Wednesday, November 13, 2013

Charting While Off the Clock By Genevieve M. Clavreul, RN, Ph.D.

From The Floor : Charting While Off the Clock
The practice is illegal, irresponsible and breeds staff resentment
By Genevieve M. Clavreul, RN, Ph.D.
It’s again become a topic of discussion over the past few months, but it’s an old conundrum that’s faced nearly every nurse at some point in his or her career. You’re taught throughout your nursing education that your work isn’t done until your paperwork is done, but some days you just run out of time during your shift or are ordered to clock out early because the hospital census is low. In such circumstances, you may find yourself wondering, “Is it legal for me to finish charting after I’ve already clocked out?”
The simple answer is, “No, and it can get you into a load of trouble!” However, as with many things in the world of nursing, the situation isn’t always so black and white.
The Risks
It’s important to draw a clear distinction here between late charting — charting done later in your shift, but while you’re still working — and charting done after you’ve clocked out for the day. Late charting isn’t unusual and most hospitals have procedures in place to handle it, usually involving noting that an entry is a “late entry” and circling the time. This can be done on either a paper chart or an electronic health record (EHR) and if handled properly meets generally accepted standards of care and can and does stand up to legal scrutiny.
Where the trouble begins is when nurses chart after the end of the shift when they’re off duty. If you chart after that point, you’re courting some very real risks:

• Malpractice liability: Most malpractice insurance, whether the hospital’s or your own policy, only covers you during authorized work hours. If there’s a complaint related to chart entries you’ve made while off duty, you may find yourself in an expensive or even career-ending legal predicament without the protection of insurance. Also, if the case ends up in court, an attorney could challenge the validity of almost anything you write in a patient’s chart while off the clock.

• HIPAA liability: When you’re off duty, you’re no longer considered your patients’ assigned nurse, which means that you no longer have the legal authority to access their medical information (at least until you next clock in). Even having a patient’s chart in your possession while you’re off the clock might be deemed a HIPAA violation.

• Labor law liability: If you’re charting after hours and not being paid for it, your employer can end up in hot water. Federal labor law requires employers to pay their nonexempt employees for all work performed even if the employer didn’t authorize the extra time. This includes time spent charting; in fact, Department of Labor Fact Sheet No. 53 (www.dol.gov/whd/regs/compliance/
whdfs53.htm) includes an example specifically dealing with after-hours charting at a residential care facility.

• Reprimand or termination: Even if your hospital doesn’t have any specific policy that says off-duty charting is a no-no (and many do), most employers have policies forbidding nonexempt employees to work unauthorized overtime. In some cases, violating those policies can even be grounds for termination.

In short, off-the-clock charting is bad news and can create problems for everyone involved, especially for the nurse.

In the Real World
At this point, I’m sure many of you are saying to yourselves, “Quoting federal law is all well and good, but in the real world, if I don’t clock out at the end of my shift — whether I’m finished charting or not — I’ll get written up or even fired!”
The sad truth is that too many nurses are placed in exactly that situation. With hospitals reducing headcount and trying to limit payroll costs, there is often a lot of pressure on nurses to finish their charting after hours. In today’s economy, many nurses feel they have no choice but to go along. Some even see it as part of their duty to their patients; as nurses, we’re accustomed to making sacrifices for the sake of others.
However, if we give into that pressure, we’re actually encouraging poor management. Shady workplace practices thrive in a “don’t ask, don’t tell”environment where people are too afraid to speak up. Once a manager realizes he or she can get away with these tactics, they quickly become the norm. Even worse, the more nurses give in, the harder it becomes for other nurses on the same team to say no.

Steps to Take
What can you do if you if you find yourself having to chart after your shift ends? Here are some steps you can take.
The first is to evaluate your work and ask yourself where the problem really lies. Are you charting off the clock because that’s the unwritten rule in your department or because you’re unable to manage your workload during your shift?
If it’s a time-management problem, ask for help: Your department or human resources should be able to offer additional training, tools or mentoring to help you. If the trouble is that you’re having trouble navigating the EHR system, your hospital may offer remedial classes that can alleviate much of the problem.
If the problem isn’t you, but the expectations of your supervisor or department, the next thing to do is to dig out the policy and procedures manual you received when you were hired and familiarize yourself with your hospital’s specific policies about working off the clock. Then, talk privately to the other nurses on your team and ask if they’re experiencing the same problem you are. If it’s a systemic issue, the odds are that your coworkers are in the same boat. Point out what you read in the policy manual and ask if your coworkers would be willing to back you up when you talk to management.
The next and hardest step is to take some deep breaths, find your backbone and go to your supervisor. Calmly point out that nurses charting after clocking out is against hospital policy — and is illegal. If you can, document some specific instances. Also be sure to document the meeting and any other conversations you have with your manager or administration about the issue.
If at all possible, get some of your coworkers to go with you when you meet with your supervisor and present a united front. If your hospital has a nursing advisory board, consider seeking their help, too. If you are represented by a union, you should also go to your union steward with your concerns.

Chain of Command
With issues like this, it’s important to involve your chain of command. In some cases, the hospital administration is part of the problem, but sometimes the director of nursing isn’t fully aware of the situation.
When I was a DON and learned that some nurses on my staff were charting off the clock, the first thing I did was investigate whether the practice was a workload problem or a personnel problem. Most workload-related problems could be resolved with organizational changes like revising patient loads, assigning additional personnel or clearing up procedural snags that made it harder for nurses to chart in a timely fashion. Personnel problems generally boiled down to a few individual nurses being unable to manage their workloads, which could be addressed through training and counseling. Either way, once I knew the problem existed, I could do something about it.
If all else fails, your next and quite possibly final option is to file a labor complaint. Doing this can have serious repercussions, but if you’re committed to making a change for your fellow nurses, you might feel compelled to take this step. Before you do, you should strongly consider seeking the advice of an attorney or legal expert familiar with healthcare employment law. Not all labor laws apply the same way to all professions and the law makes some specific exceptions for healthcare professionals.
Taking a Stand
Many nurses are afraid to confront management about this kind of problem for fear of losing their jobs, but you need to recognize that if you’re charting (or doing other work) while off the clock, you’re already risking your job and possibly even your license. If you only do it occasionally, you might think it’s no big deal and if it’s the general practice in your department, going along with it might seem like the path of least resistance, but you ultimately have too much to lose.
If you’re a nurse manager — and this includes charge nurses, head nurses and everyone further up the ladder — you have a responsibility to cultivate an environment where off-the-clock charting doesn’t happen. That means making sure the nurses under you are properly trained and equipped to handle their workloads.
You should ensure that nurses who do have to stay past the end of their shifts to finish charting (which is sometimes unavoidable, although it shouldn’t become a habit) are properly compensated. Allowing or encouraging off-the-clock charting breeds staff resentment, invites a whole host of legal problems and debases the integrity of our profession.
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Paradigm Bytes November Issue



PARADIGM BYTES

Newsletter for Paradigm 97
November 10, 2013
PARADIGM DEFINED:1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.
MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.
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SNIPPETS
I have run this before in 04, and again in 06...but I think it is worth another appearance:
Recent surveys have provided a scientific rationale for IM site selection. The Ventro-gluteal is the only site that has not been associated with any adverse effects whatsoever. The ventro-gluteal site lacks major nerves and blood vessels, has well developed muscle mass, and is easy to locate.
Directions for this placement are as follows: place heel of NON-dominant hand over the patient's greater trochanter. Position the index finger on or toward the anterior superior iliac spine, then stretch the middle finger away from the index finger. The center of this V formed by the fingers and the iliac crest is the injection site. I strongly suggest that just before injection, a small tap by the nurse's finger will be a momentary distraction, and will help alleviate the pain of the injection.
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Nerve Injuries During Venipuncture by Sue Masoorli, RN
What is the procedure if the patient- during venipuncture- states that it felt like an electric shock went down the arm? This feeling of shock is a classic symptom when a needle point contacts a nerve. This could result in a permanent nerve injury and perhaps a malpractice charge involving the nurse… and this is not uncommon.
Two nerves which are most often injured during venipuncture are the radial and median nerves. The radial passes along the thumb side of the arm from the shoulder down into the wrist area close to the cephalic vein; the cephalic vein is preferred in most instances. This distal three inches of the radial nerve, JUST above the thumb, is the area most injured during IV procedures.
The median nerve, the largest nerve in the arm, runs inside the antecubital fossa, passes through the forearm into the palm of the hand. When blood is being drawn from the antecubital fossa or when inserting peripheral IVs, this nerve could accidentally be contacted and injured. Also, insertion of IV catheters into the superficial veins of the inner aspect of the wrist above the palm can result in serious injury to the median nerve and carpal tunnel syndrome.
If the patient complains of a feeling of electric shock as the needle is being inserted, the appropriate intervention is to remove the needle immediately causing only minimal damage.and prevents permanent injury. However, if the nurse continues with the procedure, a permanent , progressive, and painful disability resulting in reflex sympathetic dystrophy or Complex Regional Pain Syndrome (CRPS) can result.
The patient’s symptoms can include: hypersensitivity to temp changes, a mottled and cold hand/ forearm, excessive nail and hair growth, and the inability to lift heavy objects. CRPS is diagnosed by nerve conduction studies and the patients’ history. Treatments can include long-term pain control with narcotics, multiple nerve blocks, implanted morphine pumps, TENS units, splints, and/or casts.
The Infusion Nursing Standards of Practice* can be used in court to determine if a nurse delivered appropriate infusion care to the patient. The standards state: “site selection should avoid areas of joint flexion”. The wrist and antecubital fossa are areas of joint flexion and insertion of peripheral IV catheters into these areas can result in the decision that there was a deviation from the standard of practice.
Also, nerve compression injuries can occur when an infiltration of a large amount of IV fluid enters the tissues creating compartment syndrome. The length of which determines the amount of nerve damage. If, when the patient complains of tingling, the infusion is not stopped, a fasciotomy is required to relieve the pressure and a second surgical procedure required to close the wound.
Nerve injury related to venipuncture is one of the most common areas of nursing malpractice and one in which the nurse is considered the primary defendant.
Therefore, anytime the patient complains of tingling or “electric shock” during venipuncture or IV infusion……..the infusion must be stopped immediately.
Reference: Nursing Spectrum, September 20, 2004 FL, p. 14.
* Infusion Nursing Standards of Practice 2000 11/12 (5).

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FROM THE MEMBER (Sandy Summers Truth about Nursing)
Scrubbing out: MTV's Scrubbing in
October 24, 2013 - MTV's new reality show Scrubbing In, which premiered tonight, focuses on nine young travel nurses in California, but it isn't really about nursing. Sure, the show created a firestorm in the nursing community before it even aired because of advance indications that the nurses might come off as twits 'n' sluts. The first episode does suggest that the nurses were not selected to appear because of their nursing experience or ability to convey an accurate and comprehensive picture of the profession. Instead, they seem to have been chosen for their strong personalities, physical appearance, and eagerness to embrace reality show culture. The vast majority of the episode is the nurses' personal interactions, with a focus on partying, romance, and sex (e.g., "I have big fake boobs!" "Did you guys bring your vibrators?"). Well, that's a different vision of Nursing's Future for show sponsor Johnson & Johnson, whose Neutrogena ...
Read more: http://www.truthaboutnursing.org/news/2013/oct/24_scrubbing_in.html#ixzz2jK0Z10TR
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MEDICAL NEWS
Medtronic heart valve found to reduce death, stroke rate (Reuters) - Medtronic Inc's CoreValve heart valve implant significantly lowered death and stroke rates in frail, elderly patients with severe aortic stenosis who were considered too ill for surgery, according to data from a late-stage clinical trial.
Medtronic is preparing to launch the product in the United States, pending regulatory approval. It will compete with Edwards Lifesciences' Sapien heart valve, the only aortic valve replacement device currently on the U.S. market that can be implanted as an alternative to open-heart surgery.
Medtronic said it expects to launch the product in the United States for use in extreme-risk patients before its fiscal year ends in April 2014, noting that the U.S. Food and Drug Administration determined it has sufficient information to evaluate the device.
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
October 11, 2013 - Good communication among health care professionals is paramount when it comes to delivering excellent patient care, and research has shown that breakdowns in communication can lead to mistakes, and even adverse events.
But how often do providers stop and consider whether the patient’s voice is represented?
In recent years, the patient’s voice has been more and more of a consideration--especially as the movement toward patient-centered care has gained traction and health care organizations have become more concerned with their patient satisfaction scores.
Yet some experts like Mary Ann Friesen, PhD, RN, would like to have the patient’s voice represented in even more aspects of their care. Friesen believes in the value of including the patient--or, in some circumstances, the patient’s family--in the change-of-shift handoff, a transition that traditionally has excluded the patient.
“How can you be patient-centered if you talk around the patient and not with the patient?” said Friesen, the nursing research coordinator for Inova, a not-for-profit healthcare system based in Falls Church, Va.
Communication’s role in a handoff
Effective communication is essential when it comes to handoffs. In fact, patient harm can result from communication failures during handoffs or sign-offs from one provider to another. Other problems can arise, as well, as noted in a 2012 study for the journal BMJ Quality & Safety that analyzed shift handoffs between nurses and found a great deal of variability.
John Carroll, PhD, a professor in the Sloan School of Management at the Massachusetts Institute of Technology, described a situation in which a half-dozen nurses who were coming off shift were all crowded into a room with another half-dozen nurses, trying to hand over their patients as quickly as possible. Imagine the noise, he noted. And this scenario assumes that nurses have a dedicated space in which to sign off on their patients, which isn’t always the case.
Carroll and his fellow researchers also found that experienced nurses tended to shorten their reports when handing off patients, which led to new nurses feeling they needed to ask more questions. That sometimes led nurses to feel frustrated with the communication.
Carroll said that a disaster won’t automatically follow if something isn’t said during the handoff, but it might make a mistake more likely to occur.
“The hope is that if they communicate better, there will be fewer of those [mistakes],” he said.
Bringing the patient into the process
Like the BMJ Quality and Safety study, much of the attention on the communication aspect of handoffs has focused on the nurse-to-nurse angle. So considering the patient’s perspective--and incorporating patients’ voices into the handoff--does require a paradigm shift, Friesen noted.
In a recent article for the International Journal for Human Caring titled “Caring, Connecting, and Communicating: Reflections on Developing a Patient-Centered Bedside Handoff,” Friesen and her co-authors described the benefits of focusing on better two-way communication with patients during the change of shift.
They wrote that “well-intentioned staff nurses believed they were patient-centered when, indeed, they were not.” They added that the nurses needed “targeted instruction on how to bring the patient into the interaction,” which led to the creation of bedside handoff scripts to help nurses bring the patient to the center of the handoff and truly engage with them.
And that’s how a specific process like the ISHAPED bedside report can be useful. The process was designed to keep the patient at the center of the process, while also respecting patient safety. ISHAPED is an acronym for Introduce, Story, History, Assessment, Plan, Error Prevention and Dialogue.
Nurses can use the ISHAPED form to guide them during the handoff process. For instance, the outgoing nurse and incoming nurse enter the patient’s room together. Then the outgoing nurse introduces the patient to the incoming nurse. The outgoing nurse completes the handoff at the patient’s bedside, rather than out in the hallway or at the nurses’ station. During the transition, the outgoing nurse would communicate back and forth with the patient as he/she goes over plans for the patient. The patient has a chance to ask questions and provide feedback, and both nurses have a chance to participate in the dialogue. During the handoff, the nurse also writes important information on a white board to which a patient could later refer.
Friesen was also the lead author for a study in the July-September 2013 issue of Journal of Nursing Care Quality that described recommendations for implementing ways to include patients and their family members in the ISHAPED handoff process.
She credited the Picker Institute, which funded the project detailed in the International Journal for Human Caring, for insisting that patients and family members be involved in the creation of the patient-centered handoff. The patients and family members provided invaluable insight that might not have ever been considered otherwise.
“That was a true revelation,” she said.
Another recent study that explored the patient’s role in change-of-shift transitions in the oncology arena noted that patient participation in handoffs is still a new phenomenon that may require some changes.
“Expanding handoffs to include inpatients would be well supported by most oncology patients, but will require substantial changes in behavior on the part of patients and education,” wrote Nancy Staggers, Marge Benham-Hutchins, Luciana Goncalves, and Laura Langford-Heerman in the article that appeared in the Journal of Participatory Medicine in July 2013.
They also suggested that “future research might include developing and evaluating specific patient-centered content and processes to support handoffs.”
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Down Syndrome Treatment Study Shows Experimental Drug Reverses Cognitive Deficits In Mice There's still no cure for Down syndrome, but recent research is raising hopes that drugs can be found to counter the cognitive deficit that characterizes the genetic disorder.
In July, University of Massachusetts researchers said they had found a way to shut down the extra chromosome that causes the syndrome, at least in test tubes. And now comes word that scientists have identified a compound that brings dramatic improvements in learning and memory in mice bred to have a Down-like condition. One injection of the compound given on the day of birth seemed to work by allowing the animals' cerebellums to grow to full size.
"Most people with Down syndrome have a cerebellum that's about 60 percent of the normal size," Dr. Roger H. Reeves, a professor at Johns Hopkins University and one of the scientists behind the research, said in a written statement. "We treated the Down syndrome-like mice with a compound we thought might normalize the cerebellum's growth, and it worked beautifully... We were able to completely normalize growth of the cerebellum through adulthood with that single injection."... http://www.huffingtonpost.com/2013/09/05/down-syndrome-treatment-experimental-drug-cognitive-deficits_n_3875217.html?utm_hp_ref=science&ncid=webmail29

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Building Civility Capacity in Nursing Removing incivility from nursing practice requires improving communication skills at all levels
Elements of a Healthy Workplace
Shirey (2006) describes a healthy work environment as a setting where "employees are able to meet organizational objectives and achieve personal satisfaction in their work" (p. 258).
In 2005, the American Association of Critical-Care Nurses (AACN) identified six standards for healthy work environments including skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. 2
In addition, Clark (2013) found that healthy work environments also require a shared organizational vision, mission, and values, a high level of civility, and effective leadership, both formal and informal, at all levels of the organization.
A healthy workplace also includes an environment that promotes physical and emotional safety, positive recruitment and retention, competitive salaries and benefits, reasonable workload, high morale and job satisfaction, and policies to promote a healthy work environment and protocols to address incivility.4,5 ...
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Breath Test IDs Lung Cancer Types(CME AND CE)
CHICAGO -- A breath test for volatile organic compounds accurately detected lung cancer in high-risk patients and characterized its subtype, a study showed.
The test had C-statistics of 0.824 to 0.874 for various cancer subtypes compared with controls; 0.8 or better on the 1-point scale is considered strong concordance, Peter Mazzone, MD, MPH, of the Cleveland Clinic, and colleagues found.
It was even better at distinguishing adenocarcinoma from squamous cell carcinoma, with a C-statistic of 0.896, the group reported here at the American College of Chest Physicians meeting. ... http://www.medpagetoday.com/MeetingCoverage/CHEST/42533
(Disclaimer from the article:
  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
  • This cohort study suggests that a "breath test" has reasonable power to detect lung cancer in certain high-risk individuals.
  • Be aware that larger studies are necessary before the sensitivity, specificity, and predictive values of the test can be reliably reported.
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    Understanding Nurse Liability 2006-2010

    Providing quality care - ensuring patient safety - improving patient outcomes. Nurses strive toward these goals every day. But what happens when something goes wrong, and results in a claim?
    Understanding Nurse Liability 2006-2010: A Three Step Approach helps nurses and healthcare organizations gain a better understanding of the risks and challenges nurses encounter on a daily basis.
    Download this free report today, compliments of CNA HealthPro and Nurses Service Organization. Please note that you must be logged in to Lippincott's NursingCenter to access the free report.

    compatible with PCs, tablets, smartphones, and most eReaders.
    Word Origins: Run --- In some parts of Virginia and Maryland, small flowing bodies of water that might elsewhere be called "brooks" or "creeks" are called "runs." This comes from the dialect of southwestern England, where many colonial settlers of the region originated, and illustrates one sense of the verb "to run" as meaning "to flow." The best known is Bull Run, where two important battles of the Civil War were fought, the first on July 21, 1861.
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    Study links bipolar disorder to premature mortality
    Bipolar disorder was associated with premature mortality in a large study of Swedish adults. According to the results, women and men with bipolar disorder died an average of nine and 8.5 years earlier, respectively, than the rest of the population. Casey Crump, MD, PhD, of Stanford University, and colleagues used outpatient and inpatient data from more than 6.5 million Swedish adults, including 6,618 with bipolar disorder, to examine the physical health effects associated with bipolar disorder.

    According to the results, women and men with bipolar disorder died an average of nine and 8.5 years earlier, respectively, than the rest of the population.

    All-cause mortality was increased two-fold among women and men with bipolar disorder compared with the rest of the population.

    Patients with bipolar disorder also had increased mortality from cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, influenza or pneumonia, unintentional injuries and suicide for both women and men, and from cancer for women only.
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    (CNN) -- A flesh-eating drug that turns people into zombie-like creatures seems to have made its way to the United States.
    This extremely addictive injectable opioid is called krokodil (pronounced like crocodile) or desomorphine. It's so named in part because users report black or green scaly skin as a side effect.
    This weekend five people were hospitalized in the Chicago suburb of Joliet, Illinois, with symptoms similar to cases reported recently by health care providers in Arizona and Oklahoma.
    Dr. Abhin Singla said he suspects a woman he treated this weekend was suffering from krokodil addiction. Singla is an internist and addiction specialist at Joliet's Presence St. Joseph Medical Center. The patient lost significant portions of her legs, he said.
    Krokodil victims: We paid for heroin
    "It's a zombie drug -- it literally kills you from the inside out," Singla said. "If you want way to die, this is a way to die."
    Opinion: Drug prohibition is a global folly
    Krokodil causes serious damage to the veins and soft tissue infections, rapidly followed by gangrene and necrosis, according to a 2013 study (PDF).
    The soft tissue damage happens around the injection site. The drug also seems to clump in the veins as it fails to dissolve completely in the blood. The clumps make their way to distant places in the body and start to damage tissue, said Dr. Robert Geller, medical director of the Georgia Poison Center ...
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    See if you know the facts about hepatitis
    3.2 million:
    Number of people in the U.S. who have hepatitis C
    75%:
    More that 75% of adults with hepatitis C are baby boomers.
    1945 to 1965:
    The Centers for Disease Control and Prevention recommend that those born in this time frame have a one-time screening test for hepatitis C.
    95%:
    About 95% of adults who are exposed to the hepatitis B virus fully recover within 6 months without medication
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    Elderly exercisers have fewer broken bones after falls
    (Reuters Health) - Older adults who exercise are less likely to fall, but if they do, they're also less likely to get hurt, a new analysis suggests.
    Researchers found that older adults taking part in fall prevention exercise programs were about 37 percent less likely to be injured during a tumble, compared to non-exercising participants.
    "Falls are recognized as a serious and common medical problem experienced by older adults, but it's also widely known that falls are preventable, and that exercise is an efficient way to prevent them," Fabienne El-Khoury, the study's lead author, told Reuters Health in an email.
    "However there was no clear evidence that exercise (programs) can also reduce severe or more moderate injuries caused by falls, even though injuries due to falls have serious medical, psychological and economic consequences," El-Khoury added. ...
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    This was sent in by BAcello (Barbara)...thank you ! Barbara writes:
    "An instructor called me yesterday to ask about glove use. Specifically, she wanted to know whether it was necessary/required to wear gloves during the entire bathing procedure. For the most part, this is a facility policy issue, not a regulatory issue. This is also one of my soapbox issues. The answer is a resounding NO! Gloves are needed for potential contact with blood, body fluid, secretions, excretions, mucous membranes, and nonintact skin. People need to be touched.

    Many nursing staff apply gloves when they enter the room and wear them for the duration of resident/client contact. Of these, many do not wash hands before or after gloving. I think the gloves cause them to think that handwashing is unnecessary. I believe unnecessary glove use is offensive. To that end, you may find these guidelines for using gloves helpful:

    Sorry. My opinionated self is off the soapbox now."
    http://tinyurl.com/use-gloveshttp://tinyurl.com/WHO-gloves
    An editorial point of view about gloves... always wash hands before AND after gloving....picture all that bacterial build-up/ sweating.
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    Thank you, Marlene (MarGerlach) for the following:
    New Glaucoma Procedure Can End Need for Medications A new type of surgery offers more effective treatment for glaucoma, a leading cause of vision loss that affects more than two million Americans.
    The procedure uses a tiny stent, recently approved by the Food and Drug Administration, and is safer and less invasive than earlier types of surgery, with much quicker recovery and less discomfort.
    What's more, it can reduce or even eliminate the need for medications.
    With glaucoma, pressure from normal fluid in the eye gradually rises, causing damage to the optic nerve and eventually reducing peripheral vision. There are different forms of glaucoma, but the most common type is open-angle glaucoma, affecting 95 percent of those with the disease. The new surgery is designed to treat this exact condition.
    Eye fluid continually flocornea, which is a clear dome that covers the iris.
    This is the normal exit point for fluid. But with open-angle glaucoma, the angle is blocked, causing fluid buildup and pressure. The breakthrough surgery relieves this blockage by implanting a tiny one-millimeter stent, called the iStent.
    "The iStent will radically change the standard for how glaucoma is treated," says Robert Noecker, M.D., an ophthalmologist who is a glaucoma and cataract specialist at Ophthalmic Consultants of Connecticut in Fairfield, Conn., and one of the doctors who tested the device for FDA approval.
    Prescription eye drops are the first line of treatment for glaucoma, but many people require more than one type, making the regimen difficult to follow. And there can be side effects, such as stinging, burning, or redness in the eyes, or headaches.
    "Every one of my patients would like to get rid of their glaucoma medications," says Dr. Noecker.
    "By using the iStent, many of them will be able to go from using several glaucoma meds to fewer, or even from one to none at all."
    There are other, older types of surgeries that help fluid to drain. However, says Dr. Noecker, they carry much greater risk of complications and recovery can be painful, sometimes taking a month or more.
    Consequently, traditional surgeries are usually done only on patients at high risk of losing their sight.
    The iStent surgery, which takes 5-10 minutes, usually requires no stitches and involves much less manipulation of the eye than other surgical treatments. ...
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    Quiz Time
    Which statement about chest tube sizes is correct?
    a. The larger the French size, the smaller the tube.
    b. Common tube sizes for adults are 10 to 15 French.
    c. Smaller tubes are used to drain blood; larger tubes to remove air.
    d. Larger tubes are used to drain blood; smaller tubes to remove air.
    Answer at end of Newsletter
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    The Role Telomeres play in our lives....A new study/ discovery
    The tiny "caps" that keep our chromosomes from fusing together are also providing clues that could eventually lead to the achievement of one our nation's most important public health goals: extending good health well into old age.
    To help understand the role telomeres play within the human body, it's useful to review some basic biology. All of the tissues within the human body are made up of individual cells. These cells contain chromosomes within their nuclei. Chromosomes are the packages that hold most of our DNA - the genetic instructions that tell the cell what to do.
    To help understand the role telomeres play within the human body, it's useful to review some basic biology. All of the tissues within the human body are made up of individual cells. These cells contain chromosomes within their nuclei. Chromosomes are the packages that hold most of our DNA - the genetic instructions that tell the cell what to do.
    Telomeres are repeating DNA sequences at the ends of the chromosomes. They do not contain any genetic instructions; they simply repeat a sequence of DNA over and over. When we are young, the telomeres are very long - they may contain as many as 20,000 base pairs
    of DNA. ...
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    RANDOM FACTS: In the United States, approximately 7 percent of households are millionaires.

    According to the book The Millionaire Next Door, only 20 percent of millionaires inherited their wealth. The other 80 percent earned their cash on their own.

    Half of all millionaires are self employed or own their own business
    Bonus Fact:

    Around 80 percent of millionaires are college graduates. Only 18 percent of millionaires have Master's degrees. Eight percent have law degrees, 6 percent have medical degrees, and 6 percent have PhDs.

    The average millionaire goes bankrupt at least 3.5 times. (In case you were wondering about me... I'm not and have never been in this category)
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    Mosquitoes known to carry dengue, yellow fever seen in California
    (Reuters) - A tropical mosquito known to carry potentially fatal diseases such as dengue and yellow fever has been detected in California, raising concerns among public health officials and prompting intense efforts to eradicate the insect.
    No illnesses associated with the mosquito, known by the scientific name Aedes aegypti, have been reported since it first appeared in California's Central Valley in June, and none of the specimens trapped and tested has been found to be infected.
    But the species' feeding and breeding habits make it a voracious pest, which if allowed to propagate could pose a serious new health threat to the nation's most populous state while diminishing its outdoor lifestyle, authorities say.
    The small dark mosquito, distinguished by white markings and banded legs, feeds aggressively during the day, is especially fond of humans, often bites indoors, and requires very little standing water to reproduce. ...
    *******************
    FDA approves Abbott device for leaking heart valve (Reuters) - The U.S. Food and Drug Administration has approved Abbott Laboratories' MitraClip medical device, used to stop heart valve leakage in patients deemed unable to endure valve repair through open heart surgery, the company said on Friday.
    The MitraClip treats mitral regurgitation, a condition in which the mitral valve of the heart does not close properly, causing blood leakage that can lead to stroke, heart attack or even death.
    It has estimated the disorder affects about one in 10 people aged 75 and older.
    Those with the condition who are too frail for open heart surgery are typically treated with medicines and have high rates of heart failure and rehospitalizations. ...
    ********************
    CDC Offers Lead-Poisoning Prevention Tips
    The Arkansas Department of Health is teaming up with national agencies to increase awareness of childhood lead poisoning prevention
    LITTLE ROCK, AR -- The Centers for Disease Control and Prevention (CDC) estimates that nearly half a million children living in the United States have elevated blood lead levels that may cause significant damage to their health. This estimate is based on children with blood lead levels at or above 5 micrograms per deciliter.
    Elevated levels of lead in the blood can affect the nervous system and potentially cause other adverse health effects. Exposure to lead is especially harmful to children under six years of age because their brains and spinal cords are still developing. For these children, even being around very low levels of lead can result in permanent damage, such as: reduced intelligence, learning disabilities, attention deficit disorder, behavioral problems, stunted growth, and/or hearing and kidney damage. Therefore, health officials consider any level of exposure to lead to be unsafe, particularly for young children.

    "Preventing exposure to lead is the key," says Dr. Dirk Haselow, State Epidemiologist. "Unfortunately," he emphasizes, "the effects of lead toxicity in a young child can be devastating and lifelong."

    There are many ways to come into contact with lead: through cracked or peeling paint, household dust, bare soil, air, drinking water, food, ceramics, home remedies, hair dyes, and makeup. Much of the lead from these sources is too small for people to see. Children with elevated blood lead levels were most likely exposed to lead in their own homes from lead dust and lead-based paint chips, especially if that home was built before 1978 ...
    http://www.arkansasmatters.com/story/national-lead-poisoning-prevention-week/d/story/Jd1axSjY8U-XQnhC_CFitw
    ************************
    Radiation can pose bigger cancer risk for children - UN study Reuters) - Infants and children can be more at risk than adults of developing some cancers when exposed to radiation, for example from nuclear accidents, a U.N. scientific report said on Friday.
    Children were found to be more sensitive than adults for the development of 25 percent of tumor types including leukemia, and thyroid, brain and breast cancer, it said.
    "The risk can be significantly higher, depending on circumstances," the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) added in a statement. ...

    ***************
    U.S. proposes rules to boost animal feed, pet food safety (Reuters) - The U.S. Food and Drug Administration said on Friday it is issuing a proposed rule aimed at improving the safety of food bound for farm animals and pets.
    The rule would require companies that make animal feed and pet food sold in the United States to identify potential hazards and put in place procedures to prevent and correct them.
    Long in the making, the rule comes days after the agency turned to pet owners for help in an ongoing investigation into jerky products, most made in China, that have killed nearly 600 dogs and cats and sickened thousands of others in the United States since 2007.
    The proposal is one of seven key pillars of the 2011 Food Safety Modernization Act, an initiative designed to improve human and animal food safety and reduce food-borne illnesses by giving the FDA greater power to intervene before an outbreak occurs. ...
    ************
    Surprising Genetically Modified Foods
    By now, you've likely heard about genetically modified organisms (GMOs) and the controversy over whether they're the answer to world hunger or the devil incarnate. But for right now, let's leave aside that debate and turn to a more basic question: When you go to the supermarket, do you know which foods are most likely to be—or contain ingredients that are—genetically engineered? A handy FAQ:
    So what exactly are genetically modified organisms?
    GMOs are plants or animals that have undergone a process wherein scientists alter their genes with DNA from different species of living organisms, bacteria, or viruses to get desired traits such as resistance to disease or tolerance of pesticides.
    But haven't farmers been selectively breeding crops to get larger harvests for centuries? How is this any different?
    Over at Grist, Nathanael Johnson has a great answer to this question—but in a nutshell: Yes, farmers throughout history have been raising their plants to achieve certain desired traits such as improved taste, yield, or disease resistance. But this kind of breeding still relies on the natural reproductive processes of the organisms, where as genetic engineering involves the addition of foreign genes that would not occur in nature.
    Am I eating GMOs?
    Probably. Since several common ingredients like corn starch and soy protein are predominantly derived from genetically modified crops, it's pretty hard to avoid GM foods altogether. In fact, GMOs are present in 60 to 70 percent of foods on US supermarket shelves, according to Bill Freese at the Center for Food Safety; the vast majority of processed foods contain GMOs. One major exception is fresh fruits and veggies. The only GM produce you're likely to find is the Hawaiian papaya, a small amount of zucchini and squash, and some sweet corn. No meat, fish, and poultry products approved for direct human consumption are bioengineered at this point, though most of the feed for livestock and fish is derived from GM corn, alfalfa, and other biotech grains. Only organic varieties of these animal products are guaranteed GMO-free feed.
    So what are some examples of food that are genetically modified?
    1. Papayas: In the 1990s, Hawaiian papaya trees were plagued by the ringspot virus which decimated nearly half the crop in the state. In 1998, scientists developed a transgenic fruit called Rainbow papaya, which is resistant to the virus. Now 77 percent of the crop grown in Hawaii is genetically engineered (GE).
    2. Milk: RGBH, or recombinant bovine growth hormone, is a GE variation on a naturally occurring hormone injected into dairy cows to increase milk production. It is banned for milk destined for human consumption in the European Union, Canada, New Zealand, and Australia. Many milk brands that are rGBH-free label their milk as such, but as much as 40 percent of our dairy products, including ice cream and cheese, contains the hormone.
    3. Corn on the cob: While 90 percent of corn grown in the United States is genetically modified, most of that crop is used for animal feed or ethanol and much of the rest ends up in processed foods. Sweet corn—the stuff that you steam or grill on the barbecue and eat on the cob—was GMO-free until last year when Monsanto rolled out its first GE harvest of sweet corn. While consumers successfully petitioned Whole Foods and Trader Joe's to not carry the variety, Walmart has begun stocking the shelves with it without any label.
    4. Squash and zucchini: While the majority of squashes on the market are not GE, approximately 25,000 acres of crookneck, straightneck, and zucchinis have been bioengineered to be virus resistant.
    5. "All natural" foods: Be wary of this label if you're trying to avoid GE foods. Right now there is no strict definition of what constitutes a natural food. This could be changing soon as federal court judges recently requested the Food and Drug Administration to determine whether the term can be used to describe foods containing GMOs to help resolve pending class action suits against General Mills, Campbell Soup Co., and the tortilla manufacturer Gruma Corp.
    Are there any foods I've heard might be genetically modified—but actually aren't?
    1. Potatoes:     In 1995, Monsanto introduced genetically modified potatoes for human consumption, but after pressure from consumers, McDonald's and several other major fast food chains told their French fry suppliers to stop growing GE potatoes. The crop has since been removed from the market.
    2. Seedless watermelon: While it would seem plausible that a fruit that produces no seeds has been bioengineered, the seedless watermelon is a hybrid of two separate breeds. It has been nicknamed the "mule of the watermelon world."
    3. Salmon: Currently no meat, fish, or egg products are genetically engineered, though a company called Aqua Bounty has an application in with the FDA to approve its GE salmon.
    4. Soy milk: While 93 percent of soy grown in the United States is genetically engineered, most major brands of soy milk are GMO-free. Silk, the best-selling soy milk brand in the country, joined the Non-GMO Project in 2010. Many popular tofu brands in the United States also sell GMO-free tofu products.*
    5. Rice: A staple food for nearly half the world's population, there are currently no varieties of GM rice approved for human consumption. However, that could soon change. A genetically modified variety called golden rice being developed in the Philippines has been altered to include beta-carotene, a source of vitamin A. Backers are lauding it as a way to alleviate nutrient deficiency for the populations in developing countries.
    How about organic foods?
    Since the late '90s, USDA organic standards have prohibited any genetically modified ingredients. Originally, the agency tried to include GE foods under the organic umbrella, but it backed down in 2002 after a massive public outcry to save organic standards.
    How long have I been eating GE food?
    Scientists conducted the first GE food trials the late 1980s, and in 1994, a biotech company called Calgene released the first GMO approved for human consumption: the "Flavr Savr tomato," designed to stay ripe on the vine longer without getting squishy. The product, which Monsanto eventually picked up, flopped, but it paved the way for others: Biotech companies have made billions since with GE corn, soy bean, cotton, and canola.
    Aren't food companies required to let me know whether their products contain GMOs?
    Not in the United States. Sixty-four developing and developed countries require GMO food labeling, according to Freese at the Center for Food Safety. You may have heard about the recent string of "Right to Know" bills in state assemblies across the country. The bills are aimed to require food companies to label any products that contain genetically modified organisms. Connecticut and Maine recently passed laws that would require food manufacturers to reveal GE ingredients on product packaging, but those laws won't go into effect until other states adopt similar measures. Americans overwhelmingly support such laws, with poll after poll showing that over 90 percent of respondents support mandatory labeling. Biotech companies and the food industry say that such labeling would be expensive and pointless since genetically engineered foods have been declared safe for human consumption.
    So if the food is safe, what's all the fuss about them?
    First off, not everyone agrees that GMOs are safe to eat, especially over the long term. The European Union remains decidedly skeptical, with very few approved GE crops grown on the continent and mandatory labeling in place for products that contain GMOs. Some scientists fear that GMOs could cause allergies in humans. Others point to the environmental consequences of the farming of GE crops.
    How do GMOs affect the environment?
    One word: Pesticides. Hundreds of millions of extra pounds of pesticides. The six biggest producers of GE seeds—Monsanto, Syngenta, Dow Agrosciences, BASF, Bayer, and Pioneer (DuPont)—are also the biggest producers of chemical herbicides and insecticides. Monsanto's Roundup Ready crops, for example, are genetically engineered to be immune to herbicide so that farmers can destroy weeds without killing their cash crops. But the process has spawned Roundup resistant weeds, leading farmers to apply greater and greater doses of the chemical or even resort to more toxic methods to battle back the superweeds.
    Where can I learn more about GMOs?
    Mother Jones' Tom Philpott writes critically about GMOs often. In this 2011 Scientific American piece, Brendan Borrell lays out the pro-GMO case very well. Grist's Nathanael Johnson has written several posts that clarify the basic science behind GE crops, and a New York Times Room for Debate from 2009 offers a pretty good synopsis of the controversy. Food policy wonks might enjoy perusing the Food and Agriculture Organization's page on biotechnology in agriculture; if you're looking for a more entertaining way to educate yourself, a documentary called GMO OMG opens in select theaters this fall.
    Clarification: Previously this story stated most tofu sold in the United States is GMO-free. While the top-selling US tofu brand Nasoya and many other major manufacturers in the US have items verified by the Non-GMO Project, this doesn't necessarily encompass all tofu products.
    Become familiar with the most common applications of genetic modification. These are the products (and their derivatives) that are most likely to be genetically modified:
    • Soybeans - Gene taken from bacteria (Agrobacterium sp. strain CP4) and inserted into soybeans to make them more resistant to herbicides.[1] See How to Live With a Soy Allergy for more information on avoiding soy products
    • Corn - There are two main varieties of GE corn. One has a Gene from the soil bacterium Bacillus thuringiensis inserted to produce the Bt toxin, which poisons Lepidoteran (moths and butterflies) pests.[2] There are also several events which are resistant to various herbicide. Present in high fructose corn syrup and glucose/fructose which is prevalent in a wide variety of foods in America.
    • Grapeseed/Canola - Gene added/transferred to make crop more resistant to herbicide.
    • Sugar beets - Gene added/transferred to make crop more resistant to Monsanto's Roundup herbicide.
    • Cotton - engineered to produce Bt toxin. The seeds are pressed into cottonseed oil, which is a common ingredient in vegetable oil and margarine.
    • Dairy - Cows injected with GE hormone rBGH/rBST; possibly fed GM grains and hay.
    • Sugar. In 2012 the FDA approved GMO Beet Sugars to be allowed to be sold on the market under the name.... "SUGAR" So now, when we go to buy "All Natural" Breyer's Ice Cream, we can't even know for sure that we are actually eating regular natural cane sugar. If you see "CANE SUGAR" there's a good chance it's not GMO. This is one of the biggest frustrations with labelling, as sugar is in so many things, and we might be avoiding food that POSSIBLY has GMO sugar, but really does not.
    • Papayas.
    • Zucchini.
    • Corn sold directly to the consumer at Roadside stands / markets. Buy organic corn, popcorn, corn chips only.
    • Baked goods: Often has one or more of the common GM ingredients in them. Why do we need corn or soy in our bread, snacks or desserts? It's hard to find mixes to use as well. Some brands avoid GMs, find one you like and try to stick with it. Organic is one option, learning how to cook brownies, etc, from scratch with your own organic oils is another.
    ************************
    Similac baby formula pressured but refuses to remove genetically modified organisms
    Consumer advocacy groups say if your baby formula contains, soy, corn or dairy, there is a good chance it also contains genetically modified ingredients.
    Unlike 60 other countries, the United States does not require formula or food companies to let you know they are using genetically modified ingredients on the label. A bill to require GMO labeling of foods in Florida was defeated.
    One of the country's leading baby formula companies, Similac made by Abbott Laboratories, decided not to eliminate GMOs from baby formula during its annual shareholders' meeting.
    A spokesperson for Abbott Labs tells 10 News, its Board of Directors does not support the removal of GMO from its infant formula because:
      • All of our products are made with ingredients that are safe, effective and approved for use by regulatory bodies around the world, and we ensure that they have undergone extensive scientific evaluation.
      • Agencies such as the U.S. FDA, the World Health Organization and the Food and Agriculture Organization of the United Nations have concluded that GMO ingredients are identical in composition, nutritional value and quality as non-biotechnology derived ingredients.
      • Countries around the world have different requirements around the use and labeling of GM ingredients. Abbott fully complies with all local, regional and national standards related to the use and labeling of ingredients.
    10 News talked to board certified pediatrician, Dr. David Berger, and he said parents should be concerned about GMO ingredients in their baby formula and infant food.
    According to Dr. Berger, no long term studies prove GMO's are safe. Breast milk is best for babies but if you need to supplement with formula, Dr. Berger recommends organic formula brands because genetically modified ingredients are banned from organic formula.
    The Cornucopia Institute, a farm and food policy research group has launched a social media campaign on facebook, twitter and a petition drive to encourage parents to pressure baby formula companies to remove GMO's.
    According to Cornucopia Institute, the vast majority of corn and soy-based ingredients in processed foods in the United States, including infant formula, come from genetically engineered crops developed by Monsanto and other biotechnology companies. Dairy ingredients may come from dairy cows that were treated with genetically engineered bovine growth hormones.
    Mark Kastel with CI goes on to say, "Nobody should be eating GMO foods, especially babies. But until infant formula makers stop using GMO ingredients, hundreds of thousands of newborns and infants will be unwitting participants in this huge, uncontrolled experiment with the health of the next generation."
    Some of the GMO-free baby formulas include:
    • Earth's Best
    • Baby's Only
    • Plum Organics
    • Oh Baby
    • Organic Baby
    • Little Duck Organics
    ******************
    There is an old saying that goes, "Not in my backyard" which means that people don't want pollution-producing activities, like factories or garbage dumps, located in their neighborhoods, but as we are all beginning to learn pollution is a global problem.


    RANDOM FACT:

    The 2011 tsunami in Japan created a 70-mile-long island of debris, which is floating out into the Pacific Ocean. The debris is made up of houses, plastics, bodies, cars, and radioactive waste. Experts estimate that it will reach Hawaii in two years and the U.S. West Coast a year later.

    ***

    Bonus Fact:

    Pollution in China alters the weather in the United States. It takes just five days for the jet stream to carry heavy air pollution from China to the U.S. Once in the atmosphere over the U.S., the pollution stops clouds from producing rain and snow--i.e., more pollution equals less precipitation
    *****************
    Study ties low prepregnancy adiponectin to gestational diabetes risk
    Women with low serum adiponectin concentrations before pregnancy were at an increased risk of gestational diabetes, a study in Diabetes Care showed. Researchers also found overweight and obese women whose adiponectin concentrations were below the median had higher gestational diabetes risk than their normal-weight counterparts whose levels were above the median. ...

    ********************

    Hospital to home focus may reduce readmissions: study (Reuters Health) - Helping people who were recently released from a hospital understand how to care for themselves and informing their primary care doctors about their stay may reduce their risk of being admitted back into the hospital, says a new study.
    Researchers found that implementing a statewide transitional care program for North Carolinians on Medicaid - the state and federal insurance for the poor - was linked to a 20 percent reduction in patients' risk of going back to the hospital during the next year.
    "That finding is fairly consistent with what had been shown in other studies… We were hoping to achieve that big of a difference. The novelty was being able to achieve it on this scale," Dr. Annette DuBard, the study's lead author from Community Care of North Carolina in Raleigh, told Reuters Health.
    Researchers have known that the time immediately following patients' release from a hospital is critical to their chance of being readmitted later on.
    "The time of discharge from the hospital was a very vulnerable time for patients with complex care needs and we need to get resources in place to make sure they go more smoothly," DuBard said. ...
    ****************
    Studies find novel ways to relieve nausea after surgery Aromatherapy and intravenous administration of a dextrose solution may offer effective new approaches to relieving nausea and vomiting after surgery, according to a pair of studies in the September issue of the journal Anesthesia & Analgesia.

    Postoperative nausea and vomiting occurs in up to a third of untreated surgical patients. It not only is unpleasant for patients and associated with increased costs for antiemetic medications, but is linked to prolonged hospitalization and an increased risk of readmission, according to a journal news release. Effective, non-drug approaches to preventing and managing PONV are needed.

    In the aromatherapy study, 301 patients reporting nausea after surgery were randomly assigned to receive one of four types of aromatherapy. Two groups received true aromatherapy, with essential oil of ginger or a blend of aromatherapy oils (ginger, spearmint, peppermint and cardamom) placed on a gauze pad.

    The two other groups received gauze pads with non-aromatherapy solutions: either rubbing alcohol or, as an odorless placebo, saline solution. Rates of subsequent nausea and vomiting and need for antiemetic medications were compared between groups. ...
                                                 ~~**~~**~~**~~**~~**~~
                                                 HUMOR SECTION
    A very pregnant woman made her way to the nurses' station in the labor and delivery ward. Her mind was understandably elsewhere, as she explained, "I'm here to be seduced."

    The nurse smiled and said, "I think you already have been."
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    Frequent hand washing in my job as a medical technologist and the harsh weather combined give me very dry skin--I resolved to start taking better care of my hands.
    That night as I prepared for bed, I rubbed my hands with petroleum jelly and covered them with an old pair of white gloves. As I sat in bed reading a book with my gloves on, my husband finished showering and came into the room wearing a towel.

    Drying himself off, he went to the closet, selected a tie and put it on. "What are you doing?" I asked.

    "Well" he replied, "if you are going to be formal. So am I."
                                                              ~~**~~**~~**~~**~~**~~
    CEU SITES---(CME and CNE)
    Those that are-----Free and Otherwise..........
    Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member.
    Please follow me on Twitter as Dr Robert Hess.
    Pay Only $34.99 for a full year of CONTACT HOURS

    www.nurse.com for CNE offerings.
    ~~**~~**~~**~~**~~**~~
    WEBSITES/ LINKS
    Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.
    This is an excellent nursing site, check it out: http://nursingpub.com/

    Robert Hess, RN, PhD, FAAN     (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance
    info@sharedgovernance.org www.sharedgovernance.org

    Decubqueen's website:     www.accuruler.com
    RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm
    H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
    Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263
    If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood


    Metric conversion calculators and tables for metric conversions
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    MEDICAL RECALLS
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    Very few reports were sent out in October with one exception: FDA Enforcement Report for U.S. Food & Drug Administration (FDA) (This report is primarily on blood products being distributed without careful examination, etc.)
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    NEW MEMBERS
    Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
    WELCOME TO:
    iss1026@Yahoo.com (Val) October 20, 2013



                                                           ~~**~~**~~**~~**~~**~~
    ADVERTISEMENTS
    from the members
    This ad is from Decubqueen (Gerry)..........Accuruler Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford. Visit us at http://www.accuruler.com/.
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    GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)
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    NOTICE:
    I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address. So, be certain to let me know when you change your address. RNFrankie@AOL.com
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    MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)
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    DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
    ~~**~~**~~**~~**~~**~~
    THOUGHT FOR THE DAY
    People travel to wonder at the height of the mountains, at the huge waves of the seas,
    at the long course of the rivers, at the vast compass
    of the ocean, at the circular motion of the stars, and yet
    they pass by themselves without wondering.
    --Augustine
    Hope to hear from you..... Frankie
    while smaller tubes are used for air removal.
    Reprinted with permission from: Production/Electronic Channels CoordinatorHealthCom Media 259 Veterans Lane Doylestown, PA 18901
    The Paradigm Bytes Newsletter is published once a month and placed on our website. If you no longer enjoy receiving my notices about the publication, it you may stop at any time by contacting me (     RNFrankie@AOL.com ) or just hitting reply when my notice to you appears in your inbox. We'll be sad to see you go, but your request will be honored immediately.

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