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Tomascz ASN, CNA, RN

Wound care

Living the dream

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Tomascz has 3 years experience as a ASN, CNA, RN and specializes in Wound care.

Late life career change to lifelong dream.

Tomascz's Latest Activity

  1. Tomascz

    Over 70% of Nurse Staff Turnover is Due to Bad Leadership

    Managers work to fulfill the needs of management. Management at the floor level has an impossible job trying to mollify JCAH, Medicare, Infection control, burned out nurses, etc etc etc. Beyond that they have to deal with trying to keep up with the impossible demands of administration to constantly do more with less. We tell nurses who hate bedside to move up. Nurses who hate direct patient care don't make good nurse managers. Management is about dealing with people under stress effectively and humanely. Surprise. Nobody wants to deal with suits who have no idea what your job really entails or what empathy looks like. There is no room for any level of arrogance anywhere in a healing facility. The list goes on...
  2. Tomascz

    Drug Seeking Patients

    Apparently we get along better with our Docs than most of you. We're a relatively small critical access hospital with an acute care/med surg floor that admits from our ER and clinics and we deal with a lot of the same patients over and over, some with incredibly painful conditions; some who are "drug seekers", and some who, I swear, would rather lose a foot than do what's necessary self care wise to avoid such mutilation because of the small amount (relatively) of drugs that they might get out of the deal. I'm the nurse. I advocate for my patients by going to the Docs and "suggesting" that so and so might benefit from losing their Morphine in favor of Ketorolac or Tramadol ( a mu agonist) or having their Hydro halved and stretched to Q6 or maybe having something added for nerve pain, etc. We don't have Dilaudid in our formulary for a reason. Sometimes I go the other way. Not everybody experiences pain the same. Patients that have been here before usually get it. If you're strictly NPO for three days for pancreatitis, the pain meds end when you want something to drink or eat and you can hold it down, and we've been checking your Lipase and backing off on your Morphine and Fentanyl along the way. It really isn't that much fun. Maybe one of these days we'll lose the numeric pain scale and train RNs to objectively assess pain the way we assess other dysfunctions. The key word is "objectively". Whether somebody is a drug seeker is not really my business. Whether they're actually in pain, and what they're in pain from and what that might indicate is my business, and if they're obviously ******** me, their narcotics go away and they go home, all other things being equal. Some days I may have AMA papers made out in advance to assist my patients who don't really want to be there after all. And then I have the heart breakers who really need to stay when they'd rather be out there dying. It keeps things interesting.
  3. Tomascz

    Med-Surg Certification

    https://www.msncb.org/exam-preparation Everything you could possibly need can be found under this link. If you're a week or two away and you aren't prepared you need to re schedule your exam,or, just go take it, and if you fail, spend a couple months studying the material linked above, pay the extra $270 or whatever it is, and take it again. Cramming is stupid.
  4. And how many patients have died from untreatable c. Difficile infections? The patient was immunocompromised and the fecal samples contained antibiotic "wise" bacteria. Was the treatment used as last line or first line? Last line if current standard protocol was followed. We're still looking at individual strains of bacteria here as the culprits when what we're dealing with is "systems" that we don't really understand very well.
  5. And the difference between this and PTSD is what?
  6. Thanks for this!! I've been following research on gut microbiota for about the last 10 years. What the public lacks is exposure to reduce social sensitivity as well as education about how their bodies work. I share this stuff on Facebook all the time Allopathys approach to bacteria is rooted in ignorance as is the general use of antibiotics (hence the resistance to first line use of a treatment for c. Diff which has about a 95% cure rate), among other things. We're organic systems, including our bacteria. There are no "silver bullets" in medicine. You have to treat all living things as systems. A cursory search on google will get you this: https://www.futurity.org/sugar-gut-bacteria-protein-1941482/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5264285/ https://www.scientificamerican.com/article/how-gut-bacteria-tell-their-hosts-what-to-eat/?redirect=1 It's fascinating!
  7. As I opened this issue of Allnurses I saw an article titled in the sidebar to the effect of "New Grad (BSN no doubt) RN, absolutely hate nursing". How many times have I seen similar sentiments here? That quoted above is, in my opinion, the exact crux of the issue. You CAN NOT turn a person into a nurse by educating them. Sorry academia. A nurse with a top notch education is a powerful tool in medicine, but you have to "be" a nurse from the heart to start with. You have got to have it in you. I used to disparage people (silently) who told me "I could never do what you do". I was selling their self awareness short. I was failing to listen. I don't know where I got this; or why it took me so many years to get here, but I do have it, and I did not learn it in class. I just learned how to apply it to best effect for my patients there.
  8. Tomascz

    Playing Cards

    So, #1, I'm glad I don't work in WA. I work in a "small" hospital where our "Med Surg" floor w/ 20 beds sometimes resembles a NICU in a Memory Unit in a Psych Ward in a Drunk Tank in a nursing home. Today we have 6 RN's taking care of 13 pt's. Yawn. So far no flyouts, although, in our opinion, those should be cleared in the ER, but whatever. We have no ICU and we have no RT's. Up until recently we had no "sitters" for the 1:1's. I've worked weekends (FSS) with 3 RNs and 18 pts , all acute, at a minimum. Probably the worst part about this is the inconsistency. Small hospitals can be as bad or worse than big ones, but I don't think the GP gets it anyway. We can usually take lunch somewhere in the day. We don't play cards. We do OK, except when the Unit Clerks don't show up. Then we're pretty screwed.
  9. Major work is being done with Ketamine and some analogues to treat depression, with good results. The biggest inhibition to that research has been interference from "law enforcement" agencies in the practice of medicine. Protesting that research will put you on the side of our Calvinist theocratic approach to medicine and law. Humans have been treating themselves with psychoactive drugs for millions of years because they (apparently) gained benefit or saw the need. The "because it's illegal" approach to this argument is just a non starter. Not only does it not explain anything, it doesn't solve anything. Research CAN solve things. Putting a whole class of substances on a "forbidden list" CI, and enforcing draconian penalties against their use, is just dark age ignorance. That and the fact that the first thing the US government did when they noticed "acid" was try to weaponize it and when they found that problematic they made it illegal. Sheesh.
  10. Tomascz

    Worried sick that I may have caught MRSA?

    Germ-a-phobe in the nursing business? Hah! MRSA isn't resistant to Doxy and all your zits will dry up besides. It even kills Yersinia pestis! Not to be glib, but you need to be practicing some serious hand hygiene. There are bugs out here that do not have cures and patients don't wear armbands or tattoos to warn you. You screwed up and MRSA is the least of your worries. At least you didn't transmit nec fasc to some immune compromised 30 year old. You need to be more considerate of your patients. Just say'n.
  11. Tomascz

    New Grad Age 60 Can't Land a Job

    I was 63 yoa when I landed my first job as an RN on an acute care unit. I turned down two SNF jobs and ultimately two other hospital jobs ( I had landed this one already) before I started working here (six months after passing the NCLEX and quitting my CNA job at a hospital that refused to interview me, to the chagrin of the RNs on my unit who wanted me to hire on badly. I'm a damn good nurse). I was relentless in my job search and knew what I wanted (acute care). I applied all over the country (none in the south except FL, once, and that reluctantly) and attended online and virtual job fairs. I interviewed in person in three surrounding states and at multiple hospitals in the state in which I graduated. I got turned down beau coup times. I have an ingrained hatred of HR dept's that will last me a life time. You need to apply to a federal institution through USAJOBS - The Federal Government's official employment site The variety of RN jobs is astonishing, and ranges from Forest Service to Prisons and everything in between. The system is sloooow. Took me six months to get here. I'd suggest looking at VA. They'll give you a bit of credit for your BSN. I understand IHS is no longer hiring new grads w/o experience, but again, don't take anybody's word for anything. I was never asked my age (it's illegal and federal service is under the microscope, plus, because of need, based on my application and a phone interview, I was offered a live interview and was hired), and apparently I don't look it, but I'm obviously older than 50. Attitude counts for a lot. Any federal service you have under your belt will count toward your retirement too. You can PM me for more details.
  12. Tomascz

    Bringing in the Boys: How to Attract More Male Nurses

    And herein lies the crux of the issue: What is a "Nurse" anyway? How much education should you really have? What would be ideal in terms of the needs of the industry, which is essentially the timely and accurate delivery of direct patient care to restore health as much as possible, and to which all other functions are ancillary. Are some people more suited to be "nurses" (whatever that turns out to mean) by virtue of their gender (which it turns out is not necessarily binary)? I'm not saying we shouldn't have this discussion but in order to get meaningful useful data you need to formulate your questions with care.
  13. Tomascz

    DNR Turning Into Do Not Treat?

    Any DNR can be rescinded by any patient at any time. In any case, O2 and Morphine would be the least you could do for this person.
  14. Sure I want recognition, cash preferably, but more importantly I want a hand in ensuring and improving patient care and treatment of nurses which to me go hand in hand. Like somebody else said here, nurses aren't peas in a pod. We may be Debby Downers but a.) the response to your proposal should tell you something that you are clearly either not expecting or are unwilling to hear, or possibly b.) the experience of many of those responding here doesn't support what you're outlining. Formalized top down systems of evaluation tend to favor the needs of those who build them. I'm betting these are usually a reflection of the bottom line needs of the "business". Do you think that most "for profit" hospitals, or even non profit MBA/bean counter run hospitals, necessarily place a high priority on nurse job satisfaction? I kind of doubt it. Do I think compensation needs to be performance based? Sure, but development progresses differently for every individual. It's not a cookie cutter process; and yes, I'm extremely suspicious of management motivations.
  15. This just looks like another way for the MBA's to quantify and nitpick a process that already happens in responsible hospitals that care about competent patient care and staff development. Its just another attempt to turn love of the work into a tool of coercion and discrimination.
  16. Tomascz

    CMSRN or CCRN? Both?

    What I'd like to know is , is there any relative advantage to getting certification in Med-Surg nursing (CMSRN) or should I just go ahead and try for my CCRN, or better yet, get em' both? I'll have enough relevant experience come January to apply to take the CCRN boards, and I can sit for CMSRN right now, and I'd like to know if either would be helpful down the road. If it makes a difference I work for the Federal Gov't and I've never seen where they've asked about professional certifications in relation to jobs offered. BSN's are becoming de rigeur in the private sector and I don't see that they confer much of an added advantage, pay or advancement wise. The cost/benefit ratio doesn't seem to be there, especially for older nurses. I'm not planning on making a move in the near future but I like to act like I'm serious about this profession (I am, actually), just in case anyone's looking. I plan on staying bedside. Crazy as I am, I like helping real live people get well.
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