September 24, 2016, 5:42 pm

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Tamoxifen 20mg pills $160.00 Sorry, tamoxifen 20mg pills $160.00 no.

Tamoxifen 20mg pills $160.00 This is the problem.

Tamoxifen 20mg pills $160.00 There is a huge injustice being perpetrated against a nurse right this moment.

Tamoxifen 20mg pills $160.00 It’s getting worse.

Tamoxifen 20mg pills $160.00 And the ones who got the party started aren’t happy that it isn’t quiet.

Tamoxifen 20mg pills $160.00 That their moves, tamoxifen 20mg pills $160.00 and their motives, tamoxifen 20mg pills $160.00 are under public scrutiny.

Tamoxifen 20mg pills $160.00 That nurses are talking.

Tamoxifen 20mg pills $160.00 Because if you are quiet, tamoxifen 20mg pills $160.00 it means they’ve got you frightened.

Tamoxifen 20mg pills $160.00 If you are quiet, tamoxifen 20mg pills $160.00 it’s harder for the next nurse to speak out.

Tamoxifen 20mg pills $160.00 If you are quiet, tamoxifen 20mg pills $160.00 it is easier to intimidate and retaliate against nurses with impunity.

*****

I received a call from the Arizona Board of Nursing this morning. Tamoxifen 20mg pills $160.00 I am not able to obtain a copy of the Banner Del E. Tamoxifen 20mg pills $160.00 Webb Medical Center complaint against Amanda Trujillo, tamoxifen 20mg pills $160.00 RN, tamoxifen 20mg pills $160.00 MSN.

They are able to tell me that a complaint was filed, tamoxifen 20mg pills $160.00 and what date it was filed, tamoxifen 20mg pills $160.00 but the actual content of the complaint is confidential. Tamoxifen 20mg pills $160.00 A copy goes to the RN involved.

I appreciated the call, tamoxifen 20mg pills $160.00 they could easily have sent an email.

That doesn’t mean I won’t see a copy of it, tamoxifen 20mg pills $160.00 it just means I can’t get a copy from the AZBoN.

*****

Well, tamoxifen 20mg pills $160.00 it gets worse.

Today, tamoxifen 20mg pills $160.00 ten months after the original complaint was filed, tamoxifen 20mg pills $160.00 Amanda was advised that the Arizona Board of Nursing had called her university and reported that she is under investigation. Tamoxifen 20mg pills $160.00 Amanda is studying for her DNP.

Amanda got the email from her university, tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 who said absolutely “NO”, tamoxifen 20mg pills $160.00 they did not report nurses to universities., tamoxifen 20mg pills $160.00 That until the case is decided, tamoxifen 20mg pills $160.00 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.

Tamoxifen 20mg pills $160.00 I’m no Morley Safter or Mike Wallace.

Tamoxifen 20mg pills $160.00 This blog isn’t 60 Minutes.

Tamoxifen 20mg pills $160.00 I’m just a blogging staff nurse who is aghast at what she is seeing and I have questions.

Tamoxifen 20mg pills $160.00 Who has ties to the Arizona Board of Nursing? What pull, tamoxifen 20mg pills $160.00 if any, tamoxifen 20mg pills $160.00 does Banner Health have with the AZBoN? What pull, tamoxifen 20mg pills $160.00 if any does the doctor whose public display of rage set all this in motion, tamoxifen 20mg pills $160.00 have with the Arizona Board of Nursing?

Tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 and a referral for a case management consult for hospice placed at the patient’s request.

No patient was harmed. Tamoxifen 20mg pills $160.00 No patient was killed. Tamoxifen 20mg pills $160.00 No medication given. Tamoxifen 20mg pills $160.00 No procedure done.

A patient was given information.

Informed.

Empowered.

And god help the nurse who had the audacity to facilitate this autonomy, tamoxifen 20mg pills $160.00 this right.

How can you not be outraged?

Average Rating: 4.4 out of 5 based on 284 user reviews.

September 24, 2016, 3:03 pm

Tamoxifen 20mg Pills $160.00

Tamoxifen 20mg pills $160.00 I’ve been blogging for 6 1/2 years.

Tamoxifen 20mg pills $160.00 I have a twitter account and although I went to Facebook kicking and screaming, tamoxifen 20mg pills $160.00 I’m firmly ensconced in the world of status updates, tamoxifen 20mg pills $160.00 messages, tamoxifen 20mg pills $160.00 and the occasional “poke.”

Tamoxifen 20mg pills $160.00 I never miss BlogWorld New Media Expo, tamoxifen 20mg pills $160.00 and if I can make it to BlogHer, tamoxifen 20mg pills $160.00 I will be at the party (can you say “swag”?)

Tamoxifen 20mg pills $160.00 You might say I’m into social media.

Tamoxifen 20mg pills $160.00 The best thing about social media? It enhances the ability of people to band together, tamoxifen 20mg pills $160.00 to support causes, tamoxifen 20mg pills $160.00 and each other.

Tamoxifen 20mg pills $160.00 This week, tamoxifen 20mg pills $160.00 we’ve seen nurses band together online to support one of our own, tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 to find support and encouragement.

They use the internet and social media to gather information; to be able to decide, tamoxifen 20mg pills $160.00 in discussions with their healthcare provider, tamoxifen 20mg pills $160.00 the best treatment to pursue.

The “patient” is you. Tamoxifen 20mg pills $160.00 And me. Tamoxifen 20mg pills $160.00 We are all patients.

Knowledge is power. Tamoxifen 20mg pills $160.00 Knowledge empowers a us to advocate for ourselves.

But what happens when you are sick, tamoxifen 20mg pills $160.00 lying in a hospital bed with new information flying fast and furious, tamoxifen 20mg pills $160.00 with no time (or access) to “look it up”. Tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 either because they have not been informed, tamoxifen 20mg pills $160.00 or because they did not understand the information provided, tamoxifen 20mg pills $160.00 the nurse has a duty to:

a. Tamoxifen 20mg pills $160.00 provide the missing information, tamoxifen 20mg pills $160.00 or the needed education and/or

b. Tamoxifen 20mg pills $160.00 refer the patient to the appropriate source of information

Tamoxifen 20mg pills $160.00 There is no choice.

Tamoxifen 20mg pills $160.00 It’s not a case of making a note and hoping the next shift deals with it.

Tamoxifen 20mg pills $160.00 It’s not a case of thinking, tamoxifen 20mg pills $160.00 “oh well, tamoxifen 20mg pills $160.00 they need this surgery/procedure anyway.”

Tamoxifen 20mg pills $160.00 The nurse is mandated by law, tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 as defined by the American Nurses Association, tamoxifen 20mg pills $160.00 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.

This is why the firing of Amanda Trujillo, tamoxifen 20mg pills $160.00 RN, tamoxifen 20mg pills $160.00 MSN, tamoxifen 20mg pills $160.00 an experienced transplant RN, tamoxifen 20mg pills $160.00 by Banner Del E. Tamoxifen 20mg pills $160.00 Webb Medical Center is so mind-boggling.

She was doing exactly what she was supposed to do as a registered nurse, tamoxifen 20mg pills $160.00 for a patient with a knowledge deficit regarding an upcoming transplant.

*****

For the record, tamoxifen 20mg pills $160.00 to those who have written to say I don’t have both sides, tamoxifen 20mg pills $160.00 Banner Health isn’t talking. Tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 which should be public record.

I’ll post any response I get from them.

In the meantime, tamoxifen 20mg pills $160.00 Amanda’s legal response to the original complaint, tamoxifen 20mg pills $160.00 which answers the complaint point-by-point, tamoxifen 20mg pills $160.00 can be found at vdutton’s posterous.

I encourage you to read the comments, tamoxifen 20mg pills $160.00 as there is some interesting dialog there, tamoxifen 20mg pills $160.00 as well

*****

I am not militant.

I rant now and again, tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 I’d be watching from the sidelines, tamoxifen 20mg pills $160.00too.

My gut tells me, tamoxifen 20mg pills $160.00 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, tamoxifen 20mg pills $160.00 that means “moneymaker”) got angry at an RN, tamoxifen 20mg pills $160.00 ergo, tamoxifen 20mg pills $160.00 she must be punished.

Most hospitals just fire people, tamoxifen 20mg pills $160.00 Banner Health reports them to the Arizona Board of Nurses.

God help the nurses at Banner Health, tamoxifen 20mg pills $160.00 because I’d be watching my derriere 24/7 if I worked there.

Corporate healthcare at it’s finest.

Average Rating: 4.9 out of 5 based on 299 user reviews.

September 24, 2016, 12:03 pm

Excel 30 Pill Bottle $44.00

Excel 30 pill bottle $44.00 (ADDENDUM, excel 30 pill bottle $44.00 ADDED FEBRUARY 14, excel 30 pill bottle $44.00 2012 – When this post was written, excel 30 pill bottle $44.00 I mistakenly thought the patient in question had a transplant operation pending. Excel 30 pill bottle $44.00 The patient was actually scheduled to be transferred the next day to begin pre-transplant testing. Excel 30 pill bottle $44.00 Surgery would have come at a later date.

Excel 30 pill bottle $44.00 I now understand that Amanda assessed that the patient had a deficit of transplant knowledge in general, excel 30 pill bottle $44.00 and provided general transplant teaching concerning the evaluation process, excel 30 pill bottle $44.00 the waiting process, excel 30 pill bottle $44.00 and the care regimen. Excel 30 pill bottle $44.00 The patient changed their mind about undergoing the testing, excel 30 pill bottle $44.00 and requested a hospice consult.

Excel 30 pill bottle $44.00 So, excel 30 pill bottle $44.00 although the patient did not fully understand, excel 30 pill bottle $44.00 and may not have been “informed” about what the entire transplant process required, excel 30 pill bottle $44.00 surgery was not imminent, excel 30 pill bottle $44.00 and “informed consent” for surgery was not the issue here. Excel 30 pill bottle $44.00

Excel 30 pill bottle $44.00 I have a firm belief in not altering a post once it has been posted, excel 30 pill bottle $44.00 and owning the mistakes/misunderstandings therein, excel 30 pill bottle $44.00 so I have added this addendum for clarification.

Excel 30 pill bottle $44.00 The issues remain the same – a patient was uninformed about what was happening to them and needed education on their illness, excel 30 pill bottle $44.00 a physician/hospital did not support/respect a patient’s decision/request for information, excel 30 pill bottle $44.00 and a physician behaved in a disruptive fashion.

Excel 30 pill bottle $44.00 I apologize for the misunderstanding.)

Excel 30 pill bottle $44.00 Sorry, excel 30 pill bottle $44.00 no.

Excel 30 pill bottle $44.00 Nurses and physicians share a collaborative relationship, excel 30 pill bottle $44.00 working with the patient in a team effort.

Excel 30 pill bottle $44.00 That is how it is supposed to work.

Excel 30 pill bottle $44.00 As a nurse, excel 30 pill bottle $44.00 my duty is solely to the patient.

Excel 30 pill bottle $44.00 If I am needed to be anyone’s “right hand”, excel 30 pill bottle $44.00 it will be my patient.

Excel 30 pill bottle $44.00 I’m very lucky. Excel 30 pill bottle $44.00 I work with great docs who get it. Excel 30 pill bottle $44.00 I’ll write a post about that.

Excel 30 pill bottle $44.00 I’ve seen my share of the temper-tantrum throwing screamers, excel 30 pill bottle $44.00 and I’ve been the recipient of their wrath three or four times in my career.

Excel 30 pill bottle $44.00 I should tell those stories; they happened long ago. Excel 30 pill bottle $44.00 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, excel 30 pill bottle $44.00 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, excel 30 pill bottle $44.00 based on information that has been made public or is in the public record, excel 30 pill bottle $44.00 three things occurred or nearly occurred (In hospital terminology, excel 30 pill bottle $44.00 we call those “near-misses.”)

This should make everyone of us queasy.

1. Excel 30 pill bottle $44.00 A PATIENT WOULD HAVE HAD SURGERY WITHOUT INFORMED CONSENT.

A patient scheduled for surgery, excel 30 pill bottle $44.00 in this case a major, excel 30 pill bottle $44.00 life-altering surgery, excel 30 pill bottle $44.00 did not know (a) the extent of the surgery, excel 30 pill bottle $44.00 (b) the ramifications of the surgery – this being complex lifetime care, excel 30 pill bottle $44.00 or (c) options other than surgery.

All of the above, excel 30 pill bottle $44.00 along with the risks and benefits of the surgery, excel 30 pill bottle $44.00 constitute “informed consent.” Before any surgery consent can be signed, excel 30 pill bottle $44.00 all of the above must be addressed.

Before the discussion with the nurse, excel 30 pill bottle $44.00 the patient did not know this information.

2. Excel 30 pill bottle $44.00 A PATIENT’S DECISION WAS NOT SUPPORTED BY THE MD, excel 30 pill bottle $44.00 OR THE HOSPITAL

Granted, excel 30 pill bottle $44.00 the surgery did not happen. Excel 30 pill bottle $44.00 But instead of supporting the patient’s decision as being the patient’s decision after the patient had been fully informed, excel 30 pill bottle $44.00 as was their right by law, excel 30 pill bottle $44.00 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, excel 30 pill bottle $44.00 but I wonder – how much of that anger did the patient hear, excel 30 pill bottle $44.00 or sense?

3. Excel 30 pill bottle $44.00 A PHYSICIAN DISPLAYED DISRUPTIVE BEHAVIOR AT THE NURSES STATION.

Well, excel 30 pill bottle $44.00 this has been going on from time immemorial, excel 30 pill bottle $44.00 but it is no longer tolerated.

Now, excel 30 pill bottle $44.00 concern over a patient is not disruptive behavior. Excel 30 pill bottle $44.00 Anger is not a disruptive behavior. Excel 30 pill bottle $44.00 (If it was, excel 30 pill bottle $44.00 I’d be in trouble.) Screaming and throwing a temper-tantrum at a nursing station is, excel 30 pill bottle $44.00 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, excel 30 pill bottle $44.00 the facility? The nurses?

*****

Two of these, excel 30 pill bottle $44.00 the informed consent and the disruptive behavior are issues that are covered by licensing bodies. Excel 30 pill bottle $44.00 Joint Commission has looked at the impact of disruptive behavior by physicians and other members of the health care team. Excel 30 pill bottle $44.00 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. Excel 30 pill bottle $44.00 Webb Medical Center was not innocuous.

If not for the actions of a registered nurse, excel 30 pill bottle $44.00 doing exactly what she was educated to do, excel 30 pill bottle $44.00 and bound by the Arizona Nurse Practice Act (and her ethical duty) to do, excel 30 pill bottle $44.00 a patient would have had a surgery they were not prepared for, excel 30 pill bottle $44.00 and would not have wanted had they known what was happening.

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

Excel 30 pill bottle $44.00 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.

Excel 30 pill bottle $44.00 As a nurse, excel 30 pill bottle $44.00 and as a patient, excel 30 pill bottle $44.00 I am appalled.

Excel 30 pill bottle $44.00 Now I want to see exactly what Banner Health, excel 30 pill bottle $44.00 and the Arizona Board of Nurses, excel 30 pill bottle $44.00 are going to do to rectify this situation.

Excel 30 pill bottle $44.00 This has huge implications for nurses, excel 30 pill bottle $44.00 and patients.

Excel 30 pill bottle $44.00 All of us.

Average Rating: 5 out of 5 based on 216 user reviews.

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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