September, 2009 Archive

June 28, 2016, 9:07 am

Online Cheap Viagra

Online cheap viagra bradwtcsmI had a PALS class that morning.

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

Online cheap viagra We were there, online cheap viagra but we weren’t present.

Online cheap viagra By 1100, online cheap viagra they ended the class. Online cheap viagra It could not be business as usual.

*****

fire-fighters-raise-american-flag-in-front-of-world-trade-center-ruins21

I never left the television.

Over and over, online cheap viagra the images.

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

Shock. Online cheap viagra Disbelief. Online cheap viagra Anger.

Oh God, online cheap viagra the anger.

But never acceptance.

Not then. Online cheap viagra Not now. Online cheap viagra Not ever.

Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

Average Rating: 4.4 out of 5 based on 202 user reviews.

Read »

June 28, 2016, 12:34 pm

Cancer Symptoms Relief > Methotrexate 2.5mg Pills > 90 Pills > $169.00

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 helpThat nurse better watch her back!

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 Literally!

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 Baaaad body mechanics here.

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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?

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 I can sure appreciate the sentiment, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 though.

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 I’ve been hit with a virtual tsunami of activity now that school has started and could use a little “Help!”

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 But wait….

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 There is hope….

beatlesstereo2

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 This could “Help!”

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 My son ordered the new Beatles Boxed Set (Stereo) for me! I’m….speechless….and thrilled!!!!

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 And right now I am listening to local radio station KFRC play the entire Beatles catalog in chronological order.

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 It’s like having an audio SSRI!

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 For 46 years the Beatles have been a huge part of my life. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 When this set comes, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 I’ll be incommunicado for at least two days. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 Just me and a set of Bose headphones.

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

In the spirit of collaboration, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 Posts can be sent to “mglencorse at yahoo dot co dot uk”. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 telemetry units and ICUs have a finite number of beds. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 When they are full, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 Oh, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 the ED may triage and L&D may send a patient in early labor home, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 but in both cases, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 eventually, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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.

****

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 I will never understand the logic behind staffing an ED based on the previous 24 hour census.

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 If the ED does not meet a pre-determined number of patients on one day, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 the break nurse for the next day is canceled and there is much wailing and gnashing of teeth as the department goes over budget.

Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 Never mind that the acuity level of the patients who were seen was through the roof. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 Or that 50% of them were admitted. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 Or that the next day, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 acuity again sky high, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 the nurses go without meals/breaks and the department is required to give penalty pay. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 Again, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 there is much wailing and gnashing of teeth for having to pay this penalty, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 a penalty that would never have been required had the break nurse not been canceled.

****

Now if the ED is slow, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 staff can always go home early. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 But not too early, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 because you never know what is coming in through the doors. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 So maybe an hour, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 90 minutes early, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 both in acuity and numbers?  Ambulance diversion doesn’t stop the walk-in critical patients. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 The MIs and the possible CVAs. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 The GI bleeders. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 The potentially septic. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 When there is only one unit clerk/registrar, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 two nurses and an ED tech after 0300.

Of course, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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. Anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 If it can be done in L&D, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 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, anticonvulsants > lamictal 100mg pills (generic) > 120 pills > $193.00 but it’s okay for the ED to be waaaaay out of ratio and nobody blinks….that’s another whole post!)

Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

Average Rating: 4.9 out of 5 based on 264 user reviews.

Read »

June 28, 2016, 7:56 pm

Pain Relief > Toradol Inj 10mg Pills (Generic) > 180 Pills > $441.00

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 NASCAR Pocono Auto RacingWhat a way to end a four day work stretch!

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 Kasey Kahne wins the night race at Atlanta.

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 Oh man.

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 This was just what I needed! : D

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 I may get my voice back in a month!

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 One more week to the Chase….

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 Come on baby………

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 ndAnd as if that weren’t enough…

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 Notre Dame opens their season with a freakin’ SHUT OUT!!!!

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 USC, antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 we are comin’ for YOU!

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 Stanford, antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 don’t even try.

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 I’m tellin’ ya.

Antidepressants > remeron 30mg pills (generic) > 90 pills > $240.00 It’s gonna be a gooooooood fall season…..

Share this:
Share this page via Email Share this page via Stumble Upon Share this page via Digg this Share this page via Facebook Share this page via Twitter

Average Rating: 4.8 out of 5 based on 212 user reviews.

Read »

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...

Continue reading »

Find Me On...
Twitter     Technorati

Subscribe to Emergiblog
Office of the National Nurse

Zippy Was Here


Healthcare Blogger Code of Ethics

  • Perspective
  • Confidentiality
  • Disclosure
  • Reliability
  • Courtesy

medbloggercode.com

I Support the Public Library of Science

Dr. Val
Johnson & Johnson
Johnson & Johnson Health Channel
Webicina
Nursing and Web 2.0



Health blogs

Medicine Blogs - Blog Catalog Blog Directory

Alltop. Seriously?! I got in?

Health Blogs - Blog Rankings