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Post by medic09 on Jan 19, 2012 9:45:20 GMT -5
All I can offer is sympathy. It seems to me that most LTC (long term care) work is critically important and impossible to reconcile with our values, at the same time. Patients quickly get reduced to 'a task that needs to be done' when they are the patients most in need of being personalized and treated with extra dignity. I admire those nurses and others who can do the job well; while at the same time I resent those who reduce the job to a list of tasks and the patients to obstacles in getting those tasks done. In the ER we often receive LTC patients who we are convinced were sent to us just because the LTC facility staff didn't have time to deal with their problems properly. The poor patient to staff ratios, the general environment often don't allow for the staff doing a good and kind job. If you succeed in being one of those good LTC nurses (rare in my limited experience), you will be a heroine! I got confused by your use of NH. Didn't know if it was New Hampshire, or National Health (British). Good luck. Hashem should bless you with success and strength in taking care of these most vulnerable patients.
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Post by medic09 on Jan 11, 2012 23:51:06 GMT -5
Chaya, as an educator I say this is an excellent idea. Since I tend to interact with a more modern crowd, I didn't realize the girls have such a gap in their education. Rivka is right, by the way - yoatzot can be an excellent resource. There might be one in your area with whom you could speak directly.
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Post by medic09 on Jan 8, 2012 18:32:04 GMT -5
I would add that for the minimum required education for an RN, a nurse gets paid pretty well. One can get an RN with only two years in a community college. Who else with an Associate's degree earns over $20/hr starting pay? With opportunity to earn more in differentials for nights and weekends? And plenty of people with a BA are asking 'would you like fries with that?' for less than half of what a BSN nurse is making.
Consider it this way: a paramedic with the same amount of education out here makes about $12-$16/hr. A nurse is making $20 - $25/hr in the same area; with opportunity for more in differentials. My last flight job a full-time paramedic made about $65,000/yr while his nurse partner (same aircraft, shared duties) made about $17,000 more. Another flight job I had I was paid $450/shift, while the medic got $350/shift.
And let's not even talk about how hard our techs and aides work in the hospital during the same hours. Their pay is a fraction of ours.
When seem from the comparative perspective, I'd say nurses get paid pretty well.
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Post by medic09 on Dec 4, 2011 13:45:40 GMT -5
Clearly ICU isn't for everybody. It is where you see the sickest patients. They're very labor intensive, and you often/usually can't interact with them much on a cognitive interactive level.
These rotations help clarify what your niche might be. Most of us don't fit well everywhere. I thought I might want to work NICU, until I did a 7 week rotation there during nursing school. It was tremendously interesting; but I also found it intimidating and emotionally hard. So that helped decide the issue for me.
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Post by medic09 on Nov 25, 2011 0:32:38 GMT -5
I already have an occasional lunch with the only other Orthodox nurse in the area. He moved here recently, with his family to follow. There are now TWO Jewish nurses who are shomrei mitzvot in New Mexico! That is 100% growth. ;-) Next time he's over, we'll designate it an official AOJN lunch. How's that?
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Post by medic09 on Oct 24, 2011 12:54:14 GMT -5
Shalom Hindie and welcome!
We, too, are in a very small observant population in Santa Fe, NM; but it is bigger than yours. About 3 families, and another 4 or 5 singles are observant here; so it is a bit less lonely that way.
Tell us more about your community, if you don't mind violating your privacy to that extent. And what do you do for kosher goods (if available), shul, etc?
Have you worked out an arrangement with your program for Shabbat and holydays; or did you not want to get into that?
If you peruse the various threads on here, you'll see there has been some discussion of many relevant issues. There's always room for more, so don't hesitate to post!
Shanah tovah.
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Post by medic09 on Oct 24, 2011 12:48:25 GMT -5
Congratulations!
Clearly Hashem blessed your diligence and tenacity. Good job!
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Post by medic09 on Aug 25, 2011 22:04:02 GMT -5
Mazal Tov to member ntinarn, who became a mother-in-law Monday night! (Feeling old now?) This was an especially big simha for me, since I was at the parents' wedding; and now the oldest child's. Kein yirbu!
;D
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Post by medic09 on Aug 10, 2011 9:13:27 GMT -5
Stupid me, I am so used to having Eicha and Kinos books I forgot that it is also there! Well I havent had coffee for a week, I am totally not myself. Better to suffer one day of headache, than a week of withdrawal. ;D
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Post by medic09 on Aug 8, 2011 17:31:48 GMT -5
Oh thanks so much for posting. I accidentally took a shift tomorrow (monday, erev tisha b'av) that is going to last til 11pm. Any suggestions? I am going to make sure to drink a lot and bring food for seudah hamafseket and am bringing a tanach with me. It's just working with a camp, not in a hospital, so hopefully I will have some down time and be able to observe somewhat. I assume the Tanach is to read Eicha, or maybe the few other permitted sections? Working is permitted, though the halacha discourages this because is distracts one from real mourning. The sages greatly emphasized the importance of mourning over Yerushalayim, and being part of the entire nation's mourning. Still, it sounds like you've done pretty much the best with the situation. Since you get off at 23:00, I should think you'd be okay. You'll only be a few hours into the fast at that point.
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Post by medic09 on Aug 4, 2011 12:20:04 GMT -5
I think a woman could acquire the education and credentials necessary to advise rabbonim on issues of medical ethics even if she is not deciding halachah herself. I agree. I didn't say anything about 'deciding' halachah. I think that yoatzot halachah are an excellent model of halachic knowledge and competence. I think a *Jewish* ethicist should have a similarly thorough grounding in halachic and philosophic issues. As I mentioned earlier, "man or woman, it doesn't matter." My only point, while avoiding the unresolved question of 'is there ethics outside the halachah from a traditional perspective', is that in my view as an observant Jew, an applied ethicist has to be competent with the halachah. It isn't enough to have gotten a degree in Jewish philosophy or comparative religion.
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Post by medic09 on Aug 4, 2011 9:59:28 GMT -5
I answer partly tongue-in-cheek. I'll let you sort out which part is which.
For some, you have to have a background in nursing (preferably with a degree), you have to do coursework and training in ethics in the healthcare setting, and you have to be Jewish. That last is probably even optional.
For some, you have to have the above and a smattering of a Jewish religious education to make it sound like you are an expert on Judaism. Probably a degree in comparative religions would suffice.
To my mind? You need a practical and academic foundation in nursing, with graduate level studies in ethics. An internship in applied healthcare ethics. Ongoing Torah study that establishes you as a God-fearing, knowledgeable, competent person in matters of halacha in general; and healthcare questions in particular. Emphasis, of course, on the responsa literature pertaining to healthcare issues. In short, a talmid hacham. Man or woman, it doesn't matter.
For much of the Jewish community, competence in halacha is not a standard. To them, a general knowledge with experience of a Jewish perspective provided by broad knowledge of midrashim and philosophical discussions will do. Growing up, I recall having to read a book by a man who today is known as having been a 'foremost Jewish ethicist'. (My elderly mother really admires him.) He may have been Jewish, and he may have studied ethics; but even as a teenager I could see that I wasn't going to learn Torah from his writings.
If it sounds like much of the requirements I seriously described are for an accomplished rav - you're right. Except that most rabbanim don't really know about our profession and the day to day challenges we face. They know about medicine (sometimes); but they haven't a clue about nursing. In an applied healthcare setting, there would be a lot of crossover, of course.
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Post by medic09 on Aug 1, 2011 9:06:11 GMT -5
If by this, you mean a nursing ethicist who is truly knowledgeable and understands traditional Jewish law and ethics - I'm inclined to think there is no such person outside Israel. There has been little demand for such a person outside Israel. In the Western world, many of the 'Jewish experts' are nothing more than someone involved in a field, who happen to be or identify as Jewish. Not the same thing at all.
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Post by medic09 on Jul 24, 2011 13:46:59 GMT -5
Shalom Chana! Welcome to the ER.
The best advice really is to have a mentor on your shift. Otherwise, tell your charge nurse and even some colleagues near you, 'I'm eager and learning and hard working; but I am still a bit slow and unsure where things are. Can I ask you for help if I need it?' If they run trainings and reviews, attend as many as you can.
All the things you describe improve over time. You just need some time in the environment to get up to speed. I just came back to the ER after a year away for injuries; and I too am relearning where things are and how to do things.
Speed tricks? Far better to be safe and competent, than fast. Fast comes over time. Just stay focussed, don't get distracted from the task at hand. The ER is a busy environment with constant distractions. You may be managing four dynamic patients, and you still have to stay on task and get through the 'to do' list in an orderly manner, and chart it all.
If the morphine 'glass tubes' are (Tubex or something similar) Carpuject, there should be a device you can keep in your pocket to use the tube without drawing into another syringe. They're plastic, and the hospital pharmacy should be able to give you some. I always keep two around. Mind you, some of my friends prefer to draw into a regular syringe anyway. No big trick, and it does allow for easier titration. There are other drugs that sometimes come in tubex containers; so beware not to confuse them. Mostly narcs and benzos. Read the label twice. Be aware, too, that most of those tubes have some dead air space in them; so you need to gently expel the air before injecting.
As for the Shabbat thing, well you'll remember next time to bring that up sooner. We've had some discussion of that topic on here. Hopefully it won't be any issue again for a long time.
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Post by medic09 on Jul 18, 2011 17:37:38 GMT -5
Healthcare workers during a fast
It seems fairly simple that not working on a fast day is the better option, when possible. This is not always possible, for a variety of reasons. For the purpose of this discussion we should leave Yom Kippur out, since it is an obligation from the Torah and has its own detailed and well-discussed halachot. I would point out that Rav Neuwirth equates also the 9th of Av to Yom Kippur; but this is not a universally agreed upon approach. The 9th of Av is nonetheless of rabbinic origin as far as its halachic status, and its equation to the other rabbinic fasts is alluded to by Z'charyah (8:19). Of course, for any practical application one should consult with their rav. Rav Neuwirth succinctly states (מדריך הלכתי לאחיות בבתי חולים, פרק י) under the heading for the Fast of Gedaliah, "a nurse who has difficulty working appropriately on a fast day is permitted to eat. This applies only for the fasts like Fast of Gedaliah, 10th of Tevet, Fast of Esther, and the 17th of Tammuz; but not for Yom Kippur and the 9th of Av." As noted, the 9th of Av is indeed generally treated more strictly than the other rabbinic fasts; but it is still not identical to Yom Kippur as becomes apparent when discussing individual halachic questions. One of the useful places to learn a valid approach to these situations is in the halachic works written for soldiers in the IDF. In both frameworks, the individual is engaged in a mitzvah (defense of society, or patient care) and the welfare of others depends upon the individual soldier or worker's actions. These are considerations that may require ab initio a more lenient approach than otherwise used. In addition, once a nurse, physician, etc. has to work, there are some additional considerations that can affect their ability to carry out their duties properly. These include issues of grooming, since an unkempt appearance or bad breath can actually effect our interaction with patients.
The simplest issue to deal with is probably washing. There is a custom to not wash one's body with hot water from Rosh Hodesh Av through the 9th of Av. Ashkenazim generally avoided washing the entire body (such as a shower or bath) even with cold water; but would wash face, hands, and legs with cold water. Sefardim generally only do this during the week of the 9th of Av. The Yemenites generally did not do this, but only avoided entering a bath house or sauna (but permitted showering); while some were more strict as above. The source for this custom is in any case not from the g'mara, but later sources in the Rishonim. It should be clear that the custom prohibits only 'bathing for pleasure'. Rav Z'chariah ben Shlomo writes in הלכות צבא (פרק סט) "someone who sweats much from work, or security activity, or very hot weather, is permitted to wash in cold or tepid water." The Rema notes in the Shulhan Aruch (או"ח תקנ"א טז) that is is permitted to wash for a mitzvah, such as a woman preparing for mikvah, or someone accustomed to shampoo his hair with hot water before each Shabbat. A nurse or other professional who is concerned about hygiene, excessive sweat, or body odor while working with patients may take all this into account on the days they work. There is no question that washing one's hands or using sanitizer after patient contact is permitted and obligatory due to its proven ability to limit the spread of pathogens in the patient care environment. It should go without saying that if one has noticeable 'dirt' on their hands such as blood, etc. that it is permitted and obligatory to wash one's hands or other areas (fluids sometimes splash on one's face, hair, arms, etc.) as needed. It is important to note that Rav Yosef Tzvi Rimon (צבא כהלכה, pg. 267) discusses the notion of a 'delicate individual' in this context. In masechet b'rachot we learned that Rabban Gamliel bathed even on the night immediately after his wife's death. When his students questioned him, noting that such washing is normally forbidden, he replied, איסטניס אני - I am a delicate individual, and so exempt from this halacha. In the halachot of mourning in the Shulhan Aruch (יו"ד שפ"א:ג), Rav Yosef Karo notes Rabban Gamliel's position as the halacha, adding "not everyone who claims 'I am delicate' is allowed." Rav Rimon notes that in the reality of modern times, with our present standards of hygiene and also dealing with hot climates, it is reasonable to say that all of us are included in the category of 'delicate'; and that our washing is not for pleasure in any case, but rather for cleanliness. Therefore, he writes, it seems reasonable that out of respect for ourselves and others (כבוד הבריות) it is even desirable to wash during the nine days leading up to the 9th of Av. This, he says, is the opinion of Rav Elyashiv and Rav Sheinberg as presented in Shut Divrei Hachamim. In any case, he suggests that one should limit how often and how long one showers based on the conditions and needs. One should shower with cold water if they can, or add some hot water if it is too uncomfortable to shower with only cold. On the 9th of Av it is forbidden to wash, and even to stick one's finger in water. This is, however, still a prohibition of 'washing for pleasure'. As above, a nurse or other patient care worker who has any noticeable 'dirt' on their hands or elsewhere may and must wash as needed to remove the dirt. Similarly, when leaving patient contact one must wash or use sanitizer as required for purposes of infection control. Tangentially, it is interesting to note that Rav Shlomo Min Hahar and Rav Shlomo ben Zechariah both write that soldiers who return from patrol and have aching feet are allowed to wash them for relief, since this is considered therapeutic and not for pleasure. This is already brought in the Shulhan Aruch (או"ח תקנ"ד:יד) regarding someone coming from a journey on the 9th of Av. It may even be, in my opinion, that a nurse would find this applicable after an especially long time on their feet. As always, one should consult their rav.
Next we will look at drinking, eating, and 'tasting' on a fast.
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