Every once in a while I think it is helpful to review an issue that we assume everyone is totally familiar with. But as an employee of a staffing company that sends nurses all over the United States, it has come to my attention that not all nurses understand the multistate licensure privilege. Of course, the most up-to-date information can be found on the National Council of State Boards of Nursing website located at the following: https://www.ncsbn.org/2011_NLCA_factsheet_students_Rev_Jan_2011.pdf.

Here is the information stated on the webpage.

• A nurse must legally reside in an NLC state to be eligible for issuance of a multistate license. In order to obtain a compact license, one must declare a compact state as the primary state of residency and hold a nursing license in good standing. There is not a separate application for obtaining a multi¬state license.
• A nurse whose primary state of residence is a non¬compact state is not eligible for a compact license.
• Upon being issued a compact (multistate) license, any additional active compact state licenses held are inactivated because a nurse can only hold one multistate license.
• A nurse licensed in a compact state must meet the licensure requirements in the home state. When practicing on a multistate privilege in a remote state, the nurse is accountable for complying with the Nurse Practice Act of that state.
• A nurse with an active compact (multistate) license wanting to practice in another compact state does not need to complete any applications nor pay any fees as the home state license is accepted as a priv¬ilege to practice in other compact states.
• A nurse who declares a non-compact state as the primary state of residence will be issued a single-state license.
• A nurse must hold a separate license in each non-compact state where practice privileges are desired.
• While under disciplinary action, multistate privileges may be removed and the nurse’s practice may be restricted to the home state.
• The NCLEX® can be taken in any jurisdiction. However, gradu¬ates applying for a license, who legally reside in a compact state (the home state) can only apply to their home state board of nursing. This means that the applicant cannot apply for a compact license in a compact state other than the one in which he/she legally resides.

So, it seems a very important point is that the compact privilege is based on having a primary residence in a state that has entered the compact. If a nurse moves his/her primary residence to a non-compact state, he/she loses the compact privilege and must apply for a license in the new state of primary residence and also apply for a license in every state he/she wishes to work. Without a valid license to practice, a nurse is subject to discipline for practicing illegally.

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A recently released study supports the notion that using swear words can help a person combat pain. According to the study, cursing can provide effective, albeit, short-term pain relief. The study was published in the November 14^th issue of The Journal of Pain.

Another study done previously also found that swearing can help people withstand pain. The difference between the more recent study and the previous one is that the newer one takes into account people’s swearing habits. 

It seems that if a person swears frequently, its effects on pain relief is lessened, negligible, or not at all. The researchers say, “Swearing is a very emotive form of language and our findings suggest that over-use of swear words can water down their emotion effect.” Used in moderation, swearing can be a useful alternative pain-reliever in situations where you can’t easily access medical care or pain relievers.

There is support for the link between swearing and pain relief, but the underlying reason is unclear. Language activates the cortex (the out layer of the brain) but swearing seems to activate deeper levels—the ones more closely linked to emotions.

Of course, there will be further study of the issue since one study always seem to lead to further avenues that need exploration. The researchers add, “In the context of pain, swearing appears to serve as a simple form of emotional self-management. Whether swearing has beneficial effects in other contexts is something we would like to explore in the future.”

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http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=238525

Gallup has just released its latest poll rating the honesty and ethical standards of various occupations/professions. Once again nurses have been given the highest marks for honesty and ethics. They have been identified as number one in these qualities every year they have been included in the survey with the exception of 2001 when fire fighters held that ranking and nurses were second.

This year, Nurses were given High or Very High ratings by 84% of those surveyed. Only 1% rated nurses as Low or Very Low in honesty and ethical behavior. Pharmacists were identified as High or Very High in honesty by 73% and Medical Doctors were rated as High or Very High by 70% of those polled.

On the other end of the spectrum, only 7% of people gave Members of Congress a rating of High or Very High in honesty and ethical standards. They were tied with Lobbyists and Car Salespeople in receiving the lowest ratings. Sixty four percent gave Members of Congress a rating of Low or Very Low.

The American Nurses Association has endeavored to communicate the value of nursing and it seems the efforts have been successful. Talking points have focused on the contributions nurses make to ensure that the healthcare of everyone is more effective and meaningful. The one idea that seems to resonant with most of us is that nurses are there for patients. They are the ones who are at the bedside 24/7. They are the ones who answer patient needs—even at 2:00 in the morning.

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http://www.gallup.com/poll/151460/Record-Rate-Honesty-Ethics-Members-Congress-Low.aspx

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/Nurse-Jackie.html

Most people have heard of Johns Hopkins Hospital. The name is associated with high quality medical treatment and cutting edge healthcare research. The institution has been ranked by U.S. News and World Report as the best overall hospital in America for 21 consecutive years. 

The institution is named for the man who donated thirteen acres of land in the city of Baltimore for the purpose of building a hospital. In 1873, he wrote an Instruction Letter to the men he trusted to implement his wishes following his death. He wanted the hospital to compare favorably in construction and arrangement to “any other institution of like character in this country or in Europe”. He directed the trustees to find physicians and surgeons of the “highest character and greatest skill”. Hopkins’ vision for the hospital was, first, to provide assistance to the poor of all races, no matter the indigent patient’s age, sex, color, or religion. Mr. Hopkins would be happy to know that the hospital has stayed true to his vision by providing $248 million in uncompensated care in 2009.

As part of Hopkins’ instruction letter that clearly stated his vision, the trustees were directed to found a School of Nursing. The School was begun in 1889 after consultation with Florence Nightingale. The purpose of the school was to provide training for female nurses who could provide competent care for those sick in the hospital wards and benefit the community by supplying trained and experienced nurses. Interestingly enough, the nursing school was started four years prior to the founding of the School of Medicine. 

The hospital has implemented many “new” nursing ideas over the years. Shared governance, support for nursing research, and university affiliation for nursing education have all been part of Hopkins’ nursing legacy. It was the first Maryland hospital earning Magnate designation in 2003 and was re-designated as a Magnate facility in 2008. Magnate designation underscores the major role nursing plays in maintaining the excellence of patient care for which Hopkins is noted.

A close friend of mine elected to have his surgery at Hopkins. He traveled to Baltimore with his wife and was admitted to the surgical unit. He said the nurses were fantastic and his care the very best. His wife stayed with him and everyone made sure she was kept informed of his progress. He still raves about the care he received while he was there.

In order to continue its reputation for quality healthcare, Johns Hopkins Hospital is in process of constructing two connected, twelve story towers. One tower is being built for cardiovascular and intensive care services and the other for a children’s hospital. The children’s hospital will house the only state-designated pediatric ER in Maryland. The towers include a total of 560 beds—all inpatient beds are in private rooms with walk-in showers and sleep sofas for family members. 

In addition, the towers will feature 33 OR’s, radiologic suites, adult and pediatric ER’s, advanced air-circulation, filtration system, sound absorbing panels, advance computer systems, workstations located between every two rooms, and a quiet nurse call system. There will also be a state-of-the-art obstetric suite.

Located in downtown Baltimore, people working at Hopkins have the opportunity to enjoy an area rich in history, culture, sporting events, leisure activities and good food. There are many restaurants and clubs in the city and surrounding environs noted for seafood. The Eastern shore of Maryland is famous for steamed blue point and soft shell crab. But you have to be ready to roll up your sleeves and get a bit messy when you eat them. It is worth the effort, though.

Baltimore is close to many cities of the northeast—Washington, D.C, Philadelphia, and New York. Any of these cities are only a few hours’ drive (or train ride) away. There are lots of places to go besides enjoying Baltimore.

A traveler working with PPR says he loves working at Johns Hopkins in their ER. “There is a reason they are number one—phenomenal teamwork. They do it their way, and it works. Everybody looks out for the other, has each others’ backs.”  He goes on to say, “You cannot be a slacker at JHH. It should be this way everywhere. You work hard, you see a lot, do a lot.”

On the personal side, his wife and he live 20 minutes outside Baltimore in a beautiful apartment complex. He says the public transportation is amazing. It will take you to DC, Philly, even Boston. It’s an easy daytrip to NYC and Boston is 4-5 hours away. His wife and he spent a day in NYC window shopping and seeing the national Christmas tree in DC.

Johns Hopkins will be looking for nurses to help with the transition into the new towers. If you think you are interested in taking advantage of the opportunity to work in one of the best hospitals in the world, go on line to www.pprhealthcare.com or call (888) 909-5038.

One might guess that the biggest candy consumption day of the year is Halloween—not all of it eaten by children. After all, how many parents go through the Trick or Treat buckets (who uses bags anymore) and pick out all the “good” stuff. You know, the Snickers, Reese’s Peanut Butter Cups, and M&M’s. 

According to statistics gathered by the U.S. Census Bureau in 2005, the per capita candy consumption by Americans in 2004 was 24.7 pounds.  A large amount of that is eaten by kids immediately following Halloween. This is actually lower than the amount consumed in 1997 which was 27 pounds per American.

But Christmas is not far behind in the amount of candy we consume. Perhaps Christmas lags behind in eating candy because there are so many other goodies to munch on—gingerbread, cookies, pie, and other non-candy sweets.

I did read a very interesting article that reinforced my absolute loathing of black licorice. There is a substance in black licorice called glycyrrhizin which can give you heart arrhythmias, high blood pressure, lethargy, and congestive heart failure if you eat too much of it.  Too much is defined as consuming 2 ounces a day for two weeks.

Fortunately, many licorice or licorice-flavored products available in the U.S. contain no licorice at all. These products use anise oil. A substance that tastes and smells the same as black licorice. For those who absolutely must have the real thing, they can buy licorice root in a product knows as deglychrrhizinated licorice. So I guess you can say, you can have your licorice and eat it without worrying about heart failure. 

Just to make sure you provide the most popular candy to family and friends over the holidays, I happily provide you with the names of the candies and their sales that are the best sellers.    

• M & M’s – $673 million
• Reese’s Peanut Butter Cups – $516 million
• Hershey’s bar – $476 million
• Snicker’s – $441 million
• Kit Kat – $199 million
• Twix – $172 million
• Twizzlers – $158 million
• Skittles – $150 million
• Dove – $144 million
• 3 Musketeers – $138 million

If you add that all up, we spend over $3 trillion for just the top 10 brands of candy—most of which is consumed during the holidays. Is it any wonder that we then turn around and pay to join Weight Watcher’s and Jenny Craig come January 2^nd? 

I will admit that I will be one of those who dig through the Trick or Treat candy looking for the best stuff. And, I will enjoy every bite. I ask you, what’s Halloween without a Snicker’s Bar or two…and a Kit Kat…and some M & M’s…?

For more clinical updates, visit our blog at www.pprhealthcare.com and sign up for emails, Like us on Facebook, Follow us on Twitter.

http://www.foodreference.com/html/fcandy.html

http://www.medilexicon.com/medicalnews.php?newsid=236780

http://www.sogoodblog.com/2010/10/27/best-selling-candy/

Over 74 million people in the United States suffer from hypertension or what is known as high blood pressure to the general public. It is the leading cause of stroke and a major cause of heart attack.  

Blood pressure is the pressure that blood creates as it travels throughout the body and pushes against artery walls. It is reported in two numbers—usually expressed as a higher number over a lower number. The higher number is the pressure that is exerted on the arteries when the heart beats and the arteries are filled with blood. The lower number is the pressure in the arteries when the heart is between beats.

It is important to remember that blood pressure is not a static reading. As activity or emotional states change, so does the blood pressure. If the pressure did not increase for a person running a race or for someone experiencing a highly emotional situation, sufficient oxygen would not be supplied to the body and fainting would occur. 

The problem arises when the blood pressure remains at a high level when the person is resting. Hypertension is diagnosed when an individual has readings of 140/90 or higher on two separate occasions. Immediate treatment should be sought for an individual who has a blood pressure reading of 200/120. Diabetics require treatment for readings of 130/80 because of a diabetic’s increased risk of stroke and heart attacks. 

Many people with hypertension are not aware they are at risk because frequently there are no symptoms there is a problem. For that reason, it is important to have blood pressure checks. Getting a blood pressure taken has become fairly easy. Most drug stores have blood pressure machines that people can use without charge. Also, people can go to a fire station and ask for someone to take their blood pressure. 

Mayo Clinic physicians recommend that a person have a blood pressure reading at least every two years beginning at age 20. Children 3 and older should have their pressures checked as part of their yearly checkups.

So who is at risk? People who: have a family history of hypertension, heart disease or diabetes; are black; are older than 55; are overweight; are not physically active; drink excessively; smoke; eat foods high in saturated fats or salt; or use medications such as anti-inflammatories, decongestants, and illicit drugs such as cocaine.

The cause of hypertension in 95% of cases cannot be determined. This condition is called essential hypertension. It is believed to be sensitive to diet and life style. It is associated with high salt intake, obesity, stress, insufficient intake of potassium, calcium and magnesium, lack of exercise, and long-term alcohol consumption. 

The most common cause of secondary hypertension is kidney disease but it can be a result of adrenal gland tumors. Birth control pills containing estrogen can increase blood pressure as well as medications that constrict the blood vessels. Weight loss drugs are also able to cause blood pressure to rise.

The first step in treatment usually involves changes in life style-lowering salt and fat intake, losing weight, increasing activity, and learning to manage stress. If life style changes are not sufficient to control hypertension, it may be necessary to add a medication regimen. There are a number of drug classifications that are used to treat high blood pressure. For some people diagnosed with hypertension, more than one type of medication may be ordered. The important issue is to make sure medications are taken as ordered every day. 

According to medical research, the probability is that if a person lives long enough, he/she will experience hypertension. It is strongly associated with aging. But, it is treatable and people live long and productive lives even after a diagnosis of high blood pressure.

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http://www.bing.com/health/article/mayo-MADS00100/High-blood-pressure-hypertension?q=hypertension+prevention

http://hypertension-facts.org/hypertension-treatment.html

http://www.webmd.com/hypertension-high-blood-pressure/guide/understanding-high-blood-pressure-basics

In the past few months I have spoken to several people who have had to deal with the problem of louse infestation. In most instances, the issue arose with children in school or day care centers. However, one person believes she became infected from trying on hats in a department store. 

However and whoever becomes infected, according to several studies published in medical literature, louse infestation remains a major problem throughout the world. The incidence of pediculosis (the medical term for this condition) has increased steadily over the past three decades. More than 12 million Americans are infested each year. In many parts of the U.S., louse infestation has reached epidemic proportions.

Not to become too creepy, lice can only live on a human host. A female louse lays 3-6 eggs in a day. The eggs are called nits. Nits hatch in 8-10 days, reach maturity in 12-15 days, and live as adults for about 10 days. Pediculosis spreads from close personal contact or through combs, clothes, hats, or linens. 

Infestations are seen in all socioeconomic groups. Head lice is the most common problem. The belief that only poor, unkempt individuals get lice is a blatant falsehood. All the people I spoke with are all middle class and well-groomed as are their children. Treatment may be delayed or deferred altogether because of the stigma attached to the diagnosis.

Treatment is available but noncompliance creates ongoing problems. Eradicating the mature lice and nymphs is relatively effective, but killing the nits is more problematic. Therapy must be repeated in 7-10 days to ensure the nits are destroyed. Combing through the hair looking for lice and nits can be time consuming and frustrating.

A new drug has recently been tested that may make the treatment more effective and less time consuming. According to a study reported at the 2011 American Academy of Pediatrics National Conference, one 10-minute treatment with spinosad (Natroba) eradicates head lice. The drug was approved by the FDA in January 2011.  It must be prescribed by a licensed healthcare provider, but is already available in pharmacies around the country.

Of course, as with most conditions, prevention is the best option. Schools and daycare centers can provide cubbies or better yet, desks, for each individual child that keep clothing, hats and scarves separated. These should be sprayed routinely with permethrin or other insecticide. Combs, brushes, and headbands should not be shared. 

If a person is diagnosed with head lice, it is important to remember that they are not just a nuisance, but can cause serious health problems such as bacterial skin infections, blood infections, and kidney disease. Getting treatment and compling rigorously to the treatment regimen is critical in overcoming the infestation.

For more clinical updates, visit our blog at www.pprhealthcare.com and sign up for emails, Like us on Facebook, Follow us on Twitter.

http://emedicine.medscape.com/article/225013-overview

http://www.medscape.com/viewarticle/751666?src=mp&spon=30

I learned a new word today—obesogenic. The nutritionists who coined the phrase used it to describe the world we all live in. It is the world with a high percentage of people who are overweight, mildly and even overly obese. An obesogenic environment is full of foods with saturated fats, large portions, excessive snacking, and high consumption of alcoholic beverages. It downplays consumption of vegetables, fruits and whole grains and smaller portions. It thrives on eating out in fast food establishments and choosing foods with lots of fat and calories.

It seems that one of the problems that children face today is the easy access to foods to which they are naturally attracted—sweet and salty. Coupled with lots of “screen time” and minimal “sweat time”, kids are more inclined to face obesity at an early age. 

According to a study conducted by the Centers for Disease Control, the percentage of 6-19 year olds that are identified as obese has increased three times over the percentage recorded in 1980. An additional 15% were “at risk of becoming overweight”.

While these statistics may be alarming to some, they have been covered extensively in the news media. I think the issue becomes, what to do about the rising number of children with “weight issues”? 

Two nutritionists from Pennsylvania State University, Maureen Spill and Barbara Rolls, have made the following suggestions:

• Limit sugar-sweetened beverages (they are the largest contributor of “empty”calories in a child’s diet.
• Eat breakfast – oatmeal with fruit and skim milk is one way to start the day.
• Limit eating out at restaurants – especially fast-food ones.
• Limit portion size.
• Offer healthy snacks of yoghurt, fruit and veggies – low-fat dip can spice up the snack or add peanut butter.
• Encourage family meals in which parents and children eat together.
• Take the TV out of the child’s room and limit screen time to 2 hours per day.
• Encourage physical activity.
• Repeatedly exposing disliked foods – this is one way to increase liking of a disliked food.

The suggestion I liked best was this: Be a role-model to your children because you care and want the best for them. As one of my favorite philosophers, Dr. Seuss, says, “Unless someone like you cares a whole lot, nothing is going to get better…it’s not.”

For more clinical updates, visit our blog at www.pprhealthcare.com and sign up for emails, Like us on Facebook, Follow us on Twitter.

http://www.cdc.gov/obesity/childhood/problem.html

http://www.medscape.org/features/slideshow/749584#8

The most recent serious microbial outbreak involving foods relates to the Listeria infections in cantaloupe. Most people are probably not aware of this bacterium but are familiar with E-coli and salmonella. There have been other outbreaks involving this germ over the years. The most recent involved hot dogs and deli meats in 1998 and in 1985, 52 people died from eating Mexican-style soft cheese.

The way in which the bacteria infected cantaloupe grown by Jensen Farms in Colorado is still under investigation. At least 72 people have become ill in 18 states and more than 15 have died. The Center for Disease Control (CDC) warns that if the fruit comes from Jensen Farms it should be discarded. The cantaloupes may be labeled as “Colorado Grown”, Jensenfarms.com, “Sweet Rocky Ford” or “Distributed by Frontera Produce”. Because the cantaloupes may have been resold and distributed by other companies, identification of the fruit may be impossible. If there is no way to know where the cantaloupe was grown, it should be thrown away and NOT eaten.

Listeria infections are especially dangerous for the elderly, those who are immunosuppressed, and women who are pregnant. The most common symptoms of listeriosis are fever, muscle aches, and diarrhea or other gastrointestinal effects. Pregnant women typically exhibit mild, flu-like illness, but infections during pregnancy can lead to miscarriage, stillbirth, premature delivery or life-threatening infection to a newborn. Non-pregnant individuals may also experience headache, stiff neck, confusion, loss of balance, and convulsions. Meningitis and septicemia are the most common conditions experienced by those who are immunosuppressed.  

The CDC expects further outbreaks of Listeria infections. It is a hardy bacteria and a person can be infected and not exhibit symptoms for weeks after eating the tainted food. The CDC has made several recommendations regarding the cantaloupe outbreak.

• Do not eat cantaloupe grown at Jensen Farms. 
• Throw out any cantaloupe if the identity of where it was grown cannot be determined.
• If you have obtained an infected cantaloupe, be sure to clean off any surfaces that the fruit touched in order to ensure you or your family will not become ill.
• If it is determined that the cantaloupe WAS NOT grown at Jensen Farms, it is okay to eat.

For more information about food outbreaks, be sure to go to the CDC’s website and access the Multistate Foodborne Outbreaks page.

For more clinical updates, visit our blog at www.pprhealthcare.com and sign up for emails, Like us on Facebook, Follow us on Twitter.

http://www.cdc.gov/listeria/definition.html

http://www.cdc.gov/listeria/outbreaks/index.html

http://www.cdc.gov/listeria/symptoms/clinical-features.html

http://www.thestate.com/2011/09/28/1990159/cantaloupe-illnesses-and-deaths.html#RSS=untracked

Well, for all you coffee drinkers out there, new research shows that the risk for depression may decrease as coffee consumption increases. In a t0-year cohort study of more than 50,00 older women, it was found that those women who drank 2 to 3 cups of coffee a day had a 15% decreased risk for depression than those who drank 1 or less cups per day. Women who drank 4 or more cups had a 20% decreased risk.

In another study, those who drank 7 cups of coffee per day had a decreased risk for suicide. However, the risk of suicide increased for those who drank more than 8 cups per day. In the new study, few women consumed more than 6 cups so high consumption effects were not included in the investigation

Other benefits of coffee have been reported. These include reduced risk of Alzheimer’s and dementia, gall stones, Parkinson’s, cirrhosis of the liver, dental caries  gout, diabetes and several forms of cancer. Caffeine can increase the effectiveness of pain killers, especially in migraine and headache medications. Coffee stimulates peristalsis so acts to prevent constipation. 

However, as with everything else it seems, there are downsides to drinking a lot of coffee. It can damage the lining of the gastrointestinal organs causing gastritis and ulcers. It can cause “coffee jitters” if too much caffeine is ingested. Certain substances in coffee can raise cholesterol levels, increase the risk of hypertension, and decrease serum iron levels. Consumption of coffee is not recommended for pregnant women due to an increase in stillbirths. 

The current study focused on mental health aspects of coffee—something that makes this study somewhat different than others looking at coffee consumption. The researchers believe that the results reassure coffee drinkers that there seem to be no glaring deleterious health consequences to those who consume coffee on a regular basis. Of course, they provided the caveat that consumption should be kept to a moderate number of cups per day.

According to researchers, caffeine is the world’s most widely used central nervous system stimulant. Most of caffeine is consumed in the form of coffee. 

For more clinical updates, visit our blog at www.pprhealthcare.com and sign up for emails, Like us on Facebook, Follow us on Twitter.

http://en.wikipedia.org/wiki/Health_effects_of_coffee

http://www.medscape.com/viewarticle/750420?sssdmh=dm1.721310&src=nldne