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HUGE!
Jan 23, 2013 11:00:06 GMT -5
Post by medic09 on Jan 23, 2013 11:00:06 GMT -5
In the US, the scopes of practice, prescription authority, etc. for NPs (and PAs) varies from state to state. In some states, for instance, NPs work with some sort of physician oversight (though not so much as a PA); in others, like NM, they are independent practitioners and prescribers. I suspect that what will evolve in Israel will be the more restrictive model, since Israeli medicine is so deeply rooted in a paternalistic, territorial European model of practice. But it will still open up the field way more than it has been until now.
Rivka, I seem to recall you were interested in NP school. What happened with that?
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Yoatzot
Dec 30, 2012 8:10:15 GMT -5
Post by medic09 on Dec 30, 2012 8:10:15 GMT -5
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HUGE!
Dec 14, 2012 16:12:56 GMT -5
Post by medic09 on Dec 14, 2012 16:12:56 GMT -5
How did no one here mention this? NPs and PAs are going to be recognized and utilized in Israel! That will be a major change in the philosophy driving medical care in Israel since the founding of the state. www.jpost.com/Health/Article.aspx?id=294994
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Post by medic09 on Dec 14, 2012 13:09:04 GMT -5
I would point out that ner Shabbat is a somewhat different, and easier, issue in halachah with regards to the use of electricity. Below is an email I sent as a response to someone in Boulder yesterday:
"Actually, ner Shabbat and electricity is an easier issue. There is a pretty broad consensus that one may fulfill their obligation for ner Shabbat with an electric lamp. It isn't unanimous; but quite well accepted. I'll elaborate another time if you need me to, but let it suffice to say that Rav Neuwirth (Shmirat Shabbat K'hilchatah vol. 2) writes 'and one who lights nerot shabbat or yom tov with electric lights has who to rely upon, and also should make a b'rachah on this lighting as long as they are lighting in honor of shabbat."
Rav Shlomo Zalman Aurbach apparently saw some preference here, too, to a battery operated light over a plug-in - but Rav Neuwirth doesn't cite that in his halacha as you can see. He does mention it in a footnote.
Rabbi Dr. Abraham S. Abraham, MD writes in his Halachoth for the Patient and Attendant on the Sabbath, Festivals, and Yom Kippur "If candles are either not available or not usable, an electric light may be turned on, prior to the commencement of the Sabbath or Festival, but without a blessing. It is preferable to light a flashlight if available rather than an electric light. If these are already lit, they must be extinguished and then relit specifically in honor of the Sabbath." He footnotes to the Shmirat Shabbat noted above.
About two years ago a woman from NY called me erev Shabbat from UNM to ask what to do in this regard. I instructed her to turn off the lights in the hospital, to turn them back on l'chvod Shabbat kodesh, and to make a b'rachah on it."
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Post by medic09 on Dec 10, 2012 15:29:27 GMT -5
The clear majority of poskim do not allow use of an electric ner hanukah. The objections vary, having to do with the electric lamp not fulfilling different criteria from the g'mara having to do with wicks, fuels, or the form of the lamp. Notice that I said "do not allow"; and not "forbid". In fact, as mori Rav Nahum Eliezer Rabinowitz summarizes in his teshuva on this in Melumadei Milhama (siman 97), 'due to the lack of conclusive proofs' the poskim had to rely on various rationales to establish their opinons. Further he says, "It stands that there is no clear rationale to forbid or permit the use of electricity for ner hanukah." In a case where there are no clearly compelling halachic criteria, one must act according to the established custom - in this case, oil or candles. Relating to soldiers (the question came from a soldier) he says that if for security reasons a soldier may not light in the normal manner, he may use electricity without a b'rachah.
Rav Ovadiah Yosef, in two places in Yabia Omer volumes 3 and 4, summarizes the arguments of the poskim and concludes that if one could not light properly, then using an electric light without a b'rachah might be an option. I have been told that Rav Tzvi Pesah Frank had a similar conclusion.
On the other hand, Rav Yosef Messas (Morocco and later Sefardi Chief Rabbi of Haifa) in Mayim Haim was of the opinion that one may fulfill the mitzvah of ner hanukah with an electric light. He sees no question about it. Rav Shlomo Zalman Aurbach, in Halichot Sh'lomo, says that lacking any other option one might be able to light a battery powered flashlight and make a b'rachah (though elsewhere he makes clear his position that one should avoid using an electric lamp). Rav Yonah Metzger, in M'yam Ha-halachah writes regarding a soldier stuck in a tank that lacking any alternative there are those who would allow him to make a b'rachah on a flashlight, and that he should leave it lit for a half hour (the normal required time for ner hanukah).
It would seem, then, that residents or long term patients in a facility that prohibits lighting an open flame such as for ner Hanukah might need to consider the option of an electric lamp. Of course, one needs to ask their LOR; but this provides some food for thought and questions. I would be inclined to think that if a patient or resident has no one at home who is lighting, then using an electric 'menorah' would be an option. It seems from the analysis of Rav S.Z. Aurbach and others that a battery operated device might be preferable to one that plugs in the wall socket. Also, and possibly more importantly, it may be that one should prefer an incandescent bulb(s) to fluorescent, LED, or the like. Regarding a b'rachah, that is difficult. Based on Rav Messas and Rav Metzger, it seems that saying a b'rachah may be possible in a circumstance where the electric option is the only one.
Interestingly, I saw a responsum from Rav N.E. Rabinowitz that one might light with a blessing in the workplace. The circumstance was compared by him to lighting in the synagogue (based on the Aruch Hashulhan). IF there were a minyan present, and IF that included people who will not light otherwise at home for whatever reason, then it may be that one may light in the workplace with a b'rachah in the presence of the minyan and thus fulfill their obligation. See Shu't Siah Nahum Orah Haim siman 42. See there for details.
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Post by medic09 on Dec 7, 2012 13:52:57 GMT -5
My first round of college was in the late seventies in Israel. And yes, a baccalaureate degree took only three years because we did almost no liberal arts type courses. Almost all our coursework was related to our major. One of my friends even got credit for much of the first year of his MA in the States, because he had more credits and courses in our major than most American students do for a BA.
And yes, an accelerated nursing program is fine. I got my BSN in only 16 months (no summer off), because I had a BSc. already and didn't need any prereqs. An Israeli BSc./BSN, including prereqs, should still take 3 years (with summers off). Nurses today need more education, not less. Everything from drugs to devices to procedures is more sophisticated. Not only does good care require the education; so does professional respect. It doesn't make good professional sense to start a new nursing program with less education. All that will do is limit the opportunities and usefulness of the graduates in a field that is continually demanding more education. And if those nurses lack a good HS preparation, then they will end up being glorified CNAs, I fear.
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Post by medic09 on Dec 6, 2012 21:14:42 GMT -5
Seems related to the idea we discussed here: aojn.proboards.com/index.cgi?board=breakroom&action=display&thread=297. Medicine and nursing are getting ever more sophisticated and complex. I don't see how this will be good for patient care. At best, it will create a סוג ב/second class nurse who will be able work in limited capacities with limited opportunities. And Rivka's question is a good one. Where will they work?
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Post by medic09 on Nov 26, 2012 13:40:47 GMT -5
Well, there definitely is an additional factor to consider here since it is your phone and computer that they want to use. That potentially restricts things further.
Again, I for one am glad you brought this up as it is a good example of the interesting and complex issues that sometimes confront us as Jewish nurses.
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Post by medic09 on Nov 22, 2012 12:54:18 GMT -5
This is a great question/dilemna because it brings out a number of the issues we contend with as Jewish nurses. I see a bunch of topics folded into this.
I always have to bite my tongue when a non-observant friend tells me what is or is not a priority in Torah and halachah. The irony or hypocrisy really grates on me, personally.
As for your colleague's assertion - I highly doubt it. If this isn't an issue of pikuah nefesh or safek pikuah nefesh, then it does not trump hilchot shabbat. What the problem is with hilchot shabbat may be debatable. See below.
Of course, your working relationship with your colleague is part of the question here. Whether or not to pursue a debate or discussion with her of the issue largely depends on your relationship. We should always, in my opinion, be acutely aware in our dealings with other people of the potential for kiddush hashem and hillul hashem.
Regarding the actual communication, it isn't clear in halachic consensus what is happening here. Your patient is not violating Shabbat, since it has ended. He isn't necessarily causing others to do so, since they can refuse the call/Skype; or they might engage in an alternative hillul Shabbat like going for a drive. There is a bit of dispute among contemporary poskim on such an issue. The classic question about inviting non-observant guests for a Shabbat meal is related. Does my mere invitation serve as a 'stumbling block' by setting them up to drive on Shabbat to my house? Many rishonim and aharonim would say no. Many obversely say it is forbidden and a violation of the Torah's prohibition of a 'stumbling block'. Personally, I hold it is not a violation of 'michshol lifnei iver', following the lead of Rav Tzvi Yehudah Kook and Rav Hershel Schachter, with whom I briefly discussed this issue for our beit midrash. But many rabbanim forbid this.
Similarly, your patient places a call. It is an 'invitation' to the other side to pick up (or get on Skype). They don't have to answer. They could also initiate the call themselves. So it isn't clear that that your patient is violating the prohibition of michshol. Even if he is not, one might still argue that if he avoided calling till later it would still be better. Personally, I think so. If all things are equal, why not delay the call?
By the way, I'll point here to the dirty little secret regarding electronic devices on Shabbat. It is not at all certain or clear what prohibition is involved in using them. Going back several decades, Rav Shlomo Zalman Aurbach was of the opinion (published in his book on the topic) the use of electricity on Shabbat does not involve any violation of the Torah. He was convinced, even after debating it with the Hazon Ish, that at most a rabbinic prohibition would be involved. It seems that with modern electronic devices, this would even more be the case. Older rabbanim have told me how back in the 40s and 50s there was a lot of debate and varying opinions on the matter, regarding Shabbat and Yom Tov. Again, today's electronics are likely much less of a problem - though that is my limited conjecture.
So, there is an outside chance that the use of electronic media on Shabbat involves no issur d'oraita. And making the call may not be a michshol lifnei iver. It would still be far better not to impinge on kedushat Shabbat, as the navi says v'daber davar; but there may not be an obvious or definite issur.
Lastly, we are nurses and we are Jews. Our mandates are complex and at times in tension with each other. As a nurse you have a mandate to promote your patient's welfare and sensitively navigate what is supporting/encouraging vs. what is interfering. It varies, as you know better than I, with each patient. As a Jew you have a mandate, nay an obligation from Torah, to promote Torah in general and specifically encourage another Jew to honor and uphold the Torah. Sometimes we have to think a bit strategically about how to do that. We have to think about our effect on the individual about whom we care; and we have to think about the effect on the organization or institution. Usually, slow and easy is the better long term strategy. Divrei hachamim b'nahat nishmaim. Sometimes we have to emulate Hashem and apply some tzimtzum, and hold restrain ourselves.
The 'proselytizing' argument bothers me. You're in Israel. You normally have an obligation to encourage another Jew to observe Torah. An objection to 'proselytizing' in that context is pretty goyish; but that is how some of our colleagues and friends think. But it is what it is, and again the strategy has to be one of darkei noam and pursuing kiddush hashem. That sages say that the mitzvah of 'loving hashem' involves making hashem loved by others through our actions. That places, I believe, a high emphasis on keeping it pleasant as much as possible; and sometimes just stepping back.
I know you know whatever I brought up here; but sometimes seeing it laid out by a friend helps. My thoughts on the matter are only worth what you paid for them. ;-)
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Post by medic09 on Nov 11, 2012 15:49:35 GMT -5
Good response, Achot. I think you should write to Judy Seigel-Itzkovitch at the Jerusalem Post. Years ago I found her to be responsive when I wrote to her on a matter that bothered me then.
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Post by medic09 on Nov 11, 2012 9:56:28 GMT -5
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Post by medic09 on Nov 2, 2012 12:23:41 GMT -5
This sounds like a really good opportunity, even if it is in NYC. Nurses who have family or other business near NYC could use this as an excuse for a combined visit. Has this announcement been email distributed?
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Post by medic09 on Sept 7, 2012 6:48:20 GMT -5
rnrachel,
Maybe tell us more. I'm curious - what is Frum Nurses Network, Inc. How does it differ, or what it does it do that this group isn't trying to do?
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Post by medic09 on Aug 16, 2012 21:18:14 GMT -5
אשריכם
Hashem should bless you all a thousand times over in this world and the next! Your whole career was worth it for something like this.
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Post by medic09 on Aug 16, 2012 21:13:33 GMT -5
Since no harm came of it, don't agonize over the incident. It was a relatively small learning event for you.
As for gumption: remember always that you are Hashem's shaliah as the patient's advocate. The patient's welfare is your only concern. When someone intimidates or just harasses you - stop and take a deep breath to center yourself. I tell you in all candor that even under fire, that's the thing to do. Don't let them distract you from your task as patient advocate.
As for Ashot's comment that parents sometimes lie by commission or omission - remind to tell you sometime about the late night rescue we did for a teenager hiking with a group at altitude. Seems no one thought it relevant to inform the group leaders that he had a congenital cardiac problem. Well, when it bothered him hiking at nearly 10,000 feet (he lived at sea level) we had to do a full on rescue and evacuation with no idea what was really happening. Always be prepared for surprises. Patient care is an adventure! ;-)
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