July 31, 2016, 5:42 pm

Overnight Delivery Cialis

Overnight delivery cialis Sorry, overnight delivery cialis no.

Overnight delivery cialis This is the problem.

Overnight delivery cialis There is a huge injustice being perpetrated against a nurse right this moment.

Overnight delivery cialis It’s getting worse.

Overnight delivery cialis And the ones who got the party started aren’t happy that it isn’t quiet.

Overnight delivery cialis That their moves, overnight delivery cialis and their motives, overnight delivery cialis are under public scrutiny.

Overnight delivery cialis That nurses are talking.

Overnight delivery cialis Because if you are quiet, overnight delivery cialis it means they’ve got you frightened.

Overnight delivery cialis If you are quiet, overnight delivery cialis it’s harder for the next nurse to speak out.

Overnight delivery cialis If you are quiet, overnight delivery cialis it is easier to intimidate and retaliate against nurses with impunity.


I received a call from the Arizona Board of Nursing this morning. Overnight delivery cialis I am not able to obtain a copy of the Banner Del E. Overnight delivery cialis Webb Medical Center complaint against Amanda Trujillo, overnight delivery cialis RN, overnight delivery cialis MSN.

They are able to tell me that a complaint was filed, overnight delivery cialis and what date it was filed, overnight delivery cialis but the actual content of the complaint is confidential. Overnight delivery cialis A copy goes to the RN involved.

I appreciated the call, overnight delivery cialis they could easily have sent an email.

That doesn’t mean I won’t see a copy of it, overnight delivery cialis it just means I can’t get a copy from the AZBoN.


Well, overnight delivery cialis it gets worse.

Today, overnight delivery cialis ten months after the original complaint was filed, overnight delivery cialis Amanda was advised that the Arizona Board of Nursing had called her university and reported that she is under investigation. Overnight delivery cialis Amanda is studying for her DNP.

Amanda got the email from her university, overnight delivery cialis informing her of what they had been told.


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, overnight delivery cialis who said absolutely “NO”, overnight delivery cialis they did not report nurses to universities., overnight delivery cialis That until the case is decided, overnight delivery cialis 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.

Overnight delivery cialis I’m no Morley Safter or Mike Wallace.

Overnight delivery cialis This blog isn’t 60 Minutes.

Overnight delivery cialis I’m just a blogging staff nurse who is aghast at what she is seeing and I have questions.

Overnight delivery cialis Who has ties to the Arizona Board of Nursing? What pull, overnight delivery cialis if any, overnight delivery cialis does Banner Health have with the AZBoN? What pull, overnight delivery cialis if any does the doctor whose public display of rage set all this in motion, overnight delivery cialis have with the Arizona Board of Nursing?

Overnight delivery cialis 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, overnight delivery cialis and a referral for a case management consult for hospice placed at the patient’s request.

No patient was harmed. Overnight delivery cialis No patient was killed. Overnight delivery cialis No medication given. Overnight delivery cialis No procedure done.

A patient was given information.



And god help the nurse who had the audacity to facilitate this autonomy, overnight delivery cialis this right.

How can you not be outraged?

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July 31, 2016, 3:03 pm

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Bactrim 480mg pills $75.00 I’ve been blogging for 6 1/2 years.

Bactrim 480mg pills $75.00 I have a twitter account and although I went to Facebook kicking and screaming, bactrim 480mg pills $75.00 I’m firmly ensconced in the world of status updates, bactrim 480mg pills $75.00 messages, bactrim 480mg pills $75.00 and the occasional “poke.”

Bactrim 480mg pills $75.00 I never miss BlogWorld New Media Expo, bactrim 480mg pills $75.00 and if I can make it to BlogHer, bactrim 480mg pills $75.00 I will be at the party (can you say “swag”?)

Bactrim 480mg pills $75.00 You might say I’m into social media.

Bactrim 480mg pills $75.00 The best thing about social media? It enhances the ability of people to band together, bactrim 480mg pills $75.00 to support causes, bactrim 480mg pills $75.00 and each other.

Bactrim 480mg pills $75.00 This week, bactrim 480mg pills $75.00 we’ve seen nurses band together online to support one of our own, bactrim 480mg pills $75.00 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, bactrim 480mg pills $75.00 to find support and encouragement.

They use the internet and social media to gather information; to be able to decide, bactrim 480mg pills $75.00 in discussions with their healthcare provider, bactrim 480mg pills $75.00 the best treatment to pursue.

The “patient” is you. Bactrim 480mg pills $75.00 And me. Bactrim 480mg pills $75.00 We are all patients.

Knowledge is power. Bactrim 480mg pills $75.00 Knowledge empowers a us to advocate for ourselves.

But what happens when you are sick, bactrim 480mg pills $75.00 lying in a hospital bed with new information flying fast and furious, bactrim 480mg pills $75.00 with no time (or access) to “look it up”. Bactrim 480mg pills $75.00 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, bactrim 480mg pills $75.00 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, bactrim 480mg pills $75.00 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, bactrim 480mg pills $75.00 either because they have not been informed, bactrim 480mg pills $75.00 or because they did not understand the information provided, bactrim 480mg pills $75.00 the nurse has a duty to:

a. Bactrim 480mg pills $75.00 provide the missing information, bactrim 480mg pills $75.00 or the needed education and/or

b. Bactrim 480mg pills $75.00 refer the patient to the appropriate source of information

Bactrim 480mg pills $75.00 There is no choice.

Bactrim 480mg pills $75.00 It’s not a case of making a note and hoping the next shift deals with it.

Bactrim 480mg pills $75.00 It’s not a case of thinking, bactrim 480mg pills $75.00 “oh well, bactrim 480mg pills $75.00 they need this surgery/procedure anyway.”

Bactrim 480mg pills $75.00 The nurse is mandated by law, bactrim 480mg pills $75.00 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, bactrim 480mg pills $75.00 as defined by the American Nurses Association, bactrim 480mg pills $75.00 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, bactrim 480mg pills $75.00 RN, bactrim 480mg pills $75.00 MSN, bactrim 480mg pills $75.00 an experienced transplant RN, bactrim 480mg pills $75.00 by Banner Del E. Bactrim 480mg pills $75.00 Webb Medical Center is so mind-boggling.

She was doing exactly what she was supposed to do as a registered nurse, bactrim 480mg pills $75.00 for a patient with a knowledge deficit regarding an upcoming transplant.


For the record, bactrim 480mg pills $75.00 to those who have written to say I don’t have both sides, bactrim 480mg pills $75.00 Banner Health isn’t talking. Bactrim 480mg pills $75.00 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, bactrim 480mg pills $75.00 which should be public record.

I’ll post any response I get from them.

In the meantime, bactrim 480mg pills $75.00 Amanda’s legal response to the original complaint, bactrim 480mg pills $75.00 which answers the complaint point-by-point, bactrim 480mg pills $75.00 can be found at vdutton’s posterous.

I encourage you to read the comments, bactrim 480mg pills $75.00 as there is some interesting dialog there, bactrim 480mg pills $75.00 as well


I am not militant.

I rant now and again, bactrim 480mg pills $75.00 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, bactrim 480mg pills $75.00 I’d be watching from the sidelines, bactrim 480mg pills $75.00too.

My gut tells me, bactrim 480mg pills $75.00 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, bactrim 480mg pills $75.00 that means “moneymaker”) got angry at an RN, bactrim 480mg pills $75.00 ergo, bactrim 480mg pills $75.00 she must be punished.

Most hospitals just fire people, bactrim 480mg pills $75.00 Banner Health reports them to the Arizona Board of Nurses.

God help the nurses at Banner Health, bactrim 480mg pills $75.00 because I’d be watching my derriere 24/7 if I worked there.

Corporate healthcare at it’s finest.

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July 31, 2016, 12:03 pm

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Augmentin 375mg pills $204.00 (ADDENDUM, augmentin 375mg pills $204.00 ADDED FEBRUARY 14, augmentin 375mg pills $204.00 2012 – When this post was written, augmentin 375mg pills $204.00 I mistakenly thought the patient in question had a transplant operation pending. Augmentin 375mg pills $204.00 The patient was actually scheduled to be transferred the next day to begin pre-transplant testing. Augmentin 375mg pills $204.00 Surgery would have come at a later date.

Augmentin 375mg pills $204.00 I now understand that Amanda assessed that the patient had a deficit of transplant knowledge in general, augmentin 375mg pills $204.00 and provided general transplant teaching concerning the evaluation process, augmentin 375mg pills $204.00 the waiting process, augmentin 375mg pills $204.00 and the care regimen. Augmentin 375mg pills $204.00 The patient changed their mind about undergoing the testing, augmentin 375mg pills $204.00 and requested a hospice consult.

Augmentin 375mg pills $204.00 So, augmentin 375mg pills $204.00 although the patient did not fully understand, augmentin 375mg pills $204.00 and may not have been “informed” about what the entire transplant process required, augmentin 375mg pills $204.00 surgery was not imminent, augmentin 375mg pills $204.00 and “informed consent” for surgery was not the issue here. Augmentin 375mg pills $204.00

Augmentin 375mg pills $204.00 I have a firm belief in not altering a post once it has been posted, augmentin 375mg pills $204.00 and owning the mistakes/misunderstandings therein, augmentin 375mg pills $204.00 so I have added this addendum for clarification.

Augmentin 375mg pills $204.00 The issues remain the same – a patient was uninformed about what was happening to them and needed education on their illness, augmentin 375mg pills $204.00 a physician/hospital did not support/respect a patient’s decision/request for information, augmentin 375mg pills $204.00 and a physician behaved in a disruptive fashion.

Augmentin 375mg pills $204.00 I apologize for the misunderstanding.)

Augmentin 375mg pills $204.00 Sorry, augmentin 375mg pills $204.00 no.

Augmentin 375mg pills $204.00 Nurses and physicians share a collaborative relationship, augmentin 375mg pills $204.00 working with the patient in a team effort.

Augmentin 375mg pills $204.00 That is how it is supposed to work.

Augmentin 375mg pills $204.00 As a nurse, augmentin 375mg pills $204.00 my duty is solely to the patient.

Augmentin 375mg pills $204.00 If I am needed to be anyone’s “right hand”, augmentin 375mg pills $204.00 it will be my patient.

Augmentin 375mg pills $204.00 I’m very lucky. Augmentin 375mg pills $204.00 I work with great docs who get it. Augmentin 375mg pills $204.00 I’ll write a post about that.

Augmentin 375mg pills $204.00 I’ve seen my share of the temper-tantrum throwing screamers, augmentin 375mg pills $204.00 and I’ve been the recipient of their wrath three or four times in my career.

Augmentin 375mg pills $204.00 I should tell those stories; they happened long ago. Augmentin 375mg pills $204.00 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, augmentin 375mg pills $204.00 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, augmentin 375mg pills $204.00 based on information that has been made public or is in the public record, augmentin 375mg pills $204.00 three things occurred or nearly occurred (In hospital terminology, augmentin 375mg pills $204.00 we call those “near-misses.”)

This should make everyone of us queasy.


A patient scheduled for surgery, augmentin 375mg pills $204.00 in this case a major, augmentin 375mg pills $204.00 life-altering surgery, augmentin 375mg pills $204.00 did not know (a) the extent of the surgery, augmentin 375mg pills $204.00 (b) the ramifications of the surgery – this being complex lifetime care, augmentin 375mg pills $204.00 or (c) options other than surgery.

All of the above, augmentin 375mg pills $204.00 along with the risks and benefits of the surgery, augmentin 375mg pills $204.00 constitute “informed consent.” Before any surgery consent can be signed, augmentin 375mg pills $204.00 all of the above must be addressed.

Before the discussion with the nurse, augmentin 375mg pills $204.00 the patient did not know this information.

2. Augmentin 375mg pills $204.00 A PATIENT’S DECISION WAS NOT SUPPORTED BY THE MD, augmentin 375mg pills $204.00 OR THE HOSPITAL

Granted, augmentin 375mg pills $204.00 the surgery did not happen. Augmentin 375mg pills $204.00 But instead of supporting the patient’s decision as being the patient’s decision after the patient had been fully informed, augmentin 375mg pills $204.00 as was their right by law, augmentin 375mg pills $204.00 there was anger and recrimination from the physician and the facility.


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

I’m speculating, augmentin 375mg pills $204.00 but I wonder – how much of that anger did the patient hear, augmentin 375mg pills $204.00 or sense?


Well, augmentin 375mg pills $204.00 this has been going on from time immemorial, augmentin 375mg pills $204.00 but it is no longer tolerated.

Now, augmentin 375mg pills $204.00 concern over a patient is not disruptive behavior. Augmentin 375mg pills $204.00 Anger is not a disruptive behavior. Augmentin 375mg pills $204.00 (If it was, augmentin 375mg pills $204.00 I’d be in trouble.) Screaming and throwing a temper-tantrum at a nursing station is, augmentin 375mg pills $204.00 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, augmentin 375mg pills $204.00 the facility? The nurses?


Two of these, augmentin 375mg pills $204.00 the informed consent and the disruptive behavior are issues that are covered by licensing bodies. Augmentin 375mg pills $204.00 Joint Commission has looked at the impact of disruptive behavior by physicians and other members of the health care team. Augmentin 375mg pills $204.00 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. Augmentin 375mg pills $204.00 Webb Medical Center was not innocuous.

If not for the actions of a registered nurse, augmentin 375mg pills $204.00 doing exactly what she was educated to do, augmentin 375mg pills $204.00 and bound by the Arizona Nurse Practice Act (and her ethical duty) to do, augmentin 375mg pills $204.00 a patient would have had a surgery they were not prepared for, augmentin 375mg pills $204.00 and would not have wanted had they known what was happening.

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

Augmentin 375mg pills $204.00 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.

Augmentin 375mg pills $204.00 As a nurse, augmentin 375mg pills $204.00 and as a patient, augmentin 375mg pills $204.00 I am appalled.

Augmentin 375mg pills $204.00 Now I want to see exactly what Banner Health, augmentin 375mg pills $204.00 and the Arizona Board of Nurses, augmentin 375mg pills $204.00 are going to do to rectify this situation.

Augmentin 375mg pills $204.00 This has huge implications for nurses, augmentin 375mg pills $204.00 and patients.

Augmentin 375mg pills $204.00 All of us.

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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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