September, 2007 Archive

September 30, 2007, 11:00 am

Putting On the Links


Oh,what I would have given to have one of these sets when I was little!

That’s a whole freakin’ office in a box!

Can’t say much for the nurse’s cap, though. I could make a better one out of a piece of typing paper. I made a ton of caps back then.


Lots of things going on in the blogosphere, so I thought I’d dedicate a post to some of the happenings!

First of all, the iPhone contest is still going on over at Nursing Voices! You have until October 15th to register and post for a chance at not one, but two iPhones. Follow the link and if you win, I’ll be totally jealous!



The latest edition of SurgeXperiences is up today at Suture for a Living. Lots of good surgical stories, but the tiny MC Hammer dancing is worth the visit!


sumerDr. Sumer has brains and he’s happy to show you the MRIs to prove it!

Radiology Grand Rounds is now up over at Sumer’s Radiology Site.

Check out the great overview of pineal tumors!


Our good friend and fellow blogger, Doctor Anonymous is a talk show host! A BlogTalkRadio host, that is! His latest interview is with Dr. Rob of Musings of a Distractible Mind. His BlogTalkRadio site has all the info!


I was honored to be a guest blogger over at My post is about “Five Suggestions for Visiting the Emergency Department”, and can be found here.



Change of Shift will be hosted by GirlVet at Madness: Tales of an Emergency Room Nurse this coming Thursday. Submissions can be sent to mj.finn at hotmail dot com or through Blog Carnival.

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12:59 am

The Standard of Care in an HMO – Compare and Contrast


Joe doesn’t know it yet, but he is on a date with…

Anne Jamison, RN, of the Super Secret Assessment Squad!

Secretly and with deft precision, she feels for enlarged lymph nodes while dancing with her target.

Audaciously, she audits his auditory acumen by whispering in his ear.

Her diagnosis?

Coordination, impaired, manifested by an inability to dance secondary to klutzemia and exacerbated by ETOH intoxication.

Recommendation: no second date.



Ahhhhh….the statistics test has been uploaded. The literary narrative has been finalized and sent to my professor in Wisconsin.

I can breathe. Finally.

Actually, I was breathing pretty heavily earlier this week. With all due respect to my husband, here is a pic of yours truly with the cause of last Tuesday’s hyperventilation.

That’s Jeff Scott Soto on the right, just in case you were wondering who was who. You know, I’d look a hell of a lot better if I had Photoshop. My image correction software just doesn’t cut it.


I am appalled at a certain HMO whose slogan rhymes with “Drive”.

Let me put it this way.

In my ER, if you come in with pain in your calf with redness and heat, a doppler study is done to determine if a deep vein thrombosis (DVT) is present. If you complain that your other calf is also sore, we will do a doppler study of that leg to make sure you don’t have bilateral DVTs.

In my ER, if you present with bilateral calf pain, redness and heat and you happen to mention you had burning in your chest that morning and jaw pain the night before, you get all of the above and (a) an EKG, (b) a big ass IV in your left antecubital space for the contrast you will get when you go for the (c) CT scan of your chest to rule out pulmonary embolism.

In my ER, if you present with all this and you are a status/post trauma patient of four-and-a-half-months with bilateral fused ankles, a cast on one leg and a halo on the other leg with explicit instructions to keep your legs elevated since the accident until you began weight bearing two weeks ago, you would be admitted for observation.

At least.



Take the same patient with the same chief complaint and let’s see how one particular HMO facility decided to handle the case.

Well, they did a doppler study of one leg, despite the presence of pain in both. What do you know? There’s a DVT there!

Then, they gave an anticoagulant and sent the patient home.

No doppler on the second leg. No EKG. No CT of the chest despite the presence of transient chest burning and jaw pains earlier in the day.

You see, if you have a simple DVT, you can take oral anticoagulants and follow up as an outpatient with your doctor.

But…the patient didn’t have a simple DVT. The patient had bilateral DVTs.

That wasn’t all she had.


How did the patient finally get the correct diagnosis? She was taken by ambulance late last night to a decent facility; one that was not affiliated with the HMO.

She had chest burning, shortness of breath and bilateral leg pain.

She was throwing pulmonary embolisms.

This facility gave a damn. This facility did not brush off her complaints. This facility did the tests. This facility made the diagnosis. And this facility will treat her appropriately.

Just like they did last May.


You know that HMO, the one that has the slogan beginning with “Be Well….”? They should change it to “Go to Hell…” because that is how they treat their members.

Yeah, pardon the language, but I’m pissed.

This patient nearly died last May. What the hell was “Brand X ” HMO thinking when they saw this constellation of symptoms?

“Let’s finish the job?”

Health maintainence, my derriere.


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September 29, 2007, 1:59 am

I Say, “Why Not?”


So that’s my problem!

I’m awake, but my liver bile is still asleep!

Who knew?

Isn’t “liver bile” redundant?

I wonder what’s in those Carter’s Little Liver Pills?

An exhaustive search of Wikipedia the internet shows that Carter’s is still sold as Carter’s Little Pills and is made of Bisacodyl.

AKA Dulcolax.

Seems it wakes up more than just your liver bile!


What the hell was I thinking when I signed up for ten semester units???

I told myself I would take classes slow and easy and enjoy the process. Of course, the first chance I get I sign up for pretty near full time units. I always do that.

Now I work nursing, I study nursing and I blog nursing. I’m a nursing machine!

Somehow that didn’t come out right…


I believe that as long as nurses are employees of a hospital and not private contractors they will not have power in an organization.

I started to brainstorm ideas. After the shock of having my brain still functioning after three hours of Statistics, I asked myself…

How could this be done?

What if nurses started their own staffing companies? Companies that the nurses themselves would own.

I’m not talking registry here. I’m talking a company that contracts with a hospital to provide unit staffing. Any unit. Any floor. Long term. One year, perhaps more…


I’ll use the emergency department as an example. Suppose I brought together a group of nurses with experience in emergency nursing. All of them CEN certified with ACLS, TNCC, PALS and ENPC certifications. We form a company – just for fun we’ll call it “EmergiNurse, Inc.”

EmergiNurse, Inc. contacts Hotel Hospital and says, “For ‘x’ amount of money, we will staff your department full time for the next year.” That includes charge nurses and a manager.

If an EmergiNurse is sick, another EmergiNurse will take their place. The hospital doesn’t worry about providing health insurance, benefits, sick leave, vacation or scheduling. They don’t have to worry about paying overtime. Twenty-four hours a day, seven days a week there will be enough EmergiNurses in the department to staff the floor at least at minimum staffing levels. More staff if the acuity is up. Less if the acuity is down. We adhere to all hospital policies regarding Joint Commission requirements and patient care/procedures.


For a price. We contract with the hospital to provide nursing service on a unit for a set fee. One fee negotiated for the year. If the census drops the fee stays the same. If the census increases and more EmergiNurses are needed, the fee stays the same.

We would provide documentation of all licenses, certifications, inservices and competencies. We would provide the health insurance, vacation, sick time, educational leave and malpractice insurance for ourselves. We would pay ourselves a set monthly salary.

None of this clock punching, standing by the time clock waiting for the minutes to pass before you can leave without getting docked in pay. We are professionals. We show up and we work. If we finish our work before change of shift is over, we leave. If the unit is quiet, we decide whether to leave or staff in case of admissions. If we have to stay over one day, it’s not a big deal and we don’t quibble over 20 minutes of overtime. We set our own schedules.


We are professionals who own our own practice, and we own the company. If we make money we keep it. We aren’t going to lose money because the hospital still has to provide for nursing services to the patients – they would be paying this money anyway. They don’t have to worry about union contracts because they are not our employers. We would manage ourselves, bound only by hospital policies and state laws regarding breaks and overtime. We hire only the best nurses who meet our high standards. Magazine readers, internet surfers and all ’round lazy attitudes need not apply.

We would be paid for our service and not have our professional services hidden in room fees and miscellaneous hospital costs.

Look, doctors do this all of the time. They contract with hospitals to provide care for the patients. Yes, that generates money for the hospital but the hospital is going to have to provide nursing care no matter what for those patients.

So we make it easy for them. They are still paying (big time – nurses don’t come cheap), but with less administrative hassles to deal with.

Imagine hiring a nursing company to staff your facility.

Travel nurses do it as individuals. Registries do it per shift.

Why not entire units?

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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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