6/26 WILTW: Littlefinger's smirk makes me feel violated

[ixchel]

IXCHEL IN DA HOWWWWSSSSEEE!!!!

Okay, not entirely since my back still sucks, but still... I've gotten my lazy brain wrapped around hosting this shindig for a good go-'round. How are you all this week?

It's been a weird few weeks. Well, to be fair, it's been a weird few months, but for the purposes of the here and now, WEEKS. Brexit googling, Scotland succession, and the Donald re-establishing that Americans can still win the "who can look more ridiculous" contest. The best episode of anything ever in existence came on HBO last Sunday at 9 pm, and the memes that resulted were actually disappointing. (Except for one of a pile of dog poo alluding to a character returning in season 7.) I got a mosquito bite on the bottom of my foot. (Might be the worst spot ever.) What have I learned???

Well...

Boy Child got Rocky Mountain Spotted Fever (RMSF).

A pediatric hospitalist made me realize that if I ever travel outside my geographic area and provide care to patients, I should learn the epidemiological trends of that area.

Never, EVER ignore petechiae on the feet. It is relevant to the differential, especially on a child.

RMSF is reportable to the CDC, and from 2000-2010, there were 2,000 total cases reported per year.

The typical presentation of RMSF is fever, then rash, with a recent tick bite (1-2 weeks prior). The rash will be flat, pink spots, and sometimes blanchable. It will begin in limbs and move toward the trunk. Later in rash development, petechiae will appear on the hands, feet and ankles. If the petechial rash develops, it's typically several days (up to a week) after fever onset.

RMSF attacks vital organs, including the heart and brain. Boy Child's first BAM! symptom was syncope. I did't see the petechiae on his feet until we were at the hospital. There, we also noted sinus tachycardia and alterations in mental status.

Unfortunately, not everyone gets the rash.

In the 1940s, around 28% of those who contracted RMSF died. In the 2010 data, 0.5%. (Doxy is a helluva drug!)

In other news...

Post op after spinal fusion requires more patience and endurance than I think I have.

I don't know how to make my pool water clear.

The sun burns shock off a small pool way too quickly.

I miss work, but I don't know if I'm actually recovered enough to go back.

Littlefinger is still a creepy *****.

If AN ever decides to censor ***, ******, *****, or *****, I will be a sad, sad ixchel.

I added the link at the bottom of this days ago and can't remember what it is. We'll be learning this together.

[nutella, MSN, RN]

I learned:

I still get triggered but can handle any DV, or PTSD pts; being proactive in their journey by educating, supporting and giving resources about the "experience", while not putting myself in their shoes and self-preserving and remaining in the clinician role while empowering, is exhausting and all in the same night will make me wake up with some form of an emotional hangover...I only expect it to get better.

In my experience - it does get better.

I had some rough 10 years with PTSD that did not impact me too much at work back at that time. I worked critical care and felt very in control though emotionally distanced a lot due to PTSD.

After about 10 years things really started to fade and I hardly noticed it but got a significant PTSD flare up years later after some events triggered the PTSD stuff. With that flare up I started to struggle sometimes at work but also at home. I noticed the hyper vigilance and physical symptoms of PTSD and it was fairly uncomfortable at times. Things got better again and I do not notice much residue unless I get triggered significantly. Last year I had surgery and it triggered PTSD symptoms. I was out of work at that time because of surgery and saw a therapist for a couple of sessions to deal with that triggered aftermath from surgery and I am mostly in remission.

There is hope...

[OrganizedChaos, LVN]

Thank you for your well wishes everyone!

[meanmaryjean, DNP, RN]

I learned this week that not everyone understands that you have to pay money for nursing home care. My 87 year old dad has reached the point where he is no longer safe to be at home (dementia, Parkinson's, falling multiple times per day), and it is no longer safe for my step-mother (or anyone else for that matter) to try and care for him in their condo.

She was shocked by the idea that she would have to pay for at least part of his care with the money they have saved for retirement.

In other news, I went to visit my former workplace, and realized that I do not miss bedside nursing even a little bit. That the work I'm doing in academia IS helping people / being a nurse.

I learned that Brexit may or may not be a bad thing, but that Bon Jovi/ direct TV commercial is much, much worse.

[editingeyes]

My provider has been out of town last week and this upcoming week, so I learned just how much I am able to accomplish when I am not interrupted every 15 minutes trying to get vitals, answer questions, etc. However, it also puts more pressure on me as I am the only "medical" person in the office so everyone comes to me when a patient is in crisis mode.

I also learned that buying a house just doesn't seem to be in the cards for us right now. We've been looking for over two years and just haven't found what we want where we need it to be. If we could just move our location a little bit, I think we would be golden. However, between his job and kiddos, it just isn't possible. I keep telling myself "one day". I am getting crazy antsy though and need to either move houses or states (which isn't an option for the bf).

I am excited to have the next week to get my office all caught up with everything that seems to get thrown in the "to do when I have free time" pile. I also learned that lots of staff are trying to leave my night/PRN gig and that makes me sad because I truly like my coworkers. Change is needed there, though, and unfortunately upper management isn't very in tune with that.

Ixchel - glad your kiddo is feeling better!

[LadyFree28, BSN, LPN, RN]

In my experience - it does get better.

I had some rough 10 years with PTSD that did not impact me too much at work back at that time. I worked critical care and felt very in control though emotionally distanced a lot due to PTSD.

After about 10 years things really started to fade and I hardly noticed it but got a significant PTSD flare up years later after some events triggered the PTSD stuff. With that flare up I started to struggle sometimes at work but also at home. I noticed the hyper vigilance and physical symptoms of PTSD and it was fairly uncomfortable at times. Things got better again and I do not notice much residue unless I get triggered significantly. Last year I had surgery and it triggered PTSD symptoms. I was out of work at that time because of surgery and saw a therapist for a couple of sessions to deal with that triggered aftermath from surgery and I am mostly in remission.

There is hope...

I've had PTSD for 8 years; I have successfully been discharged from my trauma therapist since the beginning of May; I plan to do a few "checking in sessions" to help cope; I also still see a medication management psychiatry team, which is now a new team most likely the end of the summer...so I'll see how that goes.

My PTSD comes down to physical symptoms as well; I cave complex regional pain syndrome as well, so when I am triggered, it feels as though my CRPS symptoms can "flare up".

This is my second round in critical care; first in a PICU, and now in a PediED, so far I have been doing well, and this was the first time I felt exhausted and triggered. The best thing is being able to go to resources where I can talk about it freely (without mentioning PTSD) and actually have support.

[Lauraingalls, BSN, RN]

Well 10 days to Nclex.

I got a job offer for an L and D position that I wasn't expecting but am so happy to have.

My husband also got a job offer after being laid off for 3 months but in Dallas. (I am in AZ).

Trying to convince 3 teenagers that we will need to move is very hard.

The plan is for me to stay in AZ to gain a year of experience and then move.

So I will go from being a stay at home mom to a full time working single mom.

That terrifies me.

[nutella, MSN, RN]

I've had PTSD for 8 years; I have successfully been discharged from my trauma therapist since the beginning of May; I plan to do a few "checking in sessions" to help cope; I also still see a medication management psychiatry team, which is now a new team most likely the end of the summer...so I'll see how that goes.

My PTSD comes down to physical symptoms as well; I cave complex regional pain syndrome as well, so when I am triggered, it feels as though my CRPS symptoms can "flare up".

This is my second round in critical care; first in a PICU, and now in a PediED, so far I have been doing well, and this was the first time I felt exhausted and triggered. The best thing is being able to go to resources where I can talk about it freely (without mentioning PTSD) and actually have support.

I think it is just part of PTSD to know that it can flare up at any time and to have a strategy in place.

It is unrealistic to expect 100% cure or such but it is realistic to develop strategies to cope with triggers or a bad day. To be honest - when I realized I had PTSD (which was 30 years ago) I did not have much hope that it would get "better". I did a lot of research back at that time but there was not much out there at that time. With some common sense I developed my own plan and strategy, which worked just fine. And time does help.

When I had the rough patch 10 years ago there were much more resources out there. Therapy was not my number one thing but I did see somebody for a while. What helped me most was peer support ! Talking to another person who understands what you are going through and is supportive is price less in my opinion. Also, I found writing very helpful and did some "art" as a means of expression...

[cracklingkraken, ASN, RN]

Sorry I've been so MIA. So here's what my last few weeks have looked like:

I stayed at my friend's empty apartment and helped him move when his lease ended. It substituted my workout for the week.

The retreat was amazing. I was blown away by the passion and energy my students had, and I was really humbled as well during the time I served. I feel exhausted and feel a cold coming on, but there's also a newfound sense of peace and confidence.

I applied and interview for a position in Oncology at a MI hospital. It was probably one of the interviews that I prepared the least for, but I did really well and clicked with the DON and charge RN I interviewed with. When I was asked a clinical question, the DON was really impressed by my answer, which is the complete opposite of what happened at my last interview. I'm expecting an offer, but who knows. Even so, I was thankful for the opportunity to hear about the DON's praises at this specific hospital. It gave me insight into how great changes are, even thought sometimes things might not work out the way you hoped or expected.

[cracklingkraken, ASN, RN]

Oh, shoot. I forgot to put WILTW.

God is good and faithful.

I have been blessed with wonderful friends and family who have offered their unwavering support during this lull in my life.

I'm not perfect, and there are lots of areas that need improvement in my life. Although it stings, I am grateful that a friend had to rebuke me of one of those faults yesterday.

Septic pts might be receiving up to 30 mL/kg within an hr for fluid resuscitation.

[NotAllWhoWandeRN, ASN, RN]

I learned that nobody knows the ways that disabled employees are supposed to be protected by law, not even the people at the top of those food chain, whose job it is to know these things because they're responsible for handling injured employees.

I'm still not sure whether to start baring my teeth. The employer is clearly violating my legal rights, but I'm not sure if being too aggressive could hurt me. I want them to WANT to keep me on their team.

The bottom line is that if you are unable to work your original job because of a workplace injury, your employer is legally obligated to offer you a vacant position which is as close as possible in terms of hours, pay, and benefits, as long as you are qualified. You are supposed to be given priority placement over any non-injured employee who applies to transfer and any external applicants. You don't have to be the BEST qualified, you just have to be qualified.

Good luck getting an employer to comply, though.

EEOC Enforcement Guidance: Workers' Compensation and the ADA

"Where an employee can no longer perform the essential functions of his/her original position, with or without a reasonable accommodation, because of a disability-related occupational injury, an employer must reassign him/her to an equivalent vacant position for which s/he is qualified, absent undue hardship.”

Interpretive Guidance to 29 CFR § 1630 Regulations Implementing Title I of the ADA

"An individual with a disability is considered ‘qualified' if the individual can perform the essential functions of the position held or desired with or without reasonable accommodation. A covered entity is required, absent undue hardship, to provide reasonable accommodation to an otherwise qualified individual with a substantially limiting impairment or a ‘record of' such an impairment. "

Employers should reassign the individual to an equivalent position, in terms of pay, status, etc., if the individual is qualified, and if the position is vacant within a reasonable amount of time. A reasonable amount of time” should be determined in light of the totality of the circumstances. As an example, suppose there is no vacant position available at the time that an individual with a disability requests reassignment as a reasonable accommodation. The employer, however, knows that an equivalent position for which the individual is qualified, will become vacant next week. Under these circumstances, the employer should reassign the individual to the position when it becomes available.”

Enforcement Guidance:

Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act

The ADA specifically lists ‘reassignment to a vacant position' as a form of reasonable accommodation. This type of reasonable accommodation must be provided to an employee who, because of a disability, can no longer perform the essential functions of his/her current position, with or without reasonable accommodation, unless the employer can show that it would be an undue hardship.

An employee must be ‘qualified' for the new position. An employee is ‘qualified' for a position if s/he: (1) satisfies the requisite skill, experience, education, and other job-related requirements of the position, and (2) can perform the essential functions of the new position, with or without reasonable accommodation. The employee does not need to be the best qualified individual for the position in order to obtain it as a reassignment.”

The employer, however, would have to provide an employee with a disability who is being reassigned with any training that is normally provided to anyone hired for or transferred to the position.”

Before considering reassignment as a reasonable accommodation, employers should first consider those accommodations that would enable an employee to remain in his/her current position. Reassignment is the reasonable accommodation of last resort and is required only after it has been determined that: (1) there are no effective accommodations that will enable the employee to perform the essential functions of his/her current position, or (2) all other reasonable accommodations would impose an undue hardship.(80) However, if both the employer and the employee voluntarily agree that transfer is preferable to remaining in the current position with some form of reasonable accommodation, then the employer may transfer the employee.”

‘Vacant' means that the position is available when the employee asks for reasonable accommodation, or that the employer knows that it will become available within a reasonable amount of time. A "reasonable amount of time" should be determined on a case-by-case basis considering relevant facts, such as whether the employer, based on experience, can anticipate that an appropriate position will become vacant within a short period of time.(81) A position is considered vacant even if an employer has posted a notice or announcement seeking applications for that position. The employer does not have to bump an employee from a job in order to create a vacancy; nor does it have to create a new position.”

Does an employer have to notify an employee with a disability about vacant positions, or is it the employee's responsibility to learn what jobs are vacant? The employer is in the best position to know which jobs are vacant or will become vacant within a reasonable period of time.(87) In order to narrow the search for potential vacancies, the employer, as part of the interactive process, should ask the employee about his/her qualifications and interests. Based on this information, the employer is obligated to inform an employee about vacant positions for which s/he may be eligible as a reassignment. However, an employee should assist the employer in identifying appropriate vacancies to the extent that the employee has access to information about them. If the employer does not know whether the employee is qualified for a specific position, the employer can discuss with the employee his/her qualifications.”

An employer should proceed as expeditiously as possible in determining whether there are appropriate vacancies.”

Does reassignment mean that the employee is permitted to compete for a vacant position? No. Reassignment means that the employee gets the vacant position if s/he is qualified for it. Otherwise, reassignment would be of little value and would not be implemented as Congress intended.”

[smartassmommy]

With the 2 week break it's been a slow learning week. I've been reading a book on the history of nursing. I found out dear old Flo was against the registration of nurses. Clara Barton was a publicity hound and resigned from the Red Cross after being investigated for fraud.

At work I learned about CPM when I was floated to the ortho-neuro unit.

I can't wait for my next class to start.

[CT Pixie, BSN, RN]

I don't know how to make my pool water clear.

/QUOTE]

We were having a big problem trying to get our pool clear one year. If it was clear it was an 'off' color, it it were the right color it had a foggy look to the water.

Finally went to the local pool supply store and they told us to bring a sample of the water. Which we did. They ran an analysis on the water and were able to tell what was off about it. Threw the needed chemicals in it and the pool was nice and clear.