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LilPeanut MSN, RN, NP




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  1. LilPeanut

    Ventilated Patients

    Any high frequency (jet, oscillator) would not have a rate documented. Everything else should.
  2. I think the rates of addiction of nurses are similar to other people, but I'm not positive on that. The problem is that if you are someone who is on the threshold of addiction or prone to addiction, you are going to be around addictive substances that can be too easily diverted
  3. If it wasn't for personal essay/interview, I would have had a much more difficult time getting into school. I didn't have a terrible GPA (3.2something undergrad) but I had definitely let senioritis affect the end of my undergrad career. My GRE was good. But I had almost no recent work history (I had been a stay at home mom for the last 6 years) and I had a lot of trouble getting academic references because undergrad I had a weird path (senior year of HS at a community college, finishing 1.5 years of college, transferred to a 4 year university, attended for a year, transferred to different 4 year university, attended for a year, studied abroad for a year at yet another university, finished 2 classes at 2nd 4 year university and got my degree. So I didn't have close relationships with any professors my first time around, the one I was closest with was on sabbatical when I was applying. So, I had to work out a deal for one of my prereq profs to write one for me. I made an appt at the beginning of the quarter, explained my situation and asked if there was any way she would feel comfortable writing a rec for me, and if so, what would her expectations be for me? And then I had two high school teachers who I had known very well and worked very hard for write a rec. Obviously not ideal, but I just didn't have many educational people who knew me well enough. And then I wrote an essay and did an interview hoping to overcome the academic weaknesses in the application. Now, I'm likely on the spectrum - not in a stereotypical way, because I've learned to cope through my life and hide some things - but overall, I am weird. I like weird things, I remember weird stuff, my brain bounces around sometimes, I talk too much, etc. Still an RN and NNP Nursing I feel discriminates less for age than other fields. It feels like it recognizes more the experience you bring to the table.
  4. psychopath....hmmm. that explains a lot about me I was in the theater when I was younger. I do better when I have an audience I have to perform for. My first LP on a baby was with very nervous parents watching, and was a clear tap!
  5. LilPeanut

    Vaccination for clinical

    I've had to show titres/records for every job. I work in peds though. Why in heaven do you want to go into medicine/nursing if you don't believe in science?
  6. LilPeanut

    Tennessee Nurse RaDonda Vaught - Legal Perspectives of Fatal Medication Error

    I view that as a separate issue. People commit suicide because of mental illness and inadequate coping skills, not to mention impulsivity. I have always felt very uncomfortable with "blaming" people/things for suicide. While that might have been the catalyst in the moment, there's no way to know whether their mental health issues will actually send them over the edge. I've just seen too many manipulative people who use suicide threats to control people who may care for them.
  7. LilPeanut

    Nurses being reported on their spare time?

    If someone slipped me a mickey - which if the story is what you are saying, that is what they did: they substituted a substance in order to intoxicate you more - that's illegal and if I was really worried about it showing up on a tox screen or affecting my job, I'd be filing a police report. It will suck for the "friend", but friends don't slip people drugs that they aren't aware of. That's assuming everything is true exactly as you state. I agree with the above poster though that it's a little concerning to be on a 2 day drinking binge. I would really look hard at your drinking. Also, don't blame "peer pressure" for anything really after you have graduated from school.
  8. LilPeanut

    My IV Skills are Terrible!!!

    I'm a little different, since I'm solely a visual IV placer (yay for babies being see through ) but I am a "floater" for IVs typically. Once I get the tip of the catheter in, I don't try and advance it until after the flush is hooked on and flushing properly in the vein, then push the catheter the rest of the way in while you flush. Helps especially if there are valves. If the patient tells you they have a good spot or a bad spot, listen to them. I have terrible ACs. I have great hand and forearm veins though. Definitely agree with anchoring the skin. With babies, I use a finger as a tourniquet if needed, because I usually have more blows with tourniquets. Depending on the patient, if you need to place in the hand, a transilluminator may still help for some big people
  9. LilPeanut

    Tennessee Nurse RaDonda Vaught - Legal Perspectives of Fatal Medication Error

    This a lot.
  10. LilPeanut

    Realistic Facts About FNP in Northeast Ohio

    Starting out? It's not far off. There's actually a fair amount of places where an experienced nurse who becomes a new NNP will have to take a pay cut when they start practicing. In Columbus, starting RN wages are 27/hour ish, at least at the children's hospital. That's over 50k and the cost of living is low there.
  11. LilPeanut

    Tennessee Nurse RaDonda Vaught - Legal Perspectives of Fatal Medication Error

    That's absolutely what everyone needs to remember - computers and pyxis/omnicells are not replacements for our brains, they are helpers. I don't need to memorize all the dosages I prescribe because I can look them up every time. The EMR gives me a suggested dose and frequency, and that is often correct, but that doesn't mean I get to skip the verification step that I am prescribing the correct medication with the correct dosage, route, frequency etc. It just makes it easier when I do have that information and it matches, to put the order in correctly. We have to use computers for what they are good for, but not ignore the importance of the human. That's why we have job security. That's why Dr. Google doesn't work. That's why rando guy off the street doesn't give meds.
  12. LilPeanut

    Tennessee Nurse RaDonda Vaught - Legal Perspectives of Fatal Medication Error

    But for most people, it has improved med errors and mistakes, when they are simple misreading or inattention blindness. That computer double checking you provides an important service that does not get affected by routine. We just need to emphasize that the technology is an adjunct, not a replacement for nursing. Again, if machines could do it, why are we even there? We are there to look at appropriateness, at possible concerns that a machine couldn't think of because they require higher reasoning skills and interaction with the patient. It's like monitors - they are incredibly helpful for monitoring vital signs. The number of time I've had a baby in "v-tach" or "v fib" because they are being burped? >100. Or it will say that they are desaturated to the 30s, but pink and clearly not. Or that their RR is the same as their HR. They are a screening tool to help, but they don't replace nursing skills. I had a patient that the monitor was reading HR >200. They weren't sure if it was real or not though - because they didn't actually auscultate! That showed very quickly that it was real and the baby had a touch of SVT. Or if my blood gas says that my baby's pH is <7, with a CO2 of >120, but I look at the patient and they are pink, active and without respiratory distress - I think I'm going to want to repeat that gas before I intervene. All the numbers and machines are things to help us interpret our clinical exams, but can never replace them.
  13. LilPeanut

    This MD culture

    As a provider, I've definitely had those 3am calls where I'm like....really? You're calling me at 3 because a newborn has milia? Or a mild diaper rash? And not only that, you are calling every time you go into the patient's room because you are basically just telling me everything you see when you are there? If every nurse was doing that, I would not be able to function. It would essentially be alarm fatigue. The system is structured so the more patients you have, the more you are going to rely on those in the chain who have fewer patients to accurately and reasonably keep you in the loop, but you can't have the same level of knowledge and awareness as a bedside nurse when you are the provider. You just can't. A NICU nurse has 2 patients. I have 8 if I'm on days, 25 if I'm on nights. Asking me at 2 am if we wanted to do a non-urgent intervention that would typically be done by the primary team is not appropriate. I round at night, checking in with the nurses and either tell me then or gather all those ideas together and at the end of the night, share them with me. That's what I do with the fellows. They have at least double my number of patients and if I am calling them with every time a nurse calls me, they definitely won't be able to get stuff done. I also have known nurses to "punish" providers they don't like by calling them constantly all night, which is just petty. A provider shouldn't be brushing someone off, rather explaining what is and isn't important for a call, but also, critical thinking and respect on the part of the nurse too. It's sort of like the person who shows up in the ER at 4am because they have had a rash for a month. Ok, but what made you decide *tonight* at *this time* to go to an ER, instead of earlier, or seeing a PCP? Same thing with calling providers, it's helpful to keep in mind the SBAR framework. Situation, background, assessment, recommendation. Situation: I have a patient who is having continued pain in chest that has now lasted for 5 hours, but has acutely intensified in the last 20 minutes. Background: they were due to be discharged today, but it was postponed because of this chest pain, but EKG, troponins and whatever other big people tests you do were normal. Assessment: While the patient was complaining of pain before, their BP was relatively stable, HR normal and no other concerning symptoms. Now with this acute change, they are diaphoretic, pale, tachypneic to 45, with an EKG that still reads normal and other big people tests pending. Recommendation: I am looking for something to treat the pain of this patient and further guidance into the reason for the pain. I am concerned that the patient might decompensate, even though EKG is normal. Or even if it is a mandatory notification (which can drive you nuts, because depending on your unit, some of the abnormals aren't really abnormal) to say "I am required by the hospital to call you to notify you of this value, and I do not (or do, depending on the patient) think it needs intervention at this time, open to discussion of course." That way you can communicate that it is a forced call, and that you are not asking them for an order in response, just that you have to notify them and they can say "ok, noted".
  14. LilPeanut

    Tennessee Nurse RaDonda Vaught - Legal Perspectives of Fatal Medication Error

    I believe RV has her CCRN. I don't have the same hospital bedside experiences as most people here, even before I started work in CA with the mandated ratios, so that makes me perhaps less likely to throw the profession under the bus and say it's broken. re: experience for ICUs. That's a tricky thing. At least with my specialty (neonatal) we prefer to get new grads, not RNs who have other types of experience necessarily, because we can then mold them to be NICU specialists. School doesn't teach much about NICU, and floor nursing will teach you nothing about the time management you need in the NICU, the skills you will use and how to assess the patients we have, because they are so wildly different. I suppose it might be different for big people ICUs, but there is some value to the whole "molding" concept. But, they have to be competent. I've met fewer than 5 NICU nurses that I truly felt shouldn't be NICU nurses, or perhaps even nurses at all. There are some I might prefer not to work with, or who annoy the heck out of me, but not dangerous/careless/unable to critically think/no sense of priority/no sense of urgency. Some people will have moments of those things, but honestly, now that I'm trying, I can really only pinpoint 1 nurse that I feel was dangerous, and 1 I feel is ill-suited and would be more successful in a different environment, not dangerous per se, but also not someone I'd want taking care of my child. Most who can't cut it, leave. I am usually amazed at the ratios that people seem to think are ok with big people, that I've never seen with peds, and how that manages to keep happening, not to mention nursing homes. I mean, some of the units, if they had enough non-licensed personnel to do tasks for the RNs it might be doable, but they often don't have enough of either. I think it's hard to compare the "good old days" to today, because we are a different profession honestly than we were 50 years ago. That's why I think the whole system needs an overhaul. Vote me for grand supreme leader of world 2019!
  15. LilPeanut

    Realistic Facts About FNP in Northeast Ohio

    I lived in NE Ohio a few years ago - that's not the area I would anticipate a high-end holistic NP practice. It's an economically depressed area, overall. I'm a hospital based practitioner, and my specialty typically is on the higher end of the pay scale, but I would not anticipate that being an easy business to get off the ground there. It is possible, I'm sure, but many self-owned businesses do not start becoming profitable at best for a couple years, and working in a practice group before that is going to be necessary. I think the average FNP around there makes 75-85k maybe? I've seen higher estimates online, but just in conversations had with colleagues, I don't think it actually ends up panning out that way for many people in a practice. I would look for any existing clinics of that type in the area, and then see how they are doing, what their financial stability is, whether it is a place you feel you would be happy working, or whether it seems to be a viable business model. Going to school for an NP with the idea to open a business isn't what I would automatically recommend - opening a business is very hard to do correctly and needs its own specialized education, but if you really want to do it, do the research, see what is possible, see if it is more possible in other areas if you are willing to move, and then make decisions with that information.