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guest940422's Latest Activity

  1. I started working in UM a year ago. They want strong clinical background, charge experience, and really look at extras like being certified having a BSN and committee work. I also never stopped applying for jobs... for real... like submitting applications several times a week for over a year. I started working for disaster health services at the red cross as a case manager. The training is annoying, but once that's over you do virtual case work on your phone with a computer. They don't have minimum hour requirements so you can just do it whenever you have a little time (like never more than 20 min here and there). It was the only way i could find to get experience without already having experience. my boss said that was the only reason they were willing to interview me.
  2. guest940422

    The Gypsy Rose Blanchard Story

    It doesn't matter if you have the pieces together. It doesn't matter if you can prove it. All that matters is the red flag. As mandatory reporters we are expected to report to social services (not to our supervisor, or the facility social worker, or to the doctor) any suspected abuse. We aren't trained criminal investigators, no one expects us to have solid evidence. We are trained professional healthcare providers. We are often the only people given access to these kids. And we can see discrepancies no one else would think to look for. I'd rather put 1000 families through the stress of a CPS investigation than let one kid get abused right under my nose. I've seen parents hide diapers to make it look like their kid was in renal failure, i've seen a 3 year old with a positive tox screen for cocaine with a doting inconsolable mother at his bedside worried about his most recent cardiac arrest, a mom that was pouring just enough saline in her daughter's gtube to screw up her electrolytes and get her admitted every month, and another who was caught on camera contaminating a PICC line with feces. This is so much more common that people think it is. We run to the phones to alert authorities if injuries are not consistent with the report the parents give us. Our culture needs to evolve to have the same urgency when the presenting clinical picture is also inconsistent. If you still aren't sure, then think about the fact that you are setting yourself up for some serious liability. failing to follow through with a report, especially if you have documented suspicions, can loos you your licence and expose you to civil litigation. It's no different than documenting someone is suicidal but not doing anything about it. When they kill themselves, it's on you.
  3. guest940422

    So Mandatory Reporting Isn't a Thing for Doctors?

    Ya you're right, they did say someone had made a report at one point. Even that doesn't mean much, CPS is far too understaffed and overworked. I think i just got rawled up because he was on camera stating he suspected abuse but couldn't report it without proof. Its more common than people think... typically its parents/caregivers refusing to believe their child is well or convinced they are sicker than they are. It is exceptionally rare that they are actively making the child sick. I just keep thinking of all the reports I've had to make over the years and all the professionals she was paraded past and no one helped her... that's a damn shame.
  4. OK… let he who is without sin cast the first stone. I know I haven’t always been a perfect healthcare provider, I know I have screwed up and possibly put lives at risk, I’m not pretending I’m perfect… but I really need to vent here before I say something somewhere where I’ll get more than a tongue lashing from my peers. I watched “Mommy Dead and Dearest” a few weeks ago and I just can’t get it out of my head… I’m just angry! Dr. Bernardo Flasterstein, is a neurologist at Children’s Mercy Hospital. He is being interviewed in this documentary saying “I had a big doubt about the whole thing from the beginning”!!!! He wrote in his documentation that he believed the mother had Munchausen syndrome by proxy and publicly admits he never reported it because too many people believed she was really sick so “All I could really do was put it in the chart” (cough cough) B&!! $&*T (cough) I’ve been a mandatory reporter since I got a weekend job in a daycare in high school…. WHEN I WAS STILL A MINOR I had to take training on identifying and reporting suspected abuse. The key word here is suspected… you do not have to confirm abuse to be responsible for reporting it… confirming it is CPS’s job. If you suspect it, you are responsible for reporting…. And not just any reporting, telling social work or your boss and assuming it got to CPS isn’t good enough… you are responsible for making sure the report goes to the authorities. The first time I received this training, I was 16 years old, Gypsy was 11! I understood, why didn’t her doctor??????? In 2007 he wrote a whole provider’s note about not thinking she was sick... they hold it up in the movie… pause it you can read every word…. Years later she is on trial for murdering her mother. As healthcare workers we are held accountable for everything, from paying child support, to defaulting on our student loans, to getting a DUI… any of those things can leave us liable and put our careers at risk. How is this man able to work after openly admitting he knew and did nothing?!?!?! Screw it, let’s put him on TV so he can tell us what we already know and feel sorry for him because no one would have listened any way if he had bothered to speak up! I mean come on can we at least use this extreme case to learn and prevent other severely abused kids from slipping through the cracks??? He said we call social services in the case of neglect but that wasn’t what was going on in this case… long before Gypsy got her boyfriend to murder her mother, Dell Children’s hospital had cameras installed to catch a mom who was contaminating her child’s PICC line. This is hardly a new form of abuse and this man knew what he should have done and just chose not too. OK thanks I just needed to vent…
  5. guest940422

    Nurse Gives Lethal Dose of Vecuronium Instead of Versed

    I work in radiology and sedate patients every day, our hospital has a scanning system but we don't scan any of our meds, the patient is either covered or inside the scanner, the meds aren't ordered ahead of time so they aren't on the patient's profile, except in this case because the doctor is scrubbed in and gives verbals during the case, the time-out is the patient check, since we do anesthesia cases also our Pyxis has paralytics in it and all our meds have to be an override, if you are not trained or in too big of a hurry, i can see how you could grab the wrong vial, i've written several safety reports because the wrong meds were in drawers or because the way the pyxis was loaded made it too easy to grab the wrong thing (you have to pull it out the whole way to get zofran if you only pull it out halfway you get amlodipine) I agree the nurse was negligent, but blaming her won't save anyone's life. Learning from this can. -Don't give meds you aren't familiar with, if you aren't sure look them up. In a genuine emergency someone else will be there to ask -If you aren't trained in an area or aren't comfortable in a task refuse the task no matter how pressured you may feel -No ICU patient should be out of the ICU without an ICU nurse or an anesthesiologist assuming care. If the nurse covering for lunch wasn't an ICU nurse or sedation nurse either lunch break has to wait, the scan has to wait, or someone else needs to take them -No ICU patient should be on any table or in any scanner without monitoring and a nurse monitoring them -If a patient is sedated for a scan or procedure (even if all you gave them was 0.5 of Versed) they have to be monitored for the duration of the scan ICU or not -Know what resources your hospital can pull out of a hat, I've call my house supervisor after hours because the patient's ICU nurse had to leave since his other patient was coding upstairs leaving me alone with a patient that had unstable pressures, needed drips titrated and I had already started sedating. She sent me a rapid response nurse to manage the drips so I could focus on the sedation
  6. I know the demands on nursing students is different now than it was when I was in school (and that wasn't very long ago). When i was a student, you picked your patient the night or day before and did all the research and paperwork before you got to clinicals. Now I see more and more students showing up the day of with stacks of paperwork they need to fill out on a patient they pick in the morning and be ready to present this by post-conference. So if your teacher is making you spend your clinicals on the computer then I don't know what to tell you. That situation aside, I feel like clinical experience is sacred and you only have a finite amount of it... don't waste it working on your homework doing care plans or studying for exams. We are really busy, we don't stop to hunt you down when there is a great learning opportunity. Stay on your nurses heels and you'll get more out of it. Do the grunt work. Vitals and bed baths may not be what you thought you were signing up for, but support staff is a luxury you may never have. You need to be able to do those things without thinking, they need to be in your muscle memory so you can be simultaneously assessing your patient and noticing trends prioritizing your day and other things that will come later. You don't want to graduate and still be having to think and focus on which way a blood pressure cuff goes. The only stupid question is the one you don't ask Never stand when you can sit and if you see a bathroom use it keep a mini sample size perfume bottle on you and spray it inside your mask for tasks that might make you sick from the smell (12 years in and I still can't handle the smell of puss) You don't get anything you dont ask for. If your patient is going to the OR for surgery ask if you can go to observe... you may never get another chance and even though your school doesn't get OR rotations they will almost always say yes (just don't touch anything) I work in IR, we don't take students, but if a patient has a student attached to them and the student asks I let them stay and observe. When I was in school I got in to a ton of specialty areas doing this. If there is a code, don't just watch in the doorway, walk in the room, find a spot out of the way You will see lots of nurses do things that are not the way you are being taught in school. Some are open minded and would love to learn the latest techniques from you. Most have egos and pride and do not want a student telling them how to do their job. the fastest way to get a nurse to ignore you and not want to teach you is to tell them they are doing something wrong or pull a "well we learned it this way because...." If you like a unit you are on, ask for a reference from a preceptor and get the manager's card (its usually at the desk) start thinking about job hunting now and make those contacts. This is going on your resume after all.
  7. guest940422

    Inclement weather conditions...mandatory to work?

    You're welcome to read the article I posted about my experience swimming out of my car after getting hit by a flash flood during the 2016 tax day floods in Houston. That wasn't even a Hurricane. If it had taken me seconds longer to snap that I needed to role down my window, I would have been one of the people who died that day too.
  8. guest940422

    When did being pregnant become a disability?

    You're right, It wouldn't have been. I bring people patients up or go get them a lot (even when I really don't have time). I know I have the luxury of only being responsible for one patient at any given moment. I have 4 more stacked up in pre-procedures which is why I call ICU before the patient comes off the table in hopes of timing their arrival to keep from slowing down the flow. A lot of the ICU patients are on pressers and the IR nurses give sedation and circulate. Not all of us have ICU background. The ICU nurse is expected to stay with the patient during the procedure. I don't make them stay unless the patient is really unstable. I think that added to my irritation. But I can't expect someone to read my mind. Instead of getting huffy, I should have asked her to come down and monitor the patient while she waited for escort, then gone to get report on my next case. I've never worked in management, but in my experience anyone who has been on FMLA has their position held. Ive had managers say they are applying to add additional positions to the budget during hiring freezes while people are out on fmla. So that makes me believe their specific spot is still theirs We've gotten transfers before and not known they were on IFMLA, when they apply for transfer the unit they are coming from can't disclose it. It could cause the unit they are applying to to discriminate based on a disability.... you know... sort of like I was doing Travel Nurse, I guess in that moment I was trying to make my measly almost-12-years of nursing experience sound impressive. Instead of just blowing off an ignorant comment, I went off on a childish narcissistic angry rant... not my finest hour. I'm sorry you went through that, I understand you not reading the comments. The long and short of what you missed is I was talking about the population of women who aren't having any of these symptoms but still want to do less. This was me venting at the end of a rough day and it was never my intention to piss off the better part of the nursing community. I did, however, learn a lot from the 70ish subsequent comments and my perspective has grown because of it. If anything, this experience has made me take a hard look at the way I treat/view/judge my peers. If you do decide to go back and read the comments, I beg you to please try not to judge me too harshly for some of the things I wrote... again not my finest hour.
  9. guest940422

    Misuse of the ER

    Preach! I just ran screaming from my orientation shift in the ER when they wanted me to start floating PRN. Ever since I have tried to see the hospital as a whole and not blame one department for things backing up. We regularly had 16 hour wait times and were on diversion for weeks at a time. Everyone wanted to blame the ER for running badly, I realized there were things I could do to help from the ICU too. Decreasing ratios house-wide lowered wait times pretty significantly. I think some of the CNS are working on publishing that data.
  10. guest940422

    drug calculation

    It helps me to line up the units 800mg 500mg ----------------- Xml 1ml 800mg=500ml/X x500 x500 ------------------ 1.6ml =x then 3X for the three doses =4.8 ml or 2400mg whichever it asked for does this make sense? hard to type it out in the box
  11. guest940422

    Inclement weather conditions...mandatory to work?

    True, even hospitals in known disaster zones won't call in essential staff every time they should. It costs too much. They wait and see often far longer than they probably should and end up waiting until it's too late for the "ride out" team to get there. This leaves people stranded at work and others unable to safely get there. I have an article posted about when I had to swim out of my car in Houston when I got hit by a flash flood. no hurricane involved. They never called a carla. We got more rain in 24 hours that night than we did during the week of tropical storm Allison. Hindsight's 20/20 they weren't sure the storm would hit and didn't want to drag hundreds of staff members in just to send them home and make them mad. Each time something like this happens we learn (I did). Now I hope you will have time to weigh risks and benefits, talk about it with your family (when you aren't in crisis mode with an immediate looming threat), and know without hesitation what the plan is if this ever happens again.
  12. guest940422

    Where were you...9/11

    Tenth grade world history class (Ironic I know). In first period they made us watch the news for the first 20 min every day. When I came into class everyone was laughing and joking about how some dumb drunk pilot accidently drove a plane into the side a skyscraper in New York (15 year olds what can I say). Our teacher was losing the fight to make us understand actual living people were inside the building we were laughing at. He couldn't get us to take it seriously. I was watching the footage live when the second plane hit the other tower. This is apparently what it takes to get 30-some-odd narcissistic teenage millennials to shut up all at once (no one was calling us that back then but you get the idea). The school cleared out in less than an hour. Students with a driver's license or a parent could leave without a note. I was 15 and my mom was at work in the CVICU. My teacher let me leave with the campus cop who lived down the street from me when he flatly said he was my dad.
  13. guest940422

    Med carts with no drawers

    I know it is time consuming, but I never have more than one patient's meds on my person at a time (except in the example with the big multi drawer carts which have been phased out in a lot of facilities). It is just too easy to make a med error. I start my shift by making sure everyone's meds are accounted for so i can request missing meds, then i gather room 1's meds take them to room 1 administer. Go back to the med room gather room 2's meds repeat... Now this is, in part, because i came from PediLand, so room 1's Diuril and room 2's Diuril will almost never be the same dose. But even in school I got in this habit to avoid double dosing a patient or mixing up meds. I'm sure having everyone's meds on me at the same time is faster, but I've never done it that way. If this isn't really a safety issue that applies to your unit the other thing to consider is joint commision. All sharps have to be in locked containers if in public spaces so only clinical staff have access. If there are needles in these drawers do they lock? Medications have to be stored in locked areas where only licensed staff have access, so the drawers have to lock, and only nurses doctors or RTs should be able to get to them. If you have more than one patient's medications on you; the other patient's meds are supposed to be locked to keep from being contaminated when you are in the room. This might be why they are making you change your practice since there is only one unlocked drawer on the new carts. Have you considered sorting meds for each patient in the med room ahead of time, and dividing them up maybe in lab bags with the patient's sticker? That might be a little more time consuming but not much more than what you were already doing. As per keeping meds safe. It isn't uncommon for nurses to tell families they can't get them something because they first need to safely administer medications. "I would be happy to, but first I need to give my patient their medications" People generally know that is more important. If a patient can't take a narcotic right now, depending on the hospital, I will either put it in a med cup with their sticker covering the top and secure it in the med room. Or waist it and pull another when they can. Again the lab bags have always been my friend. I put their meds in the bag, sticker the bag, and tape it to the cart. I even tape an extra one for small trash (blister packs, alcohol swab wrappers, unit dose wrappers) you can't walk away from the meds on the cart, they need to be in your hand. But at least they are all together.
  14. guest940422

    Misuse of the ER

    I've had friends with kids send me pictures of limbs on their phones and ask me if they are broken (more than once). I watch the ER tracker and have seen "primary complaints" including lice, sneezing,hiccups, rash, green poop, yellow snot, and any other random most likely harmless thing you can imagine. But parent's can't triage their own kids, they may say "tummy pain" and "they just don't look right" when the kid has necrotic bowel and is septic. This is different from the woman who calls 911 then jumps off the stretcher in the ambulance bay and says she feels fine but she needed a ride downtown. Or the doctor using the ER instead of registration to admit his patients because the hospital doesn't have any beds and he doesn't want to have to make the calls. People using the ER as primary care is a complicated public health problem that requires multiple agencies to decongest those ERs. Each community has unique concerns. While the ER wait times may not be a problem in rural areas, access to care paired with inappropriate reimbursement may come into play. Urban areas have the financial access problem. If we don't pay pennies for someone's insulin we are going to pay dollars for their DKA. What I have learned as I've matured (a little bit at least) is the ER wait time belongs to the whole hospital. The waiting room in the ER is the most dangerous real-estate in the building. There is a serious possibility someone who is very sick may leave without being seen because the people who aren't sick are making them wait. Everyone can help by improving patient turnover. Don't hold on to your discharge till after lunch, someone needs that room. If your room is empty and you've got a patient assigned, be proactive and call to do what you can to facilitate getting them moved. Pick your patient up from ER when you can (its not always possible) they will be extremely thankful.
  15. guest940422

    I don't think i can be around this co-worker anymore.

    1) Your personal history has nothing to do with this. YOU are not the problem. Anyone would have been uncomfortable in this scenario other than an intimate partner of his. You are his co-worker. This is not appropriate behavior. 2) What you described could be word-for-word a script required of staff to watch in new employee orientation. 3) Shame on your boss for even telling him you made the complaint. "it was a misunderstanding" leads me to believe they actually told him you were uncomfortable in the supply room. That is extremely inappropriate leadership behavior. 4) You should feel safe at work. When you tell your boss someone is violating that safety, they have an obligation to protect you and make you feel safe. Being able to set boundaries is a great skill, but we don't all have it. Any working professional (especially one required to have yearly sexual harassment and mandatory reporting education) should know flirting and giving an uninvited backrub in a secluded private locked room is a boundary. You don't have to feel down because you didn't say it out loud. You went up the chain of command and nothing was done. It is perfectly reasonable to go over your boss's head and make a formal report. I would write down specific dates and events before you do it, so you have your head on straight and don't feel like you are on the spot when you are telling them your concerns.
  16. guest940422

    Lifetime Stutter

    Marilyn Monroe also had a dibilitating stutter. She used a similar method. That's why her speach was so breathy and deliberate. People always thought she was trying too hard to sound sexy, she was really just trying to sound normal.

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