October, 2006 Archive

June 28, 2016, 10:10 pm

Herbal Viagra Uk

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Herbal viagra uk This is an interesting little gem.

Herbal viagra uk I believe it was part of an ad for health insurance.

Herbal viagra uk Interesting because it looks about circa 1950.

Herbal viagra uk Because for what I spend on amazon.com, herbal viagra uk I could have my appendix out every ten days.

Herbal viagra uk With the Grade A anesthesia!

Herbal viagra uk And because this patient looks to be headed for surgery in an evening gown!

Herbal viagra uk Honey, herbal viagra uk in my facility, herbal viagra uk you don’t even get to keep your underwear on!

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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. Herbal viagra uk 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.

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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. Herbal viagra uk Maybe I’m naive. Herbal viagra uk 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, herbal viagra uk but have noticed an increased willingness to mention the presence of Viagra without being asked.
    • Again, herbal viagra uk 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.
*****

Herbal viagra uk More patients are using the emergency department as their source for narcotics.

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

Herbal viagra uk There are more patients in the emergency department.

Herbal viagra uk This isn’t my imagination, herbal viagra uk we’re adding more nurses like crazy to handle the load!

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

  • In reality, herbal viagra uk 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.
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Herbal viagra uk So it appears the rapid changes I’ve witnessed in the last three years are a mixed bag.

Herbal viagra uk On the one hand, herbal viagra uk patients are more willing to discuss intimate aspects of their care with their health-care providers.

Herbal viagra uk On the other hand, herbal viagra uk the census of my emergency department is swelling secondary to non-emergent patients utilizing our services.

Herbal viagra uk A major factor are patients with chronic pain utilizing the ER for pain relief services on a continual basis. Herbal viagra uk Most are legitimate. Herbal viagra uk Many are not. Herbal viagra uk 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.

Herbal viagra uk Add the increasing amounts of paperwork, herbal viagra uk and you see a much different ER than you saw just three years ago.

Herbal viagra uk I wonder what changes I’ll be writing about in 2010…..

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June 28, 2016, 9:11 am

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And so am I.

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Where is this energy coming from?

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June 28, 2016, 3:08 pm

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Change of Shift really is going on the road!

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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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