Paramedic to RN bridge….. options?

I am in my final semester of my ADN program at a community college (nowhere near Georgia, sorry). I have an admin job at the fire department, M-F 8-4 with a small amount of flex in that schedule. I had been working at this for some time, so I completed every non-nursing class prior to starting. Each of the first 3 semesters was 2 classes, a nursing class and a pharm class, the 4th semester was a nursing class and a human growth and development class, and this semester I only have my nursing capstone course.

I am a blended student. I don't attend any lectures, which has it's advantages and disadvantages. Coming into nursing school, I had completed a bachelors in public safety online without any issues, but the depth of knowledge for RN is so much greater, so self-study (even with recorded lectures) took a SIGNIFICANT amount of self discipline and devotion. The advantage is that I only have to attend a lab once per week (sometimes once every other week) and most of my labs are in the evening.

With clinical, I have been so lucky that each course has had a weekend and evening clinical available and I have managed to get into one of those every time so my work schedule is minimally interrupted (some days I need to take an hour of vacation to get to the hospital in time). This semester is going to suck, because we have clinical 2x per week for 9 weeks.. I got saturday/sunday.. So yeah, 9 weeks of zero days off..

As to your comments on the volume of reading, that's just nursing school. Like a lot of the folks in this thread, I was a "top of my class" medic student and always looked at as one of the stronger medics on the department, but I have found nursing school to be overall difficult and requires a significant amount of work. I do think the grind of the last few semesters has improved me though, as this capstone class actually seems to be pretty smooth sailing.

I can't tell you if nursing is right for you or IT or underwater basketweaving.. For me it was originally medical school, but by the time my life was in a place that I could actually do it, I did some soul searching and realized I didn't want that life. Docs work hard, and they work a lot of hours, and I do want to slow down at some point. I went to RN with the plan on going direct to NP so that I could work at the provider level. I did find that I enjoy direct patient care as an RN more than I expected, so I think I may take a few years to work as a nurse (part-time while I finish out my time in the pension system) and then decide.

A final note on scheduling. In 2007 I put myself through the police academy (wanted to be a state fire investigator, it never panned out). That class was M-Th 6p-10p and every Saturday from 8a-5p for 6 months, mandatory in-person attendance. At the time, I was working on company so 24/48. Between vacation time and a small number of trades, I never missed a single class. Working and going to school is doable, it just takes energy.
 
I am in my final semester of my ADN program at a community college (nowhere near Georgia, sorry). I have an admin job at the fire department, M-F 8-4 with a small amount of flex in that schedule. I had been working at this for some time, so I completed every non-nursing class prior to starting. Each of the first 3 semesters was 2 classes, a nursing class and a pharm class, the 4th semester was a nursing class and a human growth and development class, and this semester I only have my nursing capstone course.

I am a blended student. I don't attend any lectures, which has it's advantages and disadvantages. Coming into nursing school, I had completed a bachelors in public safety online without any issues, but the depth of knowledge for RN is so much greater, so self-study (even with recorded lectures) took a SIGNIFICANT amount of self discipline and devotion. The advantage is that I only have to attend a lab once per week (sometimes once every other week) and most of my labs are in the evening.

With clinical, I have been so lucky that each course has had a weekend and evening clinical available and I have managed to get into one of those every time so my work schedule is minimally interrupted (some days I need to take an hour of vacation to get to the hospital in time). This semester is going to suck, because we have clinical 2x per week for 9 weeks.. I got saturday/sunday.. So yeah, 9 weeks of zero days off..

As to your comments on the volume of reading, that's just nursing school. Like a lot of the folks in this thread, I was a "top of my class" medic student and always looked at as one of the stronger medics on the department, but I have found nursing school to be overall difficult and requires a significant amount of work. I do think the grind of the last few semesters has improved me though, as this capstone class actually seems to be pretty smooth sailing.

I can't tell you if nursing is right for you or IT or underwater basketweaving.. For me it was originally medical school, but by the time my life was in a place that I could actually do it, I did some soul searching and realized I didn't want that life. Docs work hard, and they work a lot of hours, and I do want to slow down at some point. I went to RN with the plan on going direct to NP so that I could work at the provider level. I did find that I enjoy direct patient care as an RN more than I expected, so I think I may take a few years to work as a nurse (part-time while I finish out my time in the pension system) and then decide.

A final note on scheduling. In 2007 I put myself through the police academy (wanted to be a state fire investigator, it never panned out). That class was M-Th 6p-10p and every Saturday from 8a-5p for 6 months, mandatory in-person attendance. At the time, I was working on company so 24/48. Between vacation time and a small number of trades, I never missed a single class. Working and going to school is doable, it just takes energy.
You sir sound like someone who majority of the population should aspire to be. You have to respect. You really do. Not many people can do what you do.

It certainly does take energy. Right now in my life I am not sure how much I want this. Let me explain. Do I enjoy healthcare? Yes. Do I enjoy changing someone’s life for the better? Absolutely.

My struggle right now is knowing the amount of working that is required. Knowing this, I’m struggling to make a decision if it is worth it or not.

Is it worth it for me to sacrifice my mental health and physical health for a career and healthcare system that truly does not care. Our healthcare system is horrible. I’m not sure if what I need to sacrifice is worth it.

You have so many nurses and videos of nurses at the 5 year mark, regret their career choice completely and would do anything to get out. I hear more of that than I do positives.

Of course I have a huge respect for nurses and all professions but I’m struggling to understand why me learning how to properly fold a **** in a rectangle pattern hitting every corner in a specific way will lead to something. I feel like this system is so focused on pill popping and money. We have some that care but admin takes that spark away.

Again, you have my total respect. You really do. I just don’t know if nursing is worth it. Nurses make great money because of the pandemic but is it worth it after? I personally am not sure. It’s not about the money. It’s about the quality of life and what this system truly should be. The other day at work, I saw a person go into cardiac arrest…. The nurses went into the room and sat ventricular fib on the monitor. They waited 2 minutes to shock it because they had to wait for a doctor to give permission……

You can clearly see the burn out and lack of compassion anymore…. I don’t know if I want to be apart of that anymore.

Maybe I’ll go into Cardiovascular Tech or Cybersecurity. Who knows.
 
Well thanks for the kind words :)

One thing I will say on nursing is that the return on investment (especially right now) is unmatched. On top of the fact that nurses are currently making obscene amounts of money, there is so much you can do with an RN, and a good chunk of those jobs don't involve patient care at all.

I'm honestly not sure there is a more versatile degree out there..
 
Well thanks for the kind words :)

One thing I will say on nursing is that the return on investment (especially right now) is unmatched. On top of the fact that nurses are currently making obscene amounts of money, there is so much you can do with an RN, and a good chunk of those jobs don't involve patient care at all.

I'm honestly not sure there is a more versatile degree out there…

Absolutely. Everything you mentioned is the exact reason why I wanted the nursing degree over other degrees. It’s very mobile and the pay certainly is unmatched as of right now due to the pandemic. Who knows what will happen after.

Personally, after attending a nursing program and feeling it out and see what it offers… I just don’t agree with the material. Especially when you are already in healthcare and see how bs the school is. Idk. I understand this sounds like excuses but I’m just tired of making mistakes in life and I really want to make sure I finally make the right one.
 
You sir sound like someone who majority of the population should aspire to be. You have to respect. You really do. Not many people can do what you do.

It certainly does take energy. Right now in my life I am not sure how much I want this. Let me explain. Do I enjoy healthcare? Yes. Do I enjoy changing someone’s life for the better? Absolutely.

My struggle right now is knowing the amount of working that is required. Knowing this, I’m struggling to make a decision if it is worth it or not.

Is it worth it for me to sacrifice my mental health and physical health for a career and healthcare system that truly does not care. Our healthcare system is horrible. I’m not sure if what I need to sacrifice is worth it.

You have so many nurses and videos of nurses at the 5 year mark, regret their career choice completely and would do anything to get out. I hear more of that than I do positives.

Of course I have a huge respect for nurses and all professions but I’m struggling to understand why me learning how to properly fold a **** in a rectangle pattern hitting every corner in a specific way will lead to something. I feel like this system is so focused on pill popping and money. We have some that care but admin takes that spark away.

Again, you have my total respect. You really do. I just don’t know if nursing is worth it. Nurses make great money because of the pandemic but is it worth it after? I personally am not sure. It’s not about the money. It’s about the quality of life and what this system truly should be. The other day at work, I saw a person go into cardiac arrest…. The nurses went into the room and sat ventricular fib on the monitor. They waited 2 minutes to shock it because they had to wait for a doctor to give permission……

You can clearly see the burn out and lack of compassion anymore…. I don’t know if I want to be apart of that anymore.

Maybe I’ll go into Cardiovascular Tech or Cybersecurity. Who knows.
Congratulations. You just talked yourself out of RN because you don’t want to commit to the work reqhired. You obviously don’t have the drive, and are fishing around for the easiest way you can game it. You can’t. It actually takes WORK and dedication.
Go into cybersecurity. You can do it online. No lives are at risk, and it doesn’t take much effort.
 
Congratulations. You just talked yourself out of RN because you don’t want to commit to the work reqhired. You obviously don’t have the drive, and are fishing around for the easiest way you can game it. You can’t. It actually takes WORK and dedication.
Go into cybersecurity. You can do it online. No lives are at risk, and it doesn’t take much effort.
Ouch

You're not wrong.. nursing school is a ton of work. Some of it is hard, some of it is just tedious, but it is definitely a lot of work that can't be shortcutted. I think it's fair to say that during my 8 weeks peds block, I was easily hitting 40+ hours per week of pure studying and homework..
 
So why did YOU wait 2 minutes to shock a witnessed Vfib? And at what point did you stand back, see the VF, and decide "I'm going to set my timer to see how long this takes"?
 
I truly do not know where people who are not nurses keep coming off with this "have to ask for or wait for doctor order BS"... I have worked many ERs now as a traveler, and I legit cannot think of times where I have had to ask permission for anything urgent. I drop orders before the doc ever sees the patient, I work them up before the doc ever sees them, in times of emergency we act. We do NOT work for the doctors, we work WITH the doctors. And in a professional environment where we interact 12+ hours a day, for many days in a row, pretty much talking medicine non-stop, your peers and colleagues all develop professional awareness and respect for each other. Your capabilities and weaknesses are known, and trust ensues. This leads to not having to ask for much of anything.
 
I truly do not know where people who are not nurses keep coming off with this "have to ask for or wait for doctor order BS"... I have worked many ERs now as a traveler, and I legit cannot think of times where I have had to ask permission for anything urgent. I drop orders before the doc ever sees the patient, I work them up before the doc ever sees them, in times of emergency we act. We do NOT work for the doctors, we work WITH the doctors. And in a professional environment where we interact 12+ hours a day, for many days in a row, pretty much talking medicine non-stop, your peers and colleagues all develop professional awareness and respect for each other. Your capabilities and weaknesses are known, and trust ensues. This leads to not having to ask for much of anything.
What I didn't realize (and I think it's true of most medics) is that between standing and PRN orders, RN's essentially have the same rules of engagement as medics. Nurses can see, identify, and act just as much as paramedics, but with a much broader depth of knowledge and a bigger toolbox. It really was a pleasant surprise for me..
 
I truly do not know where people who are not nurses keep coming off with this "have to ask for or wait for doctor order BS"... I have worked many ERs now as a traveler, and I legit cannot think of times where I have had to ask permission for anything urgent. I drop orders before the doc ever sees the patient, I work them up before the doc ever sees them, in times of emergency we act. We do NOT work for the doctors, we work WITH the doctors. And in a professional environment where we interact 12+ hours a day, for many days in a row, pretty much talking medicine non-stop, your peers and colleagues all develop professional awareness and respect for each other. Your capabilities and weaknesses are known, and trust ensues. This leads to not having to ask for much of anything.
A lot of the disparaging remarks about nurses I've heard from EMS colleagues sound like contrived attempts to portray "street medicine" as the only real medicine -- danger, lives on the line, intubating upside down and all that. Even more ridiculous is when medics start second-guessing physicians with, say, 10 years more training, just because the docs don't ride ambulances.

"Book learning" is often valued less than physical prowess, psychomotor skills, and years in the field. I think most medics who haven't been to medical school (or nursing school) aren't going to know what they don't know. I'd rather just take pride in what we do without turning it into a competition.
 
A lot of the disparaging remarks about nurses I've heard from EMS colleagues sound like contrived attempts to portray "street medicine" as the only real medicine -- danger, lives on the line, intubating upside down and all that. Even more ridiculous is when medics start second-guessing physicians with, say, 10 years more training, just because the docs don't ride ambulances.

"Book learning" is often valued less than physical prowess, psychomotor skills, and years in the field. I think most medics who haven't been to medical school (or nursing school) aren't going to know what they don't know. I'd rather just take pride in what we do without turning it into a competition.
I want to like this twice
 
I have been physically assaulted more, been in more physical takedowns of patients, and been exposed to far more weapons of all types as a RN in the ER these past few years than I ever have as a Paramedic in the past 27 years. No, I have not forgot where I came from, nor will I, however there is so much that goes on in those 12 hours that many from EMS will never see, know about, or appreciate.

And to echo Fireman Mike...EXACTLY!! I legit have autonomy to do anything. I do not ever have to "sit and wait" on orders or advice. If RNs did that, the ERs would shut down. So many times, the Provider puts a patient up for discharge and then says "Oh I need to go lay eyes on them real quick". The reason that occurs is they trusted the RNs judgment, all labs and tests were completed, such a clear picture was painted, the Provider felt they had physically seen them already. I have dropped more IOs and done more EJs as a RN than I have as a Paramedic. While intubations are rare admittedly, at the small critical access facilities, what needs to happen, will happen.

What I am truly enjoying as a ER RN currently is the ability of assessing a patient, forming my own plan of care, initiating it, then talking to the Providers about it, getting their thoughts, their ideas, and actually learning quite a bit, and then carrying out that plan of care according to how I fit it into my assignment. Let's not forget, I am doing this for a minimum of 4 patients (that change often typically), non-stop for 12 hours. And although it should not occur, the ratios are actually higher on most days and I have had to push back a few times and say no. And I am a huge Team Nurse, most if not all of my current colleagues are the same. So aside from my own assignment, I am in and out of theirs and vice versa. As EMS in general, we grossly underestimate the amount of knowledge and continuous exposure/learning which is taking place in our own local ER. We judge by how everyone seems to be relaxed or sitting when we roll through with that stretcher, all eyes on "us". Why aren't they coming over to assist us with our patient handover? They are just sitting waiting on doctor's orders anyways. We need to get back outside, they need us out there. In reality, we possibly did not know you were coming, we are assessing (especially all the crap NOT done), trying to see where the patient will go, and already mapping it into our timeline of planned events. When EMS rolls in, it is actually a good time to sit and pause or think. You had them for "20 minutes already", what's another 3 gonna hurt? Maybe "try" that IV again? And go a little higher since they are ABD pain? :)
 
I have been physically assaulted more, been in more physical takedowns of patients, and been exposed to far more weapons of all types as a RN in the ER these past few years than I ever have as a Paramedic in the past 27 years. No, I have not forgot where I came from, nor will I, however there is so much that goes on in those 12 hours that many from EMS will never see, know about, or appreciate.

And to echo Fireman Mike...EXACTLY!! I legit have autonomy to do anything. I do not ever have to "sit and wait" on orders or advice. If RNs did that, the ERs would shut down. So many times, the Provider puts a patient up for discharge and then says "Oh I need to go lay eyes on them real quick". The reason that occurs is they trusted the RNs judgment, all labs and tests were completed, such a clear picture was painted, the Provider felt they had physically seen them already. I have dropped more IOs and done more EJs as a RN than I have as a Paramedic. While intubations are rare admittedly, at the small critical access facilities, what needs to happen, will happen.

What I am truly enjoying as a ER RN currently is the ability of assessing a patient, forming my own plan of care, initiating it, then talking to the Providers about it, getting their thoughts, their ideas, and actually learning quite a bit, and then carrying out that plan of care according to how I fit it into my assignment. Let's not forget, I am doing this for a minimum of 4 patients (that change often typically), non-stop for 12 hours. And although it should not occur, the ratios are actually higher on most days and I have had to push back a few times and say no. And I am a huge Team Nurse, most if not all of my current colleagues are the same. So aside from my own assignment, I am in and out of theirs and vice versa. As EMS in general, we grossly underestimate the amount of knowledge and continuous exposure/learning which is taking place in our own local ER. We judge by how everyone seems to be relaxed or sitting when we roll through with that stretcher, all eyes on "us". Why aren't they coming over to assist us with our patient handover? They are just sitting waiting on doctor's orders anyways. We need to get back outside, they need us out there. In reality, we possibly did not know you were coming, we are assessing (especially all the crap NOT done), trying to see where the patient will go, and already mapping it into our timeline of planned events. When EMS rolls in, it is actually a good time to sit and pause or think. You had them for "20 minutes already", what's another 3 gonna hurt? Maybe "try" that IV again? And go a little higher since they are ABD pain? :)
I was today years old when I decided to move a bit further out and find an ER RN job at a critical access hospital.. :D:D
 
How much of the ED RN scope is facility location and/or level dependent? I have to imagine there is a good deal of base level therapies available at most places (venous access, oxygen, anti-emetics…)?
 
How much of the ED RN scope is facility location and/or level dependent? I have to imagine there is a good deal of base level therapies available at most places (venous access, oxygen, anti-emetics…)?
In most ED's you'll have standing orders for oxygen, IV access, labs, IVF, EKG, and maybe things like albuterol or anti-emetics or analgesics, putting in orders for imaging, etc. It really depends on where you work. Usually at that point not much else gets done until the patient is seen by a provider.
 
In most ED's you'll have standing orders for oxygen, IV access, labs, IVF, EKG, and maybe things like albuterol or anti-emetics or analgesics, putting in orders for imaging, etc. It really depends on where you work. Usually at that point not much else gets done until the patient is seen by a provider.

Makes sense. Might have more in a rural setting?
 
Definitely have WAY greater scope in critical access facilities, however I am currently in a fairly booming area and our scope or ability to do whatever is fair game as described. There are "lazy" nurses who intentionally sit and wait to be told every move, either through fear, lack of knowledge, or intentional so they do not work as hard, however the majority drop orders left and right and get stuff done. It simply is not possible for the Provider to get through the day's load without the bulk of RNs doing this.

Another win for smaller facilities is the collaboration and ability to veer off script quite often as needed. I have not worked as a ER RN in a HUGE Level 1 or dense populated area where a facility is on every corner like NYC or something. However, I have yet to run across a place or a traveler where the operational plan is "wait for orders" or "let the doc think for you, then do what they say".

Fresh example from last night: I get a bradycardic/hypotensive from EMS, rate 52, systolic 53, feels disoriented and weak, 70 years old, visual disturbances. Rapid assessment, stroke scale, the usual exam for this type of pt. I start a line that actually works, but then it blows. I dropped an EJ, started fluids wide open. I ordered a CT w/o contrast STAT, 12 lead, and ordered all labs including lactic, threw in cultures even though currently afebrile, cause daughter shows up and mentions there was a fever earlier in day. Go ahead and order covid swab. Unable to pee, so straight cath for a sample as she is fairly dry. I then went and gave the Provider a rundown, no further orders, answered a few questions.

By time Provider laid eyes on the patient, he had early results in, other results trickling in, and based on our history with each other he was able to cut some of his exam time short. He told me to carry on. I hung a 3rd liter at 250/hour, her pulse had been steady climbing to the 60s and hanging, the BP was barely inching along, visual disturbances resolved. Through all this time, managing many other patients of higher and lower acuity, briefing provider on those, managing family, working the phones (we dont have secretary), and then of course she is Covid+ like 99% of all patients in ER currently. So I said to the doc, I think it is time we hang some levophed, shall I go ahead and start it? Patient's MAP was ****, widening pulse pressure, still inconclusive as to cause, not septic that we know of. He said good idea, go ahead. So I did.

That is just one short example of the dozens and dozens scenarios which occurs weekly. All day, every day. I am in no way hyping myself or comparing EMS to Nursing. I have just as much, if not more autonomy as a RN in the ERs I have experienced than I have in most EMS systems. As I said earlier, the knowledge is growing by leaps and bounds, and repeated exposure to so many outcomes, and seeing conclusions to all the EMS patients I once brought in through the door....there is NO comparison.

My only regret is not going to nursing many years ago. I always had it on my list, but then I put family, overtime, flight, expeditionary, contract, overseas, businesses, etc....I kept putting anything and everything in front of going to school and I used to spew the same stories and excuses without knowing what I truly did not know. Finally in my 40's I returned full time college and did traditional nursing program. Wish I did it 20 years ago, regardless I am doing it now, traveling, learning, making sick money, and loving it.
 
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So why did YOU wait 2 minutes to shock a witnessed Vfib? And at what point did you stand back, see the VF, and decide "I'm going to set my timer to see how long this takes"?
Because I’m not allowed to function as a paramedic in a hospital setting.

So I’m in the wrong when there was 5 nurses in the room and 3 doctors and two PAs working in the ER?

You are correct. This is completely my fault and I should of stepped into that Covid room without proper PPE and shocked that patient.

Ill remember that for next time.
 
A lot of the disparaging remarks about nurses I've heard from EMS colleagues sound like contrived attempts to portray "street medicine" as the only real medicine -- danger, lives on the line, intubating upside down and all that. Even more ridiculous is when medics start second-guessing physicians with, say, 10 years more training, just because the docs don't ride ambulances.

"Book learning" is often valued less than physical prowess, psychomotor skills, and years in the field. I think most medics who haven't been to medical school (or nursing school) aren't going to know what they don't know. I'd rather just take pride in what we do without turning it into a competition.
I’m misunderstood.

I’m not by any means crapping on nurses and degrading the importance.

I’m used to the EMS profession being degraded on a daily basis. It’s normal. I have respect for my nurses and I would never bash the profession as a whole. For me personally, after going through the school… I did not feel like I wanted to be apart of the American health care system anymore.
 
Definitely have WAY greater scope in critical access facilities, however I am currently in a fairly booming area and our scope or ability to do whatever is fair game as described. There are "lazy" nurses who intentionally sit and wait to be told every move, either through fear, lack of knowledge, or intentional so they do not work as hard, however the majority drop orders left and right and get stuff done. It simply is not possible for the Provider to get through the day's load without the bulk of RNs doing this.

Another win for smaller facilities is the collaboration and ability to veer off script quite often as needed. I have not worked as a ER RN in a HUGE Level 1 or dense populated area where a facility is on every corner like NYC or something. However, I have yet to run across a place or a traveler where the operational plan is "wait for orders" or "let the doc think for you, then do what they say".

Fresh example from last night: I get a bradycardic/hypotensive from EMS, rate 52, systolic 53, feels disoriented and weak, 70 years old, visual disturbances. Rapid assessment, stroke scale, the usual exam for this type of pt. I start a line that actually works, but then it blows. I dropped an EJ, started fluids wide open. I ordered a CT w/o contrast STAT, 12 lead, and ordered all labs including lactic, threw in cultures even though currently afebrile, cause daughter shows up and mentions there was a fever earlier in day. Go ahead and order covid swab. Unable to pee, so straight cath for a sample as she is fairly dry. I then went and gave the Provider a rundown, no further orders, answered a few questions.

By time Provider laid eyes on the patient, he had early results in, other results trickling in, and based on our history with each other he was able to cut some of his exam time short. He told me to carry on. I hung a 3rd liter at 250/hour, her pulse had been steady climbing to the 60s and hanging, the BP was barely inching along, visual disturbances resolved. Through all this time, managing many other patients of higher and lower acuity, briefing provider on those, managing family, working the phones (we dont have secretary), and then of course she is Covid+ like 99% of all patients in ER currently. So I said to the doc, I think it is time we hang some levophed, shall I go ahead and start it? Patient's MAP was ****, widening pulse pressure, still inconclusive as to cause, not septic that we know of. He said good idea, go ahead. So I did.

That is just one short example of the dozens and dozens scenarios which occurs weekly. All day, every day. I am in no way hyping myself or comparing EMS to Nursing. I have just as much, if not more autonomy as a RN in the ERs I have experienced than I have in most EMS systems. As I said earlier, the knowledge is growing by leaps and bounds, and repeated exposure to so many outcomes, and seeing conclusions to all the EMS patients I once brought in through the door....there is NO comparison.

My only regret is not going to nursing many years ago. I always had it on my list, but then I put family, overtime, flight, expeditionary, contract, overseas, businesses, etc....I kept putting anything and everything in front of going to school and I used to spew the same stories and excuses without knowing what I truly did not know. Finally in my 40's I returned full time college and did traditional nursing program. Wish I did it 20 years ago, regardless I am doing it now, traveling, learning, making sick money, and loving it.
I’m happy and pleased to hear you found passion in what you wanted to do. I have a lot of respect for what you do and many other nurses do. Keep up the great work and stay safe.
 
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