Pharmaceuticals female viagra Yes.
Pharmaceuticals female viagra It’s an actual photo of “Flat Cap Syndrome”.
Pharmaceuticals female viagra Flat Cap Syndrome developed when the brim of one’s nursing cap was larger than the fold behind it.
Pharmaceuticals female viagra Some say that the victims were responsible for choosing to go to a School of Nursing identified by those caps.
Pharmaceuticals female viagra Don’t blame the victim.
Pharmaceuticals female viagra Maybe it was the only School that she was accepted to.
Pharmaceuticals female viagra Maybe…..maybe she didn’t know….
Pharmaceuticals female viagra By the time I graduated, pharmaceuticals female viagra designs in nursing caps had pretty much made Flat Cap Syndrome a thing of the past.
Pharmaceuticals female viagra My cap was never flat, pharmaceuticals female viagra and to this day it stands proudly in its case in the den closet in pristine condition.
Pharmaceuticals female viagra (Disclosure: it’s in pristine condition because I just bought it off of eBay.
Pharmaceuticals female viagra 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.
Pharmaceuticals female viagra If all of a sudden there is no more Emergiblog, pharmaceuticals female viagra it’s because they killed me with ridicule.
Pharmaceuticals female viagra Call the authorities.)
Pharmaceuticals female viagra I’m not talking about using nurses instead of doctors, pharmaceuticals female viagra a la the problems that Dr. Pharmaceuticals female viagra Crippen at NHS Blog Doctor describes, pharmaceuticals female viagra I’m talking about protocols that allow nurses, pharmaceuticals female viagra using certain criteria established by the ER physicians, pharmaceuticals female viagra to initiate care prior to the doctor seeing the patient.
Pharmaceuticals female viagra It is!
Pharmaceuticals female viagra The best ERs that I have worked in are the ones that, pharmaceuticals female viagra per protocol, pharmaceuticals female viagra allow the RNs to do what they do best.
Pharmaceuticals female viagra Conversely, pharmaceuticals female viagra 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”, pharmaceuticals female viagra this was the case. Pharmaceuticals female viagra The nurses could not make a move without an order.
- It was a teaching facility. Pharmaceuticals female viagra How could the interns/residents learn to order appropriately if the nurse did it first? And forget verbal orders, pharmaceuticals female viagra if some resident gave an order you grabbed the nearest order sheet and made them write it. Pharmaceuticals female viagra So often you’d have five or six different order sheets going.
- Because if there was a descrepancy between what was said and what was done, pharmaceuticals female viagra guess whose derriere would be on the line? Right, pharmaceuticals female viagra the nurse’s. Pharmaceuticals female viagra Remember the old saying about how excrement flows downhill? It’s true.
- And the wait to get into a room? Hours. Pharmaceuticals female viagra We’re talking 5-7 hours at times. Pharmaceuticals female viagra You could be vomiting, pharmaceuticals female viagra have a 5-day migraine with photophobia, pharmaceuticals female viagra 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, pharmaceuticals female viagra coughing bronchitis patients. Pharmaceuticals female viagra And don’t think asthma would get you a front row seat, pharmaceuticals female viagra either. Pharmaceuticals female viagra If your O2 sat was normal, pharmaceuticals female viagra have a seat like everyone else.
- Because the beds never turned over. Pharmaceuticals female viagra Because one nurse would be responsible for six monitored patients plus the psych isolation room across the hall. Pharmaceuticals female viagra Because….
- … first the “Pulmonary Team” had to see the patient, pharmaceuticals female viagra 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, pharmaceuticals female viagra only to discover that said patient couldn’t be admitted there anyway, pharmaceuticals female viagra 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.
Pharmaceuticals female viagra Get the picture?
Pharmaceuticals female viagra Then we have example number two.
- Small community hospital, pharmaceuticals female viagra one that I will call “Mini County Hospital”. Pharmaceuticals female viagra Sat right in the middle of a very ethnically diverse, pharmaceuticals female viagra lower-income area of a suburb that could be called the Meth Capital of the SF Bay Area. Pharmaceuticals female viagra Many patients. Pharmaceuticals female viagra Many clinical, pharmaceuticals female viagra non-emergent patients. Pharmaceuticals female viagra Some very emergent patients.
- The nurses were not allowed to do anything. Pharmaceuticals female viagra Nada. Pharmaceuticals female viagra Kaput.
- Because the department had a wide mix of nursing experience, pharmaceuticals female viagra from new grads to newly designated dinosaurs like me, pharmaceuticals female viagra and there were no protocols because they could not depend on all the nurses to have the same level of competency.
- So one day, pharmaceuticals female viagra Nurse Experience (me), pharmaceuticals female viagra brings in a patient with chest pain, pharmaceuticals female viagra starts a line while the tech does the EKG and within five minutes hands the doctor the EKG and the orders for CBC, pharmaceuticals female viagra Chemistry Panel, pharmaceuticals female viagra Cardiac Enzymes and portable chest to the unit clerk. Pharmaceuticals female viagra No problem, pharmaceuticals female viagra right? Wrong.
- I was curtly asked, pharmaceuticals female viagra “Who the hell told you to order those labs?”.
- I looked at Dr. Pharmaceuticals female viagra 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 , pharmaceuticals female viagra “Are you telling me that after (then) 24 years experience in nursing, pharmaceuticals female viagra that I cannot at least get a cardiac workup started?
- That was exactly what he was telling me. Pharmaceuticals female viagra I had three times the experience and was old enough to be his…..older sister, pharmaceuticals female viagra but it didn’t matter. Pharmaceuticals female viagra The nursing expectations went to the lowest common denominator, pharmaceuticals female viagra that of a new grad.
- Which meant the patients in the waiting room waited, pharmaceuticals female viagra sometimes 8 hours for the same reasons stated above. Pharmaceuticals female viagra The nurses could not facilitate patient movement. Pharmaceuticals female viagra Because we worked with relatively new doctors, pharmaceuticals female viagra every child who vomited even once got an IV and a bolus. Pharmaceuticals female viagra Most got septic workups.
Pharmaceuticals female viagra Now let’s contrast this with an ER that runs quite smoothly, pharmaceuticals female viagra 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. Pharmaceuticals female viagra Detailed, pharmaceuticals female viagra well written protocols. Pharmaceuticals female viagra Here’s what happens when you come into this ER:
- For example, pharmaceuticals female viagra you come in and your chief complaint is nausea, pharmaceuticals female viagra vomiting, pharmaceuticals female viagra diarrhea for three days with fever and you are extremely dizzy when upright. Pharmaceuticals female viagra I’m your nurse.
- Before the doc shows up I will have orthostatic vital signs, pharmaceuticals female viagra an IV in, pharmaceuticals female viagra bloods drawn, pharmaceuticals female viagra a bolus of Normal Saline initiated (unless you are elderly or have heart trouble) , pharmaceuticals female viagraat 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, pharmaceuticals female viagra which may or may not be needed, pharmaceuticals female viagra 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. Pharmaceuticals female viagra You can barely walk, pharmaceuticals female viagra you are in so much pain. Pharmaceuticals female viagra If I’m your nurse you will have a catheter in before you can say “ouch”, pharmaceuticals female viagra assuming your prostate co-operates.
- Your wait on a bad day in our waiting room may be three hours max.
Pharmaceuticals female viagra 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.
Pharmaceuticals female viagra My attitude is that by the time that doctor walks in to see the patient, pharmaceuticals female viagra everything he/she needs has been at least considered. Pharmaceuticals female viagra I am able to do much more than described above, pharmaceuticals female viagra but it often isn’t necessary because the doctors see the patients so quickly, pharmaceuticals female viagra they are usually right behind me.
Pharmaceuticals female viagra (Yeah, pharmaceuticals female viagra I have a great job, pharmaceuticals female viagra which I appreciate all the more because I’ve had some bad ones.)
Pharmaceuticals female viagra So the Emergency Departments that give nurses the most autonomy via protocols wind up being the ones that really need it the least. Pharmaceuticals female viagra And they wind up being the ones with the highest patient satisfaction ratings.
Pharmaceuticals female viagra A little ironic…
Pharmaceuticals female viagra Doncha think?
Pharmaceuticals female viagra Addendum: Dr. Pharmaceuticals female viagra 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. Pharmaceuticals female viagra He was the one I missed most acutely when I left for my current job. Pharmaceuticals female viagra Go figure.