September, 2009 Archive

September 27, 2016, 9:07 am

Ordering Viagra

Ordering viagra bradwtcsmI had a PALS class that morning.

Ordering viagra The receptionist at the consortium could not reach her brother. Ordering viagra In New York.

Ordering viagra We were there, ordering viagra but we weren’t present.

Ordering viagra By 1100, ordering viagra they ended the class. Ordering viagra It could not be business as usual.

*****

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I never left the television.

Over and over, ordering viagra the images.

The horrific sanitized-for-our-protection American versions; the unimaginable reality of the European versions.

Shock. Ordering viagra Disbelief. Ordering viagra Anger.

Oh God, ordering viagra the anger.

But never acceptance.

Not then. Ordering viagra Not now. Ordering viagra Not ever.

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September 27, 2016, 12:34 pm

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Elavil 75mg pills $109.00 helpThat nurse better watch her back!

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Elavil 75mg pills $109.00 I can’t figure out this little tableau; is she pulling him out of the ditch? Why is there a book on the edge of the fox hole?

Elavil 75mg pills $109.00 I can sure appreciate the sentiment, elavil 75mg pills $109.00 though.

Elavil 75mg pills $109.00 I’ve been hit with a virtual tsunami of activity now that school has started and could use a little “Help!”

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Elavil 75mg pills $109.00 My son ordered the new Beatles Boxed Set (Stereo) for me! I’m….speechless….and thrilled!!!!

Elavil 75mg pills $109.00 And right now I am listening to local radio station KFRC play the entire Beatles catalog in chronological order.

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Elavil 75mg pills $109.00 For 46 years the Beatles have been a huge part of my life. Elavil 75mg pills $109.00 When this set comes, elavil 75mg pills $109.00 I’ll be incommunicado for at least two days. Elavil 75mg pills $109.00 Just me and a set of Bose headphones.

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In the spirit of collaboration, elavil 75mg pills $109.00 Change of Shift is occasionally hosted by our non-nursing colleagues and the next edition gets the EMS treatment! Medic 999 is doing the honors and he has proposed a theme! Information at Change of Shift Comes Visiting. Elavil 75mg pills $109.00 Posts can be sent to “mglencorse at yahoo dot co dot uk”. Elavil 75mg pills $109.00 Mark also hosted Grand Rounds this week and the latest edition of The Handover (the EMS carnival)! Wow!

About the only carnival Mark did not host is Patients for a Moment, elavil 75mg pills $109.00 and you can find that over at Leslie’s blog Getting Closer to Myself.

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

Emergency has something in common with Labor & Delivery.

Neither department has control over their census.

Medical/surgical, elavil 75mg pills $109.00 telemetry units and ICUs have a finite number of beds. Elavil 75mg pills $109.00 When they are full, elavil 75mg pills $109.00 they are full; they cannot physically expand to more beds.

ED patients and laboring women are never turned away no matter how full the department may be. Elavil 75mg pills $109.00 Oh, elavil 75mg pills $109.00 the ED may triage and L&D may send a patient in early labor home, elavil 75mg pills $109.00 but in both cases, elavil 75mg pills $109.00 eventually, elavil 75mg pills $109.00 all will be seen.

Labor and delivery has one advantage over the ED.

They can have someone on call.

I’ve never worked in an ED that has had an “on-call” nurse.

****

Elavil 75mg pills $109.00 I will never understand the logic behind staffing an ED based on the previous 24 hour census.

Elavil 75mg pills $109.00 If the ED does not meet a pre-determined number of patients on one day, elavil 75mg pills $109.00 the break nurse for the next day is canceled and there is much wailing and gnashing of teeth as the department goes over budget.

Elavil 75mg pills $109.00 Never mind that the acuity level of the patients who were seen was through the roof. Elavil 75mg pills $109.00 Or that 50% of them were admitted. Elavil 75mg pills $109.00 Or that the next day, elavil 75mg pills $109.00 acuity again sky high, elavil 75mg pills $109.00 the nurses go without meals/breaks and the department is required to give penalty pay. Elavil 75mg pills $109.00 Again, elavil 75mg pills $109.00 there is much wailing and gnashing of teeth for having to pay this penalty, elavil 75mg pills $109.00 a penalty that would never have been required had the break nurse not been canceled.

****

Now if the ED is slow, elavil 75mg pills $109.00 staff can always go home early. Elavil 75mg pills $109.00 But not too early, elavil 75mg pills $109.00 because you never know what is coming in through the doors. Elavil 75mg pills $109.00 So maybe an hour, elavil 75mg pills $109.00 90 minutes early, elavil 75mg pills $109.00 knowing that the remaining staff can handle whatever they need to handle until the next shift comes in.

But what happens when the patients overwhelm the staff, elavil 75mg pills $109.00 both in acuity and numbers?  Ambulance diversion doesn’t stop the walk-in critical patients. Elavil 75mg pills $109.00 The MIs and the possible CVAs. Elavil 75mg pills $109.00 The GI bleeders. Elavil 75mg pills $109.00 The potentially septic. Elavil 75mg pills $109.00 Trying to get patients out of the department and up to the floor doesn’t work when the floor won’t take the patient for four hours because it would put them “out of ratio”.

This is a huge issue on the night shift. Elavil 75mg pills $109.00 When there is only one unit clerk/registrar, elavil 75mg pills $109.00 two nurses and an ED tech after 0300.

Of course, elavil 75mg pills $109.00 at night it is feast or famine.

Either the feces hits the proverbial fan or…it doesn’t.

Which is exactly why we need a nurse on-call.

The ED needs flexible staffing that accounts for those times when the acuity level/census is overwhelming. Elavil 75mg pills $109.00 Not canceling the extra break nurse is one way of doing that on days and evenings; using the on-call system is another way that could be utilized at night. Elavil 75mg pills $109.00 If it can be done in L&D, elavil 75mg pills $109.00 why can’t it be done in the ED? Surely the money saved in penalty pay for missed breaks and meals would make it budget neutral.

All I know is that trying to drop staff in an ED based on what happened the previous 24 hours makes zero sense.

(And don’t even get me started on why nurse-patient ratios are treated like unbreakable rules on the floors, elavil 75mg pills $109.00 but it’s okay for the ED to be waaaaay out of ratio and nobody blinks….that’s another whole post!)

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September 27, 2016, 7:56 pm

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Clomipramine 10mg pills $214.00 This was just what I needed! : D

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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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