January, 2012 Archive

September 25, 2016, 5:42 pm

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Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 This is the problem.

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Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 That nurses are talking.

Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 Because if you are quiet, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 it means they’ve got you frightened.

Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 If you are quiet, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 it’s harder for the next nurse to speak out.

Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 If you are quiet, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 it is easier to intimidate and retaliate against nurses with impunity.

*****

I received a call from the Arizona Board of Nursing this morning. Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 I am not able to obtain a copy of the Banner Del E. Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 Webb Medical Center complaint against Amanda Trujillo, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 RN, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 MSN.

They are able to tell me that a complaint was filed, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 and what date it was filed, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 but the actual content of the complaint is confidential. Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 A copy goes to the RN involved.

I appreciated the call, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 they could easily have sent an email.

That doesn’t mean I won’t see a copy of it, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 it just means I can’t get a copy from the AZBoN.

*****

Well, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 it gets worse.

Today, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 ten months after the original complaint was filed, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 Amanda was advised that the Arizona Board of Nursing had called her university and reported that she is under investigation. Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 Amanda is studying for her DNP.

Amanda got the email from her university, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 informing her of what they had been told.

WHAT???

Is it normal for boards of nursing to actively report registered nurses to their universities?

By phone?

While the investigation is still going on?

*****

I talked to a nurse investigator in Nevada, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 who said absolutely “NO”, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 they did not report nurses to universities., ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 That until the case is decided, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 it’s confidential and there is no way of knowing that the nurse was in school or what school she attended.

There has been no disciplinary action against Amanda Trujillo by the Arizona Board of Nursing.

So why are they calling her university?

Why now?

*****

This has gone past a regular investigation of a complaint against the license of a registered nurse and has all the markings of a personal vendetta.

Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 I’m no Morley Safter or Mike Wallace.

Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 This blog isn’t 60 Minutes.

Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 I’m just a blogging staff nurse who is aghast at what she is seeing and I have questions.

Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 Who has ties to the Arizona Board of Nursing? What pull, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 if any, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 does Banner Health have with the AZBoN? What pull, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 if any does the doctor whose public display of rage set all this in motion, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 have with the Arizona Board of Nursing?

Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 What ties does the Arizona Board of Nursing have with Amanda’s university?

*****

And let’s keep in mind why all this is happening.

A patient received education concerning their condition and upcoming procedure, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 and a referral for a case management consult for hospice placed at the patient’s request.

No patient was harmed. Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 No patient was killed. Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 No medication given. Ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 No procedure done.

A patient was given information.

Informed.

Empowered.

And god help the nurse who had the audacity to facilitate this autonomy, ovral norgestrel 50mcg + ethinyl estradiol 250mcg pills $158.00 this right.

How can you not be outraged?

Average Rating: 4.9 out of 5 based on 279 user reviews.

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September 25, 2016, 3:03 pm

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Zenegra 100mg pills $227.00 I’ve been blogging for 6 1/2 years.

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Zenegra 100mg pills $227.00 I never miss BlogWorld New Media Expo, zenegra 100mg pills $227.00 and if I can make it to BlogHer, zenegra 100mg pills $227.00 I will be at the party (can you say “swag”?)

Zenegra 100mg pills $227.00 You might say I’m into social media.

Zenegra 100mg pills $227.00 The best thing about social media? It enhances the ability of people to band together, zenegra 100mg pills $227.00 to support causes, zenegra 100mg pills $227.00 and each other.

Zenegra 100mg pills $227.00 This week, zenegra 100mg pills $227.00 we’ve seen nurses band together online to support one of our own, zenegra 100mg pills $227.00 fired and in danger of losing her license for acting as a patient advocate and providing patient education.

*****

Patients use social media to band together with others who share the same challenges, zenegra 100mg pills $227.00 to find support and encouragement.

They use the internet and social media to gather information; to be able to decide, zenegra 100mg pills $227.00 in discussions with their healthcare provider, zenegra 100mg pills $227.00 the best treatment to pursue.

The “patient” is you. Zenegra 100mg pills $227.00 And me. Zenegra 100mg pills $227.00 We are all patients.

Knowledge is power. Zenegra 100mg pills $227.00 Knowledge empowers a us to advocate for ourselves.

But what happens when you are sick, zenegra 100mg pills $227.00 lying in a hospital bed with new information flying fast and furious, zenegra 100mg pills $227.00 with no time (or access) to “look it up”. Zenegra 100mg pills $227.00 No time to find an “online support group”.

What if the quality of the rest of your life depends on the decision you make with the information you get, zenegra 100mg pills $227.00 now.

Who advocates for you/us then?

*****

The entire healthcare team advocates for you.

Nurses and physicians advocate for you.

They advocate for you by making sure you have all the information you need to make an informed decision on any plan of care.

They advocate for you by telling you all of the options open to you, zenegra 100mg pills $227.00 including no treatment.

They advocate for you by making sure you understand all of the information and education provided.

They advocate for you by respecting the fact that you are able to advocate for yourself and respecting the decisions you make.

Doing all these things is the right thing to do.

It’s also the law.

*****

When a nurse assesses that a patient does not have the information needed to make an informed decision about their care, zenegra 100mg pills $227.00 either because they have not been informed, zenegra 100mg pills $227.00 or because they did not understand the information provided, zenegra 100mg pills $227.00 the nurse has a duty to:

a. Zenegra 100mg pills $227.00 provide the missing information, zenegra 100mg pills $227.00 or the needed education and/or

b. Zenegra 100mg pills $227.00 refer the patient to the appropriate source of information

Zenegra 100mg pills $227.00 There is no choice.

Zenegra 100mg pills $227.00 It’s not a case of making a note and hoping the next shift deals with it.

Zenegra 100mg pills $227.00 It’s not a case of thinking, zenegra 100mg pills $227.00 “oh well, zenegra 100mg pills $227.00 they need this surgery/procedure anyway.”

Zenegra 100mg pills $227.00 The nurse is mandated by law, zenegra 100mg pills $227.00 and obligated ethically to act if they discover a patient does not have the information they need to make an informed decision about their care.

*****

Here’s the ethical principle in operation here, zenegra 100mg pills $227.00 as defined by the American Nurses Association, zenegra 100mg pills $227.00 who have a great website on nursing ethics:

Autonomy: agreement to respect another’s right to self-determine a course of action; support of independent decision making.

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She was doing exactly what she was supposed to do as a registered nurse, zenegra 100mg pills $227.00 for a patient with a knowledge deficit regarding an upcoming transplant.

*****

For the record, zenegra 100mg pills $227.00 to those who have written to say I don’t have both sides, zenegra 100mg pills $227.00 Banner Health isn’t talking. Zenegra 100mg pills $227.00 They made a statement on their Facebook page to that effect.

I have written to the Arizona Board of Nursing for a copy of the original complaint, zenegra 100mg pills $227.00 which should be public record.

I’ll post any response I get from them.

In the meantime, zenegra 100mg pills $227.00 Amanda’s legal response to the original complaint, zenegra 100mg pills $227.00 which answers the complaint point-by-point, zenegra 100mg pills $227.00 can be found at vdutton’s posterous.

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I am not militant.

I rant now and again, zenegra 100mg pills $227.00 but I am very happy in my corner of the couch with my trusty old MacBookPro.

But I would take to the street for this.

I am that angry.

If I thought for one minute that there was more to this case, zenegra 100mg pills $227.00 I’d be watching from the sidelines, zenegra 100mg pills $227.00too.

My gut tells me, zenegra 100mg pills $227.00 there is not.

My nursing instinct tells me there is not.

My nursing instinct tells me that a hospital corporation got upset because a “rainmaker” (in the legal world, zenegra 100mg pills $227.00 that means “moneymaker”) got angry at an RN, zenegra 100mg pills $227.00 ergo, zenegra 100mg pills $227.00 she must be punished.

Most hospitals just fire people, zenegra 100mg pills $227.00 Banner Health reports them to the Arizona Board of Nurses.

God help the nurses at Banner Health, zenegra 100mg pills $227.00 because I’d be watching my derriere 24/7 if I worked there.

Corporate healthcare at it’s finest.

Average Rating: 5 out of 5 based on 280 user reviews.

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September 25, 2016, 12:03 pm

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Methotrexate 2.5mg pills $198.00 (ADDENDUM, methotrexate 2.5mg pills $198.00 ADDED FEBRUARY 14, methotrexate 2.5mg pills $198.00 2012 – When this post was written, methotrexate 2.5mg pills $198.00 I mistakenly thought the patient in question had a transplant operation pending. Methotrexate 2.5mg pills $198.00 The patient was actually scheduled to be transferred the next day to begin pre-transplant testing. Methotrexate 2.5mg pills $198.00 Surgery would have come at a later date.

Methotrexate 2.5mg pills $198.00 I now understand that Amanda assessed that the patient had a deficit of transplant knowledge in general, methotrexate 2.5mg pills $198.00 and provided general transplant teaching concerning the evaluation process, methotrexate 2.5mg pills $198.00 the waiting process, methotrexate 2.5mg pills $198.00 and the care regimen. Methotrexate 2.5mg pills $198.00 The patient changed their mind about undergoing the testing, methotrexate 2.5mg pills $198.00 and requested a hospice consult.

Methotrexate 2.5mg pills $198.00 So, methotrexate 2.5mg pills $198.00 although the patient did not fully understand, methotrexate 2.5mg pills $198.00 and may not have been “informed” about what the entire transplant process required, methotrexate 2.5mg pills $198.00 surgery was not imminent, methotrexate 2.5mg pills $198.00 and “informed consent” for surgery was not the issue here. Methotrexate 2.5mg pills $198.00

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Methotrexate 2.5mg pills $198.00 The issues remain the same – a patient was uninformed about what was happening to them and needed education on their illness, methotrexate 2.5mg pills $198.00 a physician/hospital did not support/respect a patient’s decision/request for information, methotrexate 2.5mg pills $198.00 and a physician behaved in a disruptive fashion.

Methotrexate 2.5mg pills $198.00 I apologize for the misunderstanding.)

Methotrexate 2.5mg pills $198.00 Sorry, methotrexate 2.5mg pills $198.00 no.

Methotrexate 2.5mg pills $198.00 Nurses and physicians share a collaborative relationship, methotrexate 2.5mg pills $198.00 working with the patient in a team effort.

Methotrexate 2.5mg pills $198.00 That is how it is supposed to work.

Methotrexate 2.5mg pills $198.00 As a nurse, methotrexate 2.5mg pills $198.00 my duty is solely to the patient.

Methotrexate 2.5mg pills $198.00 If I am needed to be anyone’s “right hand”, methotrexate 2.5mg pills $198.00 it will be my patient.

Methotrexate 2.5mg pills $198.00 I’m very lucky. Methotrexate 2.5mg pills $198.00 I work with great docs who get it. Methotrexate 2.5mg pills $198.00 I’ll write a post about that.

Methotrexate 2.5mg pills $198.00 I’ve seen my share of the temper-tantrum throwing screamers, methotrexate 2.5mg pills $198.00 and I’ve been the recipient of their wrath three or four times in my career.

Methotrexate 2.5mg pills $198.00 I should tell those stories; they happened long ago. Methotrexate 2.5mg pills $198.00 I’ve kept them off the blog because of the emotions that come flooding back when I think about them.

*****

I’ve been blogging on the Amanda Trujillo situation for a few days now, methotrexate 2.5mg pills $198.00 but lets move away from Amanda being fired by Banner Health and turned in to the Arizona Board of Nursing and look at this from a patient’s point of view.

As I see it, methotrexate 2.5mg pills $198.00 based on information that has been made public or is in the public record, methotrexate 2.5mg pills $198.00 three things occurred or nearly occurred (In hospital terminology, methotrexate 2.5mg pills $198.00 we call those “near-misses.”)

This should make everyone of us queasy.

1. Methotrexate 2.5mg pills $198.00 A PATIENT WOULD HAVE HAD SURGERY WITHOUT INFORMED CONSENT.

A patient scheduled for surgery, methotrexate 2.5mg pills $198.00 in this case a major, methotrexate 2.5mg pills $198.00 life-altering surgery, methotrexate 2.5mg pills $198.00 did not know (a) the extent of the surgery, methotrexate 2.5mg pills $198.00 (b) the ramifications of the surgery – this being complex lifetime care, methotrexate 2.5mg pills $198.00 or (c) options other than surgery.

All of the above, methotrexate 2.5mg pills $198.00 along with the risks and benefits of the surgery, methotrexate 2.5mg pills $198.00 constitute “informed consent.” Before any surgery consent can be signed, methotrexate 2.5mg pills $198.00 all of the above must be addressed.

Before the discussion with the nurse, methotrexate 2.5mg pills $198.00 the patient did not know this information.

2. Methotrexate 2.5mg pills $198.00 A PATIENT’S DECISION WAS NOT SUPPORTED BY THE MD, methotrexate 2.5mg pills $198.00 OR THE HOSPITAL

Granted, methotrexate 2.5mg pills $198.00 the surgery did not happen. Methotrexate 2.5mg pills $198.00 But instead of supporting the patient’s decision as being the patient’s decision after the patient had been fully informed, methotrexate 2.5mg pills $198.00 as was their right by law, methotrexate 2.5mg pills $198.00 there was anger and recrimination from the physician and the facility.

Why?

Why did a patient’s decision to not have surgery cause this upheaval? Who lost out here?

I’m speculating, methotrexate 2.5mg pills $198.00 but I wonder – how much of that anger did the patient hear, methotrexate 2.5mg pills $198.00 or sense?

3. Methotrexate 2.5mg pills $198.00 A PHYSICIAN DISPLAYED DISRUPTIVE BEHAVIOR AT THE NURSES STATION.

Well, methotrexate 2.5mg pills $198.00 this has been going on from time immemorial, methotrexate 2.5mg pills $198.00 but it is no longer tolerated.

Now, methotrexate 2.5mg pills $198.00 concern over a patient is not disruptive behavior. Methotrexate 2.5mg pills $198.00 Anger is not a disruptive behavior. Methotrexate 2.5mg pills $198.00 (If it was, methotrexate 2.5mg pills $198.00 I’d be in trouble.) Screaming and throwing a temper-tantrum at a nursing station is, methotrexate 2.5mg pills $198.00 no matter what the reason.

How would you feel as a patient if you heard a screaming rant going on at the nurse’s station outside your door?

How would you feel about the doctors, methotrexate 2.5mg pills $198.00 the facility? The nurses?

*****

Two of these, methotrexate 2.5mg pills $198.00 the informed consent and the disruptive behavior are issues that are covered by licensing bodies. Methotrexate 2.5mg pills $198.00 Joint Commission has looked at the impact of disruptive behavior by physicians and other members of the health care team. Methotrexate 2.5mg pills $198.00 The Centers for Medicaid and Medicare Services are also concerned with the effect of this behavior of patient safety.

What happened at Banner Health Del E. Methotrexate 2.5mg pills $198.00 Webb Medical Center was not innocuous.

If not for the actions of a registered nurse, methotrexate 2.5mg pills $198.00 doing exactly what she was educated to do, methotrexate 2.5mg pills $198.00 and bound by the Arizona Nurse Practice Act (and her ethical duty) to do, methotrexate 2.5mg pills $198.00 a patient would have had a surgery they were not prepared for, methotrexate 2.5mg pills $198.00 and would not have wanted had they known what was happening.

That should scare the hell out of every single one of us.

Methotrexate 2.5mg pills $198.00 Because something like this has a chilling effect on all the other RNs in a facility – and I hope that the other registered nurses at Banner Health have the guts to keep educating their patients without the fear of losing their jobs and their licenses for doing their ethical duty.

Methotrexate 2.5mg pills $198.00 As a nurse, methotrexate 2.5mg pills $198.00 and as a patient, methotrexate 2.5mg pills $198.00 I am appalled.

Methotrexate 2.5mg pills $198.00 Now I want to see exactly what Banner Health, methotrexate 2.5mg pills $198.00 and the Arizona Board of Nurses, methotrexate 2.5mg pills $198.00 are going to do to rectify this situation.

Methotrexate 2.5mg pills $198.00 This has huge implications for nurses, methotrexate 2.5mg pills $198.00 and patients.

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Average Rating: 4.9 out of 5 based on 252 user reviews.

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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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