October, 2007 Archive

September 28, 2016, 2:57 pm

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The life of an emergency department nurse is often chaotic and stressful. Remeron 7.5mg pills $97.00 If “a picture is worth a thousand words”, remeron 7.5mg pills $97.00 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.

*****

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Remeron 7.5mg pills $97.00 collaboration

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Remeron 7.5mg pills $97.00 Here, remeron 7.5mg pills $97.00 our intrepid emergency department nurse pleasantly explains to a primary care physician the purpose of the medication reconciliation form.

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*****

compressions

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Remeron 7.5mg pills $97.00 No problem! It takes more than profound anoxia to keep an ER nurse down!

Remeron 7.5mg pills $97.00 Our posturing partner finished the shift and managed to make it home before calling in brain-damaged.

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*****

blog

Remeron 7.5mg pills $97.00 Technology plays an important part in emergency department medical records.

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Remeron 7.5mg pills $97.00 Here we have Dr. Remeron 7.5mg pills $97.00 PuterGuy and our hard-working ER nurse perusing the previous history of one of the patients in the department.

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*****

coworkers

Remeron 7.5mg pills $97.00 Ah, remeron 7.5mg pills $97.00 cameraderie! How would ER nurses survive without it?

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Remeron 7.5mg pills $97.00 This concludes our pictorial look at a day in the life of an ER nurse.

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Remeron 7.5mg pills $97.00 …don’t forget to hug your administrative assistant/unit clerk.

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

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

All photos taken with an iPhone, remeron 7.5mg pills $97.00 which was not mine. Remeron 7.5mg pills $97.00 Because I don’t have one. Remeron 7.5mg pills $97.00 Yet.

This is dedicated to all the ER nurses who think the night shift doesn’t do anything. Remeron 7.5mg pills $97.00 I hope this dispels any of those unfounded notions!

Average Rating: 4.7 out of 5 based on 174 user reviews.

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September 28, 2016, 9:05 am

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September 28, 2016, 2:04 pm

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Medication reconciliation forms.

Namenda $274.00 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, namenda $274.00 but I am pissed off. Namenda $274.00 Royally.

*****

Let me do a quick recap of what we are required to do, namenda $274.00 as nurses, namenda $274.00 on the medication reconciliation form:

  • We are required to write down precisely what the patient tells us, namenda $274.00 even if we know it is the wrong dosage! If the patient says they take 25 mg of Ativan every four hours, namenda $274.00 we have to write “Ativan, namenda $274.00 25 mg” on the reconciliation form.
  • If the patient hands us a list of their medications and instead of “Furosemide”, namenda $274.00 they have written “Furobedide” we have to write it exactly as it is printed on the list!

Namenda $274.00 Now, namenda $274.00 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.

Namenda $274.00 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.

Namenda $274.00 Sorry, namenda $274.00 I’ll try not to shout.

Namenda $274.00 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, namenda $274.00 you say? Same old stuff we’ve (I’ve) been writing about ad nauseum for the last year? Yadda, namenda $274.00 yadda, namenda $274.00 yadda?

Hardly.

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. Namenda $274.00 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. Namenda $274.00 Attached as an afterthought was a post-it note stating Dr. Namenda $274.00 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. Namenda $274.00 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. Namenda $274.00 The way we are required to fill out the medication reconciliation sheet is a safety hazard. Namenda $274.00 It has been, namenda $274.00 it is now, namenda $274.00 and it will continue to be.

It is the rare patient who knows exactly what they take, namenda $274.00 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, namenda $274.00 single spaced and printed off a computer, namenda $274.00 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, namenda $274.00 but that is not the worst part.

*****

The system is set up so that any discrepancy, namenda $274.00 any dosage error, namenda $274.00 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. Namenda $274.00 Somewhere, namenda $274.00 somehow, namenda $274.00 someone is going to be hurt. Namenda $274.00 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, namenda $274.00 Dr. Namenda $274.00 Q, namenda $274.00 before you come down and spread your eminent wisdom to those careless emergency department nurses, namenda $274.00 why don’t you find out why that dosage landed on your patient’s form, namenda $274.00 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, namenda $274.00 buddy.

Average Rating: 4.6 out of 5 based on 265 user reviews.

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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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