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traumaRUs MSN, APRN, CNS

Nephrology, Cardiology, ER, ICU

Content by traumaRUs

  1. Here in the US, there are long delays for organ transplants: for kidneys, its not unusual to wait 5 years as dialysis is an alternative. If you need a heart or liver transplant it is based on your overall condition as well as the severity of need - in other words, how quickly the organ is failing. However, in China the wait for a transplant might only be months, weeks or even days. Why???? This story comes out of China recently: "Official organ donations may come from people who voluntarily choose to donate their organs after death, or people who sell organs such as kidneys. But in June, the China Tribunal, an independent organization created to investigate the alleged crimes, found that some prisoners have their organs forcefully harvested—sometimes while they’re still alive. Human rights lawyers estimate 65,000 Falun Gong practitioners have been killed for their organs since 2001, and members of other religious and ethnic minorities, including Uyghurs, Tibetans, and some Christian sects, have suffered the same fate." According to a recent NBC news story, "Some of the more than 1.5 million detainees in Chinese prison camps are being killed for their organs to serve a booming transplant trade that is worth some $1 billion a year, concluded the China Tribunal, an independent body tasked with investigating organ harvesting from prisoners of conscience in the authoritarian state." The International Coalition to End Transplant Abuse in China made the above observation. There have been accusations over the years of unethical transplant practices in China. There are multiple academic and news reports of unwilling living donors mostly prisoners who were selected to be organ donors. See references for links. However, China continues to state that they stopped the practice of utilizing prisoners as unwilling organ donors in 2015. So, what about the recipients of these organs? From the NY Post, "Experts estimate that between 60,000 and 100,000 organs are transplanted annually in China. Multiply that number times the cost of a liver transplant ($170,000) or a kidney transplant ($130,000), and the result is an eye-popping $10 billion to 20 billion." The article goes on to state that most "transplant tourists" don't ask or care to know where their organs come from, only that they get their transplant. Are some of these recipients from the US? Well, there are no published statistics of WHO receives these forced donations. China has faced scrutiny in the past few years for this practice. However, the transplant assembly line seems to continue. Recently the UN has been urged to investigate this practice. "A senior lawyer called on Tuesday for the top United Nations human rights body to investigate evidence that China is murdering members of the Falun Gong spiritual group and harvesting their organs for transplant. Hamid Sabi called for urgent action as he presented the findings of the China Tribunal, an independent panel set up to examine the issue, which concluded in June that China’s organ harvesting amounted to crimes against humanity." In the US, we do utilize living donors for kidneys and partial liver transplants. However, transplantation from non-volunteer or incarcerated prisoners would be abhorrent to all. Ethically, in the US, we do not utilize prisoners for organ donations as they are considered an at-risk population in that they have limited ability to refuse. Intentionally executing people for their donors seems like something out of a horror movie for most of us. What are your thoughts? What about the medical personnel who take part in these operations? References: Compliance with ethical standards in the reporting of donor sources and ethics review in peer-reviewed publications involving organ transplantation in China: a scoping review Transplant Medicine in China: Need for Transparency and International Scrutiny Remains Unethical Surgery
  2. Registered nurses across the US will hold a one-day strike of their own demanding higher wages and better working conditions. Over 6,500 registered nurses in hospitals in California, Arizona, Florida, and Illinois will strike on September 20 demanding higher wages and better working conditions. The strike will mark the first-ever nurse strike in Arizona, and the first hospital registered nurse strike in Florida's history. Nurses who are part of the National Nurses United union are asking for better nurse retention and nurse-to-patient ratios. Most nurses who will be participating in the strike are employed with Tenet Healthcare, a multinational health-services company that operates 65 hospitals and 500 other healthcare facilities. Nurses told Business Insider they have been negotiating with Tenet for a better contract for over a year and haven't received the concessions they demand. The union said that nurses have worked without a contract for two years in Arizona and under expired contracts for several months in California and Florida. Nurses also want lower nurse-patient ratios to improve the quality of patient care and prevent nurse burnout. Some hospitals are assigning twice the number of patients to nurses that research recommends. 2,200 University of Chicago Medical Center Nurses Walk Off the Job Nurses working at the University of Chicago Medical Center plan to strike for five days in an effort to bring additional attention to their continuing struggle to get better nurse-patient ratios. About 2,200 nurses are expected to strike. Wow, I'm in Illinois and had not heard this. Anyone participating? What's your facility's take on this? https://www.businessinsider.com/nurses-to-go-on-strike-for-better-patient-ratios-2019-9 So here's an update: From Illinois: CHICAGO (AP) — "Nurses at University of Chicago Medical Center are holding a one-day strike following what they call a breakdown of contract negotiations between their union and the hospital. The walkout began Friday morning, with nurses marching and chanting outside the hospital. The 618-bed hospital prepared for a walkout by the about 2,200 nurses by diverting ambulances and moving patients. Although the nurses say the strike will last one day, hospital officials have told the nurses to stay away until Wednesday because temporary nurses have been contracted. The walkout began Friday morning, with nurses marching and chanting outside the hospital. The 618-bed hospital prepared for a walkout by the about 2,200 nurses by diverting ambulances and moving patients. Although the nurses say the strike will last one day, hospital officials have told the nurses to stay away until Wednesday because temporary nurses have been contracted." https://qctimes.com/news/state-and-regional/illinois/nurses-hold--day-strike-at-university-of-chicago-hospital/article_fa1892c8-2311-5c36-aefd-2b190bba2d14.html From Florida: HIALEAH, Fla. (AP) — "Registered nurses staged a one-day strike against Tenet Health hospitals in Florida, California and Arizona on Friday, demanding better working conditions and higher wages as the nation's labor movement has begun flexing muscles weakened by decades of declining membership amid business and government attacks. About 6,500 National Nurses United members walked out at 12 Tenet facilities after working toward a first contract for a year in Arizona and under expired contracts for months in California and Florida, the union said. They plan to resume working Saturday. Members also passed out leaflets in Texas, where contracts at two Tenet hospitals in El Paso expire later this year." https://www.stltoday.com/business/national-and-international/nurses-staging--day-strike-at-hospitals-in-states/article_b86900c9-5800-564b-bdbe-1af836fcd8e7.html
  3. traumaRUs

    NP vs FNP

    Moved to advanced practice forum
  4. traumaRUs

    Why Nurses Should Join the Gig Economy Right Now

    You should make your time count. Totally agree. However the reality of life is that most of will work a long time. Why not do something you enjoy? With decreasing pensions and 401k’s and the fact that you do t want to outlive your retirement options are always a good idea to consider. that’s all this is - an option
  5. traumaRUs

    Happy Veterans Day 2019

    I just wanted to wish all my fellow military veterans a wonderful, peaceful day. This is a day to honor all veterans and active-duty military. Many businesses honor us with discounts today. However, more importantly, is our country recognizing our commitment and sacrifices. So many veterans have returned from military service disabled either physically or mentally. allnurses.com salutes our veterans! Veteran's Discounts Thank you for your service to our great country!
  6. traumaRUs

    What's Happening at the VA Hospitals?

    There is a recent article from the Washington Post about several suspicious deaths at a Veterans Administration (VA) Hospital in West Virginia: "An investigation into the suspicious deaths of 11 veterans, who may have been given deadly insulin injections at a West Virginia VA Medical Center, is reportedly focusing on a nursing assistant who worked the overnight shift and had “improper access” to a supply room. The woman, whose name was withheld by the Washington Post, was fired from the facility last year and has not been charged. Seven veterans’ bodies have been exhumed as part of the homicide probe, which has raised troubling questions about the Department of Veterans Affairs’ health-care system. “You mean to tell me that for nine months you didn’t know what was going on in your hospital?” Sen. Joe Manchin told the Post. “Either you didn’t care, or there was a lack of competency.” In one instance, a non-diabetic man had a progressively decreasing blood glucose, without known cause, and died shortly thereafter. This is just the latest in a string of issues at various VA Hospitals: August, 2019 a former VA pathologist in Fayetteville, Ark., was indicted on three charges of manslaughter after officials say he misdiagnosed thousands of patients while using drugs or alcohol. In Beckley, W.Va., a former VA doctor is under investigation for sexually assaulting as many as 20 of his male patients, according to two people familiar with the case. Should the VA Hospitals be overhauled? There are many other issues at VA hospitals all over the US. From USA Today: At the Loma Linda VA Hospital the average wait time in the ED is >7 hours Almost all VA Hospital fare worse than their civilian counterparts in patient satisfaction surveys In 2014, the Phoenix VA came under scrutiny when it was reported that vets were dying while waiting for appointments. Equipment sterilization issues in a Washington VA Hospital How should this be addressed? The VA says they care for elderly, very ill, sometimes immunocompromised patients. In June 2019 the VA published information about the new Veterans Community Care Program and here are some of the details: Veterans can work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. Veterans may elect to receive care in the community if they meet any of the following six eligibility criteria: A Veteran needs a service not available at any VA medical facility. A Veteran lives in a U.S. state or territory without a full-service VA medical facility. Specifically, this would apply to Veterans living in Alaska, Hawaii, New Hampshire and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands and the U.S. Virgin Islands. A Veteran qualifies under the “grandfather” provision related to distance eligibility under the Veterans Choice Program. Is this enough? It's a start for sure. It is yet to be seen if this initiative will improve care to our vets. As a veteran do you trust the care at the VA? Do you use the VA?
  7. The American Association of Critical-Care Nurses (AACN) first coined the term “progressive care nursing” in 2001. As all areas of nursing have evolved, so has progressive care. AACN now offers certification for this specialty. There are core competencies that form the basis of education and training of progressive care nurses. Mary Watts, BSN, RN, allnurses.com’s Content and Community Director recently interviewed Linda Bay, DNP, RN, ACNS-BC, PCCN-K, CCRN-K and discussed progressive care nursing. Dr. Bay is a Clinical Nurse Specialist at Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin. She recently presented on the topic Why Building a Strong Foundation to Care for the Progressive Care Patient is Important. Mary asked how Dr. Bay got involved in progressive care nursing and she stated, “I wanted to reinvent myself. I spent 10 years as an acute care CNS.” She added that she wanted to have a different type of impact on patient care. Goal They discussed that the goal of progressive care is to keep patients out of the ICU. Typical patients found in a progressive care unit include a patient with respiratory distress who needs a higher flow of oxygen or more intensive monitoring. These types of units also care for patients with sepsis who might need simple hemodynamic monitoring in an effort to avoid an ICU admission. It may seem like these units care for a wide variety of patients. However, in reality, they care for patients whose commonality is the need for a higher level of care than the usual medical-surgical unit. Nurse/Patient Ratios They also talked about nurse/patient ratios and Dr. Bay said, “this should always be what the patient needs. Hopefully, not more than one nurse to three patients.” Mary then asked if the need for progressive care nursing was increasing. Dr. Bay agreed and stated that there are certain factors in our country that make progressive care a growing specialty: Older age of the patient More comorbidities Technology that is allowing patients to live longer with chronic illness Progressive care costs less than ICU level of care Adds another tier of care to the hospitalized patient Next, they talked about the “identity crisis” that these types of units experience. Different hospital systems refer to these units by many different names: Progressive Care Units Step-Down Units Telemetry Units Direct Observation Unit Clinical Decision Unit Intermediate Care Unit This results in confusion among patients, visitors, and even staff. When a nurse applies for a job at a particular hospital, it is helpful to have an understanding of the unit. On a related noted, Dr. Bay indicated that a Progressive Care Unit is a good place for new grads, “I believe nurses need these skills. Assessment is the key and this is a nice bridge to an ICU.” Here is the complete interview.
  8. Nancy Blake, PhD, RN, CCRN-K, NEA-BC, NHDP-BC, FAAN has been at the forefront of healthy work environments since its inception. She has been very involved at both the national and local levels. Mary Watts, BSN, RN, allnurses.com’s Content and Community Director was fortunate to visit with her recently. There have been research studies and several papers published that state improving communication is key. What Defines a Healthy Work Environment? Hospitals recognize that a healthy work environment encompasses six points: Communication - between all levels in the facility, from the Chief Nursing Officer to the transporters to housekeeping to dietary Collaboration - among all teams in the hospitals Staffing - adequate and individualized staffing matrixes Effective decision making - researching the problem and bringing a variety of solutions to the table for discussion Authentic leadership - managers and leaders who come to the bedside to talk to staff Meaningful recognition - for all members of the team Safe Staffing Those are the primary elements. Nancy Blake then honed in on safe staffing. Acuity tools need to be used to ensure the experience level of the nurse as well as their training matches the patient acuity. “Also ensuring nursing competency is very important,” she continued. How is the Safe Number of Nurses Determined? She went on to state there are many different factors to consider when using an acuity tool. This involves making sure you have the right numbers for the right patient acuity. Patient acuity means making sure you have the right number of patients to the right nurse. The nurse needs the skill set to care for a particular patient as it relates to their medical condition. There are times where a patient needs two or three nurses. “It's really important that nurses get refreshed during their shift - take their breaks.” Staffing is not a one-size-fits-all matrix. Even in an ICU, patient acuity must be taken into account. “I’m not a fan of ratios, it needs to be individualized.” “Actual acuity depends on the patient.” What Can Nurses Do to Improve the Work Environment? They next discussed what nurses can do to improve the care situation: Have a positive attitude that the situation can be changed. Provide feedback to administration regarding concerns. Talk with your manager and then go up the chain of command if needed. Be a team player. Important to realize that you are not alone - you are part of a group. For managers - please listen to the bedside nurses. Help them to succeed and ultimately provide the care your patients need. Realize that you need to consider many factors when determining what nurse or nurses are taking care of which patient. How does your facility work to provide you with a safe work environment? What could be done to improve the situation? Do you feel comfortable going to your leadership team to try to find solutions? Here is the complete interview: References: Programs that Support a Healthy Work Environment The Healthy Work Environment Standards, Ten Years Later Appropriate Staffing for a Healthy Work Environment
  9. traumaRUs

    Webcams in Nursing Homes?

    What happens when your parents get older and can no longer care for themselves? What happens if a catastrophic event occurs? They fall, break a hip and can't go back to their previous living arrangement? Yikes! What do you do? Okay, so you have decided or already have a family member living at a nursing home. You've looked at several nursing homes and chosen one and have moved in. How do you make sure that they are safe even when you can't be there? Families are resorting to the use of webcams to watch when they can't be present. Here's a story from Minnesota about one women's fight to ensure that she KNEW what was going on with her Mom. When her Mother developed a blister that no one knew about and when she saw a puddle of urine below her Mom's wheelchair, the daughter took action and installed a webcam in her room. "To her surprise, staff at the nursing home objected — even covering the camera with a towel on some occasions or unplugging it. Eventually the family filed a complaint with the Minnesota Department of Health, and even though the home said it tried to resolve the dispute, the agency last week issued a far-reaching ruling in favor of the family. The maltreatment finding is significant because it is considered the first of its kind to affirm, in clear language, the right of a Minnesota senior home resident to use a camera in a private room without fear of harassment." Other families in Minnesota report they have faced intimidation and objections from nursing home staff when webcams are installed. "State law is murky on the matter, even as hidden camera footage has become increasingly useful for law enforcement officers and regulators investigating allegations of criminal abuse." In one instance the resident was asked each time a staff member came into the room to turn off the webcam. However, the resident made it clear that it made her feel safe and she declined to deactivate it. They would then state to her that they would have to move her to a different room. State investigators found that after the webcam was installed, staff entered her room less often and engages in less conversation when compared to before the camera was installed. So, is this a violation of staff rights? Apparently not as the state sided with the family. What if this is a semi-private room and a roommate is accidentally filmed? What rights do they have? Why do families feel the need to install webcams? Would more staffing and more open and honest communication resolve issues before this became necessary? According to the National Center on Elder Abuse; "As of 2017, Illinois, New Mexico, Oklahoma, Texas, and Washington have laws that permit the installation of cameras in residents’ rooms, if the resident and roommate have consented. Each state law addresses issues including consent, and who can provide it; notice requirements, including who must be notified of the camera in use and placement of notices; assumption of costs associated with the cameras; penalties for obstruction or tampering with the cameras; and access to the recordings. While not having a law in place, Maryland has issued guidelines for the use of cameras in nursing home residents’ rooms; and New Jersey’s Office of Attorney General will loan camera equipment to families who want to monitor their loved one’s care." Do you have experience with webcams in healthcare settings? As staff? As a concerned family member?
  10. The Emergency Nurses Association's Annual Conference was held in Austin, Texas recently. With almost 200 presentations, the 3800 attendees had the opportunity to learn much and network among colleagues. One of the interesting presentations involved complications of the legalization of recreational marijuana. The presenter was Lisa Wolf, PhD, RN, CEN, FAEN, ENA's Director of Emergency Nursing Research. allnurses.com was able to interview Dr Wolf. First, we asked what types of complaints do you think will be more commonly seen in the ED due to legalization of recreational marijuana? Hyperemesis syndromes - one of these is cannabinoid hyperemesis syndrome (CHS) which according to Cedars-Sinai hospital is a condition that leads to repeated and severe bouts of vomiting. It is rare and only occurs in daily long-term users of marijuana Pediatric ingestions of edibles (brownies, cookies, and gummies) - According to a Journal of Pediatrics article, "Unintentional cannabis ingestion by children is a serious public health concern and is well-documented in numerous studies and case reports. Clinicians should consider cannabis toxicity in any child with sudden onset of lethargy or ataxia" Geriatric ingestions can also result in a myriad of issues; Acute asthma exacerbation Pneumomediastinum and pneumothorax suggested by tachypnea, chest pain, and subcutaneous emphysemas caused by deep inhalation with breathholding Occasionally angina and myocardial infarction We discussed the possible increase in MVAs associated with the legalization of recreational marijuana? Dr Wolf stated that this would be difficult to discern as "edibles have a delayed onset of effect, and people may misjudge." Drugged driving is being addressed by state legislatures; "Detection of marijuana in drivers involved in traffic crashes has become increasingly common. According to the National Highway Traffic Safety Administration, 12.6 percent of weekend nighttime drivers in 2013-2014 tested positive for tetrahydrocannabinol (THC), the component that gives marijuana its psychological effects, compared to 8.6 percent in 2007." Some of the first states to legalize recreational marijuana are on the forefront of developing tests to determine impairment: "In Colorado, the first state to legalize marijuana use, the Colorado State Patrol (CSP) includes specialized drug recognition officers. Any driver arrested after a trooper observes signs of impairment is given a blood test. “When driving a motor vehicle in Colorado, any driver has given their consent to submitting to a chemical test if they are presumed to be under the influence of drugs or alcohol,” Sgt. Rob Madden, a CSP representative, told Healthline. “Drivers can refuse a test, but that leads to an immediate revocation of their driving privileges.” Madden also noted that the CSP is entering the final phase of testing of new “oral fluid” devices. California, where the recreational use of pot became legal on January 1, also has specialized drug recognition officers and rules stipulating drivers arrested for driving under the influence are required to take a blood test if marijuana is the suspected intoxicant. That suspicion is formed during a 12-step roadside evaluation process that includes some familiar elements — walking in a straight line, standing on one foot, touching fingers to nose — as well as checking pulse rates at three different points in the process and checking pupil size in ambient light, near-total darkness, and direct light." We then shifted to what ED complaints are being seen in states where there is legalized recreational marijuana. Dr Wolf does live in a state, Massachusetts which has legalized recreational marijuana and she reports the most common complaint they see is hyperemesis. As more states move to the legalization of marijuana, I asked if she had any tips for those EDs in states where recreational marijuana will soon be legalized to prepare for this suspected onslaught? Her comments included these tips: Educate the ED staff Push for good community education in the same way we educate about alcohol Access protocols for managing cannabinoid hyperemesis (Colorado has some good ones) Thank you Dr Wolf and ENA for facilitating this interview. Has legalized recreational marijuana impacted your ED? Please share.
  11. traumaRUs

    Most important thing to look for in training/school

    Moved to SRNA forum
  12. traumaRUs

    RN. BSN

    We are going to need some more info - what kind of experience do you currently have? You need to choose a specialty in order to decide on NP track?? FNP, ANP, ACNP??? Moved to student NP
  13. traumaRUs

    What should I do?

    Moved to student NP forum - congrats
  14. Many people in the US have some degree of renal impairment. The Centers for Disease Control (CDC) estimates that 15% or 37% of adults have chronic kidney disease (CKD). It is the 9th leading cause of death in the US. Here are some more sobering statistics: CKD is more common in people aged 65 years or older (38%) than in people aged 45–64 years (13%) or 18–44 years (7%). CKD is more common in women (15%) than men (12%). CKD is more common in non-Hispanic blacks (16%) than in non-Hispanic whites (13%) or non-Hispanic Asians (12%). About 14% of Hispanics have CKD. What Are The 2 Main Causes Of All-Renal Disease? We know the two main causes of all-renal disease are hypertension and diabetes. Unfortunately, both diseases can go unnoticed for many years before a diagnosis is made and treatment started. By then, sometimes the damage is already done. And as CKD advances, more complications occur: Anemia or low red blood cell count (can cause fatigue and weakness). Low calcium levels and high phosphorus levels in the blood (can cause bone problems). High potassium levels in the blood (can cause an irregular or abnormal heartbeat). Loss of appetite or nausea. Extra fluid in the body (can cause high blood pressure, swelling in the legs, or shortness of breath). Infections or a weakened immune system Depression. In reaction to this growing epidemic, Presidential Donald Trump signed an Executive Order outlining concrete steps that the US is going to take in order to reduce the number of patients with CKD. This mandate will also offer more choices for patients who progress to end-stage renal disease (ESRD) and must then rely on dialysis or a transplant to live. Some of the points include: Preventing kidney disease through improved diagnosis and treatment of underlying conditions Increase affordable treatment options and provide education for patients and encourage the development of artificial kidneys Increase access to kidney transplant by modernizing the transplant system and updating counterproductive regulations How Will We Reduce The Number Of Patients With Chronic Kidney Disease (CKD)? And how will all of this get accomplished? There are multiple steps in this process and it isn't expected to be a quick solution to a growing problem. Medicare will be testing payment options to increase preventative care and the use of home dialysis modalities and transplants The President is enacting Congress to increase research and development of artificial kidneys Streamline and expedite the matching of kidneys for transplants So had does this Executive Order affect US - those caring for the renal patient on a daily basis? For this, I went to the Renal Physicians Association for their review. A kidney disease awareness campaign is to be launched by the Health and Human Services (HHS) Department within 120 days (mid-November). The Secretary of HHS must develop within 30 days a model which would “broaden the range of care and Medicare payment options available to potential participants with a focus on delaying or preventing the onset of kidney failure, preventing unnecessary hospitalizations, and increasing the rate of transplants. It should aim at achieving these outcomes by creating incentives to provide care for Medicare beneficiaries who have advanced stages of kidney disease but who are not yet on dialysis." (Quote from Executive Order) Create payor incentives for home therapy modalities The Food and Drug Administration (FDA) must consider requests for premarket approval of wearable or implantable artificial kidneys and to produce a strategy for encouraging innovation in new therapies HHS is directed to revise within 120 days Organ Procurement Organization (OPO) rules and evaluation metrics to establish more transparent, reliable, and enforceable objective metrics for evaluating an OPO's performance. Additionally, within 180 days, the Secretary is required to streamline and expedite the process of kidney matching and delivery to reduce the discard rate Formulate plans to provide financial assistance for living organ donors, specifically stating “the regulation should expand the definition of allowable costs that can be reimbursed under the Reimbursement of Travel and Subsistence Expenses Incurred Toward Living Organ Donation program, raise the limit on the income of donors eligible for reimbursement under the program, allow reimbursement for lost wage expenses, and provide for reimbursement of child-care and elder-care expenses.” (Quote from Executive Order) There will be incentives for nephrology practices as well as for dialysis providers to meet these deadlines. However, this is a formidable task. This will benefit nurses too. Nephrology nurses and advanced practice providers can expect new roles to come out of this initiative. Some of these might include: Expanded nurse educator roles Advanced practice providers will expand to providing more in-office CKD and ESRD education as well as transitional care visits More nurses needed for home modality teaching and surveillance Opportunities for pre- and post-transplant patient care will increase What are your thoughts? Do you think the timeline is realistic?
  15. traumaRUs

    Serial Killers Who are Nurses!

    The Emergency Nurses Association (ENA) recently held its annual conference in Austin, Texas. Nearly 3,800 attendees chose from almost 200 presentations as they learned about the latest in emergency health, continued their education through hands-on clinical simulations and networked with their peers from around the world. One of the most popular presentations was Death Row: What We Can Learn from Nurse Serial Killers! by Gina Carbino, BSN, RN, CEN, CPEN, TCRN, CTRN, CFRN CCRN, PCCN, SANE-A. allnurses.com staff were fortunate to interview the presenter. We initially asked what piqued your interest in this topic? Gina replied, "I have always been fascinated with toxicology. I started to research drugs that are most common to overdose on - potassium, digoxin, and beta-blockers. I was going to do a lecture on the drugs and their reversal agents. I ran across a case of a nurse serial killer that used beta-blockers to kill his patients. I was hooked! It is such a fascinating topic. With the new movie on Ted Bundy and Mindhunter series on Netflix, I thought it was great time to learn more about this phenomenon. I have spent the last two years researching nurse serial killers." Though serial killers are not common, hence the interest, we asked about common characteristics among nurses who were serial killers. Gina's research showed that almost all 27 nurse serial killers have traits in common. They all use only a handful of drugs: insulin, potassium, beta-blockers, and epinephrine. Transferred jobs/hospitals frequently. All seemed to be present during code situations. One of them (Neils Hogel) was called "resuscitation rambo" by his coworkers. All of these serial killers were eventually caught. However, in several cases, it took years to bring them to justice. What evidence led to the investigation of suspicious deaths? Gina responded, "In almost all cases there was a spike in mortality rate in the hospital. In one case, in Indiana, the annual mortality rate quadrupled. In pediatric cases, the nurses and pediatricians found the events suspicious. Things just didn't add up." What commonalities exist in this segment? Is there a common mental illness diagnosis among nurse serial killers? Beverley Allitt, for instance, was diagnosed with Munchhausen. A majority suffered childhood trauma. Charles Cullen was a stalker that broke into his coworker's house while she and her child were asleep. He suffered from depression and multiple suicide attempts. Also, a majority never seemed to "fit in." Beverley Allitt was found rubbing feces on the wall during one of her nursing clinical rotations. She flunked out of her first attempt at nursing school related to these types of issues. She later went on to murder 4 children and attempt murder in 6 more. She was taken on a temporary six-month contract at the chronically understaffed Grantham and Kesteven Hospital in Lincolnshire in 1991, where she began work in Children's Ward 4. There were only two trained nurses on the day-shift and one for nights when she started, which might explain how her violent, attention-seeking behavior went undetected for as long as it did. Gina went on to explain, "I think it is important to note that that nurse serial killers are extremely rare. They are only a fraction of one percent of nurses. Nurses as a whole are extremely dedicated, ethical, and trustworthy group of professionals." allnurses.com thanks Gina Carbino and ENA for their assistance
  16. traumaRUs

    To retake chemistry for CRNA school?

    Moved to SRNA forum.
  17. traumaRUs

    RN --> CRNA or Law School?

    IMHO life is too short to do something you aren't passionate about. What do you LIKE to do? Have you shadowed or talked with any RN, JDs? That might be a starting point.
  18. traumaRUs

    Apple Watch - Why I Love It!

    First a disclaimer: I am an Apple-geek. I eagerly await those Wednesday keynote addresses, wondering what will they come up with next. I currently own two Macbook Air computers,one iPad Mini, an iPhone 6+ and now an Apple watch (sport edition). I'm a working APRN who sees patients in chronic hemodialysis units, office setting and inpatient settings. I frequently work with immunocompromised individuals and wash my hands VERY frequently. Personally I do not care for the brand of hand sanitizer that one of my facilities use so I do wash my hands even more when I see patients there. For me, I use the watch to receive text messages and it is great for this. When I am with patients I try not to interrupt them. It is so easy when I get a little notification (which is customizable) to either decide to read the text or quickly place my hand over it to hide it. This saves me a lot of time and many times my patients don't even realize that I've received a text. Since my practice utilizes a service for encrypted text messaging, I do need to go to my phone to retrieve it but my watch gives me a heads up which I appreciate. So...here goes my review of the Apple watch: I purchased my watch at an Apple store However, it is now available at Best Buy and other select stores. You MUST have an iPhone 5 and newer running at least iOS 8 in order to connect to the Apple watch. There are two size options: 38mm and 42mm. While 4mm doesn't seem like much, I would recommend the larger watch. Even for someone who is very petite (as one of the Apple store employees was ) the bigger watch is more functional. The Apple watch doesn't have internet capability You must have an iPhone in order to utilize the full functionality. One of the coolest features is the ability to customize your watch face. There are multiple options with each one of them offering multiple options. I chose the simple but very clear to view watch face with second hand. Built In Apps Work-Out which has multiple options including timing an indoor walk, outdoor walk, elliptical, running, cycling, rowing and "other" so this is customizable. Activity which is a visual guide to your activity during the day. Colorful circles enlarge as you increase your activity throughout the day. World clock - options for time other then where you live (self-explanatory). Maps - I didn't find this particular app useful as the screen is pretty small. Since I live in the country unless you can see a wide area (like 25-50 miles) then its not very useful for me. However, I can see that if you are in a more urban area, this would be useful. There is a camera option but its really NOT a camera - it simply displays photos from your iPhone. However, it CAN be used as a remote for your iPhone camera so you can click your watch and take a pic on the camera. Alarms - self-explanatory. Stocks - which you can customize as to which stocks appear and the data regarding those stocks. Timers - various timers as well as stop-watch capability. Passbook which is easily one of my favorite apps. This connects you to Apple Pay which you can use to auto-pay by holding up your watch to the Apple Pay reader and clicking twice. These are most of the apps already-installed on your watch. At the moment there are not too many additional apps that you can install. However, I did install Fit.Simply which is a pretty simple pedometer that measures steps. Add-ons So far I have only purchased the following and really like the options of changing the bands. Watch-bands - there are several options for colors. I originally purchased my watch with the orange band and while I still love it, I bought a more conservative black band for work. Super easy to change out the bands - you just press one button on the back and voila, slip one off and slide the new one on. Because the watch is unisex, the bands come in two sizes S-M and M-L. Night-stand - when the watch OS 2 comes out (which hopefully will be soon) one of the new features will be that the orientation will flip so that when you charge it at night, the watch face will rotate also. Now the perceived cons... I have read several reviews of the Apple watch and most seemed to perseverate on the need to charge the watch. Believe me, its not that big of a deal - you just plug in the charger, place the watch on it (its magnetic) and voila in the morning its charged. I use my watch all day long with messages, phone calls, etc., and I have always had at least 33% battery charge left at the end of the day. As to being sturdy - believe me, I'm rough on watches and have not had any problems with it so far. The cost - yes I do admit that I have never spent $399 on a watch before. However, like all Apple products it will be easy to update as new watch OS's (is that a word?) come out. I have one Macbook Air from 2010 that is just as up to date as my Macbook Air from 2014. So, Apple does have an ability to keep this watch up to date as new advances are made. So...what do you all think? I give it a 5-Star. I know from reading another thread that several of our posters have Apple watches. MY RATING Share your thoughts....thanks in advance. UPDATE: Jan 2019 - so I purchased an Apple Watch series 4 over Christmas, again at an Apple store. It is great, love it. It has internet capability, doesn't require the iPhone to be nearby and has the every popular EKG button.
  19. traumaRUs

    Post-interview update

    Great - first hurdle done. I would be leery of the Friday call - sounds like it could really eat into your weekend unless there is a "night call" MD. In our practice our "call" ends at 5pm when the "night call" MD comes on.
  20. traumaRUs

    Reconstitution safe dosage calculation question

    Moved to pt medications forum
  21. traumaRUs


    Can you be more specific?
  22. traumaRUs

    NP in genetics?

    Moved to APRN forum
  23. traumaRUs

    First official NP job interview

    Congrats on your upcoming graduation. 1. What is orientation like? Didactic/shadowing? Amt of time? Pay during this time? 2. Where will you be practicing? Hospital/office? If you are an FNP, do your local hospitals credential FNPs to see pts in the hospital? 3. How long is the credentialing process for insurances? Is there a dedicated credentialing person at the practice? This can be a deal breaker for me as credentialing, licensing, etc., can vary so much that it can be so time consuming and frustrating - I wouldn't take on this task alone. 4. Have they worked with APRNs before? Will you be the first APRN employed in this practice? Difficult place to be in IMHO - to be the first APRN they hire as expectations might not mesh with reality. 5. Who will be your boss as an APRN? As an employee? In my practice, we have an MD we answer to clinically but we also have a practice manager (non-clinical person) who we answer to as an employee. Best of luck - let us know how it goes
  24. traumaRUs

    FNP school-Georgetown vs USC

    Moved to student NP forum.
  25. traumaRUs

    Would you stay?

    After reading all the more recent comments I'm going to change my advice. Expecting a work family is not what being an APRN is all about. Its nice if you all get along but not necessary. The MAs need to do their job and you do yours.