Frozen08

Having worked with medical teams on interdisciplinary rounds I would say that we've lost the "whole patient" battle. MDs do treat nutrition, spiritual health, social issues, etc.. They often are not the ones doing the care, but they were on top of recognizing when RD's Chaplains and social work needed to see patients for various issues and asking/ordering those providers consults. At the end of the day it's an individual thing. not a profession thing. We can all choose to treat the whole patient or just focus in on specific issues to get through the day.

It is unprofessional and unethical to refuse to provide treatment because of your religious beliefs. That said, you are protected legally to refuse to perform any treatment which violates your religious convictions. This issue has been all over the news in the past few years, mostly concentrated on pharmacists refusing to fill birth control. I think the law was reinstated/originally during the Busch W administration. It also probably varies state by state. For a full rundown: http://www.thehastingscenter.org/Publications/BriefingBook/Detail.aspx?id=2266

Sorry to hear about your first needle stick. I too had a needle stick but mine was on someone seropositive for Hep B and C. My advice is to seek out a primary care doc or find an infectious disease doc willing to work without a referral. Your employee health is most likely inexperienced at dealing with actual infected needle stick accidents; they don't usually happen that often at individual facilities (unless you happen to work at a huge quaternary care facility). If your exposure was Hep c or HIV positive make sure you have your primary care doc involved right away. I didn't think much of it at the time, but I was advised by employee health to just stick with monitoring. Looking back (i did not become infected) it was stupid to not seek PCP consultation. As of now there is no effective prophylaxis treatment for HCV (talk with your doc though, it might be worth trying ribavirin and interferon as a hail Mary if your stick is HCV positive). I assume that you have HBV vaccination, if not there is passive immunity available.

Tangential Idea. We have two call lights in each room. One is a "patient" light: I need help/I'm dying. Two is a "customer" Light: I need coffee, attention, pillows. We get some minimum wage workers to help with the number 2 lights... freeing nursing staff up for the "patient" lights. We get a possible third light: I need more of that candy you call Vicodin. I'm pretty positive this will revolutionize health care as we know it.

Just a point of clarification, NP's don't really want to go into primary care anymore than physicians do. At best only about 20% NP's go into primary care full time. ( I will find the literature later, I'm headed out for the night right now.) And yep the title of Dr. in a hospital is dependent on hospital rules. This guy is a douche, but it is interesting to read the underflow of these battles. Nursing organizations are quietly pushing legislation for complete independence from medicine, while physician organizations are quietly pushing legislation to limit nursing independence. I guess at least this douche is open and honest about what he thinks and does.

More Hyperbole. Booster is simply same vaccine, just called a new name, occasionally with a different dose. Vaccinate until the cows come home? Again your speaking with hyperbole. You told an individual on an online forum that receiving another series of Hep B was not "Medically Supported", I called you out on that as inappropriate unless you happen to be her PCP. I pointed out that receiving a second series would have negligible health risks, which is true. If you had also read my other posts, I pointed the OP to review newer literature because there is evidence that many non reporters are still in fact immune. Again not much of a controversy, just differing recommendations based on a scarcity of data. Also you should try to avoid personal attacks in your argumentation, it is unnecessary. ("retake vaccines 101" ) And yes, had you taken the time read the thread you would have seen that I too am a non-responder, who was vaccinated multiple times (3).

Controversial? That's stretching the issue, and hyperbole. Risk from hep b vaccine is pretty negligible. You should probably look up the differences between a "booster" and vaccine. Not medically supported by whom, YOU ? Repeat Hep B is recommended by the CDC for non responders before declaring them non responders if subsequent titers are still low.

This is a common issue. I too am a non responder. There has been some new research that shows that we have antibodies to Hep B, they are just not high enough for the screening test. Even though we are non responders, we still have immunity to Hep B. Check out PubMed. That said. No immunizatoin is always 100% across the population and always take all precautions.

This is the problem. Few OB/Midwives are trained and feel competent delivering higher risk lady partsl delivery. I would argue about point 1 though...If no other options are available C-section is the best/safe option. Ultimately you will have to change the US legal system to increase providers willing to do high risk lady partsl delivery. The payout limits and the statute of limitations are both huge, making any deviation from SOP in the local area a huge liability. Not my hospital, but one near us in the state just had a 16 mil payout for a cerebral palsy case.

No one is forced to have have procedures done or withheld. Providers simply can refuse to take part or treat conditions which they feel uncomfortable or untrained to perform. You don't want a repeat c section? Go to a different provider who will accommodate you or deliver in the backseat of your car. Also at time of delivery the fetus/baby now has ethical consideration and limited legal protections in these things since they can now technically survive outside the womb. These issues can conflict with the mother/fathers autonomy wishes.

You nailed the whole issue right on point. KUDOS to you!! Not inferior or separate, but rather an integral part of the team.

As a former Lab Tech... It varies on the hospital. Ours uses IV's for labs sometimes. T Infectious contamination is less of an issue than ruining the access with a clot, but the biggest issue is contamination of the sample (mixing normal saline and other pharms in with blood sample is common, as was hemolysis). This can all be avoided by doing said collection following the right protocol. We too switched phlebotomy to nursing to save money, only to switch back to having phlebotomists a few years later due to poor sample quality and increased value errors. I'm glad we don't do blood draws, it can be a colossal time suck.

The dirty little secret that no one wants to talk about....Nursing and Medicine are not "philosophically different". Everyone works together in a team to carry out different and sometimes the same roles in order to get the job done. Nursing is "Holistic" while medicine/PT/Social work/etc.. are not, is BS and deep down everyone knows it. If everyone spends so much time clammering for ways to look independent because we have a inferiority complex about being a physicians "handmaidens" (this is not the 1960's for crying out loud), we are going to miss the real revolution which is everyone working together in a team for the common good of the patient. NDx = Thumbs down

If the jug has an airtight lid and there is sufficient ventilation in the utility room...your ppm in the air should PROBABLY be within limits. The information you want is found on MSDS files that your clinic/hospital should have available to all employees. Contact your lab director or pathologist to determine if your current storage strategy is sufficient. http://www.hvchemical.com/msds/form10.htm

Lots of hospitals are employing integrative physicians. It's very lucrative ($$), with very little risk associated (speaking generally). Unfortunately, outcomes are generally not great when you look at large controlled studies for many of these modalities making the ethics a little questionable (are you robing your patients, or reducing symptomatology?) BIG places are those cancer treatment places you see advertised on late night T.V., and Arizona (CAM therapy is big in Arizona). Washington state is also full of CAM practioners (N.D.'s have prescription rights in that state). Enjoy