NurseFirst

FWIW -- it seems like many of the community college LVN programs (in California) are 3 semesters long. Also interesting is that LVN programs reportedly have more clinical hours than the ADN programs (!). This came up for discussion when some of my fellow classmates were inquiring about getting an LVN before we graduated. We were told that by the time we had sufficient clinical hours, plus the time it took to get the LVN license (with the LVN board being reportedly slow in licensing), we'd be RNs any way. Now, granted, all that was by report. However, I did check into the number of clinical hours -- which is quite substantial -- for LVN programs (why, I guess, that they are 3 semesters long instead of just 1 year -- although, come to think of it, you could probably fit 3 semesters into 1 year -- just that most schools don't.) Incidentally, all RN programs are listed on the BRN site on ca.gov Oh, and since I posted, I discovered that Samuel Merritt is going to have a 1 yr accelerated BSN program in the South Bay, starting soon. The cost seems to be around $45K. Certainly, one way of getting more nursing instructors (one theory as to why there are not sufficient places in RN schools to meet the demand) is to pay them more -- so, I'm guessing, with that kind of tuition, they are paying the instructors better than they could otherwise get... Cheers, NurseFirst

If you want to look at JUST the community colleges in California that have RN programs, the following website will be of some help: http://www.cccco.edu/ It will list what degree programs are at which community colleges in California. It also can be interesting to explore what other kinds of health care training is offered -- such as the interventional cardiology program at Grossmount (near San Diego). I guess when someone asks if there are any schools without a waiting list, I think of that meaning, are there any RN programs that are not impacted. With the presence of lotteries, there may not be wait lists, but those schools that have them, have them because they are impacted. The idea of going the LVN route, then a bridge program, has its advantages, as has been noted by other posters. After completing pre-reqs to RN program, it may also put you ahead of other applicants to the LVN program, which has differing requirements for admission. (i.e., at Mission College, admission only requires the 1 semester of A&P -- but if you have a year of A & P, that gives you an advantage in the admission selection process.) When I discussed this with folks at my Nursing School they did feel that the LVNs were at a bit of a handicap when it came to writing nursing plans. Sequoia Hospital has an accelerated BSN program in conjunction with University of San Francisco (I think that's the one; I know it's not UCSF.). San Jose State was also given some money and were also setting up an accelerated BSN program, or possibly accelerated MSN program. Samuel Merritt is another private school in the Bay Area with an RN program which used to have an accelerated 18 month program. But -- as for cost -- you have to consider. What are you NOT making by NOT being an RN sooner? Taking out loans for $18,000 to get done in 18 months I think would be well worth it in the long run. I'm sorry to hear about the gal who has been trying to get in for 5 years. I know that DeAnza has (at least in the past) had a "weighted" lottery -- with additional "chances" entered into the lottery for each quarter that the person has applied and has not gotten in. When you think of the possibility of having to wait out years, entering an LVN program first and then bridging seems like a far more attractive option. NurseFirst

Hi, I wasn't interested in donating. I'm a moderator on a private internet marketing board where this person had posted, and I was trying to do a bit of vetting--the rules about which the board owner as subsequently clarified, so the vetting is not really necessary now. I'm still interested in knowing if it makes medical sense that someone's heart would be entirely removed from the thorax, and lay on a table, in order to be operated on. To me, it doesn't. But what do I know? Like I say, it sounds like it would be a bit hard on the great vessels :) Thanks for all your help! NurseFirst

Make sure you know what the time commitment is from YOUR local Red Cross. Here, in the San Francisco Bay Area, they've lowered it to a 9-day commitment. I'd be surprised if that weren't true in other places. As for the person who thinks they can distribute food and learn how on the way down...I'm wondering...would that training include what to do if you are 1) shot at; 2) mobbed; 3) run out. Some of these things might need to include more training than just sitting in a classroom, may include some exercises requiring some space... I will say that it's ironic that September is "Disaster Preparedness Month"... :) NurseFirst

I did do some clinical time in an LTC where the patient was on a bed, I assume with the type of mattress folks have described here, but which ALSO rotated the patient gently from side to side. Anyone know much about these beds? Thanks, NurseFirst

Wow! Only $8.95? Seems extremely reasonable--great ROI, I would think. NurseFirst

A few months ago I had the opportunity to stir up a bit of controversy (quite unintentionally) about Chris Reeve and decubiti. Now, I am asking for help. A dear friend of mine's Mom has been recently diagnosed with advanced terminal cancer (mets everywhere). I don't know whether hospice covers preventative treatment for decubiti, or if so, what kind. I know when my Dad was in hospice, they paid for a hospital bed--but nothing special. I woke up every 2 hours to turn my Dad. I'm interested in knowing what kinds of preventatives there are for decubiti...I guess beds are on the top of the list. But other things, too. I'd like to give my friend some recommendations--I don't think depending upon paid or unpaid caregivers to turn a patient every 2 hours is the best approach, especially if the caregiver is providing 24 hr care. Suggestions? Comments? Thanks...and happy 4th, everyone!!! NurseFirst

Hi, I just found out from a dear friend that her mom is dying from advanced terminal CA (mets everywhere)--recently discovered. Her mom can't take morphine and reportedly is on codeine. I was a bit surprised, because I don't think of codeine as, generally, a particularly strong analgesic (I couldn't even find it on any of the equalanalgesic charts) and hadn't heard of it being used for CA pain (but what do I know? I'm only a 2nd/2 yr student). Could someone enlighten me? My friend also mentioned something about demerol--maybe it had been used in the hospital? I'm not sure. But I understand that many places shy away from demerol because it tends to make pts loopy. I told her that we've used dilaudid for some folks for whom morphine didn't work--though I'm not sure if there is any cross-sensitivity between morphine and dilaudid. Can anyone help me out ? Thanks very much in advance, NurseFirst

The best thing you can do for yourself is to know about your care, and to ask questions. PLEASE ask questions--especially if someone is giving you a pill you've never had before and you are suddenly getting it. Patients need, more than ever, to be responsible for their own care; not that the nurses aren't responsible--but, just for your own protection. Know about your disease (I'm sorry about your neurofibramatosis; I hope it never gets very severe. I've seen some programs on Discovery Health having to do with people who have neurofibramatosis--severely.)--know what is expected and what isn't. Know what medications you are taking, what they look like, and why. Just my "two bits", NurseFirst

I had to think about that for a second....yep, medical school. That's about all her fiance will have a chance to see her :). Seriously, go check out my friends at http://www.valuemd.com -- a site which, if your fiance doesn't know about it, he should become acquainted! The site is set up for foreign medical school students, or those trying to get into foreign medical schools--particularly from the U.S., but there are some foreign-born med students/docs there as well. The site has Very useful, good information--about everything: island life, dealing with administrations, etc., etc.; the students share lots of information about life on the island--but, do a search on the threads as many of the questions have been asked over and over again, and some of the regulars get a bit perturbed. AUC, I believe, also has a "spouses" club. From the things I've read on that site, I'm not sure you would want to do nursing on St. Maarten...something about the level of practice, especially when it comes to standard precautions and the like (and there is a lot of AIDs in the Carribean). For instance, from what I understand, most of the wives return to the states to have their babies. Remember, the Carribean Islands ARE third world countries. NurseFirst

Well...it may not apply to you...but the San Jose Mercury just ran an article in the Real Estate Section. Nearly all of the housing in the Bay Area has increased in price between 21-40% within the last year. And I already thought my house had increased in price quite a bit LAST YEAR. NurseFirst

Er, uh...even medical residents are limited to working 80 hours weeks in many places. 112 hours in a week? Yikes!!!! I guess you don't need much sleep? NurseFirst

Still learning... But, one thing I've learned so far is that healthcare is a team effort, not only do I not have all the answers, no one else does either. That's why we have to help each other out. NurseFirst

Check with the HR departments of the hospitals in your area that you might be interested in working at. They will give you the most definitive information, since they are the ones doing the hiring. Some places around here want such things as diverse as being an EMT-P; or having EKG and phlebotomy skills. NurseFirst

foods: don't eat anything white: no white bread, no white flour, no white rice, no white sugar; make sure that you get your daily quota of fiber, both soluble and insoluble. for insoluble fiber, i've just started researching xanthan gum--looks promising. i've been looking at increasing the fiber in my diet because i recently had an attack of diverticulitis. diets: check out dr. dean ornish's books as well as dr. john mcdougall's. mcdougall actually has a line of "just add water" meals that come in handy take-with-you cups. don't forget to exercise! i'm sure you've heard much of the right things to do through your cardiac rehab... nursefirst

What kind of ideas are you looking for? There's plenty of information about it on the 'net. NurseFirst

I've said my piece. You can read it and provide cogent counter-arguments, or we can just end the discussion here. So far, the biggest justification I've heard on this thread sounds a lot like "it's too much trouble"--even to take the simple action I describe. I can understand where you are coming from; when I worked on the streets in the late '70s I'm sure that most of the folks I worked for would have had the same reaction you are having to the suggestion that they wear gloves. Oh my goodness! That's too much trouble. That will cost too much? Will we have to provide our own? What I say here matters littlle. You can take what I say under consideration or not--it's really not going to change things. Unfortunately, when people fail to take individual responsibility, or businesses to live up to their corporate responsibility--we become enslaved to someone on high making those decisions for us which then tend to become "black and white" instead of the nuanced decision-making that would be most beneficial to all. You are right; perhaps handicap parking doesn't show a sufficiently direct correlation. How about this one: how about comparing it those people who feel that immunization is an individual decision and doesn't effect anyone else--unaware of the power of herd immunity. Personally, I think our responsibility to the public health goes beyond simply obeying what infection control folks require at the hospital. NurseFirst

i have not said that changing scrubs before leaving or starting work is necessary. however, having a cover that you wear (a simple long coat, perhaps) over them while in public might be warranted. nursefirst

Okay, for the third time--I am NOT advocating people being required to change uniforms at the hospital. I am suggesting that cross-contamination can be reduced by people wearing something over their uniforms to and from work. (And I think Marilyn is a bit hysterical in her response, in case anyone was thinking I was advocating Marilyn's position). I normally wouldn't go into this much detail, but I understand that you are someone who can deal with ideas at this level of sophistication--so here are some things to consider: You say that you accept "actual research". But, of the the volumes of research that are out there--much of it contradictory--how do you decide which "actual research" you believe? How do you decide what is "good" research? (Linus Pauling--who won the Nobel Prize twice, once for chemistry and once for peace--in a rush to publish first on the structure of DNA published an article -- in a peer-reviewed journal, no less--containing an error in a very basic chemical concept--(how many bonds Carbon has). You (and everyone else) has a way in which they decide what is "real". How much "acual research" do you need for you to believe that it is "real"? Incidentally, the study of "how we know what we know" is a philosophical study known as epistemology. Actually, most people believe things because they were either raised that way or they are "sold" the beliefs, the ideas. The sales people tell us we get sold things for emotional reasons (envy, fear, greed, etc.), but need "proof" to justify our emotional reasoning. Enjoy, NurseFirst

i think you live in an idealized world, where accepted scientific studies really are proof. no, they aren't; they are slightly better than educated guesses--because they deal with a piece of space and time and then the data is generalized. do you really think that these studies would have shown the same thing if they had been done on a ebola ward? the problem is--as those who study epistemology would say--we keep looking for better predictive tools, and, so far, science has been shown to be the best predictive tool we have. but it is not without flaws, some of which i have mentioned; not the least of which is the politico-economic cost of "doing the right thing." try reading "and the band played on...". just one more food for thought: why is it worse to take those hospital germs on a tour of the grocery stores? one of the reasons i can think of is that hospitals use stronger cleaning solutions because its known that such things are required in hospital environments--because people bring in known virulent bugs; or, maybe, even bugs we don't know yet that are virulent. grocery stores do not prepare themselves for the same onslaught of virulent bugs--why? again, economic reasons. oops...and one more... when i was first studying microbiology there wasn't such a bug as e. coli h0157. now it has been shown to kill people if the fastfood places don't cook their meat well enough. seems some human being managed to get some e. coli next to some other virulent bug which then had bacterial sex and gave what had been here-to-fore a relatively innocuous bug a strain of virulence that now makes bacteriologists shudder. what they think could happen with the avian flu is pretty darn scary, too. as for "effective"--look, we know bugs ride around; we know there are more virulent bugs in hospitals. why would it be so hard for people to wear something over their uniform to and from work? nursefirst -- more things to think about... a short reading list: the structure of scientific revolutions by thomas kuhn how real is real by paul watzlawick the making of a counter-culture by theodore rozcak

Principle #1: Public schools are harder to get into than Private Schools (unless the private school is well-known and/or has a lot of scholarships). Principle #2: New programs are easier to get into than established programs. Not as well known, not a known quantity, fewer applicants. Principle #3: You need to find out how the school is accepting applicants--how they are CURRENTLY evaluating students--evaluation methods can change, as programs become impacted, maybe there's a new dean--all kinds of things. Find the one that most appeals to you, or that you have the better chance of getting in to. Principle #3B: maybe one of the things that is evaluated is whether you are currently a student. There's nothing like getting known by the admissions committee because you are in closer proximity! More than one pre-med has gotten into medical school via the "backdoor" -- such as becoming a research assistant at the medical school and becoming known. NurseFirst

I'm not relying on my gut. I am relying on principles. One of those principles is that "absence of evidence is NOT evidence of absence." I think you may have missed that part of my post...I never said I relied on my gut. OTOH, that's an interesting point: I *could* surmise that you didn't read that part of my post--however, absence of evidence isn't evidence of absence (evidence of the fact the you did not read that part of my post.) I certainly think it's evidence of you jumping to conclusions about what I said, when I really never said that. We can get into entire discussions about aerosol vs. non-aerosol, and how far a bacteria can go, or live (and who says it has to be a bacterium--how about viruses and parasites.) Why not the rest of the hospital staff? I would say that nurses have more intimate and more prolonged contact with patients than most other hospital personnel, with, perhaps, the exception of the nurses aides. So, we have greater exposure both in terms of quantity and variety. Perhaps, in terms of someone in NICU, you aren't exposed to bugs that are as dangerous to the general adult population--RSV comes to mind; metabolic problems like hyperbilirubinemia; congenital defects. I'm not sure that that can be said for all nurses in the hospital. As for logistics. Hey, think outside the box! The whole issue could generally be solved not by nurses changing in and out at the hospital, but how it's addressed in multiple situations--why not wear something OVER your uniform on your way to and from the hospital...??? As for absolutes -- yep, there is no "absolute". When someone grabs "clean" gloves out of the box in the patient's room, they are still most likely cleaner than the nurse's hands, I don't care how much they've been washed. But, as far as the point you address--yep, that's right--gloves came into use because of the fear of healthcare workers getting something from the patients--no doubt about that! Nevertheless, if the ID people weren't concerned about transmission patient to patient, why wash our hands before and after each patient? As far believing people in authority (the ID specialists), I guess I grew up with those bumper stickers that said "question authority." I also find it is a helpful attitude to have when I advocate for my patients--after all, who is at the top of medical authority chain? The physician... Oh, and finally, about all those other people who are doing terrible things, like the butcher cutting the meat then the cheese? That is out of my domain of concern; I am entering the nursing profession, not meat-cutting or deli-work. Maybe if I were an epidemiologist...(But Robin Cook did write a pretty scary novel that involved the lack of controls over the meat industry...) NurseFirst

I guess the question I have is, how do you know that they were treating him that way because of his past? Make sure you know WHY they think it is "just easier"...Was it more because he "is not the nicest person in the world." ? Not defending the practice; just trying to point out that there may be more than one way to look at the situation. Personally, I think one of the best ways of dealing with unpleasant patients is to treat them with dignity; if you see them as a person, they will see you as a person and things will work better. It also helps if you treat your co-workers the same way. Yes, there are ideals in how we should behave, but most of us fall short. A lot of times if you don't go along, others may re-consider their actions. NurseFirst

First of all, I don't fully agree with the idea of evidence-based practice. Scandalous, you say? Perhaps. But there isn't time nor money enough in the world to test everything--throw in a bit of "who paid for that research" (think of the cigarette companies) along with Mark Twain's very valid statement that there are "lies, d*** lies, and statistics," and you have some significant ammunition with which to question scientific studies. Further, I think "positive" proof is much more reliable than "negatie proof" (we know disease is transmitted thusly vs. we know that disease is NOT transmitted this way.) Scientific method is a useful tool, but there are limitations. Oh, and then, of course, you have to have a study that is significantly seminal to make a difference; otherwise, scientific studies can get bogged down in arguments about the experiment methodology, etc. Sometimes we have to act on the PRINCIPLES that have been proven and then make logical conclusions from those. Let's see: Cas we agree that, if someone is in a classroom with people who have a cold, their chances of getting a cold are greater? Hospitals are "supermarkets" of germs; you will find worse bugs in the hospital setting than in the general environment. ISTM that I heard the reason why nurses stopped wearing caps was because they were detected as being modes of transmission of bugs; and people have eyed physicians' ties as well. In fact, hospitals can be quite dangerous places for patients just because of the types of germs that live there--they are the worst of the worst. You've only addressed one part of the equation: bringing bugs into patients. I don't think that's the worrisome part. The worrisome part to me is spreading germs that are more endemic to the hospital environment to others, outside. But, if we take your original scenario, that of preventing spread of disease TO patients, I do know that Kaiser in my area had any patient coming in to the clinics who had a cough to wear a mask; and that I was told by my physician to not be around patients while I had a URI. NurseFirst PS Back in my undergrad days I did work with Electron Microscopy. To do some of the work, the staining and so forth, we needed to have triple-distilled water. We had the water, but at one point the water was "bad"--I don't recall the details--but I do know that it took them an awful long time to figure out what was wrong with "our" triple-distilled water--and these were Ph.D. scientists trying to figure it out. I guess that's another mythology about science--that we really have identified all the variables... PPS FYI: I have a B.S. in Microbiology, specialty "med tech" (now CLS) option.

Okay, I'm going to be the curmudgeon here... Just like everyone immediately changed how they did things when Semmelweiss figured out how to lower the infection rate in childbed fever, eh? Our student uniforms have a large vest that we wear over whites. Can't put it on until we get into the clinical setting, must remove right before we leave--can't wear it anywhere else. Uniform is to be washed evey time we wear it (vest and whites). By the logic some people are using in this thread, we shouldn't wash our hands between patients, before or after eating, etc. It's a bit worrisome; I wonder how much micro some folks remember... NurseFirst