myoglobin ASN, BSN

Good point, it is part of “parole” so they don’t have to pay for it. I wonder if Medicaid will pay? I’ve cared for a few transsexuals who told me part of their therapy was a aid by Medicaid.

I would say in general that prescribing outside your scope is a bad idea even in an IP state. I could see a case for prescribing an antibiotic for a suspected UTI, but only as a bridge to the PCP. Keep in mind that PCP will have a better handle on bacteria resistance trends in your area (as well as possible previous antibiotics that the patient has been treated with. Now the metformin for antipsychotic induced weight gain might be a different matter, although uncommon it could be considered enlightened practice in some circumstances (for example as part of a holistic diet and exercise program to manage weight and DM2 risk). One of the problems with simply giving metformin is that it can contribute to "the cycle of insulin resistance" that is to say the cell receptors become more sensitive to insulin, but if people keep eating a diet with a high glycemic load (or taking a second generation anti-psychotic like olanzapine or quetiapine without modifying their diet and exercise routine) they will find that their insulin resistance has worsened in a few years (or sooner) and will need to be started on insulin therapy (definitely from their PCP). I have seen some psych providers prescribe OTC Tylenol off label for pain especially when someone was experiencing and adjustment disorder given new evidence that it may blunt emotional pain in the amygdala https://www.npr.org/sections/health-shots/2017/12/04/567762087/tylenol-may-help-ease-the-pain-of-hurt-feelings. There is also evidence that turmeric may not only help with joint pain, but also be useful in augmenting the effectiveness off SSRI's possibly via the reduction of inflammation within the brain (Saffron has also been shown to have efficacy in this role, although greater potential for toxicity exists at higher dosages) https://universityhealthnews.com/daily/depression/2-natural-antidepressants-found-to-be-as-effective-as-prozac/ .

I get at least two calls per day from someone trying to "sell me" a travel nurse position, and all I did was express an interest to one or two companies maybe six years ago. I think if you are willing to relocate to where the demand is that there is still abundant demand. Also, during "strong" economies such as we are currently experiencing nursing demand tends to increase, because people flock to jobs that promise better pay and benefits. It is during the economic downturns that people tend to flock to nursing for security.

Here’s the thing I believe the original poster had some sincere concerns based upon his observations of NCLEX pass rates/questions in his cohort. There may be some statistical explanations for his observations that render them true for his cohort, but false from a larger perspective. The issue of equal pay is equally (or even more) complex and varies by not just industry, but nationality and specific location. In the final analysis Some of us may be liberal, conservative, progressives, libertarians, and socialists, but we are all nurses trying to make sense out of difficult, and often perplexing situations. We shouldn’t extrapolate personal characteristics about how we treat our patients based upon heated discussion about controversial subjects on a discussion board.

I agree they should stay locked up. However there is also evidence that chemical castration reduces (but doesn’t eliminate) recidivism. Therefore, it should at least be an option for those who will be paroled (but shouldn’t) as well as those convicted of charges like possession of child pornography which carries less than a life sentence. It should also be an option for those of us who are non criminals and simply want to reduce our normal sex drive for one reason or another (such as being able to focus on school or staying together in a largely sexless marriage). If you can “ get a pill” to increase sex drive or to change your sexual phenotype, you shouldn’t be prevented from doing the same to decrease it.

That survey by it’s own wording considers institutions where individual variance can occur because of negotiation. Union facilities follow a set formula. Now it might be the case (even at a union facility) that men choose to work more night shift or more in the ICU, but this is self selection bias not discrimination.

That’s why I hate NNU endorsing single payer so strongly. Some of us are progressives/ socialists, who may be more inclined to back Sanders or say Biden, while others are conservative, or libertarians who supported Trump. However, we are all nurses and there are many issues like ratio laws where our consensus is probably at least 80% in support. However, Medicare for all is probably more like a 60/40 issue (split close to overall voting trends) and is quite divisive. I can think of at least five good reasons to support such a policy, and five why it would be a poor choice.

Why didn’t you file a grievance? Pay, is set ( at union facilities) by a set formula that looks at years experience, with add on for unit( ex ICU), shift (ex nights and weekends), plus degree and crendentials ( ex CCRN, plus BSN). However, the protection, of a union means little if the employees do not exercise their rights under the contract.

Also according to some studies women are far less likely to reoffend (less than 1%) and over 50% of the time their crimes were committed with the assistance of a make co- felon.

This is one of the rare issues where I disagree with NNU. There are of course certain advantages to socialized healthcare, but there are also important disadvantages and it is a contentious political issue that divides nurses.

As I told my son the great thing about nursing is that it is a miserable job in many ways. Because of that there will always be demand "at the bedside" for a stressful, intellectually demanding, back breaking job especially at my hospital. I would say that staff turnover year to year at bedside makes jobs nearly always available. Also, I would say that it helps to be flexible with where you live. If you are will to be "a travel nurse" then you can have additional assurance of having a position, along with the extra pay that goes with the position.

I think there is good evidence that there is also a sexual drive aspect to molestation. Just consider the enormous amount of pedophilia related pornography that is seized each year and the many charges brought based upon this. Also, consider the shows like "To catch a Predator" which detailed hundreds of men who sought to arrange sexual contact with (what they believed) were underage children. In these cases the motivation is clearly sexual. Therefore, it is not unreasonable to believe reducing sexual desire may reduce recidivism and there are studies to support this view http://jaapl.org/content/33/1/16#sec-18 (although these studies acknowledge that the data set is small, it is not a complete elimination of recidivism, and should be part of larger psychological interventions). Also, while I believe that sentences should be longer for these crimes, we are talking about people taking parole (if I understand the law correctly). A convict can simply choose to serve out their sentence and not take the parole and avoid the chemical castration (although, I don't think parole is usually a good idea in this population as a general rule).

I meant only that one thing can be a proxy or “placeholder” for something else and that something else may be the deterministic variable that accounts for the difference. I might have said instead “those who drive big pick up trucks are more likely to die by firearm suicide.” If this statement is true ( and I do not know that it is) it is likely because those who drive big trucks are more likely to be male and to own firearms both of which are associated with a higher likelihood of firearm suicide. The truck is a proxy for a higher order correlation that may not be obvious without the benefit of data analysis. Credit scoring systems make use of this principle to assign differential risk assessments all the time.

Nursing assistants and unit secretaries do so much to improve patient safety, satisfaction, and reduce stress for RN's and MD's that it is impossible to give them adequate credit. Since our ICU did away with both patients get turned less, call's (both telephone and call lights) take longer to answer, falls are more likely, to name but a few of the issues that I have noted. I believe that nursing assistants should advocate for laws that require specific education and regulations that mandate their usage in acute care facilities. Over time this would help to contribute to higher wages. Hospitals will never pay more "out of the goodness of their heart" or even out of concerns like "patient safety" most of the time. Don't kid yourself if laws didn't require it hospitals would pay nursing assistants $10,00 per hour and have then write the orders (like MD's and NP's), and pass the medicines (like RN's) the only reason that they don't are the legal restrictions that have been put in place over many decades.

Unions are not the whole answer, but they are certainly part of it. Even in Florida at an HCA hospital the unions at least propelled the hospital to play by "some of the rules some of the time". Before unions people would be floated according to the whims of the manager, some people would get vacation requests and others would not according to the whims of the manager. Some would get written up and some would not "according to the whims of the manager". At least with unions there is some basic "due process" and managers and administrators actually sometimes think about inane policies before implementing them anyway. To me the best answer is multifactoral: a. Strong unions b. California nurse to patient ratio laws. c. A move back towards non profit hospitals away from for profit ones. d. Strong nursing advocacy and NP groups that lobby for legislation that protects both patients, and nurses. If nurses can unite at least moderately we are potentially stronger than most other legislative forces in the United States and can enact real change. That is why when groups like the ANA doesn't even support California ratio laws, that I am so frustrated.