” is because we’re at the beginning of an epidemic in America. China is at the “middle.” Do you think that America will escape a similar fate? Consider China’s response was fast and Draconian. America’s response was, for instance, let into America about 20,000 passengers each day for the past three weeks, from Incheon Airport in South Korea, a county where the infection was growing exponentially, without even checking for fever. I do like your: “A little critical thinking might go a long way here...” I hope that my level of concern turns out to be radical and I sincerely hope that your level is the one that American RNs will experience.
  12. 42pines

    Thieves! Stealing Supplies During COVID-19 Crisis

    What really infuriates me is that the entire public health system in America is rabid with both misinformation and an utter LACK of information. Take a look at this: (Map of coronavirus cases/deaths/recoveries/isolations in Hong Kong--up to date every day: https://chp-dashboard.geodata.gov.hk/covid-19/en.html WHY does American NOT have such a map? Such a map would be of immense value to everyone. "Hot spots" can be quickly identified allowing viewers to take appropriate action. If you see a dozen cases pop-up in your neighborhood, you're going to be far more careful than if you live in a small city of ~40,000 as I do, with no community infection and the nearest positive test is an hours drive away. Such a map would let you, as an ED nurse, and your boss, identify just when you ought to run and hide. And for anyone who takes offense to "run and hide," consider that every case of infection that requires hospitalization that could be avoided, should be avoided. Reality bites and the rules have changed--adapt or (for some) perish.
  13. 42pines

    Thieves! Stealing Supplies During COVID-19 Crisis

    Planning on selling the items. Thieves that are intelligent enough to know where the "goods" are, are smart enough to suspect that hospitals are not good places to visit these days....
  14. From the article: “'Don't believe the numbers you see': Johns Hopkins professor says up to 500,000 Americans have coronavirus” and from the article: 'Don't believe the numbers you see': Johns Hopkins professor says up to 500,000 Americans have coronavirus.” “Ohio Department of Health Director Amy Acton said at a press conference alongside Gov. Mike DeWine (R) that given that the virus is spreading in the community in Ohio, she estimates at least 1 percent of the population in the state has the virus.” “"We have 11.7 million people. So, the math is over 100,000. So that just gives you a sense of how this virus spreads and is spreading quickly." I’ve never been more disgusted with our government and our public health system. I wrote to my Senators on January 30th, and never even received an answer. I’m disgusted that there has been little action, it smacks of utter incompetence. One of the Boston hospitals wanted to develop their own test and indicated that they could, in fact do this, but FDC said “no.” The reality is that it does not matter if the eventually CFR turns out to be 3% or Italy’s 7% or 1% or ½% I really don’t think this will turn out to be “just the flu.” To all you nurses out there on the front line, (however, there is no front line here, this will touch pretty much all nurses and Practitioners) take care!
  15. It's a difficult scenario. It sounds as if, indeed, this nurse has Covid-19. She's "currently sick and in quarantine," presumably at home. This indicates that assuming she is Covid-19 + that she currently has a mild case. Clearly there are lots of mild cases that never need hospitalization. So just what good is seeing a "positive" for Covid-19 on a piece of paper, going to do, versus a "presumptive +?" The reality is, it won't do any good other than convincing this nurse that she truly is infectious and therefore she should honor the quarantine. As MunroRN states: "For hospitalized patients it's extremely important to identify whether or not coronavirus is the culprit since it does actually guide decision making." The nurses' case is obviously mild, the patients that MunroRN refers to are far from mild. She "need(s) to know if I am positive before going back to caring for patients." Fair enough, and she won't be allowed back until she has a negative test. Two weeks hence the amount of tests may be exponentially more available that on the day she wrote her statement. When she wrote her statement clearly there was a severe shortage. The shortage might not last. The nurse says: "I am appalled at the level of bureaucracy that’s preventing nurses from getting tested." Perhaps she should be appalled/concerned to the question of just why there are not plenty of tests available. Clearly CDC has had problems with tests. Clearly CDC has had problems with fixing an early issue, then producing tests, then facilitating testing centers. Whether we should be appalled is a question that is not readily answered. One does not "snap their fingers," and a valid, reliable, test with high specificity and sensitivity instantly appears. Still, there are enough questions that we are left wondering about how efficiently this crisis has been dealt with. The question of why there are not adequate tests/test facilities can't be answered (or won't be) today, but they will sometime in the future. Nurse SMS mentions, "... testing doesn't sway treatment all that much, but what it DOES impact is tracking the spread..." "Tracking" is extremely important. Known exposure tracking and isolation stops the virus dead in its track (assuming infected individuals do honor isolation). Once tracking breaks down and "community spread," occurs, the ability to stop the spread of the virus ceases. One cannot stop the spread of a virus that cannot be seen. SubieRN states: "It matters to that nurse if she is trying to submit a worker's compensation claim for her medical costs or complications. If she doesn't have a positive test on record, then her employer can claim no harm, no foul." Interesting subject SubieRN. Workers' Comp is state-related. Based on my experience in Massachusetts, you may be correct. In New Hampshire, you probably are incorrect. In Vermont you are undoubtedly incorrect, that's my take based on my WC case management in three states. If complications occur, that would likely put her back into hospital where she (might) would be tested. Perhaps some lawyers do not fear the virus. Walti states, "As always, work acquired illness is going to be denied as it cannot be proven that it was not community acquired." True, however I'll bet that as time goes by tests will become far more available and for a health-care-worker who cared for any proven + patient, WC will kick in. For mild cases such as the one discussed, WC really does not matter much, most states do not pay wages for a week or two anyway. Also, undoubtedly antibody tests will likely become available even if the virus does not create a lot of antibodies. Workers' Comp can be nightmarish, or not. Brownbook asks "Is it time to panic yet?" Panic serves a function. "They (panic/anxiety) are a goad to action." (Neuman, The Evolution of an Anxious Feeling, Psychology Today, 2014). Perhaps the extent of either should be taken into account. Just an hour ago I said "no," to a job that I had applied for, and had just been given an offer. (It was a 6-week temp, non-medical, but very well-paying job) If I was age 48, I would have said, "yes," but I'm not, I'm (almost) 70. According to Roser & Ritchie Ritchie in the excellent article "Coronavirus Disease (COVID 19) (Updated March 9, 2020) there is a graph showing "Coronavirus: early-stage case fatality rates by age-group in China which shows increasing age is correlated with higher case fatality rates. If I were aged 48 then 2 cases out of 100 might die. But I'm 70 and (at least based upon China's data) an expected 8 out of 100 might die and if 80 or older then almost 15 out of 100 might die. The 15/100 chance does not bother me as much as knowing that if 15/100 die that means that probably 35/100 end up in hospital and I hate hospitals. Therefore, I'd say that panic would be unwise but risk analysis for oneself or one's loved ones (or when consulting with an anxious client) might be wise. In my case I was not anxious in the short-term because I live in a rural area in New Hampshire. NH has four cases and there does not appear to be experiencing "community spread." However if I had accepted this job that I just said "no" to, training would be close to Massachusetts. Cases just rose 68% in the state of Massachusetts last night. I reviewed them and, not that it matters much, my opinion is that in MA "community spread" is likely existent. My prediction (which I hope is wrong) will see Massachusetts in an increasing "community spread," over some months, possibly exponential increase. I analyzed and thought, under my circumstances, the risk was greater than the reward. I'll find another job when things calm down. Therefore the usefulness of panic/anxiety really depends upon the person(s) and their situation. The real problem with panic is that it's often herd-type panic without a useful direction. You can see this in a Youtube video where a fellow at Costco has over 130 rolls of toilet paper stacked on his cart for a disease that doesn't create diarrhea. Should things get really rough, perhaps he intends to eat the TP. I think he would have been better off buying some rice and beans.
  16. Got a link Nurse SMS? I'd like to see that.

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