March, 2009 Archive

March 5, 2009, 11:34 am

Cherry Ames, Casino Nurse?

reno1I’m sitting here in the Oakland Airport waiting for the flight that will take me to….

Wait for it….


I’m attending the Emergency Nurses Association Leadership Conference this weekend.

Ah, but all is not fun and gambling games. I have to study when I’m not at the conference.

The slots can call all they want, but I have work to do.

I’ll let you know how much I win.

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March 3, 2009, 12:05 pm

I Wanna Be A Blog Star!

3ff0_1Holy cow.

This this is five feet long and two feet wide.

I can’t believe someone would try and sell something like this on eBay.

I mean really.

Is there no limit to what someone will try and pawn off on another unsuspecting person?

I don’t know what to say!


This is going to look great in the downstairs “Nascar” themed bedroom.

The one my husband does not know about.



It’s Grand Rounds Day!

David over at Health Business Blog takes the reins this week in a very succinct, Twitter-style format that is easy on the eyes and fun to read!

Be sure to check out next week’s plans at the bottom of David’s post.  A Grand Rounds first!



There’s a new blog carnival in town!

Welcome to the first ever edition of  “The Handover”, a blogcarnival dedicated to the staff who provide emergency care both in the community and in the Accident and Emergency Department (or ER).”

Okay all you medics, fire-fighters and ER personnel!

This one is for us!

Mark has asked me to host a future edition, and I’m happy to do so!  Be sure to check out this great collection of pre-hospital/ER stories and by all means submit yours to the next edition!



Okay, so I’m driving to work last night and what comes on the radio?

Rockstar, by Nickelback.

Of course, I’m singing at the top of my lungs when I realize that this would make a great “blog song”.

So I took the lyrics (originally written by Daniel Adair, Michael Kroeger, Chad Kroeger and Ryan Peake) and transformed them into “I Wanna Be A Blog Star”.

(Yes, I do have time on my hands, how could you tell?)

Ahem. Here is the result:

I’m through with submitin’ links to sites I’ll never get in
It’s like a posting contest that I’m never gonna win
This blog hasn’t turned out quite the way I want it to be

(Tell me watchya want)

I want a brand new website that don’t cost a million
A Site Meter widget goin’ to a bazillion
And an Alltop confirmation that indeed, I really do kick ass

(Tell me watchya need)

I’ll need a MacBook Pro with a screen de-fogger
And a big black jet that’s gonna fly me to BlogHer
Gonna join the mile high club and post at thirty-thousand feet

(Been there, done that)

I want a Google ranking that goes higher than Mars
With a broadband connection faster than a Nascar
Somewhere between Kasey Kahne and Dale Earnhardt is fine for me

(So how you gonna do it)

I’m gonna write my guts out for fortune and fame
I’d even quit my job and divulge my name

Cause we all just wanna be big blog stars
And spill our whole lives writing in a coffee bar
The links come easy and lattes come cheap
With an extra shot so we just won’t sleep
And we’ll
Be so cool that we won’t even blanch
When we see Glenn Reynolds sent an “Insta-lanche”
Every good Mommy Blogger’s gonna wind up there
Every Medblogger  blogging in the scrubs they wear and
Hey hey I wanna be a blog star
Hey hey I wanna be a blog star

I wanna be great like Dooce, and have super grammar
Hire eight body guards that love to beat up spammers
Get some business cards and hand ’em out to everyone I see

(And write ’em off at taxtime)

I’m gonna Tweet my blog links with the utmost gusto
Get a free registration to  the BlogWorldExpo
Gonna sell ad space so I can spend all my money on me

(So how you gonna do it)

I’m gonna post my way to fortune and fame
I’ll comment on every blog and even leave my name

‘Cause we all just wanna be big blog stars
Hopin’ the posts they read are almost always ours
We can post in our underwear and stay in bed
And make avatars that look just like a Lego head
And we’ll
Hang out in a virtual place
In the VIP where the blogosphere waits
Every good post writer’s gonna wind up there
And we’ll post with abandon and not even care
Then we’ll
Get a guest to do our blogging for us
Use the latest dictionary and a big thesaurus
Then we hit the “submit” button with an relieved smile
Everybody’s got a web consultant on speed dial, well
Hey hey I wanna be a blog star

I’m gonna be controversial and give my opinion
Cos this blog I’m writing’s under my dominion
And it ain’t lip service, it’s just where I’ve been
And tomorrow I’m just gonna do it all again

Well we all just wanna be big blog stars
And post our heartfelt stories and expose our scars
The ideas come easy and comments come cheap
We take it with a grain of salt and don’t lose sleep
And we’ll
Pull up a keyboard and pour out our hearts
Cuz we know with every blogger, that is where it starts
And we post because we don’t want our blogs to tank
And we freak out when we realize our minds went blank
And we’ll
Look for inspiration anywhere right then
Something that will get us fired up again
Then a post idea just hits us and we start to run
And we realize again that this whole blogging thing’s fun
Hey hey I wanna be a blog star
Hey hey I wanna be a blog star

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March 1, 2009, 2:19 am


al-fenn-6551And the staff gathers ’round to watch the last episode of ER…..

I hear George Clooney will be back.

Doesn’t matter, I can’t stand that show.

It’s like being at work, only I’m not getting paid.  Clooney may be handsome, but he’s not that handsome. Now, if Will Smith or Jeff Goldblum had been in the show, that would have been compensation enough for me!

My husband could never understand why watching “Trauma: Life in the ER” was not high on my list.


(Photo credit: Al Fenn for Life Magazine. June, 1955. Omaha, Nebraska)


If you have not tentatively RSVP’s for the medblogger conference, be sure to do so on the survey to the right! It’s not a commitment, we just need to have a ball park figure!  Thanks!


It’s time for an intervention.

I have to admit it.

I am Facebook illiterate.

People poke me, send me goodies, invite me to groups, send me really cool memes on rock songs, buy me drinks, send me plants.

And I have no clue what to do with those.

Okay, I do know how the Pirate game works and I will steal your gold coins if I find them, but that’s it.

Oh, and I learned how to upload videos – found an old Boyce and Hart video. Totally cool.


I’m in a mood.

Luckily, I’m not at work because moods don’t really make one popular with one’s colleagues.


This patient came into the clinic the other day…

Oh, you thought I worked in an ER?  Well, that is what it says on the sign on the street and over the sliding doors, but trust me, I work in a clinic.

And, if you walk into your place of business and it says “Emergency” over the door, you probably work in a clinic, too.



I give the general public, health care consumer, client, guest (or whatever the current politically correct term-of-the-day might be), credit.

Yes, I give the vast majority of those people who walk into the ER credit.

Credit for knowing exactly what they are doing and why they are doing it.

  • Credit for knowing what a true emergency is: chest pain, stroke symptoms, broken limbs, eye injuries/pain, difficulty breathing, uncontrolled bleeding
  • Credit for being concerned that something dangerous might be happening.  You can have gastroenteritis from hell and think you are dying.  Pain so severe it cannot wait until the next day.  An ankle the size of a grapefruit and you aren’t sure if it’s broken.  Cut a wide berth of slack here – pain is frightening.
  • And most of all, I give most folks credit for knowing when an emergency department visit is not appropriate, but they use it anyway….because…

1.  They can’t be turned away.

2.  They don’t have to pay a penny up front.

3.  They don’t have to wait for an appointment with their doctor.


Are you surprised by #3 up there?

I know we are supposed to believe that the emergency department crisis in this country is tied to the 45 gazillion un-insured amongst us.

Not in my experience.

I would hazard an educated guess that at least 80% of the patients I see for non-urgent problems have primary doctors, and that is a low estimate.  I know, because I ask them at triage.  Which means they have insurance coverage of some type, even if it is through the state.

If they have Medi-Cal, they are supposed to use the county hospital and clinic system, but they don’t because our ER is (a) nicer, (b) faster, (c) convenient. So, these insurance companies and the State of California are paying through the teeth for emergency department visits that did not need to happen.

Or, they don’t pay at all, which drops the over $1000.00 bill right into the patient’s lap.

And often, the emergency department doctor is not paid for their services and the hospital takes a loss because, well, not everyone can handle a debt like that, and not everyone makes payment arrangements.

If you get my drift.

One. Thousand. Dollars.


For a cold, a stubbed toe, back strain, minor fever, cough x 5 weeks, headache x 8 months (I’m not kidding), STD testing, family of five children with runny noses (I’m serious),  family of five with no symptoms who were rear-ended and “just want to be seen”….


As long as it is convenient and there is no incentive to do otherwise, the ER will continue to be populated by people with clinic-type chief complaints that have no place in an emergency department – see #1, #2 and #3 above.

Meet the Emergency Medical Treatment and Active Labor Act (EMTALA), the King of Unfunded Mandates.

So, how do we provide the incentive to use a primary physician or clinic when the patient actually has one?

It’s called a medical-screening exam.  A provider evaluates the patient at triage and if it is determined that the patient is not having a life or limb-threatening emergency (see above), and the patient has a primary doctor or clinic, they are told to follow up with their provider and will not be seen in the emergency department.


What is the advantage of the Medical Screening Exam?

I know it can seem harsh to send a patient away from the ER.

But in the end, it is a patient-centered procedure.


  • Staff can focus on the patients who need care the most.
  • The ER is not tied up with non-urgent/emergent cases, decreasing wait times for the patients who need care the most.

Meaning, the patients who truly require the resources and procedures of an ER receive those services more efficiently.

And while they may be miffed at not getting an emergency department berth, by being triaged to their doctor or clinic for follow up, the  patient with the clinic complaint is (a) not saddled with an ungodly bill for unnecessary ER visit, a bill they may not be able to pay and (b) sitting in a waiting room, possibly for hours.


I know I’m a nurse and I should have unmitigated mercy and compassion for all those with whom I come into contact with in the course of my duties.

I ain’t feelin’ it.

Especially when I know that most people are not dumb and they know exactly what they are doing when they come to an ER for a non-urgent problem.

I give them credit.

Now give me time to work with the patients who really need me.

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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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