October, 2006 Archive

August 30, 2016, 10:10 pm

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I’ve lived through many changes in health care over the last three decades.

Seen trends come and go.

Seen fancy “miracle” drugs come and go. Clomid 100mg pills $70.00 And come back again.

But something is happening.

The changes are coming faster.

I’m coming up on three years in my current ER.

Here are a few of the changes I’ve seen in that relatively short length of time.

******************************

Patients are more open about their health issues.

  • Patients seem more willing to let you know when they have infections like Hep C or HIV.
    • Words and intitials that used to be whispered with averted gaze are now spoken outright and without shame.
    • I like to think that patients are more comfortable because they don’t feel the stigma that was once attached to infectious disease. Clomid 100mg pills $70.00 Maybe I’m naive. Clomid 100mg pills $70.00 I hope not.
    • I’ve had more than one patient warn me to be extra careful when taking their blood!
  • Patients are more upfront about their sexuality and medications taken for it.
    • I used to have to ask about Viagra specifically; no nitroglycerin if Viagra is on board! I still ask, clomid 100mg pills $70.00 but have noticed an increased willingness to mention the presence of Viagra without being asked.
    • Again, clomid 100mg pills $70.00 I’d like to think this is due to increased patient education from both health-care providers and that patients feel more comfortable informing us of these medications.
*****

Clomid 100mg pills $70.00 More patients are using the emergency department as their source for narcotics.

  • This leads to me believe one of three scenarios:
    • 1. Clomid 100mg pills $70.00 The patient has chronic pain and they must utilize the ER when they experience breakthrough pain or when their coping mechanisms are overwhelmed. Clomid 100mg pills $70.00 Or…
    • 2. Clomid 100mg pills $70.00 The patient does not have an adequate pain control regimen in place as yet and continues to experience episodes of pain requiring narcotics. Clomid 100mg pills $70.00 This is also legitimate. Clomid 100mg pills $70.00 Or…
    • 3. Clomid 100mg pills $70.00 The patient is a drug-seeker. Clomid 100mg pills $70.00 You know them. Clomid 100mg pills $70.00 It’s a feeling in your gut. Clomid 100mg pills $70.00 Daily visits for two weeks. Clomid 100mg pills $70.00 Two visits in 24 hours, clomid 100mg pills $70.00 more than once. Clomid 100mg pills $70.00 Overly-solicitous behavior to the nurses. Clomid 100mg pills $70.00 (I’m good, clomid 100mg pills $70.00 but no, clomid 100mg pills $70.00 I’m not Mother Teresa, clomid 100mg pills $70.00 thank you anyway.) “Allergic” to every medication other than the one(s) they are asking for. Clomid 100mg pills $70.00 There have been shifts when I have seen 6-7 of our “regulars”. Clomid 100mg pills $70.00 Some call in ahead to see how busy we are. Clomid 100mg pills $70.00 This is not legitimate.
  • So how do you know which is which?
    • Many times, clomid 100mg pills $70.00 you don’t.
    • That means everyone is treated as if their request is legitimate and they are not drug seeking.
    • But I can tell you there are more narcotics flowing out of emergency departments today than I’ve ever seen. Clomid 100mg pills $70.00 I can also tell you that when
      • I know the patient’s name when they walk in the door, clomid 100mg pills $70.00
      • when I can write their medical history from memory on the triage chart, clomid 100mg pills $70.00 and
      • when I am giving amounts of medication that would put me out for eternity, clomid 100mg pills $70.00 we have a problem, clomid 100mg pills $70.00 Houston.
    • Sometimes, clomid 100mg pills $70.00 I can’t help but feel like a drug pusher – in the literal sense. Clomid 100mg pills $70.00 We are doing these patients a dis-service by continuing to feed their addiction. Clomid 100mg pills $70.00 It’s a sad situation; it’s almost like they live from visit to visit. Clomid 100mg pills $70.00 But they still come in. Clomid 100mg pills $70.00 Because they get what they want.
*****

Clomid 100mg pills $70.00 There are more patients in the emergency department.

Clomid 100mg pills $70.00 This isn’t my imagination, clomid 100mg pills $70.00 we’re adding more nurses like crazy to handle the load!

Clomid 100mg pills $70.00 I’ll use my shift, clomid 100mg pills $70.00 the night shift, clomid 100mg pills $70.00 as an example:

  • The old night shift
  • Clear out the patients left over from PM shift by 0100
  • Stock the unit and order meds.
  • Catch up on all the nursing journals and research papers you have not had a chance to read. Clomid 100mg pills $70.00 (Translation: knit, clomid 100mg pills $70.00 crochet, clomid 100mg pills $70.00 write letters, clomid 100mg pills $70.00 catch up on your novel, clomid 100mg pills $70.00 do crossword puzzles, clomid 100mg pills $70.00 gossip and eat, clomid 100mg pills $70.00 eat, clomid 100mg pills $70.00 eat!)
  • Put all evidence of professional journals away by 0530 so that the day shift doesn’t think you sat on your butt half the night.
  • Get ready for the daily hip fracture patient that is sure to come in between 0545 and 0630 and the daily pulmonary edema patient that will come between 0615 and 0700
The new night shift:
  • Come in at 2300, clomid 100mg pills $70.00 pour coffee.
  • Run your derrierre off with a nearly full department.
  • At 0200, clomid 100mg pills $70.00 make more coffee (you never had a chance to sip the first cup).Run your derrierre off with the new patients that have just arrived as you hit the “on” button on the coffee pot.
  • At 0400, clomid 100mg pills $70.00 make more coffee. Clomid 100mg pills $70.00 Actually drink half of this cup. Clomid 100mg pills $70.00 Go attend to the four pediatric patients from the same family who all have fevers and just walked in with all four grandparents and a fourth cousin once removed.
  • At 0600, clomid 100mg pills $70.00 forget any more attempts at coffee. Clomid 100mg pills $70.00 Grab your six-inch high pile of charts and begin documenting what you did five hours previously.
  • Take the next hip fracture and pulmonary edema patients.
  • Kiss the day shift.

*****

The paperwork has become unmanageable.

I’ve blogged on this ad nauseum.

Ostensibly, clomid 100mg pills $70.00 the paperwork is supposed to document good patient care.

  • In reality, clomid 100mg pills $70.00 it borders on preventing adequate patient care as the nurse spends more time at the chart than at the bedside.
  • You don’t get a “gold star” on your record for making sure your patients received good skin care.
  • You get a “gold star” for filling in all the blanks on the chart.
******************************

Clomid 100mg pills $70.00 So it appears the rapid changes I’ve witnessed in the last three years are a mixed bag.

Clomid 100mg pills $70.00 On the one hand, clomid 100mg pills $70.00 patients are more willing to discuss intimate aspects of their care with their health-care providers.

Clomid 100mg pills $70.00 On the other hand, clomid 100mg pills $70.00 the census of my emergency department is swelling secondary to non-emergent patients utilizing our services.

Clomid 100mg pills $70.00 A major factor are patients with chronic pain utilizing the ER for pain relief services on a continual basis. Clomid 100mg pills $70.00 Most are legitimate. Clomid 100mg pills $70.00 Many are not. Clomid 100mg pills $70.00 And that is sad for two reasons.

  • Addiction sucks.
  • The abusers make it that much harder for legitimate pain patients to be viewed clearly and dispassionately.

Clomid 100mg pills $70.00 Add the increasing amounts of paperwork, clomid 100mg pills $70.00 and you see a much different ER than you saw just three years ago.

Clomid 100mg pills $70.00 I wonder what changes I’ll be writing about in 2010…..

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August 30, 2016, 9:11 am

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Isn’t this the coolest title for a post?

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Lindsey is having a mid-life crisis.

And so am I.

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But it’s not a bad crisis.

Where is this energy coming from?

I’m going back to school, ed trial packs prilligy dapoxetine 60mg + viagra 100mg + cialis 20mg + levitra 20mg $266.00 blogging my guts out, ed trial packs prilligy dapoxetine 60mg + viagra 100mg + cialis 20mg + levitra 20mg $266.00 writing an entire novel in November (it’s National Novel Writing Month) and going back to straight night shift, ed trial packs prilligy dapoxetine 60mg + viagra 100mg + cialis 20mg + levitra 20mg $266.00 four days a week in January.

My house is actually…organized.

A year ago a slug could have beaten me in a three metre race.

Where did this sudden urge to write come from?

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James Lileks is probably the most famous unknown writer in the world.

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August 30, 2016, 3:08 pm

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Change of Shift really is going on the road!

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It’s not too early to send your submissions to John at “disappearingjohn at gmail dot com”.

There are a million nursing stories in the blogosphere.

Send your best ones to Change of Shift!

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Blogger (and friend) Coturnix of “Blog Around the Clock” has let me know that there will be a Science Blogging Conference at the University of North Carolina at Chapel Hill on January 20, duphalac 100ml bottle $152.00 2007.

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Thanks to Bora (Coturnix) for the heads up!

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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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