March, 2006 Archive

July 29, 2016, 1:06 pm

Viagra Online

Viagra online There is a person in this photograph who suffers from a rare, viagra online dare I say extinct affliction.

Viagra online Yes.

Viagra online It’s an actual photo of “Flat Cap Syndrome”.

Viagra online Flat Cap Syndrome developed when the brim of one’s nursing cap was larger than the fold behind it.

Viagra online Some say that the victims were responsible for choosing to go to a School of Nursing identified by those caps.

Viagra online Don’t blame the victim.

Viagra online Maybe it was the only School that she was accepted to.

Viagra online Maybe…..maybe she didn’t know….

Viagra online By the time I graduated, viagra online designs in nursing caps had pretty much made Flat Cap Syndrome a thing of the past.

Viagra online My cap was never flat, viagra online and to this day it stands proudly in its case in the den closet in pristine condition.

Viagra online (Disclosure: it’s in pristine condition because I just bought it off of eBay.

Viagra online I have to get the green and gold ribbons on it and then I have to get the courage to wear it to work because my co-workers will have a field day with me.

Viagra online If all of a sudden there is no more Emergiblog, viagra online it’s because they killed me with ridicule.

Viagra online Call the authorities.)


Some of the advantages of working in different facilities are the exposure to different styles of nursing, viagra online different opportunities, viagra online different patient populations and differing protocols regarding what nurses are able to do on their own.

Viagra online I’m not talking about using nurses instead of doctors, viagra online a la the problems that Dr. Viagra online Crippen at NHS Blog Doctor describes, viagra online I’m talking about protocols that allow nurses, viagra online using certain criteria established by the ER physicians, viagra online to initiate care prior to the doctor seeing the patient.

Sounds like a great way to facilitate patient flow and satisfaction, viagra online right?

Viagra online It is!

Viagra online The best ERs that I have worked in are the ones that, viagra online per protocol, viagra online allow the RNs to do what they do best.

Viagra online Conversely, viagra online the worst ERs I’ve worked in allowed the nurses to do nothing without an order.

  • When I worked at “World Renown Medical Center With Hard To Get Into Medical School”, viagra online this was the case. Viagra online The nurses could not make a move without an order.
    • Why?
    • It was a teaching facility. Viagra online How could the interns/residents learn to order appropriately if the nurse did it first? And forget verbal orders, viagra online if some resident gave an order you grabbed the nearest order sheet and made them write it. Viagra online So often you’d have five or six different order sheets going.
    • Why?
    • Because if there was a descrepancy between what was said and what was done, viagra online guess whose derriere would be on the line? Right, viagra online the nurse’s. Viagra online Remember the old saying about how excrement flows downhill? It’s true.
    • And the wait to get into a room? Hours. Viagra online We’re talking 5-7 hours at times. Viagra online You could be vomiting, viagra online have a 5-day migraine with photophobia, viagra online writhing on the floor with right flank pain secondary to a kidney stone and you would STILL be sitting in the ER with all the feverish, viagra online coughing bronchitis patients. Viagra online And don’t think asthma would get you a front row seat, viagra online either. Viagra online If your O2 sat was normal, viagra online have a seat like everyone else.
    • Why?
    • Because the beds never turned over. Viagra online Because one nurse would be responsible for six monitored patients plus the psych isolation room across the hall. Viagra online Because….
    • … first the “Pulmonary Team” had to see the patient, viagra online then they would decide this was a cardiac problem and you’d wait a few hours for the “Cardiac Team” who would discover that the patient wasn’t on that service after all and a different “Team” would come in an hour later, viagra online only to discover that said patient couldn’t be admitted there anyway, viagra online but then the patient would vomit blood which meant that they were too sick to transfer and you had to wait for the “GI Team” to come down and finally admit the patient.
    • Not to mention every single pediatric patient in the clinic area getting conscious sedation for their boo-boos.

Viagra online Get the picture?

Viagra online Then we have example number two.

  • Small community hospital, viagra online one that I will call “Mini County Hospital”. Viagra online Sat right in the middle of a very ethnically diverse, viagra online lower-income area of a suburb that could be called the Meth Capital of the SF Bay Area. Viagra online Many patients. Viagra online Many clinical, viagra online non-emergent patients. Viagra online Some very emergent patients.
    • The nurses were not allowed to do anything. Viagra online Nada. Viagra online Kaput.
    • Why?
    • Because the department had a wide mix of nursing experience, viagra online from new grads to newly designated dinosaurs like me, viagra online and there were no protocols because they could not depend on all the nurses to have the same level of competency.
    • So one day, viagra online Nurse Experience (me), viagra online brings in a patient with chest pain, viagra online starts a line while the tech does the EKG and within five minutes hands the doctor the EKG and the orders for CBC, viagra online Chemistry Panel, viagra online Cardiac Enzymes and portable chest to the unit clerk. Viagra online No problem, viagra online right? Wrong.
      • I was curtly asked, viagra online “Who the hell told you to order those labs?”.
      • I looked at Dr. Viagra online Who Was In Training Pants When I Graduated From Nursing School and said that they were the standard labs ordered for a chest pain patient suspected of having a cardiac problem.
      • “You are not covered to order these labs!
      • I said , viagra online “Are you telling me that after (then) 24 years experience in nursing, viagra online that I cannot at least get a cardiac workup started?
      • That was exactly what he was telling me. Viagra online I had three times the experience and was old enough to be his…..older sister, viagra online but it didn’t matter. Viagra online The nursing expectations went to the lowest common denominator, viagra online that of a new grad.
    • Which meant the patients in the waiting room waited, viagra online sometimes 8 hours for the same reasons stated above. Viagra online The nurses could not facilitate patient movement. Viagra online Because we worked with relatively new doctors, viagra online every child who vomited even once got an IV and a bolus. Viagra online Most got septic workups.

Viagra online Now let’s contrast this with an ER that runs quite smoothly, viagra online which happens to be where I am now and plan to retire from when I’m so old I can’t stand up straight.

  • This ER has nursing protocols. Viagra online Detailed, viagra online well written protocols. Viagra online Here’s what happens when you come into this ER:
    • For example, viagra online you come in and your chief complaint is nausea, viagra online vomiting, viagra online diarrhea for three days with fever and you are extremely dizzy when upright. Viagra online I’m your nurse.
      • Before the doc shows up I will have orthostatic vital signs, viagra online an IV in, viagra online bloods drawn, viagra online a bolus of Normal Saline initiated (unless you are elderly or have heart trouble) , viagra onlineat least a CBC and Chem 14 ordered (with additional blood in case more tests are added) and you can expect me to ask for and collect a UA and an stool specimen, viagra online which may or may not be needed, viagra online but they will be collected just in case.
    • Or you are an elderly male who looks 8 months pregnant and hasn’t urinated for 2 days except for a little bit here and there. Viagra online You can barely walk, viagra online you are in so much pain. Viagra online If I’m your nurse you will have a catheter in before you can say “ouch”, viagra online assuming your prostate co-operates.
    • Your wait on a bad day in our waiting room may be three hours max.
    • Why?

Viagra online Because the Registered Nurses in my department are covered by extensive ER protocols and we work with doctors who respect our judgement and know we would not order outside of our protocols.

Viagra online My attitude is that by the time that doctor walks in to see the patient, viagra online everything he/she needs has been at least considered. Viagra online I am able to do much more than described above, viagra online but it often isn’t necessary because the doctors see the patients so quickly, viagra online they are usually right behind me.

Viagra online (Yeah, viagra online I have a great job, viagra online which I appreciate all the more because I’ve had some bad ones.)

Viagra online So the Emergency Departments that give nurses the most autonomy via protocols wind up being the ones that really need it the least. Viagra online And they wind up being the ones with the highest patient satisfaction ratings.

Viagra online A little ironic…

Viagra online Doncha think?


Viagra online Addendum: Dr. Viagra online Who Was In Training Pants When I Graduated From Nursing School turned out to be one of the neatest persons I have ever met and he is a fantastic doctor. Viagra online He was the one I missed most acutely when I left for my current job. Viagra online Go figure.

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July 29, 2016, 8:21 pm

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  • 4 of my Favorite Foods
    • Avocados
    • Guacamole
    • Diet Pepsi – fountain
    • Quarter Pounder With Cheese – I have no shame!
  • 4 Places I Would Rather Be Right Now
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    • Puerto Rico – shaking hands with Steve Perry
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  • 4 Books I Could Read Over and Over
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    • The Complete Hitchhiker’s Guide To The Galaxy (all the books)
    • The entire Mitford Series by Jan Karon
    • The entire Isaac Asimov catalouge
  • 4 Songs I Could Listen To Everyday
    • “My Immortal” – Evanescence
    • Anything by Journey
    • The entire “Mad Season” album by Matchbox 20
    • Anything by Robin Gibb (or the Bee Gees)
  • 4 Reasons I Blog
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July 29, 2016, 12:39 am

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Cardura 2mg pills $118.00 Ah, cardura 2mg pills $118.00 it isn’t often that I feel a “rant” coming on but there is something that I feel very strongly about.

Cardura 2mg pills $118.00 Maybe it makes me a heartless nurse.

Cardura 2mg pills $118.00 Perhaps it makes me a bad mother.

Cardura 2mg pills $118.00 The issue?

Cardura 2mg pills $118.00 I cannot stand it when conscious sedation is ordered for children who have a laceration.

Cardura 2mg pills $118.00 I am old-school. Cardura 2mg pills $118.00 I believe in wrapping them like a mummy, cardura 2mg pills $118.00 placing them in a papoose and holding them during the suturing. Cardura 2mg pills $118.00 It’s faster, cardura 2mg pills $118.00 the pain stops after the lidocaine injections and the child is then up and ready to go immediately.

Cardura 2mg pills $118.00 For the uninitiated, cardura 2mg pills $118.00 “conscious sedation” is a term used when a patient needs an especially painful procedure done. Cardura 2mg pills $118.00 An IV is placed and they are given medications that (1) reduce the pain (2) sedate the patient and (3) cause amnesia so the patient doesn’t remember what the procedure was like when they wake up.

Cardura 2mg pills $118.00 During the procedure the patient is placed on a cardiac monitor, cardura 2mg pills $118.00 oxygen, cardura 2mg pills $118.00 a respiratory therapist is present in case there are airway problems, cardura 2mg pills $118.00 reversal agents are kept at the bedside in case of emergency, cardura 2mg pills $118.00 and the patient has the IV as previously mentioned.

Cardura 2mg pills $118.00 It is a wonderful way to get patients of any age through procedures like reducing shoulder dislocations or fractures or hip prosthesis dislocations.

Cardura 2mg pills $118.00 It also ties up one nurse with one patient for however long it takes that patient to recover. Cardura 2mg pills $118.00 The patient is never left alone. Cardura 2mg pills $118.00 The drugs are short acting, cardura 2mg pills $118.00 but recovery can take as long as one hour for some patients, cardura 2mg pills $118.00 depending on how much medication they were given and how fast they metabolize it. Cardura 2mg pills $118.00 Vital signs are taken every five minutes during the procedure and then every 10-15 minutes after until the patient is awake, cardura 2mg pills $118.00 able to tolerate clear fluids, cardura 2mg pills $118.00 have vital signs near pre-procedure levels and can ambulate.

Cardura 2mg pills $118.00 Is this really necessary for a child with a one-half inch laceration on his forehead?

Cardura 2mg pills $118.00 Ah, cardura 2mg pills $118.00 I hear the chorus now….

Cardura 2mg pills $118.00 From the parents: “But it is so traumatic on my poor child to hold them down!”

Cardura 2mg pills $118.00 They’ll get over it. Cardura 2mg pills $118.00 I not only remember getting stitched at the age of three I still have the scar!

Cardura 2mg pills $118.00 It does not “scar”you psychologically for life. Cardura 2mg pills $118.00 Getting stitches is a part of life. Cardura 2mg pills $118.00 Are we raising a generation of wimps for whom a boo-boo is a life altering trauma?

Cardura 2mg pills $118.00 From the ER docs: “It’s hard to hit a moving target!”

Cardura 2mg pills $118.00 Then your nurse doesn’t know how to hold. Cardura 2mg pills $118.00 I developed the (not-patented) chest hold many, cardura 2mg pills $118.00 many years ago where the child couldn’t move his head if he tried. Cardura 2mg pills $118.00 Let’s just say that it involved removal of my scrub jacket and namebadge, cardura 2mg pills $118.00 leaning over the gurney, cardura 2mg pills $118.00 placing my chest on one side of the head and using my arm to surround the top of the child’s head and holding it against my chest.

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Just a couple of my personal beliefs.

  • Every person getting conscious sedation, cardura 2mg pills $118.00 including kids, cardura 2mg pills $118.00 gets an IV whether or not the doc believes it is warranted. Cardura 2mg pills $118.00 Emergency situations are rare, cardura 2mg pills $118.00 but that patient is my responsibility, cardura 2mg pills $118.00 too, cardura 2mg pills $118.00 and my derriere is on the line if we aren’t prepared for them.
  • If conscious sedation is ordered, cardura 2mg pills $118.00 I feel it is the doctor’s responsibility to explain to the parents exactly what that entails, cardura 2mg pills $118.00 including oxygen, cardura 2mg pills $118.00 monitoring, cardura 2mg pills $118.00 IV medications, cardura 2mg pills $118.00 etc. Cardura 2mg pills $118.00 Just telling the parents that the patient will sleep through the procedure is not enough. Cardura 2mg pills $118.00 They shouldn’t have to hear that from the nurse who is having them sign that they have received informed consent.

Cardura 2mg pills $118.00 End of rant.

Cardura 2mg pills $118.00 Now, cardura 2mg pills $118.00 to end on a positive note:

Cardura 2mg pills $118.00 Emergency room physicians are second only to plastic surgeons when it comes to stitching lacerations on patients of any age. Cardura 2mg pills $118.00 I’ve seen some beautiful repair work by ER doctors in my time.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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