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rn/writer RN

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  1. rn/writer

    Brian Short News

    To those who didn't know Brian, this is just a story. To those of us who knew and loved him and his family, it's a deep heartache and a nearly unfathomable mystery. "Sources" can be wrong or incomplete, but regardless of the the outcome of the investigation, we will mourn the terrible loss. No matter who was responsible, complex, beautiful people were involved and "gotcha" pronouncements and knee-jerk judgments do nothing but kick the already wounded. Even when we know who, we may not understand why. That doesn't negate the love and concern. It just means some things will never make sense on this earth. God have mercy on them all and comfort those left behind.
  2. rn/writer

    Brian Short News

    This is unspeakably sad. I was a moderator and guide here for a number of years and helped with the AN booth and the ATI conventions several times. My husband participated, as well, and would periodically trade pictures of fishing and turtles with Brian on Facebook. Brian was funny and kind and generous and had great vision. He built AN from a tiny little outpost with a sprinkling of tents into the thriving "metropolis" it is today. I can't wrap my head around any of this tragic news, but I pray for Brian and Karen's families and for this other family here at AN. I especially ask for strength and wisdom for the admins and other staff whose hearts must be breaking. Please, know that you are loved and supported and will be in the spiritual embrace of many in the days ahead.
  3. rn/writer

    allnurses will continue

    Good to know that in the face of such unfathomable news the community will go on. What Brian created has lasting value that should endure. Thank you for this reassurance.
  4. rn/writer

    Crying babies

    Not sure how old this kiddo is, but if mom smokes, she might have been going through nicotine withdrawal. I've noticed that breastfeeding seems to help with that, as they get a little nicotine in the milk. Definitely a mixed message--breastfeeding and smoking, but it does happen. Glad to hear the little one is settling down.
  5. We use all of the above, depending on the situation. I would also encourage you to consider the source of the pain. Is the patient sore from pushing? Did she pull a groin muscle? Did she have episiotomy or a tear? I have seen some 4th degree tears that look far worse than a c-section incision. How about hemorrhoids? Ibuprofen is the go-to med for cramping, muscle aches, and general soreness. Percocet (or Norco) along with ice pads, ice diapers, and Dermoplast spray help a lot with stitches. Tucks pads and ointment give relief with hemorrhoids. Used in combination, we can get nearly all of our vag patients comfortable. We also encourage them to use their water bottle to spray while they're urinating to decrease stinging. I'm so glad we no longer advise the use of those plastic inflatable doughnuts. I tried to use one of those after I had a baby and all it did was squish the tender area in the opening.
  6. rn/writer

    How Not to Get Taken Advantage Of

    It's fine to share possessions, food, clothing, etc. freely and without reservation, because no one is going to be graded on eating the casserole or wearing the donated jeans. Patient safety won't be riding on the box of dishes you gave a friend. There will not be an exam for the toys you passed on to a neighbor. Sick and vulnerable people will not be shortchanged by your generosity. Learning will not suffer nor will good study habits be compromised if you are motivated to help others. The same cannot be said for schoolwork. Although it may seem like you're being kind by giving away your materials freely, ultimately, you are not. I'm not talking about helping a classmate in a bind now and then. But spoon-feeding those who have poor study habits (other than helping them to learn better ones) or enabling people who just want to coast through the class is about as responsible as letting someone copy off your test paper. Some have protested that it doesn't cost anything to be "nice." I disagree. If you gift-wrap a superficial grasp of the material (just enough, say, to pass a test) you give the message that it's okay to game the system. Undisciplined takers (as opposed to genuine study group participants) learn that ethics don't really matter. The end justifies the means. Besides robbing classmates of the chance to internalize the subject at hand, you may also short-circuit a much-needed reality check. Imagine the difference in outcome between a person who found a way to skate semester after semester and one who, with the clarion call of a failed exam or a flunked class, realized this isn't high school anymore. Add all of this to the concerns some have stated about plagiarism, and it doesn't appear to be a good idea to post or share certain items. In many (if not most) academic honor codes, the one who assists the cheater is viewed to be as culpable as the one who does the cheating. I imagine this would only intensify if money had changed hands, an arrangement that bears an uncomfortable resemblance to buying and selling term papers on line. It boils down to doing someone else's work for them. That isn't fair to anyone in the group, and it could expose many people to extra risk down the road. Just to clear up any confusion, I think we're all pretty much in agreement that there is a big difference between a generally responsible person taking part in a study group or needing help through a bad patch and a loafer who just wants someone else to do his or her heavy lifting. Sometimes being nice means saying no.
  7. rn/writer

    What's The Weirdest Name You've Heard A Patient Name Her Baby?

    Most often when people post about these legendary names, it's a second- or third-hand account (or more). They know someone who knew someone who had a co-worker who took care of the unfortunate child (or children, in the case of the Jello twins). Only occasionally does a member say they witnessed any of these names personally. At the same time, these names have been making the rounds for so long that I wouldn't be surprised if some silly person thought it would be a cool idea to saddle their baby with one of them because they didn't understand the difference between famous and infamous. I'm guess that at least 95% of the accounts mentioning L-a, Nosmoking, Chlamydia, and all their little pals are either outright lies or misinformed mistakes.
  8. rn/writer

    How Not to Get Taken Advantage Of

    Generosity does not require you to enable poor study habits. Sharing your notes, calendars, concept maps and other materials without a darn good reason could mean that, far from being a better person, you could be helping someone else to become a lesser student/nurse. I don't recommend lies or cutesy excuses. The shorter the answer the better. "I'd rather not." "ExCUSE me? You want what?" "Sorry. No." If you think there is a good reason to help the person (she wants the notes from the class she missed because her child was sick), make it clear that it's "just this once," and only because there were extenuating circumstances. Invite free-loaders (those riding other people's coattails) to start a study group, or even to join yours if they are prepared to contribute. None of this need be done with a snarky attitude. You just shouldn't feel pressured to let others use your efforts while they skate by. Their future patients deserve better. One last thought--you could print up a sheet with your study habits and all the ways you prepare for tests and exams. Make some copies. Then when someone asks for your help, you can provide the recipe for success. If all they're interested in is a handout, they'll be able to see (though they might not admit it) why you're reluctant to just fork over your notes, etc. Anyone who is really serious about learning stands to benefit from your information. Anyone else . . . maybe they'll get the idea that this isn't a game.
  9. rn/writer

    Possible termination for HIPAA violations

    If you were asked to assist or cover for another nurse and you looked up information for that purpose you should sign the chart and also note what you did. This covers you by showing that you had a legitimate reason for accessing the patient's information. Even so, I wouldn't go tip-toeing through the tulips. I'd stick to the areas that pertain to the current need or assignment (pain orders, dressing description, etc.) and leave the rest alone.
  10. rn/writer

    HIPAA Violation?

    I was thinking more along the lines of giving a new med or doing discharge teaching. I agree with you that it isn't necessary to go through the whole shebang each time. Sorry that wasn't expressed better.
  11. rn/writer

    HIPAA Violation?

    If the bracelet can be used to verify name and date of birth, that part of the review does not need to be stated out loud. But the rest of the med review--name, action, dosage, times, and other pertinent info--should still be done verbally (unless the patient is unable to do this--then it needs to be done with their designated assistant). The teach-back technique requires the patient to say what they are taking, why they are taking it, and all the rest. We're not reviewing the meds for ourselves. We're doing it for the patients. Many misunderstandings have been clarified and mistakes have been prevented during this crucial step. Of course, we need to be as discreet as possible, but we don't want to omit such a valuable part of patient teaching in the name of keeping everything secret.
  12. rn/writer

    HIPAA Violation?

    Wow. I was not expecting such common sense in a government directive. Good information to have. Thanks, EricJRN and GrnTea.
  13. rn/writer

    Losing respect for nursing students

    It isn't about age so much as maturity level. Some folks are level-headed and responsible at twenty. Some are still self-centered and undisciplined at forty. Maybe it's time for clinical sites to dust off (or come up with) their expectations for students in a clinical setting. Yes, the students are under the direction of the instructor, but while they are on the floor, they represent the facility in the eyes of patients and their visitors. It is not the least bit unreasonable to require respectful and responsible behavior, demeanor and appearance. If the students can't rise to that level for clinicals, they don't seem like good candidates for employment. I would go so far as to present the students (and instructors) with a contract clearly outlining the rules and requiring them to sign it if they want to proceed. I find it laughable that a student would say that she didn't want to take vitals because they "already covered that." Are you kidding me??? New skills don't replace the old ones--they are added to them. The goal is to integrate all the individual pieces of patient care into one functional unit, so that by the end of the clinical the student is doing everything she has learned that semester for those under her care. People who don't get that need an attitude adjustment. If I were an instructor, I would want to make it clear to my students that they are on the floor to learn and become proficient at nursing basics. If, after a warning or two, they found their phones or their classmates or anything else to be unmanageably distracting, if they couldn't be bothered to take learning opportunities offered by the staff, if they displayed an entitled mindset and showed anything other than respect for the staff and patients, I would show them the door with only one chance to make up the missed time. Instructors who aren't willing to shepherd their flock, so to speak, may not be up to the job. Clinical settings have been lost due to the actions of an irresponsible few. For the sake of the group, bad apples need to be dis-invited to the party. Instructors who are unwilling or unable to enforce the rules should not be in that leadership role. Clinical performance may open or close doors to students after they graduate. Many times a reference from an instructor or a precepting clinical nurse has helped someone to get a job. The smart ones know that.
  14. rn/writer

    Let RN license lapse to get out of "Old" new grad rut?

    I would check with your state BON. Letting your license lapse is a pretty extreme measure. Some states do not allow an easy reinstatement. They may require more education or have other hoops for your to jump through.i And, think about it--if you are hired as a CNA and it comes out that you did, in fact, have an RN license which you allowed to lapse, you could be fired on the spot if you hadn't disclosed that information earlier. If there were ever any legal problems, you'd be hung out to dry because of your elevation to RN status. You'd be held to a higher standard because of your advanced knowledge. Letting your license lapse wouldn't look like a shrewd career move. It would instead suggest that you couldn't handle the responsibility. A plaintiff's attorney might imply that you "surrendered" your license rather than have it revoked. Take a long hard look at this before you do something this drastic. I'm sorry you haven't been able to find a nursing job, but I've heard lots of hopeful things of late. Nurses are beginning to retire again after their 401K plans have recovered somewhat. Hospital hiring freezes are slowing lifting. Some people are cutting back to part time because a spouse has become employed again. Hang in there. Look at taking an inexpensive refresher course at a community college if you feel your skills have gotten rusty. Volunteer at a facility you might consider for employment. There are many steps you can take before you do something as serious as allowing your license to lapse. Let us know when you find a job, so we can rejoice with you.
  15. rn/writer

    Can a pt hyperventilate themselves into resp failure?

    Five seconds of not breathing does not constitute apnea. Think about it. A low-normal respiratory rate of 12 breaths per minute would mean five seconds between one breath and the next, and that certainly isn't apnea. If the patient had been hyperventilating, that five-second gap could have seemed quite a contrast without presenting any actual threat. Hyperventilating can cause something called circumoral cyanosis, meaning the area around the mouth can look bluish, or in the right lighting, even gray. Taking small, shallow breaths for more than a few minutes can by physically taxing and the patient would very possible work up a sweat. The fact that the patient could stop and start this behavior at will (when asked to, when no one else was in the room); his ability to wander the halls, eat and converse with others; and his removal of O2 suggest a problem rooted in anxiety rather than physical pathology. I DO question why the patient was intubated if the "apnea" lasted for only five seconds. Diminished level of consciousness is not the same as loss of consciousness, and if the patient resumed breathing on his own, why would the doc perform something so invasive and unnecessary. Even if the patient passed out, I would hope the doc would wait longer than five seconds to determine the need for intubation. Hyperventilating blows off too much CO2. This, in turn, lowers blood pressure. If the blood pressure drops too far, the person can pass out. Even though his initial blood pressure reading was elevated, it may well have dropped after his lengthy bout of hyperventilating. The ABGs bear this process out, as you said his O2 level was fine but his CO2 was low. I'm thinking you witnessed a good old-fashioned panic attack followed by a fainting spell. It doesn't matter if the patient was or was not intentionally manipulating the situation. The result would have been the same either way. The treatment, as you described it, seems questionable, at best. Unless there was underlying pathology--contraindicated by the labs and other diagnostic tests--normal breathing would have resumed as the CO2 level built up in the patient's blood stream. This is the flip side of the little kid who holds his breath and turns blue when he doesn't get his way. Breathing too much or two little can cause you to faint. But then the homeostatic drive kicks in and the body works to regain its normal balance. Intubating someone who is hyperventilating makes about as much sense as it does for the stubborn child. It is simply not necessary and introduces a lot of potential for more problems.
  16. rn/writer

    Sexual Orientation Question

    NOT asking about sexual orientation makes it seem like "that which shall not be discussed." It's the elephant in the room. Young people especially might be hesitant to initiate conversation but would respond if someone else brought it up. If a healthcare provider can ask such questions in an honest and matter-of-fact manner, this could be a message to the patient that this is a safe environment in which to confide and seek assistance with whatever they need. If a healthcare provider is not able to ask in a non-emotional, non-judgmental way, they might want to work on that.
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