October, 2007 Archive

August 29, 2016, 2:57 pm

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The life of an emergency department nurse is often chaotic and stressful. Estrace 2mg pills $193.00 If “a picture is worth a thousand words”, estrace 2mg pills $193.00 let me take a moment to actually show you what a typical shift in a community ER might look like.

Disclaimer: those depicted in the following photographs shall remain nameless to comply with current HIPAA regulations regarding patient confidentiality.



Estrace 2mg pills $193.00 Any visit to the emergency department begins with triage.

Estrace 2mg pills $193.00 Here, estrace 2mg pills $193.00 we have a patient with a chief complaint of pain, estrace 2mg pills $193.00 nausea and feeling as though he is “full of air”.

Estrace 2mg pills $193.00 The patient’s wife reports increasing incidents of the patient hiding behind chairs and flinging feces in her direction, estrace 2mg pills $193.00 thereby causing increased stress in the home.

Estrace 2mg pills $193.00 It is important to note that although the patient is smiling, estrace 2mg pills $193.00 he reports pain to be a 10/10. Estrace 2mg pills $193.00 Nurses must be careful to take the patient’s word and not make value judgments based on outward signs of pain or a lack thereof.

Estrace 2mg pills $193.00 On arrival to the room, estrace 2mg pills $193.00 the patient immediately asked for something to eat. Estrace 2mg pills $193.00 This is not an unusual situation, estrace 2mg pills $193.00 as 98.6% of all nauseated patients become hungry on arrival.

Estrace 2mg pills $193.00 A banana was given.


Estrace 2mg pills $193.00 collaboration

Estrace 2mg pills $193.00 Communication is the heart of collaboration.

Estrace 2mg pills $193.00 Here, estrace 2mg pills $193.00 our intrepid emergency department nurse pleasantly explains to a primary care physician the purpose of the medication reconciliation form.

Estrace 2mg pills $193.00 Dr. Estrace 2mg pills $193.00 Primary is astounded at the amount of work the nurses do to make his job of ordering easier. Estrace 2mg pills $193.00 He vows to make sure he completes the form in the future. Estrace 2mg pills $193.00 Another ER success story!

Estrace 2mg pills $193.00 I’m sure holding Dr. Estrace 2mg pills $193.00 Primary by the back of the neck had nothing to do with it…



Estrace 2mg pills $193.00 CPR certification is one of the more important requirements of emergency department nursing.

Estrace 2mg pills $193.00 Here, estrace 2mg pills $193.00 we see one of the ER staff working diligently, estrace 2mg pills $193.00 practicing chest compressions on a colleague.

Estrace 2mg pills $193.00 Uh oh! It seems that someone has forgotten the “R” of CPR and now their colleague is exhibiting decerebrate posturing.

Estrace 2mg pills $193.00 No problem! It takes more than profound anoxia to keep an ER nurse down!

Estrace 2mg pills $193.00 Our posturing partner finished the shift and managed to make it home before calling in brain-damaged.

Estrace 2mg pills $193.00 The nurse was, estrace 2mg pills $193.00 however, estrace 2mg pills $193.00 counseled for not breathing on the job.



Estrace 2mg pills $193.00 Technology plays an important part in emergency department medical records.

Estrace 2mg pills $193.00 Computers have made it easier to read blogs on the job access patient’s medical records, estrace 2mg pills $193.00 thereby improving continuity of care.

Estrace 2mg pills $193.00 Here we have Dr. Estrace 2mg pills $193.00 PuterGuy and our hard-working ER nurse perusing the previous history of one of the patients in the department.

Estrace 2mg pills $193.00 Hmmm….

Estrace 2mg pills $193.00 It seems this patient has a family history of feces flinging.



Estrace 2mg pills $193.00 Ah, estrace 2mg pills $193.00 cameraderie! How would ER nurses survive without it?

Estrace 2mg pills $193.00 It’s your coworkers who have your back, estrace 2mg pills $193.00 help you when you are swamped, estrace 2mg pills $193.00 fill-in for you when you are sick, estrace 2mg pills $193.00 take the feces-slinging patient when you’ve had enough and basically make coming to work a joy.

Estrace 2mg pills $193.00 They also hold you up when you are sleeping at 0500, estrace 2mg pills $193.00 as is obviously happening with our hard-working ER nurse.


Estrace 2mg pills $193.00 unitclerk

Estrace 2mg pills $193.00 This concludes our pictorial look at a day in the life of an ER nurse.

Estrace 2mg pills $193.00 In conclusion, estrace 2mg pills $193.00 when things get hairy, estrace 2mg pills $193.00 the department is bursting at the seams and you don’t think you can take another step or read another order…

Estrace 2mg pills $193.00 …don’t forget to hug your administrative assistant/unit clerk.

Estrace 2mg pills $193.00 They’re the ones who actually run the department, estrace 2mg pills $193.00 anyway.


No emergency nurses were harmed in the making of this pictorial.

All photos taken with an iPhone, estrace 2mg pills $193.00 which was not mine. Estrace 2mg pills $193.00 Because I don’t have one. Estrace 2mg pills $193.00 Yet.

This is dedicated to all the ER nurses who think the night shift doesn’t do anything. Estrace 2mg pills $193.00 I hope this dispels any of those unfounded notions!

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August 29, 2016, 9:05 am

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Hytrin 2mg capsules $189.00 It’s time once again for Grand Rounds, hytrin 2mg capsules $189.00 this time hosted by the intrepid contributors of Pallimed: A Hospice and Palliative Care Blog, hytrin 2mg capsules $189.00 where many in the medical blogosphere did not hesitate to participate in the “Prognosticate” theme of the week.

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Hytrin 2mg capsules $189.00 Our favorite Mother Jones is taking the reins for the next Change of Shift, hytrin 2mg capsules $189.00 coming up a week from Thursday at Nurse Ratched’s Place. Hytrin 2mg capsules $189.00 Head over to Blog Carnival with your best by-for-or-about nursing posts or send them directly to nurseratcheds place at yahoo dot com. Hytrin 2mg capsules $189.00 Either way, hytrin 2mg capsules $189.00 I predict that many of you will send in submissions!


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Boy, hytrin 2mg capsules $189.00 talk about shifting gears, hytrin 2mg capsules $189.00 I have to go write a five page rough draft of my critical argument paper. Hytrin 2mg capsules $189.00 The topic?

Terri Schiavo.

There’s a topic that will yank me back to reality real fast.

Wish me luck.

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August 29, 2016, 2:04 pm

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Medication reconciliation forms.

Moduretic 5mg pills $141.00 Every time I fill one out I have every four-letter-word known to man run through my brain and then I invent some new ones.

And last night it got worse.

Pardon my language, moduretic 5mg pills $141.00 but I am pissed off. Moduretic 5mg pills $141.00 Royally.


Let me do a quick recap of what we are required to do, moduretic 5mg pills $141.00 as nurses, moduretic 5mg pills $141.00 on the medication reconciliation form:

  • We are required to write down precisely what the patient tells us, moduretic 5mg pills $141.00 even if we know it is the wrong dosage! If the patient says they take 25 mg of Ativan every four hours, moduretic 5mg pills $141.00 we have to write “Ativan, moduretic 5mg pills $141.00 25 mg” on the reconciliation form.
  • If the patient hands us a list of their medications and instead of “Furosemide”, moduretic 5mg pills $141.00 they have written “Furobedide” we have to write it exactly as it is printed on the list!

Moduretic 5mg pills $141.00 Now, moduretic 5mg pills $141.00 the paper that we so painstakingly fill out in our ER is then taken upstairs with the patients that are admitted and all the admitting doctor has to do is look at it and check off the box if they want it ordered in the hospital.

Moduretic 5mg pills $141.00 Did you get that? We nurses write the orders out in their entirety and all the doctors have to do is CHECK A FREAKING BOX.

Moduretic 5mg pills $141.00 Sorry, moduretic 5mg pills $141.00 I’ll try not to shout.

Moduretic 5mg pills $141.00 What this means is that (1) the patient is actually writing their own orders based on what they tell the nurse on admission when (2) the admitting physician should be responsible for finding out exactly what the patient is taking and write their own orders!


So what’s new, moduretic 5mg pills $141.00 you say? Same old stuff we’ve (I’ve) been writing about ad nauseum for the last year? Yadda, moduretic 5mg pills $141.00 yadda, moduretic 5mg pills $141.00 yadda?


I walked into work last night to find a note on the bulletin board (this is the preferred method of communication where I work) telling us that Dr. Moduretic 5mg pills $141.00 Q found a dosage error on a medication reconciliation sheet that would have “sent a patient to ICU” and that we nurses in the ER needed to be more careful.

<commence seething>

It gets better. Moduretic 5mg pills $141.00 Attached as an afterthought was a post-it note stating Dr. Moduretic 5mg pills $141.00 Q also thought that the floor nurses should go over in detail everything that is written in the ER after the patient gets up to the floor. Moduretic 5mg pills $141.00 Oh….and he appreciates all our hard work.

<full seethe ahead>

I left a choice note on his note and I am too old and too cynical to give a damn about the repercussions.


So this week’s theme for Grand Rounds is prognostication.

I foresaw this trouble looooong before now. Moduretic 5mg pills $141.00 The way we are required to fill out the medication reconciliation sheet is a safety hazard. Moduretic 5mg pills $141.00 It has been, moduretic 5mg pills $141.00 it is now, moduretic 5mg pills $141.00 and it will continue to be.

It is the rare patient who knows exactly what they take, moduretic 5mg pills $141.00 how much they take or why the hell they even take it!

But this is what their orders are being based on.

Even if they come in with two full pages of medications, moduretic 5mg pills $141.00 single spaced and printed off a computer, moduretic 5mg pills $141.00 when I verify the meds with them there will be 3-4 changes and at least three that have been discontinued.

So now the ER is getting criticism while doing something the doctor should be doing to begin with, moduretic 5mg pills $141.00 but that is not the worst part.


The system is set up so that any discrepancy, moduretic 5mg pills $141.00 any dosage error, moduretic 5mg pills $141.00 any transcription error (we aren’t allowed to xerox the patient’s list) – any adverse reaction/incident….can be blamed on a nurse for writing it “wrong”.

Yet they require us to write it “as is”.

The system is set up to fail. Moduretic 5mg pills $141.00 Somewhere, moduretic 5mg pills $141.00 somehow, moduretic 5mg pills $141.00 someone is going to be hurt. Moduretic 5mg pills $141.00 And I’m not exaggerating when I say it will be the nurse whose signature is on the bottom of that form that will take the fall.

So, moduretic 5mg pills $141.00 Dr. Moduretic 5mg pills $141.00 Q, moduretic 5mg pills $141.00 before you come down and spread your eminent wisdom to those careless emergency department nurses, moduretic 5mg pills $141.00 why don’t you find out why that dosage landed on your patient’s form, moduretic 5mg pills $141.00 realize that you should be ultimately responsible for what is ordered and then thank us for doing your job.

Don’t criticize us on one hand and then patronize us with your appreciation of how hard we work.

You don’t have a clue, moduretic 5mg pills $141.00 buddy.

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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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