September, 2009 Archive

July 26, 2016, 9:07 am

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Microzide 12.5mg pills $70.00 bradwtcsmI had a PALS class that morning.

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Microzide 12.5mg pills $70.00 By 1100, microzide 12.5mg pills $70.00 they ended the class. Microzide 12.5mg pills $70.00 It could not be business as usual.

*****

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I never left the television.

Over and over, microzide 12.5mg pills $70.00 the images.

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

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Oh God, microzide 12.5mg pills $70.00 the anger.

But never acceptance.

Not then. Microzide 12.5mg pills $70.00 Not now. Microzide 12.5mg pills $70.00 Not ever.

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July 26, 2016, 12:34 pm

Avanafil 50mg Pills 40 $245.00

Lamisil terbinafine hydrochloride 1% spray $153.00 helpThat nurse better watch her back!

Lamisil terbinafine hydrochloride 1% spray $153.00 Literally!

Lamisil terbinafine hydrochloride 1% spray $153.00 Baaaad body mechanics here.

Lamisil terbinafine hydrochloride 1% spray $153.00 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?

Lamisil terbinafine hydrochloride 1% spray $153.00 I can sure appreciate the sentiment, lamisil terbinafine hydrochloride 1% spray $153.00 though.

Lamisil terbinafine hydrochloride 1% spray $153.00 I’ve been hit with a virtual tsunami of activity now that school has started and could use a little “Help!”

Lamisil terbinafine hydrochloride 1% spray $153.00 But wait….

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Lamisil terbinafine hydrochloride 1% spray $153.00 This could “Help!”

Lamisil terbinafine hydrochloride 1% spray $153.00 My son ordered the new Beatles Boxed Set (Stereo) for me! I’m….speechless….and thrilled!!!!

Lamisil terbinafine hydrochloride 1% spray $153.00 And right now I am listening to local radio station KFRC play the entire Beatles catalog in chronological order.

Lamisil terbinafine hydrochloride 1% spray $153.00 It’s like having an audio SSRI!

Lamisil terbinafine hydrochloride 1% spray $153.00 For 46 years the Beatles have been a huge part of my life. Lamisil terbinafine hydrochloride 1% spray $153.00 When this set comes, lamisil terbinafine hydrochloride 1% spray $153.00 I’ll be incommunicado for at least two days. Lamisil terbinafine hydrochloride 1% spray $153.00 Just me and a set of Bose headphones.

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

In the spirit of collaboration, lamisil terbinafine hydrochloride 1% spray $153.00 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. Lamisil terbinafine hydrochloride 1% spray $153.00 Posts can be sent to “mglencorse at yahoo dot co dot uk”. Lamisil terbinafine hydrochloride 1% spray $153.00 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, lamisil terbinafine hydrochloride 1% spray $153.00 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, lamisil terbinafine hydrochloride 1% spray $153.00 telemetry units and ICUs have a finite number of beds. Lamisil terbinafine hydrochloride 1% spray $153.00 When they are full, lamisil terbinafine hydrochloride 1% spray $153.00 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. Lamisil terbinafine hydrochloride 1% spray $153.00 Oh, lamisil terbinafine hydrochloride 1% spray $153.00 the ED may triage and L&D may send a patient in early labor home, lamisil terbinafine hydrochloride 1% spray $153.00 but in both cases, lamisil terbinafine hydrochloride 1% spray $153.00 eventually, lamisil terbinafine hydrochloride 1% spray $153.00 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.

****

Lamisil terbinafine hydrochloride 1% spray $153.00 I will never understand the logic behind staffing an ED based on the previous 24 hour census.

Lamisil terbinafine hydrochloride 1% spray $153.00 If the ED does not meet a pre-determined number of patients on one day, lamisil terbinafine hydrochloride 1% spray $153.00 the break nurse for the next day is canceled and there is much wailing and gnashing of teeth as the department goes over budget.

Lamisil terbinafine hydrochloride 1% spray $153.00 Never mind that the acuity level of the patients who were seen was through the roof. Lamisil terbinafine hydrochloride 1% spray $153.00 Or that 50% of them were admitted. Lamisil terbinafine hydrochloride 1% spray $153.00 Or that the next day, lamisil terbinafine hydrochloride 1% spray $153.00 acuity again sky high, lamisil terbinafine hydrochloride 1% spray $153.00 the nurses go without meals/breaks and the department is required to give penalty pay. Lamisil terbinafine hydrochloride 1% spray $153.00 Again, lamisil terbinafine hydrochloride 1% spray $153.00 there is much wailing and gnashing of teeth for having to pay this penalty, lamisil terbinafine hydrochloride 1% spray $153.00 a penalty that would never have been required had the break nurse not been canceled.

****

Now if the ED is slow, lamisil terbinafine hydrochloride 1% spray $153.00 staff can always go home early. Lamisil terbinafine hydrochloride 1% spray $153.00 But not too early, lamisil terbinafine hydrochloride 1% spray $153.00 because you never know what is coming in through the doors. Lamisil terbinafine hydrochloride 1% spray $153.00 So maybe an hour, lamisil terbinafine hydrochloride 1% spray $153.00 90 minutes early, lamisil terbinafine hydrochloride 1% spray $153.00 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, lamisil terbinafine hydrochloride 1% spray $153.00 both in acuity and numbers?  Ambulance diversion doesn’t stop the walk-in critical patients. Lamisil terbinafine hydrochloride 1% spray $153.00 The MIs and the possible CVAs. Lamisil terbinafine hydrochloride 1% spray $153.00 The GI bleeders. Lamisil terbinafine hydrochloride 1% spray $153.00 The potentially septic. Lamisil terbinafine hydrochloride 1% spray $153.00 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. Lamisil terbinafine hydrochloride 1% spray $153.00 When there is only one unit clerk/registrar, lamisil terbinafine hydrochloride 1% spray $153.00 two nurses and an ED tech after 0300.

Of course, lamisil terbinafine hydrochloride 1% spray $153.00 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. Lamisil terbinafine hydrochloride 1% spray $153.00 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. Lamisil terbinafine hydrochloride 1% spray $153.00 If it can be done in L&D, lamisil terbinafine hydrochloride 1% spray $153.00 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, lamisil terbinafine hydrochloride 1% spray $153.00 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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July 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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