Um, Sorry, But No. Not Even Close.

 

This is one potential question on the NCLEX, the national licensure exam for RNs.
Asking this to a CNA is like asking your dog to do calculus.
With an abacus. Blindfolded.
It's as wrong as two boys f**king.
For any RN, it's a lay-up. An easy shot.
Follow up questions:
Why is this rhythm important?
What should the (actual) nurse do next?
Answers at the bottom.

For whatever reason, Angus is under the severely-misled misimpression that a CNA with a one-month classroom and clinical certificate (total, all-in) is functionally identical to an RN with two to four years of upper-division college education and a nationally recognized license.

He states the difference between a CNA and an RN is "Not much."

A CNA is a 60 hour course, and less than 3 weeks' supervised clinical training. In CA.

Florida CNAs need even less than that. (Color me shocked.)

An RN, by contrast, is a two- to four year degree program leading to national licensure, including more clinical hands-on hours in any month than CNAs require for their entire certificate. (Florida RN licensure may be less rigorous, IDK, but that's why an RN from CA, NY, or IL can work in all 50 states, and nurses from the Gulf Coast belt can generally not get hired anywhere else without extensive testing and additional classes unless they go to similarly low-educated states. Mississippi nurses right out of school, for example, can generally not go out-of-state to anywhere else. That's not for nothing.)

Apparently we really have to go into why one of these things is not like the other one.

Starting with CNA's having a state-specific certificate, not a professional license recognized in 50 states and seven territories.

This is the difference between a vet tech, and an actual vet.

One of those cleans animal cages, and the other one diagnoses animal illness.

That's why a CNA (an expired-certificate CNA to boot) passing herself off as an RN is committing criminal malpractice.

A CNA has exactly zero training, experience, or competence in assessing patients, absolutely none in pharmacology, nor in pathophysiology, gerontology, obstetrics, pre- and post-op surgical care, pediatrics, psychology, critical care, or about a million other things large and small that even a new grad RN walks out the door with from school before they can pass their boards. 

A CNA literally lacks the knowledge of about a dozen 800-page nursing textbooks, whereas to get a CNA certificate, if you don't put your shoes and socks on in that order, you'll likely pass the class. The number of CNAs anywhere who could take and pass the NCLEX without years of study is going to be 0.000%, nationwide, since ever, even one with 25 years of floor experience behind them.

A CNA literally doesn't know what she/he doesn't know, any more than the guy who sweeps out the hangars at Boeing is a qualified aeronautical engineer. (As recent unqualified DIE hires at Boeing have demonstrated, in case anyone was watching.)

It's that big a difference, and anyone - family or not - telling someone otherwise with a straight face is talking out their other end.

And by "early on", apparently Angus is referring to 150 years ago, when even doctors had less actual medical knowledge than a modern EMT possesses. Yeah, things have changed a wee bit in nursing since Florence Nightingale got the ball rolling in the Crimea. Which is why CNA is a few weeks of night school, and not a college degree plus 3-12 months of directly-supervised clinical hands-on experience that an RN license requires. (CA requires 500 hours, minimum. My program was closer to 1300 hours.)

Putting it gently, Angus kind of stepped in it with both feet.

A CNA takes vital signs (with a machine that does 90% of the work), helps change dirty diapers and linens, and walks patients to the bathroom. That about exhausts their entire clinical skill set, and many of them are hard-pressed to be barely competent at any of that. Like I-didn't-realize-that-a-pulse-of-180-should-be-immediately-flagged-to-the-nurse/doctor barely competent. I've only seen that one - or one like it - about a thousand times in 25 years.

That skill set was covered my first week of nursing school, and they expanded on that to quite a degree over several years. Almost like one was a dead-end entry-level cert, and the other was a bona fide medical profession.

I don't know why anyone would lead someone to believe it was otherwise, but anyone so informed has been rather egregiously misled.

In Angus' experience wheelhouse, on the skillset continuum, it's the difference between a tank loader 5 minutes out of school at Ft. Benning (it still makes me shudder that it's not at Ft. Knox any more), and a SFC with 16 years in Armor who's the Tank Commander. (In point of fact, that loader got more - and better - training at his 19K MOS in 8 weeks at Ft. Benning than most CNAs get in school. EVER.)

*(Answer: C. V-tach. It's important because if it's pulseless V-tach, the patient is in cardiac arrest, and the nurse should get the defibrillator and zap that patient pronto while calling "CODE BLUE" loud enough for everyone within earshot to hear and respond to. Total amount of time CNAs get educated and trained to know and do this: Never. Period. 

Whereas for an RN, any RN, it should be automatic. Anyone who sincerely thinks the difference between a CNA and an RN is "not much" should let their grade-school-aged kids take out their appendix or gallbladder with kitchen utensils, and get back to us on how well that worked out. That's what expecting a CNA to be an RN is like.)

*** ADDENDUM ***:

If you came here, read this, and then ran over to dogpile Angus at his blog, please stop. (If anyone this applies to didn't read follow-ups there, that speaks for itself.)

1) Like most blogs (including this one) comments are moderated, meaning rude and obnoxious rejoinders disappear into the ether. Just like here.

2) Take the time to note Angus' multiple replies and amplifications on the original topic (and a couple of spicy ripostes for people doing it wrong. It's clear that what came out in his first post wasn't precisely what he meant to say, i.e. that CNAs doing CNA tasks do them as well as RNs. (We have no argument whatsoever with that contention, though we do wish it had been phrased better originally.) And that some jobs require far more licensure than the tasks that make up the job entail. We absolutely agree with him on that point as well, and we have no doubt some idiot managers over-mandate licensure levels a given job at hand doesn't require, in a phenomenon not limited to the medical arts.

3) That doesn't mean that the wingnut deliberately perpetrating a professional fraud in the OP deserves a pass (she deserves to get hammered into the ground, in fact) but it does illustrate that whoever classified that job as one requiring an RN license grossly over-stated the necessary qualifications to excel at it. Why anyone running a business would be as stupid as to do that in the first place is beyond explanation, but then so is demanding an RN license, and then performing no due diligence to ensure that anyone considered for the position actually possessed one. Stupid is as stupid does.

I got the clarification of what he intended by his second post on the topic. There have been at least two more since that, for a total of four, not counting the pointed reminders that going to his blog (or anybody else's, in nearly every case) to storm in and crap on the carpet will never see the light of day. The list of blogs on the internet where even being right, if you're a right dick about it, will get your missives discarded, is long, and distinguished. This should not be news to anyone.

FFS, I agree with Angus on many important things (guns, the military, and most current events, to name but three) more than even he thinks, even if we're not carbon copies of each other. What a boring internet that would be. And if you're going to disagree with anyone online who's worth the trouble, do it within the bounds of decorum. You'll get more flies with sugar than with vinegar.

If that's too much to ask of anyone, I don't want to know you.

Maybe You Two Could, Y'know...Talk?

I'm Just Gonna Put This Out There

Absolutely no points for guessing how I know this to be true.

When you either start reading stories about people on passing vessels (canoes, steamboats, etc.) getting nailed from shore, or boba fights erupting in food venues, and those food items suddenly disappear from the menu overnight, I want it known I have no involvement whatsoever in any aspect of that.

Rule 34, for example, says that if it exists, there's porn of it.

Rule 1 says that if you invent it, humanity will weaponize it in about 2 seconds.

(If you have any doubts about that, ask Abel about why his brother Cain was carrying that rock.)

I think Rule 1 is now in play.

You heard it here first.

YMMV.

Thought For The Day

Whatever...

Y'all do as you will. We're going to bed early. As far as we care, the new year, like the fog in a Sandburg poem, can come on little cat feet, and do so without disturbing us. We refuse to give a hoot about it until it shows us something worth noticing. Its predecessors' main claim to fame is that we never reached the point of putting a gun in our mouth. 

If we're wishing, we'd be wishful of a year with a bit more going for it than that. If anyone's taking menu requests, having Joe Biden walk into a speeding bus would cheer us up notably. If he were being held up by the Clintons at impact, we'd be positively ecstatic. We're pretty easy to please.

Just saying.

Priorities

h/t CW

Baby Duck And Cover

Given: Nuclear war would be a bad thing.

And please believe me when I tell you that every possible nuclear war scenario has been wargamed out 20,000 times, and continues to be, multiple times annually, in multiple countries, particularly the nine (so far) acknowledged to have functional nuclear arsenals. And we usually assign our brightest strategists to play the OPFOR's side, just to keep everyone honest.

And what is the result, in every one of 20,000 scenarios?

It's that if one nuke flies, from anywhere, to anywhere, ALL of them fly, worldwide, times every country that has them, generally within about 72 hours of Event Zero. Every. Single. Time.

Go back and read that again in case you missed it. I have no need to bullshit anyone on this; it's findable in a hundred open-source articles. You could look it up.

So knowing that, you have three things to occupy your time.

1) You either have access, within minutes (measured in single digits) to a fallout and/or blast-proof nuclear shelter, with the necessaries to ride out the actual apocalypse. Or, you don't. Either way, you have nothing to worry about. For different reasons, in each event.

2) If you feel the need to Chicken Little anywhere on the internet, to any degree, about decisions around the world which would unleash a nuclear weapon, over which you have less than zero control (and I'm not naming any names or pointing any fingers here), your posts and bloviations generally aren't going to age well. Because

3) Either nothing is going to happen. (And for but one example, if you're Rootin' For Putin, his life expectancy if he reaches for the nuclear option can be measured in the draw time for any one of a dozen Makarovs pointed at his head from phone booth range. Which is why he's rattled that saber 57 times in the last three years, with zero intent to ever do anything, because he reads the same wargame studies from his guys.) Or pretty much all life north of the equator will be snuffed in a very short period. And you're back to Point 1, above.

Either way, nothing you could say or do on the topic is likely to make any difference for you, or anyone you'd reach, unless they live in Australia, or had 8-figure disposable incomes to establish a zombie apocalypse warlord base of operations - and did exactly that YEARS ago.

Neither you nor anyone reading your stuff is on the Nuclear Football phone tree, and our first clue about things will likely be when the weekend football feed goes all snowy with zero warning, followed by an annoying tone coming out of the tube.

If they even bother. It will be even less useful than anything else FEMA has ever done, which is saying something. Learn that now, and wrap your head around it ahead of time. If you're not 20 feet from a long-term shelter you control, you may as well just bend over and kiss your ass goodbye.

Sorry to piss on your apocalypse party, but there it is. Some of us went through this before you were born, for decades on end, and figured all this out before you got out of plastic pull-ups.

See if you can guess why we're less than impressed with it the second time around.

If anyone really cares, there are great books on the whole topic, most of them free online as pdfs, and so old most of the authors have already long since died. (That right there should serve as a hint about how timely this information is.)

So at the end of the day, all you're accomplishing, by running to and fro on the topic, is advertising your Baby Duck status to all and sundry, because you just started noticing a subject that was old news by about 1960. (For Common Core grads, that would be 64 years ago.) That's not a good look, nor a great resume-builder.

And unless you own one of those old Atlas or Titan missile silos (in which case, why bring the topic up at all?? You don't need more drop-in guests come the day...), and have converted it into a plush nuclear war retreat long before now, all you're doing is killing electrons and wasting bandwidth, and you're not going to be one of the 1%-of-the-population surviving nuclear mutants who comes out of the other end of that pipeline, should the unthinkable happen, to a statistically inarguable 99% certainty.

So stop flapping your wings, squawking, and shitting everywhere.

It's kind of embarassing.

For you.

So maybe less clickbait, and more utility, over something that actually matters.

3-0, Lifetime.

 h/t Borepatch

The Statute Of Limitations On Election Fraud Is...?

We now have the exact number
of fake Dem votes cast in 2020

Related: It's like reality is on the tip of their tongue, but they can't quite admit the obvious.

Just Saying...

Just beating Wilder to the punch.

Nobody Touched Nothin'

I'm Winston Wolf, I Solve Problems

As the post title implies, certain niceties come to mind that ought to be addressed.

Anyone at the higher levels of organized crime, or the agencies that investigate it, feel free to share anonymously in Comments, but it seems to me if I were the Mob, or any undertaking (no pun intended) where disposal of inconvenient bodies were problematic, the first thing I'd do would be to move into the mortuary business in a big way, and acquire as many of them as I could.

1) They never go bankrupt, as clientele is an endless supply.

2) The mark-ups for legit business are quite simply recockulous.

3) Having a crew of trusted employees who would and could show up anywhere, any time, 24/7, like the clean-up crew in a John Wick movie, would be a boon to Mob business. For a gold coin (let's call it an ounce, currently around $2500), they dispose of all the evidence to those "in the trade". For anyone inside the family, it's literally on the house.

4) Murder? Not without a body. Evidence? Gone forever. As Stalin noted famously: "No man; no problem." Troublesome people simply disappear, and their faces go on milk cartons. But now, nobody can dime out anyone and tell anyone "where the bodies are buried". Because now, they get sprinkled at sea, flushed down the toilet, scattered to the winds. Whatever.

What happened to Left-Handed Louie?

The answer, my friend, is blowin' in the wind...

I bring this up not to tell organized crime (and as Ben Kingsley's character observed in Sneakers: "Trust me, Marty, it's not that organized.") how to go about their business, because they doubtless already know it (recall, if you will, Signore Bonasera, whom Don Corleone befriended at his daughter's wedding at the opening of The Godfather - Mario Puzo didn't spin that out of whole cloth), but truth be told, they aren't likely the only ones for whom disposal of certain things is solely their problem.

More proof that this is really a thing, in case you needed it:

For a hint about how certain things are handled "officially" I note for the record that Clint Emerson, Navy SEAL and CIA SAD worker, didn't include this information in his book for nothing, nor did he learn the information presented solely secondhand, through reading classroom materials. This is first-hand knowledge and years of experience talking. Take that to the bank.

And make no mistake, those methods will work. But they're intended as one-time field expedients. If you try thermal burial more than once in your own back yard, even if you live on 100 acres, sooner or later, a neighbor or passerby who's not the same color pin on the map as you is going to see repeated black columns of smoke, realize you're not having a pig roast nor electing a new pope, and call all the wrong people to come chat you up.

All those problems go away with the right excuse, and proper equipment.

While half-way helicopter rides would be satisfying, you need a convenient ocean nearby and hungry sharks and such to make the plan foolproof. In Pinochet's Chile? The country is one continuous coastline. But it isn't going to work, for example, in Nebraska. Mineshafts work, but you're always one sheriff's SAR rappel away from 200 consecutive life terms in the Big House, right?

I don't know what the cost is of the unit above, or what the buy-in is to open or acquire a nominally legit crematorium. But whatever that price, it pales to insignificance compared with the peace of mind that would come from knowing there's never going to be a corpus for some flatfoot to habeus, and thereby change people's retirement plans from white sands to gray bars.

It's less messy than a Morbark, and dead certain. Used judiciously (say an extra body a day), you could eliminate a lot of problems in your local area, completely under the radar.

Which, frankly, would move it right up near the top of the list of Things One Might Wish For if events required a lot of troublemakers to become "no problem".

Of course, that would never happen here, right?

Just saying.

(Addendum: Note the Comments for rural - particularly southern - equivalents, regarding domesticated pigs, feral hogs, and alligators. Al Swearingen and Mr. Wu from Deadwood send their regards.)

Gray Man, My @$$

And that was from among other Bostonians, which is really saying something.
He also managed to be top of the list for nearly every
"Detain and hang on sight" order from 1775-1783. 

Become ungovernable. Find your balls, grow a spine, and dare to attempt great things. It's your birthright, and it's in your DNA.

Thought For The Day

 

Just Saying...

Tense Matters

 Vox: The US will lose the next war

Point Of Order:

Pvt. Hudson was all over this long before you figured it out.

FTR, when you write an article today, that could (and should) have been penned in 2000, you are the guy explaining the vulnerabilities of the US Navy at Pearl Harbor to sneak attack in a memo to the President.

In 1964.

Thanks for waking up, but this isn't a will question, it's a have already retrospective history. Folks already grok this, and had it pretty well figured out by our assholes-and-elbows bug-out from A-stan.

The memo is 23 years late. Might as well have sent it in the US mail.

Point: Counterpoint

 h/t WRSA

Just saying.

Reminder: The Vehicle FAK

 

Somebody's patient, somewhere, may have blown out a varicose vein at work, managed to spurt out two units (a liter) of blood while driving to the hospital, had it immediately repaired by the ED MD on duty, and then, apparently stable, have then actually gone into mild shock, passing out, and requiring fluid resuscitation with half a gallon of normal saline, and required a hospital admission, for "just a little bleeding".

If that were my patient, I - of course - couldn't talk about it because of HIPPA laws. But there's always the possibility it happened somewhere.

Which is why keeping at a minimum some QuikClot, a roll of Coban, an ACE or Israeli bandage wrap for a pressure dressing, and a CAT-T tourniquet or equivalent, in a small and handy vehicle first aid kit isn't just a random option.

You may not be interested in trauma, combat medicine, or bleeding control, but that doesn't mean trauma isn't interested in you. Failure to plan is planning to fail.

This was "just a little ruptured vein". That wouldn't stop.
This patient didn't get to the hospital. But they made it to the morgue.
Leaks - ANY leaks - in your meatsuit can be terminal.

Unless you want to roll the dice on passing out in your car at freeway speeds, injuring yourself and possibly other people, and ending up in shock in Main Trauma all busted to hell, after the equivalent of a pinhole in a minor superficial vein turned into Demolition Derby. All because "you thought you could make it to the ER okay on your own", right up until things got hazy, and your car went all spinny and flippy and perhaps explodey.

Don't want to deal with the hassle of having that kind of stuff near to hand, anywhere, anytime?

No problem. Suture self.

Point Of Order

 

Some information is good to know, purely as such, but if it really affects you, you've been doing it wrong for literally decades. So if anyone out there as an adult in the big wide world is seriously concerned for more than 0.2 seconds that bank and credit companies can and are now tracking firearms and ammunition purchases made with bank cards (which name kind of gives the answer away), including ATM/debit cards, I have something you really need to hear:

WTF is wrong with you, you mouth-breathing paint-chip-eating inbred retarded moron fucktard? Have you never heard of using CASH?!?

If that sentence requires any further explanation or elucidation, or you feel honor-bound to try and respond in defense of Chicken Little, you're not tall enough for the entire internet, let alone this blog. DLTDHYITAOYWO.

Those of you looking on at all this in bemusement, and wholly unaffected by events, continue to MYOB, and carry on as before. You are not the target audience.

Random @$$clowns