musingmom

So is anyone trying to incorporate the new recommendations and definitions into their current sepsis protocols? If so, how are you reconciling the CME core measure reporting requirements that are based on the outdated info?

I gave this last week: 60 mg of solumedrol was the order, and the Pyxis gave me 2 vials of 40mgs in 1 ml. If I call the pharmacist, she will tell me how many mls to give, but since I am ultimately responsible for what the patient actually gets, I should know how to do it myself.

We typically get an order such as Fentanyl gtt, titrate to CPOT of 1. I have seen target scores from 0 to 2, depending on the patient and circumstances. It's almost always paired with sedation, for which we use a different scale.

The other option not already discussed here is the entry level masters. If you are sure advanced practice is where you want to end up, check it out in your state. There will be those that say you need bedside experience before you move to advanced practice and those who will say that primary care is nothing like the bedside, so it's not necessary. People feel strongly on both sides. I have a previous BA and that's the route I took, although after the prelicensure portion (which is the equivalent of a 15 month accelerated bsn) I took a job as a bedside nurse and am finishing the Masters part-time. I will have 3 years of bedside experience by the time I graduate. Part of my dilemma is I am seriously considering an acute care np path, and bedside experience is very useful for that. The entry level masters programs have pretty good reputations here, and mine required a 240 hour preceptorship before finishing the prelicensure portion. I was a very competitive new grad candidate. The other thing I would suggest in your decision making process is to check the NCLEX pass rates for the programs you are considering. That may help narrow it down for you.

Three times in the last year I have dreamt that I was getting a central line, in my ICU, by one of the fellows. Three times. Always in the RIJ. I'm 11 months into my new grad year. Please, no more central lines.

At the risk of generalizing a people group and some specialties: I have several friends with asbergers. Their attention to detail and ability to make critical thinking connections without bias would make them excellent nurses in critical care and/or OR. I'd want them to be my nurse over the warm fuzzies with excellent people skills. But they are all engineers.

When asked why the unit was hiring, the interviewer said that recently the entire night shift quit all at once.

I can't find any info on the prevalence of immune compromised children in schools, nor can I determine your exact definition of "immune compromised." Your link does not shed light on any of that, nor does it even mention the exposure of immune compromised children to unvaccinated children... in fact your link confirms that many times, when most vulnerable, immune compromised children must stay home. Which is what I said. It also confirms that immune compromised children are just as at risk with the common flu, as with a disease that has a vaccine, as either could be very problematic for them. Which is what I said. Here is the CDC's info on the CA measles outbreak: Measles | Cases and Outbreaks | CDC. I hope you'll forgive me if I don't take the Today Show's word for anything. The CDC says the outbreak originated with a traveler from the Philippines, though they never found that individual. The link gives the reasons why they made that determination. The outbreak then spread through unvaccinated individuals, both children and adults. The number of cases linked to Disneyland was actually far less than cases in 2014, linked to the Amish in Ohio. But even the 2014 outbreak was linked to the Philippines. Of course, "Disneyland measles" is far more sensational than "Amish measles," I guess, which is why it received more news coverage. And legislation. At any rate, I'm done with this, I've made my point. I AGREE that vaccinations are important and safe, and high rates protect those who cannot be vaccinated. I really dislike the rhetoric that comes with all the schools must be fully vaccinated and it's all those unvaccinated children's fault, because it is inaccurate and weakens the case for vaccination.

Last shift: I got called to a (intact motor function) patient's room because he wanted me to fix the temperature. Ok, that's plausible, often in order to get the wall thermostat to work we have to call engineering. I asked if he felt the room was too cold, or too warm. He said too warm. Well the thermostat was already on the lowest setting, and it was cool in the room (to me), so I suggested that maybe he would like to take some of the 7 blankets off of himself, you know, to cool down. He replied, "Well, what if I get cold?" I said, "Uh, cover yourself back up?" He said, "Is that ok to do on my own?" Yes. Yes it is.

Um, yes. I believe it is standard practice to keep children undergoing chemo out of school while their white count is down. Do you have different info? And yes, children with HIV can receive some vaccines, and are not always considered immunocompromised, based on their viral load. With appropriate treatment their outcomes are quite good. Again, do you have different info? I'm not a pediatric HIV or chemo nurse. If you are and have some EBP sources for us, please share. I can be wrong. I don't have personal experience with children with HIV, but I do have some with children undergoing chemo. They stayed home. The school sent a teacher, who wore a mask. I bet she was fully immunized too. The measles outbreak, which inspired this legislation, did not occur in a school. It occurred in a crowded public place with an airborne illness. But Disneyland doesn't have to make sure guests are vaccinated. Again, I'm for vaccines. Everybody should do it.

Actually, unvaccinated children were not responsible for the outbreak, or at least they were not the only ones responsible. It turns out that when we switched from attenuated to conjugate vaccines in 1997, we needed to have also added a booster. So we did. See the CDC info here: http://www.cdc.gov/media/matte/2011/10_whooping_cough.pdf and a New England Journal of Medicine article here: MMS: Error. The booster works. I am not saying that unvaccinated children don't pose a risk to herd immunity, please read my original post again. I'm saying that, in general, BECAUSE VACCINES WORK, vaccinated humans are not at risk from unvaccinated humans. In the original I think I said school children, but humans works too. It is this kind of information that makes the crazy antivaxers shut off and not listen to us... because of faulty rationale like "my vaccinated child deserves to be safe at school." To be clear: I am not against vaccinations. I like them. They're good. I think everyone should do it. I am against legislating things that should be parental choice. This applies to other things besides vaccines, like how my child should be educated, for example. I realize that there has not been a better solution for vaccination rates. I don't have a better plan. I still don't like this plan. edited to add: I don't know why the NEJM link says error, but it works for me, let me know if no one else can access it.

"This is just saying that if your child is going to go to public school, they can't put other kids at risk." (Sorry I don't know how to use the quote feature that shows the author on my phone.) I don't like this rationale. Before I go on, my kids are fully vaccinated, and I think vaccines are safe, and to not vaccinate only means you are choosing the risk of the disease, over the risk of the vaccine. But, NOT vaccinating does not put others at risk -at school-... There are no immune compromised kids at school, because their risk is just as great to the flu as to measles, meaning either could be really bad for them. And, there are no babies under 1, the other risk group I hear cited. Now, if you want to talk about herd immunity, and vaccination rates commensurate with effective herd immunity, then I get you. But using school milestones is just a convenient way to enforce vaccination. As far as I know, people who got measles in the recent outbreak who had confirmed vaccination histories all had not been vaccinated. If you are vaccinated, you are not going to get it. School children who are vaccinated do not get diseases from school children who are not vaccinated. If someone has different info, I'd be glad to look at it. And I don't like it. If we legislate the stupid out of people... How long before someone else's stupid is something I don't want to do? However, I don't have a better solution either. In Southern California, my demographic, there are still a lot of people with bad information, or who refuse to make a decision just in case (which is choosing the disease imho), or are just lazy (they exist, I know them) and this will get those people vaccinating. In the debate over this law, the "crazy" was too loud, and the parental rights folks didn't get a word in edgewise. I.

I was an EMT before becoming a nurse. The EMS standard for an out of hospital birth is largely to DO NOTHING. Make sure baby is breathing and keep it warm, preferably on mom's skin. Otherwise, don't touch anything. Transport. Turns out, nature pretty much has the process perfected.

My school had a maximum number of units you could have "in progress" in order to be accepted. So, you need to contact the school and ask if you need the required units at the time of application, or if you only have to have them by the time you start.

I did nursing school with a newborn. It is definitely doable, with a lot of support and organization. I agree with a lot of the previous posters, so I won't repeat what they've said about the newborn period. Here's a few other things to consider: You will need more support than just your husband. Do you have lots of supportive family around? What will be your child care plan? Most day cares won't take an infant under 6 weeks. Do you have resources for in home care? You might be able to take a sleepy newborn to lecture, but definitely not lab. (My husband took 8 weeks off to care for our baby while I was in school, and after that my sister watched her.) The other thing I would point out, is that this is your first baby, so it's hard to know how things will go. When I had a baby during school, it was my fifth. I have pretty easy babies: they sleep and eat well and generally aren't colicky. If the newest baby didn't sleep or had colic, it would have been much harder to get through. I will say that if you can do it, it would be ideal, get through those classes during the newborn phase, and the baby will be a year old by the time you start nursing school. But if it doesn't work out, I have no doubt based on your posts that you will get it done eventually! Best wishes and congratulations, Musingmom

Tequila over here... My mother in law suggested it for my teething baby. I rather thought that if I just took a couple of shots myself, I wouldn't care if the baby was teething. Just kidding. Sort of.

The nurses of USC wear cardinal scrubs every day. All 1200 of them. (I don't know these people, this photo was from another AN post).

Can someone clarify: hasn't the OP fulfilled any "duty to report" by reporting to her manager? The duty to report doesn't extend to "duty to assure action" which of course we can't... But is there a further duty besides reporting to the manager? Does it have to be somewhere more specific? Don't get me wrong, it sounds like a very unsafe situation and an anonymous compliance line seems ideal to avoid blowback. I'm not advocating not reporting.. Just wondering what constitutes sufficient "reporting."

I don't know the law (either criminal or employment) in your state. If this was happening in my state, I would advise you go directly to your own doctor and get a medical leave of absence for stress; PTSD, whatever they will call it. In my state this would give you a little temporary disability income that would make the lack of work not as big of a financial strain. Then I would advise that you get a restraining order against your abuser. You will need his current address, but since he should have to register as a sex offender, that shouldn't be too hard. In my state, as a victim, you would be granted an order without any trouble. It is HIS responsibility to stay away from you. Not the other way around. Lastly, I would advise you to do as you yourself suggested and try to find alternate employment. Your employer has allowed you to work in a hostile environment, but I wouldn't wait for them to correct their mistake. Not firing him as a patient is indefensible in my opinion, and even if they can't be compelled to, it just simply makes them bad humans.

I've followed this case since the video first got shared online, since I am a member of a birth advocacy group and an unofficial birth junkie. Having said that, like Red Kryptonite, I can never work in OB because "I'd do murder in my heart," every shift. So, it bears repeating: I am not an OB nurse. I am an ICU nurse, and still in my first year of practice. So my perspective is drawn from my own 4 birth experiences (4 births, 5 children) that span the spectrum from high intervention to no intervention and just about everything in between. I also attended the births of two family members, and I volunteered over 500 hours in an L&D unit prior to nursing school... plus of course: nursing school clinicals. So I have been present for dozens of live births, but never as a licensed nurse. I also live and practice in the same state as the woman in the video, though I have never been inside Providence Tarzana, the hospital identified in the lawsuit. In my opinion, even if the woman in the video signed a consent for an episiotomy, she clearly withdrew it, and this is bothersome. I have seen women ask for the pitocin to be turned off and the dr and nurse refuse. 100% of the births I witnessed in my OB clinical had an episiotomy performed. Ironically, my OB clinicals were in the same hospital I gave birth to my twins in, 10 years before. One male classmate was horrified at the high episiotomy rate and said "It's like they just fillet them all, for no reason!" In no other specialty would a practitioner proceed in the context of someone saying at the last minute, "No, don't do it!" But women are told the "health" of their baby trumps their personal wishes (those two things do not have to be mutually exclusive, and the 'health' of the baby being a subjective conclusion at best), and we all know that provider convenience drives OB practice in many, many cases. I also put forth that women of means have WAY more influence in how their birth goes, and I truly believe that some of these issues disproportionately affect minorities and women of lower socioeconomic status. Part of the problem of changing birth culture, is that the prevailing cultural viewpoint is, if the outcome was good... mom and baby are fine, then there is no issue. This is why it was difficult to find an attorney to take this woman's case: there is no loss, no permanent injury. Because it's birth, the lack of patient autonomy is not seen as an issue, as long as everyone survived. Women are told, well at least you got your baby! You should be happy he's healthy! I don't mean to disparage the specialty, I had lovely L&D nurses for 3 of my births, one who nearly delivered the baby by herself, and another whom I completely credit my drug free VBAC to; without her, I would have had surgery. I had 4 different OBs for 4 births (different geographic locations), and I would recommend 3 of them unreservedly. My last birth, I did not have an episiotomy, and I did not tear, and I'm grateful my OB took a wait and see attitude. The recovery was SO MUCH easier. I appreciate this thread, and the opportunity it gives us all to perpetuate the conversation about autonomy in birth. I have learned a lot from you all. -Musingmom

The woman in the video served the MD in a lawsuit today, alleging assault and battery, according to the Improving Birth website that initially posted the video. The lawsuit comes after a fundraising and nationwide search for an attorney that would take the case. http://improvingbirth.org/2015/06/preview-woman-charges-ob-with-assault-battery-for-forced-episiotomy/

It is a tale Told by an idiot, full of sound and fury, Signifying nothing. - Bill @ the Globe

Suit, unless given specific instructions otherwise.

Business formal. A suit. At least, a jacket.

It sounds like you want to take care of healthy babies. Perhaps you should look into early childhood education instead of nursing.