Now that I’m not in the middle of having a very crap first day back at work and have come up with a workaround for image uploads, I’ll go more into my visit with this little cutie pie....
Sorry you had a trash first day back at work. If it’s any consolation, I’m laying here on day two home from work with norovirus that I caught from a patient, so that’s been fun.
National Aviary! How did I not know about this place?? I’m originally from Ohio/WV. I’ll have to arrange to take my sister’s kids on a trip from Charleston, WV to Pittsburgh sometime to see this place. Looks amazing, thanks for sharing.
I love that it occurred to you to notice smells. That’s perfect, immersive experience to share with us. Also really surprised you could feel a Screechie’s claws through that glove?! Tiny it may be, but apex predator nonetheless.
Kinda has those little needlepoint claws like my littlest cat. Her tiny claws go right through everything, probably including prey, if I ever let her outside.
The highest of the highest Cali get $90/hour. Bar Area only as far as I know. Highest I know in Massachusetts is like 20 years ICU experience getting $80/hour.
I work cardiac critical care in Mass, making $46/hour
Lots of misunderstanding in this thread about how much nurses are billed at. That’s the fun part: Nurses are NOT billed.
In US hospitals, nursing services are bundled into the “room and board” cost. Which means there is no increase in billing charges for any increase in nursing labor.
It’s absolutely the worst part of hospital nursing in the States. We are a net cost for the hospital. No matter what we’re doing or how critical it is, the hospital is always incentivized to pay us as little as possible and cut costs by preventing us from spending more time with an individual patient. It’s an archaic holdover from a time before modern medical care when nurses were really just combo housekeepers and CNAs rather than educated medical professionals. It’s actually a huge problem.
No worries, I’m happy to explain because it’s not like anyone learns in school how the medical field works (although I wish we did)
The process nurses are trained to perform and which we’re constantly doing without even thinking about it anymore is an acronym ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation.
Assessment is physical assessment of a patient. We’re constantly assessing no matter what else we’re doing because you’d be amazed what we can tell by just looking at a person. Are they alert? Confused? Breathing normally or labored? Skin color normal, pale/ashy, blue? Moving symmetrically? Strong or weak? How much of the food on their table did they eat? How much of that water we left in here three hours ago have they drunk? Do they cough when they swallow (a sign of aspiration)? We often know within seconds what we’re worried about. And we’re obligated to report that to your doctor.
Diagnosis for us doesn’t mean medical diagnosis like what your doctor gives you. It means diagnosing what we’re seeing in the moment. Say, for example, your oxygen levels are dropping on your monitor. Just turn up the oxygen right? But not so fast. Is the person cold? Have low hemoglobin counts? Peripheral artery disease (aka poor circulation)? Mouth breathing while wearing a nasal cannula? All of those things can cause the O2 monitor to drop and turning up the oxygen isn’t the correct intervention for any of them. (Maybe for low hemoglobin in the short run, but really you’ll be looking for a blood transfusion if it’s that low.)
Planning, intervention, evaluation are just doing a thing to fix a problem and seeing if it works. If the O2 monitor is reading low because someone is cold, let’s try some different things to warm them up and see if that fixes the problem.
BEFORE we call your doctor. If the O2 monitor reads low and I just call your doc before I’ve tried anything to fix it, they’re going to be irritated and probably have a chat with my supervisor about what an idiot I am wasting their time. In fact, personally, I like to try everything in the world that I can think of before I call a doc.
Then I can call them and say “Hey there was a problem but I fixed it, here’s what I did.” And then I can write my favorite note in your chart “MD aware” lol. Or I can call them and say, “Hey I’ve tried all these things and nothing is working, do you want to order XYZ?”
Yes, we are often suggesting orders to your doctors because we’re the ones seeing the minute by minute goings on. I affectionately refer to this part of my job as “reading physicians’ minds” lol. “Anticipating what might be ordered” is actually a formal part of our training. Docs don’t just take our word for things, but often they agree with us, and we don’t do things without consulting them because often they just know more than we do. It’s a team effort.
And there’s a lot more to giving actual medications than just throwing some pills at a room as we’re running by (although it feels like that’s all we do sometimes). We have to understand the pharmacology of the medications we’re giving. What are we expecting this med to do for you, what are the usual side effects, how long before the med kicks in so we know when to recheck to see if it’s working? Some medications have very specific means of administration. If you give them too quickly through an IV, you can cause problems, or even kill someone (with some of the cardiac meds that I give regularly).
Even just giving pills is more complicated than handing them to someone and walking away. Lots of people, older folks especially, need help or accommodations taking pills such as taking them one at a time or taking them crushed up and placed on a spoonful of applesauce. We have to know these things about you.
And lastly, my favorite part of the job because apparently I like the sound of my own voice (I’m sure you’re surprised, if you’ve made it this far through the comment) is patient education, which is a particular specialty of nursing. The typical order of operations is a doctor diagnoses you, gives you the broad stroke details and answers questions, then we fill in the details and answer ongoing questions that didn’t occur to you while the doc was in your room.
For example, when you start on a blood thinner, the doc tells you why and what the med is and probably tells you “it will increase the chances of bleeding,” but what does that mean for you in particular? I’ll get into the weeds with you about “if you cut yourself shaving or in the kitchen, it’s going to bleed more than you’re used to and that’s normal” and “if XYZ happens, you should go to the emergency department” and “here’s some good resources you can use for reference at home”
In a hospital, we’re also the ones coordinating all of your care. Getting you sent off for scans, timing medications around that, advocating for more interventions when we’re concerned about your status, etc.
“Person watches X creative and clearly fictional content” is not analogous in any way to “person watches X video essay crafted to look like a documentary, but actually just full of lies and propaganda”
they can change a patient’s medication or dosage without first alerting their doctor
Just wanted to point out that I’ve done this as a nurse. Working home dialysis, which involves training a patient and then providing remote monitoring case management services. We had clinical algorithmsthat were ordered by a physician that we followed for dialysis order changes, med dosing changes, etc.
These changes were reviewed monthly with the prescribing physician, there were parameters on every algorithm that indicated when a physician should be notified, and of course there was always the option for the physician to order something different, if they felt it was appropriate for that particular patient.
It worked very well for everyone - patients, us, docs - by automating the parts of the process where the physician would have started by just prescribing by algorithms anyway, and assessing if the patient was stable and responding as expected before deciding whether or not to continue by algorithm.
So I’m assuming these nurse driven changes are based on clinical algorithms that already exist and are done with a physician’s approval.
Babies are 38 and 35 days old now. Momma is feeding them less herself and doing more food drops and leaving the babies to figure out what to do from there....
Imagine hearing ad nauseum about the pending healthcare and manufacturing crisis that will be caused by the retirement of the boomers and thinking there won’t be anything for people to do for work in the future because some things are automated.
I was just thinking about Marvel stuff that has gotten unfair negativity. So I was wondering what people are liking. Not just controversial stuff. Just, whatever you’re into at the moment....
That’s one of the things I told my friend is that I was so pleasantly surprised by what they did with Awkwafina. Katie was a much better character than I expected.
Barred Owl at Sunset (lemmy.world)
Photos from Heather Farrell Photography...
Go forth and conquer the day! (lemmy.world)
Happy Friday!...
Weekly GHO Baby Update (lemmy.world)
I’ve fallen behind on these 2 this week due to being away, but I wanted to do my regular Friday photo update....
"No CGI" is really just invisible CGI (YouTube Series) (www.youtube.com)
I linked to this in a previous post along with my hot take about general things (hachyderm.io/@maegul/112132220413742000)....
Some more Cedar and a review of the experience (lemmy.world)
Now that I’m not in the middle of having a very crap first day back at work and have come up with a workaround for image uploads, I’ll go more into my visit with this little cutie pie....
Nvidia Wants to Replace Nurses With AI for $9 an Hour (gizmodo.com)
Quote from the article...
Cedar (lemmy.world)
Here is a photo of Cedar, the Eastern Screech Owl we got to hold. Looks like cropping the pic got it past the Cloudflare error I’ve been getting....
Brown Fish Owl (lemmy.world)
Photo by Peter Edmonds
Judge rules YouTube, Facebook and Reddit must face lawsuits claiming they helped radicalize a mass shooter | CNN Business (www.cnn.com)
Covid and Medicare Payments Spark Remote Patient Monitoring Boom (kffhealthnews.org)
Billy Abbott, a retired Army medic, wakes at 6 every morning, steps on the bathroom scale, and uses a cuff to take his blood pressure....
Caption this. (mander.xyz)
Baby Update (lemmy.world)
Babies are 38 and 35 days old now. Momma is feeding them less herself and doing more food drops and leaving the babies to figure out what to do from there....
How's your week going, fellow lower deckers? (tesseract.dubvee.org)
Post photo describes how I wanted to end not one, but two different meetings today. So, yeah. lol. Happy Hump Day...
This should be the norm for the average family again (lemmy.world)
In a freak accident today, a photographer was killed when a huge lump of cheddar landed on him. To be fair, the people who were being photographed did try to warn him.
Smile :) (mander.xyz)
A Proper Home (lemmy.world)
From the Owl Research Institute...
What are you all enjoying?
I was just thinking about Marvel stuff that has gotten unfair negativity. So I was wondering what people are liking. Not just controversial stuff. Just, whatever you’re into at the moment....