September, 2009 Archive

August 26, 2016, 9:07 am

Herbal Alternative Viagra

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August 26, 2016, 12:34 pm

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Tegretol 400mg pills $143.00 helpThat nurse better watch her back!

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Tegretol 400mg pills $143.00 I can sure appreciate the sentiment, tegretol 400mg pills $143.00 though.

Tegretol 400mg pills $143.00 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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Tegretol 400mg pills $143.00 For 46 years the Beatles have been a huge part of my life. Tegretol 400mg pills $143.00 When this set comes, tegretol 400mg pills $143.00 I’ll be incommunicado for at least two days. Tegretol 400mg pills $143.00 Just me and a set of Bose headphones.


In the spirit of collaboration, tegretol 400mg pills $143.00 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. Tegretol 400mg pills $143.00 Posts can be sent to “mglencorse at yahoo dot co dot uk”. Tegretol 400mg pills $143.00 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, tegretol 400mg pills $143.00 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, tegretol 400mg pills $143.00 telemetry units and ICUs have a finite number of beds. Tegretol 400mg pills $143.00 When they are full, tegretol 400mg pills $143.00 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. Tegretol 400mg pills $143.00 Oh, tegretol 400mg pills $143.00 the ED may triage and L&D may send a patient in early labor home, tegretol 400mg pills $143.00 but in both cases, tegretol 400mg pills $143.00 eventually, tegretol 400mg pills $143.00 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.


Tegretol 400mg pills $143.00 I will never understand the logic behind staffing an ED based on the previous 24 hour census.

Tegretol 400mg pills $143.00 If the ED does not meet a pre-determined number of patients on one day, tegretol 400mg pills $143.00 the break nurse for the next day is canceled and there is much wailing and gnashing of teeth as the department goes over budget.

Tegretol 400mg pills $143.00 Never mind that the acuity level of the patients who were seen was through the roof. Tegretol 400mg pills $143.00 Or that 50% of them were admitted. Tegretol 400mg pills $143.00 Or that the next day, tegretol 400mg pills $143.00 acuity again sky high, tegretol 400mg pills $143.00 the nurses go without meals/breaks and the department is required to give penalty pay. Tegretol 400mg pills $143.00 Again, tegretol 400mg pills $143.00 there is much wailing and gnashing of teeth for having to pay this penalty, tegretol 400mg pills $143.00 a penalty that would never have been required had the break nurse not been canceled.


Now if the ED is slow, tegretol 400mg pills $143.00 staff can always go home early. Tegretol 400mg pills $143.00 But not too early, tegretol 400mg pills $143.00 because you never know what is coming in through the doors. Tegretol 400mg pills $143.00 So maybe an hour, tegretol 400mg pills $143.00 90 minutes early, tegretol 400mg pills $143.00 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, tegretol 400mg pills $143.00 both in acuity and numbers?  Ambulance diversion doesn’t stop the walk-in critical patients. Tegretol 400mg pills $143.00 The MIs and the possible CVAs. Tegretol 400mg pills $143.00 The GI bleeders. Tegretol 400mg pills $143.00 The potentially septic. Tegretol 400mg pills $143.00 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. Tegretol 400mg pills $143.00 When there is only one unit clerk/registrar, tegretol 400mg pills $143.00 two nurses and an ED tech after 0300.

Of course, tegretol 400mg pills $143.00 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. Tegretol 400mg pills $143.00 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. Tegretol 400mg pills $143.00 If it can be done in L&D, tegretol 400mg pills $143.00 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, tegretol 400mg pills $143.00 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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August 26, 2016, 7:56 pm

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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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