merilynRN

There is a big question in my mind also, about whether the N95 is enough.

It originated from The Happy Hospitalist blog, The Happy Hospitalist and it is available on a tee shirt... Got Ebola? Blame the Nurse! Shirt | Zazzle There are some other funny "protocols" up on the site besides that one =]

I am glad Dr. Gary Weinstein spoke out. What he says only makes sense. But was he referring to the PAPR (Powered Air Purifying Respirator) as the "full respiratory mask" he speaks of, or something else? "I think that these two nurses took care of a critically-ill patient at a time when he was not in control of his body fluids, and at a time when the recommendations from the CDC that we were following did not include the full respiratory mask. I don't know that. But that's what one person thinks – that's me. That's not based in science, it's not based on anything I saw. It's just trying to be thoughtful and think about the risks that we now know."

binary, the link you provided currently is not working.

This is why I was so annoyed when the nurse Jennifer Joseph was interviewed on CNN stating that Nina was in "full Hazmat suit" without differentiating that she was given the a "full suit" only after the diagnosis was confirmed. I think it's likely the contact occurred during those first couple of days. No one in the media has been pointing this out. I didn't see the interview of the Texas hospital admin admitting Nina only had the (inadequate) standard gear when she first received Duncan (Sept 28 - 30 prior to positive result), but the LA Times had revealed this several days ago, before the National Nurses United statement came out. "Did you see the interview today where the Texas hospital admin admitted that Nina, the first nurse to contract ebola from the pt, was given the gown/gloves/mask when she first received him, then AFTER he got a positive dx she was given the full haz-mat CDC PPE to wear? She WASN'T GIVEN THE RIGHT GEAR yet they kept saying it was a breach in protocol, that she must have contaminated herself when removing her PPE! " further confusing all the misinformation.

This is a good article below about the hazmat suit and training that should be required for nurses and others treating ebola patients. In the media, and between different people interviewed including Texas Presbyterian nurses as well as friend and former coworker of Ms. Pham, I am hearing very different things about the PPE actually used by nurses caring for Duncan. Of course there was a difference between what was used before confirmation of diagnosis and after as well. But people are speaking who do not really know from start to finish, leaving confusion. Personally I believe the suit with respirator that Doctors Without Borders use in Africa, should be what is required for nurses and others (RT, CNA, etc.) involved in direct care with close contact. Even if viral particles are aerosolized for a short time due to projectile vomiting or toilet flushing (which also aerosolizes particles), that may be long enough to transmit in an airborne manner. We need the respirators. I'm a Hazmat-Trained Hospital Worker: Here's What No One Is Telling You About Ebola by Abby Hoffman I'm a Hazmat-Trained Hospital Worker: Here's What No One Is Telling You About EbolaÂ*|Â*Abby Norman

Thank you for posting. Excellent information from the Center for Infectious Disease Research and Policy. And to think this commentary was posted back on September 17th! One would think it should have been widely disseminated information by public health officials by now. COMMENTARY: Health workers need optimal respiratory protection for Ebola | CIDRAP

This below, is exactly what bothered me so much when they were calling it a "breach in protocol" when there WAS NO PROTOCOL before the diagnosis, when there should have been preemptive protocol based on Duncan's travel history, exposure history and clinical symptoms. I don't know if the CDC was involved yet before the positive results came in, but the hospital's medical personnel should have been so much more preemptive and proactive that this was indeed ebola they were dealing with. I wonder how many others were involved in direct care during Sept 28 - 30. Second Ebola nurse traveled on plane with low-grade fever Frieden called the first days of Duncan's diagnosis and isolation at the hospital the highest risk moments. He pinpointed those days between October 28 through October 30. "These two health care workers both worked on those days and both had extensive contact with the patient when the patient had extensive production of bodily fluids because of vomiting and diarrhea," he said.

It would be that 13% that do not present with a fever, that present a screening challenge.

According to this LA Times article, it appears that health care personnel taking care of Mr. Duncan were not in full protective gear until results came in positive for ebola on Sept. 30 -- two days after admission. So there seems to have been a two-day period where they were caring for him in standard isolation gear (non-protective) while he was having "explosive diarrhea and projectile vomiting". Maybe this is why they are expecting more cases. The timeline: Texas healthcare worker tests positive for Ebola - LA Times — On Sept. 25, Duncan came to the ER complaining of a headache and abdominal pain. At one point, he registered a fever of 103 and told the hospital he had been in West Africa. He was sent home with a prescription for antibiotics. — His condition worsened dramatically, and on Sept. 28, he returned to the hospital in an ambulance shortly after 10 a.m. — Doctors admitted him and put him in isolation. By evening, he was projectile vomiting, having explosive diarrhea and running a temperature of 103.1 degrees. — On Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper. — On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach. — On Oct. 8, Duncan died.

According to this article it looks like the nurses taking care of Mr. Duncan were in standard isolation garb before the positive blood test came back. "Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach." No wonder they are expecting more health care workers to test positive. Projectile vomiting. Explosive diarrhea. Yet no hazmat suits until after the results came in. Texas healthcare worker tests positive for Ebola - LA Times — On Sept. 25, Duncan came to the ER complaining of a headache and abdominal pain. At one point, he registered a fever of 103 and told the hospital he had been in West Africa. He was sent home with a prescription for antibiotics. Texas Health Presbyterian Hospital Dallas, where Ebola patient Thomas Eric Duncan was treated, is shown. A healthcare worker who participated in his care has been diagnosed with the virus. (LM Otero / Associated Press) — His condition worsened dramatically, and on Sept. 28, he returned to the hospital in an ambulance shortly after 10 a.m. — Doctors admitted him and put him in isolation. By evening, he was projectile vomiting, having explosive diarrhea and running a temperature of 103.1 degrees. — On Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper. — On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach. — On Oct. 8, Duncan died.

http://www.latimes.com/nation/la-na-1012-ebola-fever-20141012-story.html#page=1 ​

More today, from the New York Times: (emphasis mine) "On Sept. 25, Mr. Duncan began complaining to Ms. Troh about chills, and she drove him to Texas Health Presbyterian Hospital, not far from her apartment. He arrived in the emergency room with a mild fever of 100.1 degrees and reported having abdominal pain for two days, a sharp headache and decreased urination, according to the hospital. When a nurse took his history, the hospital has reported, he said he had not been around anyone ill but had recently been in Africa. The nurse noted this, but doctors apparently failed to consider the possibility of Ebola for reasons that remain unclear. Mr. Duncan was sent home with antibiotics that were powerless to halt the progression of his virus" http://www.nytimes.com/2014/10/06/us/ebola-victim-went-from-liberian-war-to-a-fight-for-life.html

Hi, I had worked GYN and also Peds (Sloane Hospital for Women, and Babies Hospital) and got to know the managers & supervisors over time, including the L&D manager, sharing with her my interest in L&D. It was a foot in the door to work in associated areas first. Later on when a position came up I was hired and worked L&D for 5 years before eventually moving. You can try getting onto a GYN unit, and as time goes on get known and express your interest to those in Maternal/Child Health. Or, if in a smaller hospital, "clean" GYN surgical cases recover on the postpartum unit, and nurses are cross-trained to nursery, L&D and postpartum / GYN. Pursue your dream! I moved on into other areas of nursing later on, but it was wonderful having experienced what was then, my dream job. But I think the key is getting to know people internally and letting it be known that you are very interested in working in L&D.

well, well, well ... Presbyterian officials initially suggested that a nurse may have been at fault for failing to tell the emergency room doctor that Duncan had recently been in Liberia. Then hospital officials late Thursday blamed the miscommunication on a “flaw” in the hospital’s electronic records system. Friday, the hospital backtracked, saying that “there was no flaw” in its electronic health records system and that the ER doctor did have access to Duncan’s travel history. Hospital spokesman Wendell Watson said Saturday that the hospital was “looking into the entire chain of events,” but he declined to elaborate. quoted from article: Dallas hospital under fire as accounts of Ebola patient’s initial release change http://www.dallasnews.com/news/metro/20141004-dallas-hospital-under-fire-as-accounts-of-ebola-patients-initial-release-change.ece

Thanks so much big al ... this would confirm the need to do the daily's, as I have thought. I did attempt to PM you first, but it seems a poster needs to have a minimum of 15 posts before they can PM anyone. It would be helpful though, if possible. Thank you.

A nurse hired at camp this summer is an LPN. Does she require daily RN supervisory visits under PA law? We have done them based on the ACA requirement that an RN needs to be onsite daily, so I've been alternating daily visits with another RN during sessions the LPN is there. She is also new to camp nursing, having primarily worked in geriatrics, so I thought she might welcome an experienced camp nurse checking in with her to discuss situations. One year another nurse and I had done shifts rather than whole weeks, and we enjoyed discussing situations and issues together at turnover, pooling our combined knowledge and experience. I've noticed, however, this particular nurse does not like it when I show up even briefly (I do not take over) and becomes even more furious when the director has called me in for a second opinion on a situation. I actually dread going on these visits as she will not discuss issues with me so I can not get a good idea of what is going on, and find out about things through others later on. She also has what I call 'staff groupies' around her in the health center a good deal of the time. I know you are pretty familiar with nursing practice law regarding camp nursing and wonder if the daily visits truly are a requirement as I have thought. Thank you

Thank you for your response - no meandering I appreciated hearing your experience. Last year I had told them at the onset that I had another full time job and would not be available but would help train new health staff in the system etc. The nurse they ended up hiring did not want to hear anything from me so I bowed out. It turned out to be a disaster of a summer in the health center for them and she was fired. (No one had checked her creds and she was not an RN!!!) I came in later in the summer and it took a week to straighten out the mess (junk and food all over, no system) she had called 911 for things that were not 911 calls. Huge expense to the camp. So this year I was trying to save them from another such mess. Yet, there have been no more meetings (as there usually was with previous camp director) to discuss the health program and ongoing process of setting up the health center so I gave them a list of what I have done so far and what I will need to do. It is very frustrating that there is such poor communication. It's like pulling teeth to get things done, or like an 'intrusion' upon this assistant's day each time I try to get something done that will necessarily involve them (for funds for example). New director arrived last weekend but apparently still have to deal with the assistant as no meetings with the director yet. You are so right about 'thankless'. meri

Thank you, very helpful info. As of this time, we have 3 RNs who've worked the camp before willing to help out with a session or 2, but they still had not recruited any new nurses. This is 'scrape by' staffing. It is distressing to see year after year what a low priority they give to the health program and its staff. Thanks for your response. meri

Hi big al, I had a meeting with the assistant to the director as there is currently no director either, as of this time. This places the assistant in charge of finding an RN. He said they had an interested GN candidate that he was hopeful would take the position. I gave him the run down on legalities and such as we discussed in previous posts above. He said she was planning on taking her boards in May and thought she could be registered by late June (when camp starts). I have never heard of anyone getting it done that expiditiously--usually boards in June or July and results in Sept--but thought maybe things have changed with computerized systems now. I also told him he may need to put ads in local papers so they can attract PA licensed nurses who don't need to obtain the out of state permit. Well, I just contacted him again earlier this week--apparently the GN candidate backed out (maybe she couldn't realistically be registered in time, or maybe something else came up--he didn't say). He seemed a little defensive saying he's had other projects going on and hasn't really had time to devote to finding a nurse. He already knows, per my offer during the first meeting, that I will set up the health center, help orient health staff, and be present to help train and oversee the first couple of opening days, and closing days as well. However they will not be able to fall back on me for the rest of it, should they not come up with other nurses. If camp has to close, so be it. Maybe they need to learn this. I tried my best but apparently health center planning is still an 'afterthought'. How soon does your camp begin health center / infirmary planning?

Thanks Al, I'll share this info at the meeting tomorrow. Really, an experienced RN or LPN is what is needed. Appreciate your response. Do you have a link to the code? I'd like to print out that section for the camp. Meri

Continuous ONSITE presence vs. daily supervisory presence with continuous access by phone and availability of RN come down as needed.

I had worked a number of years at a nearby summer residential camp while maintaining per diem employment at my hospital, but am now F/T and more limited in time I can put in at camp. The various camp director's over the years have had difficulty finding RN's, even though they've posted ads through ACA. I've always tried to impress upon them to do their RN search EARLY, as RN's schedules are done months in advance. (It's, uh, not the same as hiring high school and college kids for their summer staff!) But once again, I went down there earlier this year to see how they're doing with RN hiring (anticipating the call from them later than convenient) and they haven't hired any RN's, but said they know of graduating nurse(s) who are interested, and just got an email only this week, to have a meeting at camp later this week re securing nurse(s) for camp. My question is: Does RN supervision of a GN at camp require continuous presence of the RN at camp? or just daily, as PA law requires an RN be onsite daily, not 24/7, though 24/7 is of course best and safest practice when possible. Also, if the GN errs or neglects to involve the RN (or camp director) in an important judgement decision negatively impacting a camper, who is responsible? My husband an I are both experienced RN's both currently working ED, and may be willing (setting out certain ground rules regarding health center operations) to share supervisory responsibilities. I'm doing some initial research on this first, hence my question. Neither of us can be there 24/7, but would be involved with doing initial health center set up, orientation new health staff, and (one of us) coming by daily to oversee. Any thoughts on this appreciated. What say ye. Workable? or bad idea? Merilyn

I am looking into it.

Am looking into it.