MunoRN RN

MunoRN has 10 years experience as a RN and specializes in Critical Care.

MunoRN's Latest Activity

1. 

   COVID-19 Vaccine Incentives

   MunoRN replied to NRSKarenRN's topic in COVID

   I would agree, it could be frustrating if for some reason you were under the impression that all mitigation measures would end after only about 1% of US population was vaccinated, which is where we were in February. And I could see how someone in the general public might have had that misunderstanding, but not someone who claims to be a facility's infection control nurse, that's disturbing. Vaccines aren't 100% effective (not that they need to be) particularly in those of advanced age or with chronic health conditions that make it less likely the immune response will be strong enough to impart strong T-cell immunity. In addition to being vaccinated themselves, residents of long term care facilities rely on the staff and visitors of the facility being vaccinated, since that greatly reduces the chance they will spread Covid to them. The basic premise behind vaccines in these scenarios is that once we reach a certain threshold, typically understood to be at least 70% of the population, then that prevents the ability of the virus to spread through a chain of contacts, effectively snuffing out the epidemic with the exception of isolated, rare cases, that's how we get back to 'normal', allowing for a steady-state spread due to poor vaccination levels is what keeps things how they are. (MODERATOR EDIT)
2. 

   COVID-19 Vaccine Incentives

   MunoRN replied to NRSKarenRN's topic in COVID

   If you've looked at the data and evidence and concluded that the vaccine poses a greater risk to you than Covid then that's not an 'opinion'. Whether the little dots in the night sky are stars and other celestial bodies is a fact, whether they are pretty is an opinion. Again if you're deciding to wait because you think prolonging Covid-19 is good for society or that we'd be better off with a few million less people on earth then I can't argue with your understanding of the facts, I would just disagree with your opinion.
3. 

   COVID-19 Vaccine Incentives

   MunoRN replied to NRSKarenRN's topic in COVID

   There's an important difference between considering the facts and applying your own personal values, priorities, etc and misrepresenting the facts about Covid and the vaccines. Whether a Covid infection poses a higher risk of death or severe illness than the vaccines do is not an opinion. To use the risk of thromboembolic events as an example, it's not an opinion whether 12% is a larger number than .0000002%. I may have a different view than someone who acknowledges that getting beyond Covid without widespread vaccines will take many years and millions of lives but that they like living in a Covid world and they want people to die, but I can't argue with their grasp of the facts.
4. 

   Yes, Employer Can Require Covid Vaccine

   MunoRN replied to TheMoonisMyLantern's topic in COVID

   One of my most recent patients to pass away under my care was only a year older than me, and had a daughter the same age as mine and coincidentally the same age as one of my (nine years old). I held-up the patient's intubation so that he could say goodbye to his wife and children, and the idea that his death wasn't worth avoiding through public vaccination is (MODERATOR EDIT) The purpose of Covid vaccination in younger population is not because it prevents younger people from dying, it's because that's the only know way that we get beyond Covid and the widespread death that it causes. If you want to argue that you think it's better for society for a large portion of it to die off due to an otherwise preventable illness then that's fine, at least I can't argue with your rationale, but if you're going to argue that society is better off by people not getting vaccinated against a pandemic for reasons that have no scientific basis then you are just a horrible person, there's no getting around that. And even by your own sources your 'previously infected immunity' argument is ***. We do know that those who have been previously infected with covid will continue to carry various antibodies for a period of time, but there is no evidence that the specific types of antibodies and specific immune responses necessary to prevent spread to others last beyond 3 to 6 months after infection. Your suggestion that you don't pose a threat to others because you had a Covid infection a year ago is why we don't allow evidence of a previous infection to be equal to immunization, people who believe that's true clearly don't possess enough basic knowledge about the basic premises of viral transmission to be making those decisions. (MODERATOR EDIT)
5. 

   Yes, Employer Can Require Covid Vaccine

   MunoRN replied to TheMoonisMyLantern's topic in COVID

   Of the six years this appears to include, at most one was under Trump. The basis of the argument that Biden is responsible for a surge in desire to immigrate to the US is that he's not Trump, and that Trump's 'leadership' was successful at reducing the desire to immigrate the US. ie, why would someone want to flee a country with a amoral authoritarian as the leader to go to another country with another amoral authoritarian as the leader.
6. 

   Coworker leaving but won’t put in notice

   MunoRN replied to T-Bird78's topic in Ambulatory

   You might point out to your coworker that they'll have to pay back the value of any benefits provided during FMLA if they fail to return. For instance, if they are continuing health insurance coverage during FMLA then the employee will owe all of the employer's contributions during their time on FMLA.
7. 

   Nurse Called Police/CPS on Parents over Jaundice

   MunoRN replied to Simply Complicated's topic in Nursing

   I would also agree that at now 10 years old, the newborn's jaundice has likely resolved. But it's always interesting to see how healthcare stories in particular get twisted in the general media. The common account was that a hospital pediatrician had told the parents they were free to leave, but despite that a nurse called CPS which resulted in a hold. According to a letter written by the mother, nobody told them they were 'free to leave'. A non-hospital affiliated midwife (no offense intended to midwives) told the mother that she should leave AMA. At least in my state, parents can't just freely take a newborn out of the hospital AMA, the newborn can, and typically is, legally held for a legally mandated 4 hour period pending the determination of a CPS case worker. AJUD1063M.pdf (state.nv.us)
8. 

   Giving pain meds to SCD during warmed fluid infusion

   MunoRN replied to Sammieee's topic in Medications

   If dilaudid can't be exposed to temps of >86f then it should never be given to a living human, or at least one with a reasonably normal core body temperature.
9. 

   Scope of Practice and medications?

   MunoRN replied to Catedi's topic in Safety

   Your understanding certainly isn't uncommon, I was part of a workgroup tasked with improving hospital to ECF / LTC transfers and this misunderstanding was one of the major barriers. In the workgroup was one person from AHRQ and a regulatory compliance rep from CMS, so their understanding of the process from a regulatory standpoint would seem reliable. Whether the patient's ECF / SNF stay is covered by Medicare part A, Medicare part D, or any of the private plans that generally mimic part D, it's illegal to charge the patient for medications that were not administered. The facility pays for the medications that make up their stock they are administering from and cannot charge the patient until the medication has been administered. Medications that a pharmacy has dispensed to an individual cannot be returned for refund because they cannot be legally re-sold, but medications that have been provided to a licensed facility and maintained as stock medications can be legally returned to the pharmacy. There is no exception for residents of a LTC, if they are their personally owned medications they cannot be returned. This is different for ALFs, where medications typically aren't administered but instead staff "assist with self-administration". The "diversion" that can occur related to "borrowing" is giving a patient a medication for which they do not have an order by taking it from either communal stock or stock meant for a particular patient. As I've said before, there are certainly issues pertaining to facility policy that could make this a bad idea, although these are all avoidable with better policies. For instance, if whether a medication has been given or not is determined by the number of doses in a patient-specific stock, or if the only way of knowing if the order had been pharmacy reviewed was whether the medication had been delivered. But as to the OP's question, the regulatory standards of medication administration don't hinge on how a facility chooses to organize their stock of medications. If you feel I've intentionally misunderstood something feel free to point that out to me, but the passive-aggressive snark is getting old.
10. 

    Scope of Practice and medications?

    MunoRN replied to Catedi's topic in Safety

    The OP was not proposing giving a medication that wasn't ordered. If one patient has 25mg metoprolol ordered and then it's discontinued we don't then go through the whole facility and dispose of all of the 25mg metoprolol and order new stock. It's not medicare or insurance fraud since it would be illegal to have already charged the patient for doses of a medication that were not administered, if you couldn't give the available medication because it was already billed to a previous patient then that would be medicare / insurance fraud. I think what you're talking about a patient's own medications which were provided by the patient, which are typically self-administered in these settings.
11. 

    Disheartened by Profession Realities

    MunoRN replied to 2BS Nurse's topic in Nursing

    I get it, somedays you just have to vent, but aside from not really following what your general point is you have this a bit backwards. The PCR will typically show positive for longer than the rapid test, it's testing for fragments of the viral RNA which makes it more sensitive, the downside to this increased sensitivity is that it will will detect the fragments of Covid RNA that are still present long after an active infection. One of the 'nice' things about Covid is that it offers a number of findings that easily differentiate an active infection causing acute symptoms from an incidental findings of a positive test concomitant with another health issue unrelated to Covid. In hospitalized patients we differentiate these as 'incidental Covids' from patients who's issue is the primary result of a Covid infection.
12. 

    Scope of Practice and medications?

    MunoRN replied to Catedi's topic in Safety

    There's certainly some truth to your argument if we're talking about medications that were the patient's personal property and are provided to the facility by the patient, but based on the OP's descriptions it appears more likely that facility staff are administering medications. I think some of the confusions comes from the practice of maintaining facility stocks of medications that are organized and stored specific to each patient. This is typically to help ensure medications aren't being wasted due to being misplaced or excessively ordered (some facilities may mistakenly also believe that this helps reduce medication errors). The OP's question was specific to scope of practice, regulations, and laws, in which case the criteria of administering medications is well defined; 25mg of metoprolol is 25mg of metoprolol.
13. 

    Scope of Practice and medications?

    MunoRN replied to Catedi's topic in Safety

    A "prescription" is physician's order for the medication, dose, route, etc, which is different from the medication itself. If the prescribed medication is the property of the patient then yes, you're correct, a different patient should not be given something that is the property of someone else, but this is not what the OP is describing. Medications sent to the facility by a pharmacy, even if sent there because they are needed because patient xyz has a order for them, are not the patient's personal property.
14. 

    Scope of Practice and medications?

    MunoRN replied to Catedi's topic in Safety

    I don't see where the OP stated "there are no stock meds", and actually the OP described their practice as administering meds from a stock supply. In correctional settings patients aren't typically allowed to self-administer medications from a patient-owned supply, medications are typically administered by staff. The OP also said the medications in question were about to be returned to the pharmacy, typically pharmacies don't accept returned meds that have been dispensed for someone to self-administer, but they do take back medications delivered to a facility to be kept under the control of facility as their stock supply. It's pretty common, particularly in settings that aren't administering large volumes of medications, to only keep enough common medications in stock to last until an additional supply arrives when a medication has been ordered for a particular patient (or inmate). When this additional supply arrives from pharmacy it will typically be labelled with the name of the patient (or inmate) that it was ordered for, but that doesn't make it a patient-owned medication dispensed to them, that just makes it easier for staff to find the medication. I think nurses in a number of settings mistakenly assume that when a facility only keep on hand the medications they need to administer for currently active orders that these medications are specific to that patient (that they are patient-owned medications), which isn't the case if they are being administered to patients, as opposed to being self-administered. The OP's question was what is required for a nurse to appropriately administer a medication per practice acts, regulations, etc. The components of appropriate medication administration are the correct medication and dose (ie metoprolol tartrate 25mg) the right frequency, route, and to confirm that you have the right patient that the order is written for. The history of how that 25mg of metoprolol came to be in the facility's possession does not factor into the requirements of appropriate medication administration. I'm not sure why you feel the need to respond to my views with aggressive bullying behavior, I'd welcome any examples of where I've been disrespectful or mean but I'm honestly not clear when that occurred.
15. 

    Scope of Practice and medications?

    MunoRN replied to Catedi's topic in Safety

    What the OP is describing is not a violation of any law, practice act, or scope of practice. In situations where the nurse is assisting someone in taking medications they already own, typically in ALF or ECF settings, it is true that you can't take from one patients medications to give to another patient. But what the OP is describing is administering medications from the facility's stock, not medications already owned by the patient. Facilities often manage on-hand stock based on whether there is a patient who needs that medication, but that doesn't mean if that medication is stocked that it is only for that patient. For instance, if 12.5 mg Coreg is not commonly administered in a particular facility or unit so it is not regularly stocked there, then a patient is admitted for whom that medication is ordered, the unit supply would be stocked with that medication. If that patient is then discharged and another patient is admitted for whom 12.5 mg coreg is also ordered, there is no requirement to throw away the doses stocked on the unit and replace them with the same medication, obviously that would be silly. In terms of nursing practice, not utilizing the facility stock on hand and instead delaying the medication for a new stock of the same medication (for no reason) could be argued to be a failure of the nurse to meet their professional standards.
16. 

    Chest Tube LCS

    MunoRN replied to FutureNurse0201's topic in Nursing

    The chest tubes commonly placed after CABG aren't the ones where it's important to keep them to suction continuously, particularly if the patient is upright (walking or sitting in a chair / wheelchair). And by 3 days out the drainage should be serous enough that suction isn't really doing much. The night nurse made a stink for no good reason.