October, 2007 Archive

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The life of an emergency department nurse is often chaotic and stressful. Buy cialis without prescription If “a picture is worth a thousand words”, buy cialis without prescription 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.

*****

simian

Buy cialis without prescription Any visit to the emergency department begins with triage.

Buy cialis without prescription Here, buy cialis without prescription we have a patient with a chief complaint of pain, buy cialis without prescription nausea and feeling as though he is “full of air”.

Buy cialis without prescription The patient’s wife reports increasing incidents of the patient hiding behind chairs and flinging feces in her direction, buy cialis without prescription thereby causing increased stress in the home.

Buy cialis without prescription It is important to note that although the patient is smiling, buy cialis without prescription he reports pain to be a 10/10. Buy cialis without prescription 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.

Buy cialis without prescription On arrival to the room, buy cialis without prescription the patient immediately asked for something to eat. Buy cialis without prescription This is not an unusual situation, buy cialis without prescription as 98.6% of all nauseated patients become hungry on arrival.

Buy cialis without prescription A banana was given.

*****

Buy cialis without prescription collaboration

Buy cialis without prescription Communication is the heart of collaboration.

Buy cialis without prescription Here, buy cialis without prescription our intrepid emergency department nurse pleasantly explains to a primary care physician the purpose of the medication reconciliation form.

Buy cialis without prescription Dr. Buy cialis without prescription Primary is astounded at the amount of work the nurses do to make his job of ordering easier. Buy cialis without prescription He vows to make sure he completes the form in the future. Buy cialis without prescription Another ER success story!

Buy cialis without prescription I’m sure holding Dr. Buy cialis without prescription Primary by the back of the neck had nothing to do with it…

*****

compressions

Buy cialis without prescription CPR certification is one of the more important requirements of emergency department nursing.

Buy cialis without prescription Here, buy cialis without prescription we see one of the ER staff working diligently, buy cialis without prescription practicing chest compressions on a colleague.

Buy cialis without prescription Uh oh! It seems that someone has forgotten the “R” of CPR and now their colleague is exhibiting decerebrate posturing.

Buy cialis without prescription No problem! It takes more than profound anoxia to keep an ER nurse down!

Buy cialis without prescription Our posturing partner finished the shift and managed to make it home before calling in brain-damaged.

Buy cialis without prescription The nurse was, buy cialis without prescription however, buy cialis without prescription counseled for not breathing on the job.

*****

blog

Buy cialis without prescription Technology plays an important part in emergency department medical records.

Buy cialis without prescription Computers have made it easier to read blogs on the job access patient’s medical records, buy cialis without prescription thereby improving continuity of care.

Buy cialis without prescription Here we have Dr. Buy cialis without prescription PuterGuy and our hard-working ER nurse perusing the previous history of one of the patients in the department.

Buy cialis without prescription Hmmm….

Buy cialis without prescription It seems this patient has a family history of feces flinging.

*****

coworkers

Buy cialis without prescription Ah, buy cialis without prescription cameraderie! How would ER nurses survive without it?

Buy cialis without prescription It’s your coworkers who have your back, buy cialis without prescription help you when you are swamped, buy cialis without prescription fill-in for you when you are sick, buy cialis without prescription take the feces-slinging patient when you’ve had enough and basically make coming to work a joy.

Buy cialis without prescription They also hold you up when you are sleeping at 0500, buy cialis without prescription as is obviously happening with our hard-working ER nurse.

*****

Buy cialis without prescription unitclerk

Buy cialis without prescription This concludes our pictorial look at a day in the life of an ER nurse.

Buy cialis without prescription In conclusion, buy cialis without prescription when things get hairy, buy cialis without prescription the department is bursting at the seams and you don’t think you can take another step or read another order…

Buy cialis without prescription …don’t forget to hug your administrative assistant/unit clerk.

Buy cialis without prescription They’re the ones who actually run the department, buy cialis without prescription anyway.

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

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

All photos taken with an iPhone, buy cialis without prescription which was not mine. Buy cialis without prescription Because I don’t have one. Buy cialis without prescription Yet.

This is dedicated to all the ER nurses who think the night shift doesn’t do anything. Buy cialis without prescription I hope this dispels any of those unfounded notions!

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Boy, nexium 40mg pills $146.00 talk about shifting gears, nexium 40mg pills $146.00 I have to go write a five page rough draft of my critical argument paper. Nexium 40mg pills $146.00 The topic?

Terri Schiavo.

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

Wish me luck.

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July 2, 2016, 2:04 pm

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Medication reconciliation forms.

Cialis super active 20mg pills $214.00 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, cialis super active 20mg pills $214.00 but I am pissed off. Cialis super active 20mg pills $214.00 Royally.

*****

Let me do a quick recap of what we are required to do, cialis super active 20mg pills $214.00 as nurses, cialis super active 20mg pills $214.00 on the medication reconciliation form:

  • We are required to write down precisely what the patient tells us, cialis super active 20mg pills $214.00 even if we know it is the wrong dosage! If the patient says they take 25 mg of Ativan every four hours, cialis super active 20mg pills $214.00 we have to write “Ativan, cialis super active 20mg pills $214.00 25 mg” on the reconciliation form.
  • If the patient hands us a list of their medications and instead of “Furosemide”, cialis super active 20mg pills $214.00 they have written “Furobedide” we have to write it exactly as it is printed on the list!

Cialis super active 20mg pills $214.00 Now, cialis super active 20mg pills $214.00 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.

Cialis super active 20mg pills $214.00 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.

Cialis super active 20mg pills $214.00 Sorry, cialis super active 20mg pills $214.00 I’ll try not to shout.

Cialis super active 20mg pills $214.00 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, cialis super active 20mg pills $214.00 you say? Same old stuff we’ve (I’ve) been writing about ad nauseum for the last year? Yadda, cialis super active 20mg pills $214.00 yadda, cialis super active 20mg pills $214.00 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. Cialis super active 20mg pills $214.00 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. Cialis super active 20mg pills $214.00 Attached as an afterthought was a post-it note stating Dr. Cialis super active 20mg pills $214.00 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. Cialis super active 20mg pills $214.00 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. Cialis super active 20mg pills $214.00 The way we are required to fill out the medication reconciliation sheet is a safety hazard. Cialis super active 20mg pills $214.00 It has been, cialis super active 20mg pills $214.00 it is now, cialis super active 20mg pills $214.00 and it will continue to be.

It is the rare patient who knows exactly what they take, cialis super active 20mg pills $214.00 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, cialis super active 20mg pills $214.00 single spaced and printed off a computer, cialis super active 20mg pills $214.00 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, cialis super active 20mg pills $214.00 but that is not the worst part.

*****

The system is set up so that any discrepancy, cialis super active 20mg pills $214.00 any dosage error, cialis super active 20mg pills $214.00 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. Cialis super active 20mg pills $214.00 Somewhere, cialis super active 20mg pills $214.00 somehow, cialis super active 20mg pills $214.00 someone is going to be hurt. Cialis super active 20mg pills $214.00 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, cialis super active 20mg pills $214.00 Dr. Cialis super active 20mg pills $214.00 Q, cialis super active 20mg pills $214.00 before you come down and spread your eminent wisdom to those careless emergency department nurses, cialis super active 20mg pills $214.00 why don’t you find out why that dosage landed on your patient’s form, cialis super active 20mg pills $214.00 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, cialis super active 20mg pills $214.00 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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