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

Seen trends come and go.

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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. Silymarin 140mg pills $213.00 Maybe I’m naive. Silymarin 140mg pills $213.00 I hope not.
    • I’ve had more than one patient warn me to be extra careful when taking their blood!
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    • Again, silymarin 140mg pills $213.00 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.

Silymarin 140mg pills $213.00 More patients are using the emergency department as their source for narcotics.

  • This leads to me believe one of three scenarios:
    • 1. Silymarin 140mg pills $213.00 The patient has chronic pain and they must utilize the ER when they experience breakthrough pain or when their coping mechanisms are overwhelmed. Silymarin 140mg pills $213.00 Or…
    • 2. Silymarin 140mg pills $213.00 The patient does not have an adequate pain control regimen in place as yet and continues to experience episodes of pain requiring narcotics. Silymarin 140mg pills $213.00 This is also legitimate. Silymarin 140mg pills $213.00 Or…
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  • So how do you know which is which?
    • Many times, silymarin 140mg pills $213.00 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. Silymarin 140mg pills $213.00 I can also tell you that when
      • I know the patient’s name when they walk in the door, silymarin 140mg pills $213.00
      • when I can write their medical history from memory on the triage chart, silymarin 140mg pills $213.00 and
      • when I am giving amounts of medication that would put me out for eternity, silymarin 140mg pills $213.00 we have a problem, silymarin 140mg pills $213.00 Houston.
    • Sometimes, silymarin 140mg pills $213.00 I can’t help but feel like a drug pusher – in the literal sense. Silymarin 140mg pills $213.00 We are doing these patients a dis-service by continuing to feed their addiction. Silymarin 140mg pills $213.00 It’s a sad situation; it’s almost like they live from visit to visit. Silymarin 140mg pills $213.00 But they still come in. Silymarin 140mg pills $213.00 Because they get what they want.

Silymarin 140mg pills $213.00 There are more patients in the emergency department.

Silymarin 140mg pills $213.00 This isn’t my imagination, silymarin 140mg pills $213.00 we’re adding more nurses like crazy to handle the load!

Silymarin 140mg pills $213.00 I’ll use my shift, silymarin 140mg pills $213.00 the night shift, silymarin 140mg pills $213.00 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. Silymarin 140mg pills $213.00 (Translation: knit, silymarin 140mg pills $213.00 crochet, silymarin 140mg pills $213.00 write letters, silymarin 140mg pills $213.00 catch up on your novel, silymarin 140mg pills $213.00 do crossword puzzles, silymarin 140mg pills $213.00 gossip and eat, silymarin 140mg pills $213.00 eat, silymarin 140mg pills $213.00 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, silymarin 140mg pills $213.00 pour coffee.
  • Run your derrierre off with a nearly full department.
  • At 0200, silymarin 140mg pills $213.00 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, silymarin 140mg pills $213.00 make more coffee. Silymarin 140mg pills $213.00 Actually drink half of this cup. Silymarin 140mg pills $213.00 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, silymarin 140mg pills $213.00 forget any more attempts at coffee. Silymarin 140mg pills $213.00 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, silymarin 140mg pills $213.00 the paperwork is supposed to document good patient care.

  • In reality, silymarin 140mg pills $213.00 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.

Silymarin 140mg pills $213.00 So it appears the rapid changes I’ve witnessed in the last three years are a mixed bag.

Silymarin 140mg pills $213.00 On the one hand, silymarin 140mg pills $213.00 patients are more willing to discuss intimate aspects of their care with their health-care providers.

Silymarin 140mg pills $213.00 On the other hand, silymarin 140mg pills $213.00 the census of my emergency department is swelling secondary to non-emergent patients utilizing our services.

Silymarin 140mg pills $213.00 A major factor are patients with chronic pain utilizing the ER for pain relief services on a continual basis. Silymarin 140mg pills $213.00 Most are legitimate. Silymarin 140mg pills $213.00 Many are not. Silymarin 140mg pills $213.00 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.

Silymarin 140mg pills $213.00 Add the increasing amounts of paperwork, silymarin 140mg pills $213.00 and you see a much different ER than you saw just three years ago.

Silymarin 140mg pills $213.00 I wonder what changes I’ll be writing about in 2010…..

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July 29, 2016, 9:11 am

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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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