tshores

To Laidback Al: Then why are you including only the sugarcoated Conclusions/Interpretations instead of the Results and Findings in those studies? Archives of Pediatric and Adolescent Medicine Results: During the 2003-2004 and 2004-2005 seasons, 165 and 80 inpatient/ED and 74 and 95 outpatient influenza cases were enrolled, while more than 4500 inpatient/ED and more than 600 outpatient subcohorts were evaluated, respectively. In bivariate analyses, cases had lower vaccination rates than subcohorts. However, significant influenza VE could not be demonstrated for any season, age, or setting after adjusting for county, sex, insurance, chronic conditions recommended for influenza vaccination, and timing of influenza vaccination (VE estimates ranged from 7%-52% across settings and seasons for fully vaccinated 6- to 59-month-olds). I agree that much more study is needed--but by independent researchers with no financial ties to the pharmaceutical companies. They just proved that you were not "protecting" your patients for at least 2 years in a row. 2008 Lancet article: FINDINGS: 1173 cases and 2346 controls were included in the study. After we adjusted for the presence and severity of comorbidities, as defined by chart review, influenza vaccination was not associated with a reduced risk of community-acquired pneumonia (odds ratio 0.92, 95% CI 0.77-1.10) during the influenza season. [h=4]INTERPRETATION:[/h]The effect of influenza vaccination on the risk of pneumonia in elderly people during influenza seasons might be less than previously estimated. Interpretation that you quoted is kind of watered down, wouldn't you say? I do realize they have to state 'may' and 'might' because they are interpreting only one study, but I think the whole study should be read. In the Lancet Infectious Diseases--of course, scientists are not all in agreement on vaccinations or on a lot of things, for that matter. Doesn't mean we shouldn't hear them. And in the Cochrane Database under the Main Results: "In children under two, the efficacy of inactivated vaccine was similar to placebo." I am not anti-vaccination. I've been vaccinated for several things. I am against flu vaccinations being a condition of employment when I personally do not feel it is protecting anyone much of the time and is not harmless. I agree with you that people should do their own research, but they don't have to agree with me to have a "reasoned opinion." [h=4][/h]

A study published in the October 2008 issue of the Archives of Pediatric & Adolescent Medicine found that vaccinating young children against the flu had no impact on flu-related hospitalizations or doctor visits during two recent flu seasons. The researchers concluded that "significant influenza vaccine effectiveness could not be demonstrated for any season, age, or setting" examined. A 2008 study published in the Lancet found that influenza vaccination was NOT associated with a reduced risk of pneumonia in older people. This supports an earlier study, published in The New England Journal of Medicine. Research published in the American Journal of Respiratory and Critical Care Medicine also confirms that there has been no decrease in deaths from influenza and pneumonia in the elderly, despite the fact that vaccination coverage among the elderly has increased from 15 percent in 1980 to 65 percent now. In 2007, researchers with the National Institute of Allergy and Infectious Diseases, and the National Institutes of Health published this conclusion in the Lancet Infectious Diseases: “We conclude that frailty selection bias and use of non-specific endpoints such as all-cause mortality,have led cohort studies to greatly exaggerate vaccine benefits.” A large-scale, systematic review of 51 studies, published in the Cochrane Database of Systematic Reviews in 2006, found no evidence that the flu vaccine is any more effective than a placebo in children under 2. The studies involved 260,000 children, age 6 to 23 months.

You can call the hospital's HR department and ask what the starting pay is for a new grad RN.

Maybe some people have the tin foil over their eyes...maybe they haven't read about how the CDC, FDA, WHO and the pharmaceutical companies are all interrelated, largely because of the financial ties of some of the key people in these groups. The EU Health Committee: "In order to promote their patented drugs and vaccines against flu, pharmaceutical companies have influenced scientists and official agencies, responsible for public health standards, to alarm governments worldwide," the motion says. "They have made (governments) squander tight health care resources for inefficient vaccine strategies and needlessly exposed millions of healthy people to the risk of unknown side-effects of insufficiently tested vaccines. The "birds-flu"-campaign (2005/06) combined with the "swine-flu"-campaign seem to have caused a great deal of damage not only to some vaccinated patients and to public health budgets, but also to the credibility and accountability of important international health agencies." In the first quarter of 2010 alone, the US federal government representatives received $19 million per day from lobbyists, and over $1 billion in total lobbyist spending, a large chunk of the money coming from the health care sector. Keep in mind, this is only federal lobbying efforts. This figure doesn't take into account the millions more spent lobbying at the state level, not to mention the cozy lobbying arrangements between the drug reps and individual doctors. Why this massive lobbying push by the vaccine industry? One of the reasons (certainly not the only one), is to influence vaccine mandates. The vaccine industry has a vested interest in (and continually spends big money on) trying to make sure that more vaccines and more doses are mandated by the government. BMJ reported: "The investigation by the BMJ/The Bureau reveals a system struggling to manage the inherent conflict between the pharmaceutical industry, WHO, and the global public health system, which all draw on the same pool of scientific experts. Our investigation has identified key scientists involved in WHO pandemic planning who had declarable interests, some of whom are or have been funded by pharmaceutical firms that stood to gain from the guidance they were drafting. Yet these interests have never been publicly disclosed by WHO and, despite repeated requests from the BMJ/The Bureau, WHO has failed to provide any details about whether such conflicts were declared by the relevant experts and what, if anything, was done about them. It is this lack of transparency over conflicts of interests—coupled with a documented changing of the definition of a pandemic and unanswered questions over the evidence base for therapeutic interventions—that has led to the emergence of these conspiracies." WHO for years had defined pandemics as outbreaks causing "enormous numbers of deaths and illness" but in early May 2009 it removed this phrase—describing a measure of severity—from the definition." Now, all it takes to declare a pandemic is a virus that people have no immunity toward, which is spreading beyond borders. In other words, it doesn't matter how many, or how few, people are affected. All a disease has to do to be a pandemic is move beyond a few countries' borders. Nice for whoever makes vaccines. Did you catch that? People in the WHO had financial ties to the pharmaceutical companies and stood to gain endorsing the H1N1 vaccine. And if you read, you'll see how all those agencies are tied together just like that. It's not paranoia; those are facts. You'll see who works for the CDC now and used to work for the pharma companies, and so on. And lobbying to make more mandatory vaccines would be sweet indeed. You can blindly trust if you wish, but I choose not to. And when it affects me and my body, it should remain my choice, not theirs or yours.

Many studies funded by pharmaceutical companies selling vaccines have "proved" that influenza vaccine is safe and effective. But independent reviews of those studies have found the opposite is true. Studies are now showing what people who refuse to take flu shots have known for a long time: that flu shots simply do not work as advertised. For example: *Giving young children flu shots appeared to have no impact on flu-related doctor visits or hospitalizations during two recent flu seasons, according to a study published in the Archives of Pediatric & Adolescent Medicine. *The flu vaccine is no more effective for children than a placebo, according to a large-scale, systematic review of 51 studies, published in the Cochrane Database of Systematic Reviews. *NO studies have conclusively proven that flu shots prevent flu-related deaths among the elderly. *A study published in the Lancet found that influenza vaccination was NOT associated with a reduced risk of pneumonia in older people. *Research published in the American Journal of Respiratory and Critical Care Medicine also confirms that there has been no decrease in deaths from influenza and pneumonia, despite the fact that vaccination coverage among the elderly has increased from 15 percent in 1980 to 65 percent today. One of your basic freedoms as a human being is your right to decide what you put into your own body. Especially when it comes to medical risk-taking, there is a basic human right to be fully informed about all risks and have the ability to refuse to allow substances you consider to be harmful, toxic or poisonous to be forced upon you. But are those of us who are trying to exercise our right to informed consent to medical risk-taking facing prejudice and discrimination? When it comes to getting an education, keeping your job, or being allowed to obtain health insurance and medical care, the answer could soon be "yes

Chest hair is no more "nasty" than head or arm hair or any other hair. Who decided that it is? Where did this all come from anyhow? They're MEN, not women. And they shouldn't have to cover up any more than women have to.

Proof of present-day use of aluminum-based adjuvants in vaccines just so you know: http://www.ncbi.nlm.nih.gov/pubmed/17201666 http://www.reeis.usda.gov/web/crisprojectpages/195042.html http://www.immunizationinfo.org/vaccine_components_detail.cfv?id=61 And, yes, the politicians are rewarded very well for helping the pharmaceutical companies. The big shots in the FDA who own shares in some of the pharma companies--the same big shots who decide the safety and efficacy of our medicine--don't do too shabby either. I'm glad you took the Tamiflu and hope you're ok now.

Not taking a vaccination has absolutely nothing to do with washing hands and changing gloves and paraplegic firemen. I did NOT say the government was making the vaccine mandatory; I was making statements (granted, probably unclear statements) about how people are trying to shove their views down everyone else's throat. If you aren't aware of the many drugs that have been recalled, I can't help you. There ARE aluminum-based adjuvents in vaccines, and NO mercury would be much better. They may not be out to kill us, but pharmaceutical companies are out to make the big bucks as cheaply as they can, sometimes at our risk. That's a fact. The bottom line is that YOU are the one making excuses not to get vaccinated. You're the one who is trying to get everyone else to do it for you. If you're so concerned, you're absolutely free to take it yourself--then you won't have any cause for worry when you're in the hospital.

I DO understand the reasons for taking the flu vaccinations; I just don't think they should make them mandatory because there are just as many good reasons not to take them. They could make them safer for people to take without all the extraneous garbage they put in them to manufacture them more cheaply. We've had to cover for nurses out with the flu, too--and--oh yeah, most of them had the flu shots 2-4 weeks ago. How does that protect their patients any better? Most of the nurses I work with get vaccinated every year, and a lot of them get the flu anyway. I'm sure I'm not the only one seeing that.

But I don't blindly trust the pharmaceutical companies nor their regulating agencies--they've had to recall too many medications they said were "safe"; usually after a lot of people died. There are lawsuits right now because the pharmaceutical companies hid harmful side effects from those regulating agencies and the public. Some FDA officials are monetarily tied to those pharma companies. WHO changed its definition of a pandemic--from causing a lot of deaths to just being widespread. They admit that they sometimes mix other vaccinations (for diseases that haven't been around in a while to vaccinate against them, too) with the yearly flu shots without our knowledge. Why do they insist on using mercury and aluminum-based adjuvents in much higher doses than the safety recommendations of the FDA, known toxins to the human body? Why have they stockpiled squalene to mix in the shots--something normal around your nerves, but injected can cause your body to form antibodies against the normal squalene in your body causing MS-like diseases. Thankfully, the US won't let them use it--unless an Emergency Use Authorization is issued, but Europe uses it. So I'd like to know why I should trust them?!? This is not a test or a call to arms to "stand up for the mission." It's about being politically correct and the control of others. Nowadays, it's PC to say the government and I think that's bad for you, so you can't have or do that--or we'll raise the taxes on that. The government and I think this is good for you, so we're making it mandatory for you to do this. As long as we're Americans, we should have the choices and freedom of all Americans--no matter what we do for a living, and it should be illegal for employers to mandate differently.

I'm 54 and work 7 12-hr shifts in a row and get 7 days off in a row; 29 years in so far. I wouldn't have tried it with young children, but now as long as I can get a couple of hours in the evenings to eat, shower and relax--it's all good. When I do have to stay later, I just pig out, shower, drop in bed--but I'd do that if I just worked 2 or 3 in a row, too, and had to stay. The 7 off is, of course, wonderful.

Still, there's more risk in sticking yourself somewhere else--hands, fingers, etc. and they don't make you wear leather gloves. I think it has more to do with tradition and appearance rather than safety. It hasn't been that many years ago that we weren't allowed to wear running/walking shoes (and some of those have only cloth over part of the toes), then the open heel they didn't like, and so on.

I don't understand the safety issues with the holes in the shoes. Most of us get more spills/splatters of everything on our scrub pants and tops, and that's just a thin piece of material covering bare skin. My feet are precious to me--that's why I wear Crocs with the holes with cotton socks--but no more precious than my legs, belly or chest. So unless you want to put me in a spacesuit, the logic just doesn't wash.

I'm supposed to attend a 4-day CCRN review in Little Rock next month. Do you think the Gasparis tapes/CD's helped you a lot? All this stuff is so expensive (and we don't get a salary differential for it either). There's also a program on ed4nurses.com, but I haven't heard anything about that one; he guarantees you to pass or he gives you tutoring and pays for the re-take of the test. I've been a CV/SICU nurse for 20+ years, but the CCRN test has always intimidated me...so now I have to show myself that I can do it. Maybe. Okay, okay, I can do it...if I study the right stuff... :sofahider

I've probably posted this before, but it's always with me so bear with me, please. If you straight-line someone from pushing Verapamil (and push very slow with the elderly, don't slam it in even if the docs are telling you to), push Calcium right behind it. The first patient I had that went into asystole was in his 40's with his HR in the 200's, and the second 5 mg bradied him down in a matter of a few seconds and into asystole. The calcium saved his life. Second patient was in his 80's post CABG, HR in the 170's--I literally drew Verapamil up in a TB syringe so I'd know exactly how much I was giving him (had bad, bad feeling about it), pushed it slowly even though people were yelling to hurry and push it--gave a minute amount (total of 1.25-2.5 mg, don't remember exactly now; was years ago) and he went asystole. Calcium didn't help him; nothing did. Yeah, he was old and had other things wrong with him, too, but I was the one pushing the medication that killed him. Now, if the doc orders 5-10 mg, I only push it slowly until I get the desired results, even if it's only 2 mg on a 90 lb. 80-year-old woman. I've had them laugh at me for doing that, but none have written me up for it yet. I've heard so many people (including docs) say, "I didn't know that could even happen!" or "That's never happened to me!" Guess my point is that none of the drugs we give are harmless and we should never get complacent in giving them.

You guys are so funny. Guys wear the same type v-neck scrub tops most of us wear with about the same amount of skin showing (yeah, some of those v-necks run pretty low on some of us females, too). And because their skin has more hair they should cover it? Why? Since when did hair peeking out of scrub tops become "indecent" or "unprofessional?" Heck, all these years I thought it was just a male thing...you know, just like they NEED the fly in the front of their pants for more than just taking them off like we do--just the difference between a man and a woman...Maybe we should all just get dipped in Nair every coupla weeks... :chuckle That would settle all the "disgusting" hair problems; no leg or arm or pit hair, no pubic or ear or chest or neck or facial hair, and certainly no hair for those disruptive and unprofessional hair-do's. And we'd all be so much cleaner, I'm sure, because we wouldn't be carrying bugs around on our hairs. And while we're at it (because we have a hair aversion), let's do the same thing to all of our patients. After all, some of them are pretty hairy...carrying germs and all that...it'll make 'em look more decent... :chuckle

Probably a lot depends on how closely you work with doctors. In SICU, you work with a lot of surgeons and just about every other specialty--and some of them are extremely arrogant. Yes, once in a while the nurses will have disagreements in our unit, but 99.9% of the time it's the doctors who are doing the yelling and acting like children having tantrums. Most of the docs we work with don't do that and they're a great bunch of doctors, but a few still do. One pulmonologist yelled and carried on at a nurse because she told him a cardiologist was on the phone for him--but he was writing in his progress notes and didn't want to be bothered. :angryfire I think they just need to get over themselves. If most of the doctors (or nurses) were like that, sure I'd quit bedside nursing. Who could maintain their sanity in that kind of environment?

In a post CABG patient, Tridil turned off in a peripheral line--then a few minutes later, pt. was bolused with NS in the same line. Of course, there was still Tridil in the tubing and the BP plummeted--this can happen with any kind of medication, though. New grad came out of a pt.'s room asking how we measured NTG ointment to make sure it was an inch as she rubbed her hands together. Said she felt all right, but I made her wash her hands with soap and water immediately, showed her how to use the papers and scolded her for not asking first. She'd put the paste on her hands and rubbed it on the patient's chest. Lidocaine bag instead of heparin flush bag under pressure on an arterial line. Two instances where Verapamil was pushed rapidly and it straight-lined the patients--got one back pushing calcium, the other died. The one we got back was in his 40's and the other one was in his 70's, and it should always be pushed slowly in the elderly or in anyone taking beta blockers--and sometimes it happens anyhow. I know a lot of nurses always slam it in, but I don't. You only have to see it once, no matter who actually pushed it, to make a believer out of you. Saw this once with Inderal with the second mg (in 9cc of NS) slowly pushed 20 minutes after the first mg--only that patient went bradycardic then asystole and all the atropine and epi never touched him (not really a med error, but we really have to respect these big gun drugs we use). Before pre-mixed lidocaine: came on one night and the off-going nurse said she'd put 2 gms in 500 cc D5W, but she held up 2 100 mg bolus amps to show me what she'd put in the bag, swearing that there was 1 gm in each amp and said the pharmacist had assured her of that when I told her she'd need 10 of those to make 1 gm. The patient had an MI and was having PVC's all over the place. I mixed another bag, the patient responded, and she didn't talk to me for a while after that. And I'm sure there's a lot more I can't think of right now.

I don't know much about LTC, but in ICU's I've worked in (for 25+ years), most nurses record patient-specific information in a kardex or sheet of paper (or even half-sheet of paper) left on a clipboard with the nurse's notes. That is our true care plan where we write all the diagnoses, history, lab to be drawn or other procedures, any tubes or drains to suction or not, dressings, whether to crush meds--anything at all pertaining to the care of that patient, even family phone numbers. Yeah, they get kinda messy with all the updates, but they're REAL care plans and that's what we really follow. I think we should just stick the messy old ones in the chart when we make out new ones because that's what we really do for our patients. But instead, we have a four-page NCP no one looks at (at least not for any guidance), a two-page teaching form, and a three-page admission form. Yes, we need an admission form, but we sure don't need the other forms. We should be charting our teaching anyway without a separate form. And now we have wound assessment forms and orders, restraint forms and orders, epidural forms, PCA forms, transfusion report forms, and so on. If we give blood to someone who has a PCA, we are charting VS on three different papers (including the nurse's notes). Ridiculous. I agree that NCP's are great for students, but they're an incredulous waste of time for nurses. Let's start saving our real care plans (you know, the messy but true ones) and save a lot of trees, too. :chair:

And when you're really overwhelmed and want to drop, just go again and do what you need to today. You can make yourself make it through one more day...each 'today' at a time.

Everyone should get off the unit when they can take a break, smoker or not. Go to the lounge and put your feet up, go for a walk somewhere, to the gift shop, wherever. Gives you a chance to settle down and regroup. Most smokers don't mind watching your patients if you don't smoke; that way they don't feel guilty asking you to watch theirs. They're probably looking at you funny because you don't usually take a break. And, yes, some smokers take too many breaks. And then there are nonsmokers who disappear for 30 minutes at breakfast, 45 for lunch, and so on. But if you CAN take a break and don't, you're making your own choices. There shouldn't be a problem with breaks if everyone works together like they should. By the way, I thought you were supposed to get a 10-15 minute paid break for every four hours you work--two in an 8-hour shift, 3 in a 12-hr shift (not counting the 30 min unpaid lunch break). I am against nonsmoking hospital campuses because I think people should have choices in this country. If they're smoking outside (most of the time in designated areas), I can't see where they're hurting anyone else. I don't think cheeseburgers or french fries or sugar should be banned either. You have the right to make your choices...but not to force your choices on anyone else.

I, too, remember the Emerson bottles and stainless steel bedpans and urinals. I also remember ducking a few thrown by patients in DT's. I went to school in California and moved to Arkansas in the 70's. I was supposed to wear a cap and white nylons and got into trouble all the time because I wouldn't. The pins we used to hold those caps in place hurt! We had to call each other by our last names and I wasn't too good at answering because I was used to being called by my first name. I'm so thankful I didn't work in a hospital where I would've had to stand up for doctors because I'm sure I would've been fired. I remember the two huge medication trays and cards the medicine nurse carried at 0900 every morning. The only IV pumps we used were on pediatric patients or drips. So we ran up and down the hall with those glass bottles, and I bet we all broke our share of them. The glass toomey syringes, the smell of IM paraldehyde (yummy), and I wonder where that little old lady is that used to be admitted every Christmas Eve because her family left town and she liked our fried chicken. ------------------ Trella