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Critical Care
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ZASHAGALKA has 15 years experience as a RN and specializes in Critical Care.

44 male, wonderfully married, 3 boys and a girl

ZASHAGALKA's Latest Activity


    Fired from first job

    It's not your job on a resume or in an interview to represent yourself badly. You can tell the story from your point of view without it being a lie. For example, I have no clue why you would be terminated based on what you said. There's more to that story -- the stated reason sounds like a pretext. Nevertheless, don't put it in the resume and when asked say that the employment wasn't a good fit. If pressed, say that YOU feel like they weren't giving you an adequate orientation. 1. That sounds to me like a true representation of your post. 2. If the place is local to where you're applying, most hospital administrators consider their programs to be superior to their competitors. You saying that you weren't being properly oriented probably fits into the pre-established mindset of how HR thinks of their competitor anyway... You can be vague without being dishonest. It's not your job to represent yourself in a bad light. Put those two things together and you can navigate an interview. ~faith, Timothy.
  2. A free market will rise to meet demand. There are billions of cell phones on the market and in use - right now. Nobody had to ration them, and the competition to put them in YOUR hands have made them cheap: cheaper than that black rotary-dial phone was 30 yrs ago. Here's a four-part plan to make health care affordable. The number one aspect of any such plan is that it must be primary-payor: the user must retain control of the dollars in order to maintain cost-conscience choice. 1. End employer tax breaks for coverage. Employer provided coverage would fall to nothing inside of 3 yrs. Good. You shouldn't be forced to keep a job to keep insurance. 2. Give citizens a 2-fold tax break. A. - a $5,000/person Health Savings Account (HSA) tax deduction that allows a pool of money to grow tax free for use in health care. Similar to the cafeteria/flex plans many employers use now, but able to "rollover" year to year. When the average person is healthy - in their 20's, this account will build as it's not used much so that, when you're 50-ish, and more prone to chronic problems, you have a relatively big account to pay for care. B. - Make a catastrophic plan tax deductible as well. 3. Catastrophic Insurance. - Covers only big expenses. Your car insurance doesn't pay for gas and tune-ups, and neither should health INSURANCE. Today's Health Insurance isn't insurance at all; it's pre-paid health care. Make it Insurance: 5k/yr deductible (conveniently the size of your HSA) - when your HSA is depleted, catastrophic coverage kicks in. But. Not before. 4. Gov't pro-rated coverage for anybody in the gap - make it a % of income so that, at about 50k for a family of four, it becomes cheaper to get your own, using the methods above. That gov't asst would extend to the chronically ill. For example: It's cheaper for society to ensure that a diabetic has access to the right primary care than it is to treat them for non-compliance. ~~~ Right now, Geico, State Farm, Farmer's, All State - they all market heavily to YOU for their business. Why is that? They must compete TO you for YOUR dollars. Why doesn't Blue Cross have a gecko hawking health care to you? You don't count; your employer provides your insurance and YOU have no say. THAT could change. Give people control over their own dollars and watch health care change. With most routine care being paid "out of pocket", there will be competition for those dollars. "Come to OUR ER, and any CT scans will be free!" LOL. There are better methods than gov't run care. There are even better methods to universality than gov't run care. Gov't run care isn't about being fair - or universal. It's about lobbyists having more of a say in what kind of care you get than YOU do. Money is power and gov't restricted care is about a few in gov't having access to the power that is 1/7th of the economy. AND. NOT. YOU. ~faith, Timothy.
  3. 1. I think you will see 'pay as you go' (no insurance) clinics in Walmarts, etc., be a standard of care within 10 yrs. It's already starting. Just as $4 generic prescriptions didn't need a huge gov't bureaucracy to become a standard with lots of big-name pharmacies. The free market does the best job of mitigating price while expanding quality and cutting edge. 2. Who wants things to remain the same? I advocate for the government to become LESS intrusive in health care. Gov't restricted health care advocates for MORE restrictive gov't interference. I don't know anybody that wants more of the same. 3. What I specifically advocate is that the gov't end tax breaks for businesses to provide for health care and instead provide those breaks directly to consumers. That would break the back of gov't supported (with lobbiest infested rules for care) tax breaks to businesses and put health care back in the hands of individuals. Combine that with health savings accounts and catastrophic insurance, and you would have a model that would control pricing and bring health care to the masses. I don't depend on my employer for my car insurance, and I shouldn't need to for my health care. Nobody should be forced to keep a job in order to keep health insurance. THEN, after the gov't gets out of the business of interfering with care, THEN, the gov't could set up a catch all plan to insure that everybody is covered. 4. Universal health care isn't about universal coverage, at all. There are far cheaper -and less intrusive - ways to accomplish that. It's about controlling YOUR health care. It's about the money - why let YOU decide how to spend YOUR money best, when some bureaucrat in Washington knows YOUR health needs better than you do - and has the actuarial tables to prove it! 5. The only reason why a CT scan costs a thousand dollars is because, get this - YOU DON'T ACTUALLY PAY FOR IT. Remove the middle man and it would be far less. In order to have a market for a product, that market MUST be created at a price that will sustain it. Nobody advocates leaving things status quo. I advocate a better system that keeps Washington out of your lives and provides par excellent care to everybody - with no rationing lines. Gov't restricted health care advocates want a fair share in a dismal gov't outcome for all. ~~~~ I advocate that we all have the ability/opportunity to have blackberry cell phones. Gov't restricted advocates argue that, out of fairness to everybody, we must all have black box rotary-dial phones. Would you want to bring back Ma Bell and that black rotary-dial box phone for all? For goodness' sakes, then, WHY ON EARTH would you want to do the same to health care? If you advocate trusting the gov't with your care, then, having put your faith in a bureaucracy for such a personal and important aspect of your life, you cannot then complain that such a bureaucracy ACTS like a - BUREAUCRACY. ~faith, Timothy.
  4. I've worked for a VA Admin Hospital. I know you work there, now. Nevertheless. Ask a wide range of vets (not just your patients) what they think about the VA. You won't get an overwhelmingly enthusiastic answer. . . Thankfully, most of them have a CHOICE. A gov't mandated option is anti-choice. It's not about providing a better product at a superior price. Its about ensuring that Big Health, Inc., does NOT NEED your choice in selling it's product. (These businesses will not go away; they'll just take over - via superior lobbying.) Except now, you no longer have a choice. Halliburton, in charge of YOUR health care. Take it, or leave it. Gov't rationed health care is about those that would be in charge of the rationing. It has little to do and simply isn't in the best interests of - those that will be rationed from care as a result. (That would be you.) Not everybody is convinced that the VA is the model of care you suggest. I KNOW. I KNOW. President Bush's Administration vastly improved the care over what it was when I worked there, under Clinton. Still. (and WHAT IS THIS with you gaining on me in post counts? I take a little vacation from the computer . . . sheesh!) ~faith, Timothy.
  5. The system is much more equitable NOW when 86% of people have access to some form of insured care (with slightly more when you factor in that some have access to free or reduced cost clinics) and 100% of people have access to emergency care - than it will be when access to both routine AND emergency care is swamped. Imagine what it could be if the gov't got out of the way? I'll tell you what it would be: the absolute best mix of quality for price. Instead, the solution for gov't interference in your health care is - drumroll - MORE gov't interference in your health care. Amazing. So, because a black rotary dial phone from MA Bell is preferable to the risk of the market place, we should all trade in our cell phones and go back to the days of gov't domination over telecommunications. After all, EVERYBODY had a phone back then. If you stayed up really really late, the long distance rates would even go down . . . I don't doubt that the gov't could provide care for all. What I'm SAYING is that that care is a black rotary phone when you could have had a (non-gov't provided) blackberry cell phone. FOR THE SAME PRICE OR CHEAPER. As it stands, ERs are swamped NOW because of EMTALA and the concept that "it's free". Except. Nothing is free. The trade-off is long waits to see an ER doctor. Now. Take THAT concept, and double the number using the system (because, it's FREE!) and then apply it to EVERY aspect of health care. Add to that the fact that the gov't can't pay for the Medicare it is providing NOW - and so, add to that 20-30% routine cuts in funding. (Then add in even more draconian taxation to pay for it all.) THAT is what you will get. 100% of the people not getting access to adequate health care instead of 14% today. At least it will be "fair". A "fair" share in abysmal health care for ALL! Congress cannot repeal the laws of economics. Even if they want to do so. Even if they REALLY REALLY want to do so. Supply must balance demand. When demand is infinite, then supply MUST be infinite (an impossibility), or, rationed. I don't trust the fools in Washington to ration my ability to attain health care better than my ability to provide it for myself, if Washington were to leave me alone. Call me cynical, but faith is Washington is a form of derangement. But, to your main point: He who controls the purse strings, controls and owns the thing. There is no difference. What if we have the slaves do the work, and we'll just be the masters? ~faith, Timothy.
  6. Gov't rationed care is a horrible idea. These guys tanked the economy, social security is on the brink of failure and is only dwarfed by the coming financial wipeout of Medicare. And, we want to trust these people with MORE control over our lives? I think they've proven themselves to be stunning failures without giving them more to ruin. And don't even compare the gov't with Big Health, Inc. They are one and the same. Big Health, Inc. acts the way it does because its lobbiests ensure gov't protection for what they do. Did YOU pick your health care company? Or, did your employer, at the end of a gov't tax break? Hmmmmmmmm. I don't trust a politician more than I can throw them. They are all bought and paid for and I don't have the price for admission. They will make decisions, not in MY best interest, but in the best interest of the highest bidder/donor. A fair share in a dismal, gov't rationed outcome isn't very fair. It's all very nice until it's YOUR family member that dies on the wrong end of a waiting list. Can't be helped, it's not personal, you know. It's just actuarial. That said, Hutchison is leaving the Senate to run for Gov of Texas. AT least, that's what is widely predicted. I'm still mad at her for voting for the Sell-Out. Maybe she'll think twice about voting for the 850BN Great Rip-off. (I heard a rumor that rocker Ted Nugent might run for her seat.) ~faith, Timothy.

    Becoming an RN just for the paycheck

    I'm in it for the money. All true professionals are. That says NOTHING about my ability to care, or not to care. As should be. That isn't a consideration at the bargaining table - at least not one that would ever work to your advantage. So long as you give yourself reasons not to consider the bottom line, you give your employers reasons not to maximize that bottom line. I'm in it for the money. I'm not an angel and refuse to pretend to be one. Besides, I'm worth every penny. I'm in it for the money, and I want and deserve more. Much more. ~faith, Timothy.

    The ANA really doesn't like non-BSN Nurses

    And this probably ISN'T the thread for that old debate. Having said that, the ANA is the REASON why we haven't already set that standard at BSN. That standard will ultimately require that all stake-holders be at the table and be included. The ANA? The ANA kicked off this debate in 1965, with a slur: non-BSNs were merely 'technical' nurses. Until the ANA retracts its insult, this debate will never go anywhere. You can't marginalize and divide nurses and then expect to either represent them, or unite them in a concept like minimum entry. The ANA is the problem, not the solution. ~faith, Timothy.

    I Contracted HIV

    Not directed at the OP, but the risk of sero-conversion to HIV after needle stick injury from an HIV positive patient is extremely low: 0.3%. A good article on point from the NE Jrnl of Med: http://content.nejm.org/cgi/content/full/337/21/1485 "The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 percent, but the factors that influence this risk are not well understood." Specifically: http://www.heart-intl.net/HEART/030305/HIVandthehealthcare.htm As of 1996, out of 2042 needle exposures with HIV infected blood, 6 people were known to have sero-converted, for a rate of sero-conversion after direct exposure of 1/300, or 0.29% In the first cited article, by the NEJM: "After controlling for other factors associated with the risk of HIV transmission, our model indicated that the odds of HIV infection among health care workers who took zidovudine prophylactically after exposure were reduced by approximately 81 percent." That would further mediate the risk to less than 1/500. In the main, risk of HIV transmission from needle exposure is rare, and risk from non-needle exposure for health care workers is even MORE rare as HIV does not survive very well outside the body: http://www.redcross.org/services/hss/tips/december/answer98.html "Although HIV (the virus that causes AIDS) can live outside the body for a few hours in certain body fluids, it cannot function when dry." How common is HIV transmission to health care workers in the workplace? Very rare. HIV was first discovered in 1981. 20 yrs later, as of 2001, there were 57 total documented cases of seroconversion by health care workers as a result of job related exposure, according to the CDC: http://www.cdc.gov/hiv/resources/factsheets/hcwprev.htm "As of December 2001, occupational exposure to HIV has resulted in 57 documented cases of HIV seroconversion among healthcare personnel (HCP) in the United States." (The 2nd article I linked suggested that about 40% of those exposures were nurses, about 25% lab techs, and the rest distributed throughout the rest of health care, generally. So, about 22-24 total sero-conversions by workplace exposures to nurses, in 20 yrs.) Can it happen? Of course: this is a thread on point. But. ~24 nurses out of >3 million nurses over a 20 yr time span equals: rare. THE POINT is that such a transmission is very rare. I'm not commenting about the OP. My point is aimed at all those other new (and not new) nurses and students: be careful, but there is no need to be paranoid. ~faith, Timothy.

    Ten Reasons Why American Health Care Is so Bad

    American health care is the best in the world. America doesn't have a health care provision problem. We have a health care FINANCING problem. There IS a difference. And. It's a big one. ~faith, Timothy.

    Is it true that a BSN will be mandatory soon?

    Won't happen anytime soon. The ANA divided nursing on this issue from the very start. Until they repair the breach (their "technical" insult), no sale. This debate is 43 yrs old. The ANA first mentioned this in 1965. In another decade, it'll simply be 53 yrs old and no closer to being resolved. The only way to go forward is NOT with legislation but with a consensus that brings all stakeholders to the table. Let me know when the ANA and the BSN programs decide that they actually want to make changes in this area instead of insult their peers. I've been patiently waiting. It's a good idea relentlessly pursued for the wrong reasons and failure has been the only consistent payoff. (Shhhhhh!: When the ANA and the Ivory Tower are ready to respect their peers, I know how to make this happen.) ~faith, Timothy.
  12. This idea started in 1965. 43 yrs later, and we are no closer to minimum entry. Nobody misunderstands what a 'grandfather' clause is - but many doubt its effectiveness. Suppose BSN became the standard, with a grandfather. With every passing year, there would be fewer and fewer ADNs and Diplomas that hold the title, RN. At what point can the BSNs, that now represent 60%, 65%, 70%, 75% of RNs end the grandfather and deny status to ADNs? Here's the thing. The 1965 call by the ANA to move to BSN included an insult: that ADNs were mere 'technical' nurses, as opposed to professional ones. Until the ANA retracts that insult, this issue is a dead issue. There will be no minimum 'entry to practice' until all stakeholders are brought to the table. We'll "grandfather" your concerns is not the same as taking them into account. I'm not saying that BSN isn't a good idea. I'm saying that it will never occur on the back of an insult and a promise of a grandfather. The 2 contradict each other. So long as the insult stands, why should I believe the grandfather clause? There you go. 43 yrs from NOW, we will STILL be debating entry to practice UNLESS all parties are brought to the table and included. And no State legislature is going out on a limb on BSN standard again. ND was a disaster. It proved that no State can be an island in this matter. If nursing wants BSN, we'll have to do it ourselves. That COULD happen, but again, not until we decide, as a group, to bring all stakeholders to the table and, for starters, retract the ANA insult. ~faith, Timothy.
  13. So. The key to nursing salaries improving is for nursing to take a higher view of what we are worth. And. That is happening. Every day, nurses "burn out" and leave the profession because they aren't getting paid enough to do the job they are doing, under the conditions in which they do those jobs. There are more nurses with licenses than there are nursing positions to be filled. But. There's a shortage when more than half a million nurses drop out of the profession. In order to combat that shortage: nurses must get paid more. As a profession, as we re-evaluate what we are worth, individually and collectively, the market will match. It has no choice. And nobody in government can, at the end of the day, tell YOU what YOU are worth. Only YOU can do that. ~faith, Timothy.
  14. The premise is wrong. You are worth 5 dollars an hour, as a Registered Nurse, if you accept that much in pay. No more. No less. Let me expand. Awhile back, there was an ongoing group of threads about paramedics coming into the ED and claims that they were going to be paid much more than the nurses working there. Here's the problem with that. Paramedics in the field do NOT get that much. IF it were the case that the money would be so much better in EDs, so many paramedics would apply for the job that the sheer glut of paramedics angling to work in the ED would bring pay back down to normal paramedic pay. Or. Take for example, nursing. Why do non-bedside jobs pay so much less? The answer has nothing to do with skill level. It's because so many more nurses WANT those jobs. The REASON why nobody pays 10 dollars/hr for their registered nurses IS that no RNs would work for that. The reason why McDonald's DOES pay 10/hr is because, there are people that WILL work for that amount of money. If our hospitals could pay us 5/hr, they would. They don't because, they can't. You get what you are worth and THAT is evidenced by what you are willing to take. No more. No less. The government cannot change that. All the gov't can do is tweak the system and the result of those tweakings will be that the system will shake out in unintended ways. This idea that you can egalitarianize labor so that outcomes match input is wrong. It's not wrong because its immoral; it's wrong because it just won't work. People will only accept for a job what it's worth for them to do that job. IF you make it so that some jobs aren't worth the effort to attain them, then, you will only make candidates for those jobs more scarce. Conversely, if you make other jobs worth MORE than they are intrinsically worth, then, you make those jobs more scarce as people over-fill them. For example, would YOU work as a unit clerk, if it paid as much as an RN? You might think that I'm being flippant, but, I'm not. This is an economic law. Congress can't change it, even if they wanted. People earn what they are worth. They do so because, by accepting the pay offered, they concur with the assessment. People that DON'T concur with the valuation of their worth: they better themselves to find jobs that DO match their evaluation, or, they make a go of it themselves. ~faith, Timothy.

    How are you going to Vote - US

    I was gonna say that I'm surprised how close the current results are at 55-45. Then I saw how few had voted so far. I'm sure higher turnout will move those numbers. . . ~Lifted UP, Timothy.

    Worst doctors orders ever received

    I once saw a doctor write, "Don't call unless SBP > 400" Same doc, on call: "Don't call me tonight, regardless." Of course, that doc was terminally ill at the time and didn't care much about his insurance premiums. . . ~faith, Timothy.