NursingCenter’s In the Round

A dialog by nurses, for nurses

Flu Panic

clock January 20, 2013 03:11 by author Lisa Bonsall, MSN, RN, CRNP

I’m a bit ashamed to be admitting this to a group of nurses, but I figure that if I shame myself enough maybe I won’t let this happen again. Ok, here it is…I didn’t get a flu shot. There, I said it. No reason, really, I just got busy and it kept getting pushed to the bottom of my to-do list. My husband got his at work, I took the kids for theirs, but mine – I just never got around to it. I am embarrassed and yes, more than a little nervous about getting sick. 

I’ve been reading a ton about this year’s influenza viruses "taking the U.S. by storm." I get emails from the CDC with the latest numbers and maps showing flu activity around the country. Our Nursing News page has links to updates and articles about this year’s virus. Our twitter timeline and facebook newsfeed also contain quite a bit of flu-related news, opinions, and personal stories these days. 

Not only am I “virtually” surrounded by the virus, but my kids come home from school each day with a report of who was absent, or more concerning, who was sick at school. My husband returns from his work as a respiratory therapist with a flu update from the hospital floors. And of course, I’m aware of every sniffle and sneeze around me when I’m out. 

My plan, which has been working well so far, consists of the usual recommended practices: frequent handwashing, not touching my face, getting enough rest and eating well, and doing my best to avoid those who are sick. However, while I’ve dodged illness thus far this flu season, I will surely be calling my nurse practitioner this week to schedule my vaccination! 

Any other advice? 

Nurses Increase Vigilance for Fungal Meningitis

Nurses must increase vigilance for identifying patients at risk for fungal meningitis following the September 26, 2012 recall of injectable methylprednisolone acetate that was packaged by New England Compounding Facility in Framingham, MA. According to the Centers for Disease Control and Prevention's website, there have been 185 cases and 14 deaths among 12 states and continues to grow (CDC, 2012). The impact is potentially greater because healthcare facilities in 21 states have received the recalled lots of the affected drug. 

Patients who received contaminated injections presented with symptoms from one week to 4 weeks after the injection. It is important for nurses to report patients who are symptomatic of meningitis through the month of October to a physician or licensed advanced practiced nurse. To further assist in the evaluation or referral for meningitis work-up, all health care professionals including those in primary care offices, emergency departments, or retail clinics should go to the CDC website ( for a current list of health care providers who administered the recalled lots. The CDC website also provides continually updated information on the meningitis outbreak and educational information for providers and patients.


Centers for Disease Control & Prevention. (2012). Multistate Meningitis Outbreat Investigation. Retrieved from Last accessed 10/12/2012.

A call for courtesy, please

clock December 7, 2010 05:35 by author Lisa Bonsall, MSN, RN, CRNP

I had originally planned a different topic for this week’s blog post, but I would be remiss if I didn’t use this time and space to share my experience at my primary care practitioner’s office today. I went in for my flu shot, not a big deal; I only spent about 10 minutes there. However, in those ten minutes I was paying particular attention to the nursing staff (don’t we all do that?) A young woman called my name and I followed her down the hall as she studied her clipboard - no eye contact, no hello, no smile, and no introduction. I also quickly noticed that while she was wearing scrubs, she did not have a name tag on, or anything identifying herself by name or role.

Off we went into a small room where another woman was working on her computer. There was no sink in the room. Just a desk with a pile of the CDC’s Influenza Vaccine fact sheets (not that it was offered to me); a cup of prefilled syringes and a cup of needles; a pile of alcohol swabs; and some other non-related items and pieces of equipment. I did notice on the wall a piece of paper with information about Guillain-Barre syndrome - definition, signs and symptoms, and prognosis. I’m not sure if it was placed there for the staff or for patients. In either case, there was no information offered about why it was posted there.

This staff member prepared my vaccine, the whole while her long hair swinging around. She put on gloves, asked me which arm I wanted the shot in (then approached my right arm after I replied “left”) and gave me the vaccine. A quick band-aid application and she handed me my “receipt.” No good-bye, smile, or any farewell greeting.

What has happened to common courtesy and manners? I won’t assume that this staff person was a nurse, but I’m sure that many other patients do and will. How can we promote a professional image of nursing when even a nurse herself (me!) feels this way after a quick visit?

I may have shared this article with you before, New Nurse Notes: 7 tips to improve your professional etiquette, but I think it’s worth sharing again. Okay, I’ll say good-bye now (with a handshake and a smile!)

Another flu season is just around the corner

clock August 30, 2010 17:39 by author Lisa Bonsall, MSN, RN, CRNP

Although the H1N1 influenza pandemic has been officially declared over (you can read the statement from the World Health Organization here), it is not too soon to start thinking about the upcoming 2010-2011 flu season. Actually, during a recent visit to our local pharmacy, I noticed the sign “Flu shots available here.” Hmmm… there is a difference between thinking and doing - is it really time to vaccinate now?

Here’s what I found:

  • The 2010-2011 flu vaccine will protect against 3 flu viruses: an H3N2 virus, an influenza B virus and the H1N1 virus.
  • Routine influenza vaccination is recommended for everyone ages 6 months and older.
  • As in the past, all children aged 6 months to 8 years who receive a seasonal influenza vaccine for the first time should receive 2 doses.
  • For the 2010-2011 season, children 6 months to 8 years who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine should receive 2 doses of a 2010-2011 seasonal influenza vaccine.
  • And lastly, yes…the Centers for Disease Control and Prevention is encouraging health care providers to begin vaccinating patients as soon as the vaccine arrives (shipments have already begun.)

You may remember from an earlier post that I never got my flu shot or H1N1 vaccine during the 2009-2010 season. The reason was simply one of convenience, or actually, inconvenience. The vaccines weren’t available when I had a visit with my physician and then there wasn't enought staff to administer the vaccines when they did become available.

I’m planning on getting vaccinated this year. How about you?


Red Book Online Influenza Resource Page from the American Academy of Pediatrics

Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010

Warning of vaccine administration errors

   Recent news about pertussis outbreaks that have resulted in infant deaths is causing serious concern in the healthcare community. Back in August 2006 and again in July 2010 the Institute for Safe Medication Practices (ISMP) issued a warning about confusion of Adacel and Daptacel which are vaccines for the prevention of tetanus, pertusis, and diptheria. ISMP explained how administering the incorrect vaccine to infants can result in ineffective immunization leaving babies vulnerable to infection. The IMSP Medication Safety Alert from July 1 2010 reported that "Part of the problem is that the official names of the products are very similar although stated in different order on the labels. One of them, diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), is sold under the brand names DAPTACEL and TRIPEDIA (Sanofi Pasteur), and INFANRIX (GlaxoSmithKline). This formulation is for active immunization of pediatric patients 6 weeks through 6 years of age. The other vaccine, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap), is sold under the names BOOSTRIX (GlaxoSmithKline) and ADACEL (Sanofi Pasteur), and is meant to be used as booster shots for older children, adolescents, and adults."

   This is back to school season and vaccines are on the minds of parents, schools nurses, pediatric nurses and NPs. This is a perfect time to review our procedures for prescribing and administering childhood vaccines to ensure that the correct vaccine is ordered and administered each time. For more details on the recommended vaccine schedule, go to the Center for Disease Control and Prevention website at

H1N1 ~ Details from the past year

clock May 16, 2010 18:18 by author Lisa Bonsall, MSN, RN, CRNP

A headline from last week about determining the end of the 2009 H1N1 influenza pandemic caught my eye. Was it really officially over?

While searching for this answer or at least information about declaring the end of a pandemic, I came across a comprehensive summary of pandemic H1N1 in the May 6th issue of The New England Journal of Medicine. I thought I’d share some highlights with you:

Estimates of cases in the U.S. (as of February 2010):
*59 million illnesses
*265,000 hospitalizations
*12,000 deaths

International information:
*Almost all countries have reported cases
*More than 17,700 deaths among laboratory-confirmed cases

Hospitalization rates were highest for those younger than 5 years (especially age 1 year and younger) and lowest for those over 65 years. Certain groups have been overrepresented among those with severe 2009 H1N1 virus infection. These groups include pregnant women (especially in 2nd and 3rd trimester), women less than 2 weeks postpartum, and patients with immunosuppression or neurologic disorders. Also, severe obesity or morbid obesity has been shown to contribute to the risk of severe or fatal disease.

So, is the pandemic over? An expert panel of the World Health Organization will review the status of 2009 H1N1 influenza later this month or in early June.  I’ll keep you posted!

Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza,
Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection
N Engl J Med 2010 362: 1708-1719

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