Thursday, January 31, 2008

throat dry as a desert
nothing interesting to say
when one is this sick

Wednesday, January 30, 2008

Abstract with Commentary

Author’s Abstract

OBJECTIVE: The impact of interventions designed to improve the nursing work environment on patient and nurse outcomes was examined. BACKGROUND: Nursing work environments have been characterized as contributing to patient outcomes as a result of organizational management practices, workforce deployment, work design, and organizational culture. METHODS: This quasi-experimental study involved 16 unit managers, 1,137 patients, and 296 observations from registered nurses over time. RESULTS: After participation in the intervention, study nurses reported higher perceptions of their work and work environment. Demographic nurse, unit, and hospital characteristics also had an impact on the work environment and outcomes. CONCLUSIONS: Findings in this study highlight the importance of understanding factors in the work environment that influence patient and nurse outcomes.
Hall, L.M., Doran, D., & Pink, L. (2008). Outcomes of interventions to improve hospital nursing work environments. Journal of Nursing Administration, 38, 40-46.

Commentary by Dana Rutledge, RN, PhD, Nursing Research Facilitator

The intervention in this study was fairly complex in that individual units determined a workplace change to implement. For 6 months, change development and implementation was facilitated by a trained bachelor’s prepared nurse who devoted efforts solely to this project. Changes included things like enhancing documentation activities, increasing medication supplies, and implementation of a communication tool related to patient transfers. Changes before and 6 months after the workplace change were determined for system data (unit/hospital characteristics), nurse outcome data (surveys on satisfaction, work quality, etc.), and patient outcomes (ADLs, satisfaction, etc.). Analysis involved “nesting” outcomes for nurses within units. Patient outcomes were not nested since different patients were used at data collection points.

Hospitals studied all were in Ontario Canada. Nurses were mostly females (95%) prepared at diploma or certificate level (76%). Experience levels varied with 29% of nurses having less than 5 years and 20% having > 25 years. Most units (60%) used “total patient care delivery model,” which was not defined. Patients were 46% medical, 54% surgical.

Six-month findings indicated positive changes in nurse perceptions of the work and work environment. This is one of few studies that measure change over time with a work environment change (probably due to the complexity of such research designs). Researchers discussed the significant contributions of nurse and unit characteristics on outcomes. For example, RNs with baccalaureate degrees reported higher levels of job stress than those with diplomas… could the “added knowledge and understanding that comes with degree education and the greater sense of accountability” be active in these findings? Unit characteristics such as proportion of part-time nurses also impacted outcomes with units having more part-time nurses having higher average nurse ratings of job satisfaction. Finally, hospital and unit characteristics impacted patient outcomes… patients in teaching hospitals reported better perceptions of quality and increased independence than did community hospital patients.

Implications from this Canadian study are that fairly simple workplace changes can quickly (within 6 months) alter nurse and patient outcomes. Authors described issues with nurse generations, nurse experience, and patient-to-nurse ratios that deserve further study.

Monday, January 28, 2008

harry fong's glasses
have a crossbeam of bamboo
now he looks 'arty'

Sunday, January 27, 2008

my eyes are as quick
as a steam roller pressing
hot tar down a road

Saturday, January 26, 2008

art ruins virtue
the mirror becomes my friend
and I hate myself

Friday, January 25, 2008

missing a day is
like riding a conveyor
through a gray airport

Wednesday, January 23, 2008

played The Tonight Show
a full brass band behind them
they finally made it

Tuesday, January 22, 2008

auntie has big teeth
her fingers are crochet hooks
a clasp is her mouth

Monday, January 21, 2008

he's fat and happy
springtime bound in his stomach
ruddy cheeks of glut

Sunday, January 20, 2008

browsing for heaters
I find the sheen alluring
slick powder coating

Connecting Some Dots

Staffing issues/Bed Occupancy/ Fucktwit politicans/ Superbugs


INCONSISTENCY and mismanagement threaten a critical shortage of GPs and nurses, warn two Fylde coast MPs.
Ben Wallace, MP for Lancaster and Wyre, and Michael Jack, MP for Fylde, said a leaked document on cuts to the NHS wage bill showed bad personnel management.
The document, part of the draft version of the NHS pay and workforce strategy for 2008 to 2011 in England, predicted that within four years the NHS will have a shortage of 1,200 GPs, 14,000 nurses and 1,100 doctors.
It also revealed an extra 3,200 consultants the NHS cannot afford to pay and an excess of 1,600 allied professionals, health scientists and technicians.
The Government has announced that more than 900 NHS staff are to be made redundant across the country as part of hospitals reorganisation.
Mr Wallace said: "The whole thing shows the Government's incompetency when it comes to workforce planning.
"It has encouraged people to join the NHS but now is laying people off and, in my own constituency, I hear of health professionals, for example, midwives, who cannot find a job.


From a recently qualified Graduate Nurse

Well, a few day's on the ward and I have neglected to really mention much of what I have been doing. There is still no job, though there have thankfully been a handful more job's posted on the NHS jobs site for my hospital. It would seem that the reason I was not shortlisted for the job on the ward was that there were 47 other student nurses who applied for the post. Yes, 47 students without jobs. I am not making this up, as I saw the pile of application forms. There were over 100 applications made when you add in the registered Nurse's that applied for the post. Good news is that they are going to keep my application if anything else turns up.


Stéphane Hugonnet and colleagues from the University of Geneva Hospitals, Switzerland, investigated the number of patients admitted to the ICU who developed ventilator-associated pneumonia (VAP), over a four-year period. They then compared this to the number of nurses on duty for each patient in the preceding days. VAP affected over a fifth of the 936 patients who received mechanical ventilation during the study.

The team found that when there were lower numbers of nurses, patients were more likely to catch pneumonia six days or more after being placed on a ventilator. This suggests that bacteria are transferred between patients, or from one site to another in the same patient. This could be due to short-staffed nurses having less time to follow hand hygiene recommendations and proper isolation procedures or being unable to provide adequate care to the ventilated patient. The nurses' training level had no effect on infection rates.

Plus This:

ScienceDaily (Jan. 16, 2007) — Hospital death rates can be reduced by employing more Registered Nurses and the routine use of care maps or protocols, according to a study in the latest UK-based Journal of Advanced Nursing.

A ten per cent increase in the proportion of Registered Nurses employed was associated with six fewer deaths per 1000 discharged patients.
The death rate also went down by nine per 1000 discharged patients when the number of Baccalaureate-prepared (university graduate rather than diploma qualified) nurses went up by ten per cent.
A ten per cent increase in adequate staffing and resources (as reported by nurses) was associated with 17 fewer deaths per 1,000 discharged patients.


Hospital acquired infections such as MRSA and C.Diff. are on the rise. There is much evidence to suggest this is mostly down to two main factors, poor hygiene standards and bed occupancy.

Bed occupancy rates within Lincolnshire are high, very high. 99.2% !!! (Apr 05-Apr 06) The govt. target is 85%.

Several times a year the whole United Lincolnshire Hospitals Trust is on red alert. This refers to the trust having no available beds whatsoever. On 25th November 2006 Lincoln hospital had to close wards as 10 patients had the c.diff bug. One patient died.

Before any more beds and services are cut at our hospital we should ask the Trust board how they can justify further cuts to bed numbers at a time when we have already had one major outbreak at Lincoln and the bed occupancy numbers are massively over government requirements of 85% occupancy.

Quotes from around the press :

"People with MRSA should be treated in isolation, but that does not happen because bed occupancy is running at almost 100 per cent. We have heard of hospitals pulling the curtains around a bed and pinning a note on it to say "isolation".
Katharine Murphy, of the Patients' Association

"Good infection control is being thwarted by high bed occupancy levels, a lack of isolation facilities and too many patients with different conditions being placed together in wards."
Edward Leigh. Public Account Committee,,1260861,00.html

And This:

Staffing patterns and nurses' working conditions are risk factors for healthcare-associated infections as well as occupational injuries and infections. Staffing shortages, especially of nurses, have been identified as one of the major factors expected to constrain hospitals' ability to deal with future outbreaks of emerging infections. These problems are compounded by a global nursing shortage. Understanding and improving nurses' working conditions can potentially decrease the incidence of many infectious diseases. Relevant research is reviewed, and policy options are discussed.

A recent evidence-based practice report sponsored by the Agency for Healthcare Quality and Research concluded that a relationship exists between lower levels of nurse staffing and higher incidence of adverse patient outcomes (14). Nurses' working conditions have been associated with medication errors and falls, increased deaths, and spread of infection (15–30) (Table). RN staffing levels have been associated with the spread of disease during outbreaks (17,22,23,25,28). However, increasing nurse-to-patient ratios alone is not adequate; more complex staffing issues appear to be at work. Many studies have found that the times of higher ratios of "pool staff" (i.e., nursing staff who were members of the hospital pool service or agency nurses) to "regular staff" (i.e., nurses permanently assigned to the unit) were independently associated with healthcare-associated infections (16,17,21,27). The skill mix of the staff, that is, the ratio of RNs to total nursing personnel (RNs plus nurses' aides), is also related to healthcare-associated infections; increased RN skill mix decreases the incidence of healthcare-associated infections (20,29,30). In a recent comprehensive review of the literature, the authors concluded that evidence of the relationship between nurses' working environment and patient safety outcomes, including healthcare-associated infections is growing. They also concluded that stability, skill mix, and experience of the nurse workforce in specific settings are emerging as important factors in that relationship (31).

Anyone see where I am going with this?

And Gordon Brown is going to spend millions on supposed "deep cleaning" instead of creating jobs for front line staff, and redesigning hospitals and creating beds.

I do not need to create a link to my posts about the staffing at my trust or managements attitude towards this problem. Randomly select any of my previous posts and read about it. We do not have enough beds to cope. New nurses cannot find employment anywhere. WE have 3 closed wards at our hospital. They are nightingale wards so cannot be used (as per government orders) but there is no money to refurbish (as per government penny pinching). I know of trusts that have the lowest staff to patient ratios in the country. They have superbug problems. They want rid of hundreds of frontline staff but they advertising for new management consultants.

Gordon, you ignorant slut.

Our domestics are only working 4 hour days and in that time they must serve breakfast and dinner. They are only hiring part timers as domestics. There are 2 domestics to do this in 4 hours and clean the ward as well in that time. The ward is at 100% bed occupancy and is totally overcrowded. They could not clean it properly if you had a gun to their heads.

Everyone understands this and has already connected the dots...everyone except the fucktwits in charge....

Saturday, January 19, 2008

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Nurse: Clinical Nurse Specialist (CNS)

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warm tapioca
fingers curling through a beard
the smell of pizza

Friday, January 18, 2008

passive witnesses
amplify qualifiers
prepositions piled

Don't Know Why, But It Makes Me Smile!

Jeep Commercial on TV these days... and I found one made for Venezuela, same concept, different animals!

Thursday, January 17, 2008

work is like playing
teather ball swings back around
never completed

Nurse for Dubai NEEDED!!!

Trust / Employer Beresford Blake Thomas Nursing
City Dubai
Location Worldwide (Outside Europe)
Career Level Enrolled Nurse
Specialism Adult / General
Working Hours Full Time
Salary Negotiable
Vacancies 9
Start Date ASAP

We are recruiting for staff nursing positions throughout the United Arab Emirates, including Dubai, for our clients. You will benefit from career development, tax free salary, sign on bonus, retention bonus, free accommodation, free transportation, free utilities, and visa application on your behalf,and more.

In return, you will be willing to commit to at least 1 year contract.
The ideal candidate for this role, must have a minimum of 2 years post qualification experience. You will come equipped with valuable skills and experience, and an appetite for a successful career, and new opportunities and development.

closing date: February 19, 2008

Adrian Duffy
8th Floor, Southside
105 Victoria Street

Freephone: 0808 143 6000

Wednesday, January 16, 2008

Tuesday, January 15, 2008

we talk about names
glasses of wine, how we love
and then sleep alone

Monday, January 14, 2008

muscles like cheese curd
from a prehistoric farm
that's how he flexes

Sunday, January 13, 2008

you join my girlfriends
start sizing us up and ask
how do you stay thin

Friday, January 11, 2008

Evidence-Based Policy and Procedures

Authors at the University of Colorado Hospital in Aurora have recently authored an article titled Evidence-Based Policy and Procedures: an algorithm for success which appeared in JONA : Journal of Nursing Administration 38(1): 47- 51, January 2008. Library users at St. Joseph Hospital, Orange and CHOC can read the full text of this article online via Burlew Medical Library's website. The authors identified nothing in the literature speaking to evidence-based policy and procedure development. Their EBP Council then identified the steps involved in evidence-based policy development and created a 10-step algorithm with very practical detail. The authors describe their process for systematically critiquing and rating the evidence identified. Another interesting innovation at this Magnet hospital is their requirement for a yearly EBP competency that is required for all clinical nurses. Does anyone out there in the blogosphere know of any other institution that has such a requirement?

Kudos to the authors: Kathleen S. Oman, RN, PhD, CEN, FAEN; Christine Duran, APRN-BC, DNP, CNS, CCTN; Regina Fink, RN, PhD, AOCN, FAAN.

Nursing Grand Rounds at St. Joseph Hospital (written by Sharon Kleinheinz, RN, MSN)

On November 19, 2007, St. Joseph Hospital held the second annual Nursing Grand Rounds dedicated to Nursing Research and Evidence Based Practice projects being conducted at the hospital.

St. Joseph Hospital’s Nurse Research Facilitator, Dana Rutledge, RN, PhD, led the seminar on the use of evidence-based practice in guiding health care decisions and improving patient outcomes.

This 4-hour program featured 10 St. Joseph Registered Nurses providing updates on nursing research studies and evidence-based practice projects that are currently underway at St. Joseph. Projects included the following outcomes and learnings:
· Outcomes of a hospital based MET team (Medical Emergency Team) in terms of decreased codes and decreased transfers of patients from med/surg units to ICUs.
· How adding a sedation protocol and vacation to a ventilator bundle has impacted the intubated patient.
· How preoperative preparation and education for the outpatient surgical patient can decrease cancellation of surgery.
· Reasons for and realities of implementing a study comparing the use of a temporal artery thermometer with oral/ axillary or rectal thermometers in the Emergency Department pediatric patient population.

Also featured were the results of a survey on the nurse’s knowledge and attitudes on breastfeeding, the implementation of education for nursing staff providing smoking cessation information to patients, and an overview of the progress of existing end of life programs for patients.

Dr. Rutledge presented the Iowa model and principles of evidence-based practice that is utilized at St. Joseph. Julie Smith, the manager of the St. Joseph Burlew Medical library provided an update on the EBP Blog and the numerous resources available to assist staff in nursing research and evidence-based projects.
the male gaze as beast
in the corner hormones ooze
gaseous from skin

Thursday, January 10, 2008


Reference RGN
Employer Royal Air Force
City Worldworld
Location Worldwide (Outside Europe)
Career Level Staff Nurse
Working Hours Full Time Job
Salary £26,650 per year
Vacancies 1
Start Date Not Specified

Pay after one year: £26,650
Joining age: 21 – 32
Category: Airmen/airwomen
Usual service: 9 years
Open to: men or women

Qualifications: Professional – RGN/NMC

Nationality: Citizen of the UK, the Commonwealth or the Republic of Ireland since birth

As a Staff Nurse (Registered General Nurse) you’ll be a member of the Princess Mary’s Royal Air Force Nursing Service (PMRAFNS). You’ll help look after the health and fitness of everyone in the RAF, whether they’re aircrew, groundcrew or other support staff. PMRAFNS nurses also provide care for entitled civilians and personnel from other Services. They have three main areas of responsibility:

Primary Health Care – based in medical centres on RAF stations in the UK and overseas;

Secondary Health Care – based at one of the Ministry of Defence hospital units at Peterborough, Portsmouth, the Royal Centre of Defence Medicine in Birmingham, Frimley Park or Derriford, in the tri-Service rehabilitation unit at Headley Court, or overseas in the Princess Mary’s Hospital at RAF Akrotiri in Cyprus; and

Operational roles – assisting in the aeromedical evacuation of casualties from overseas to hospitals in the UK for treatment.

For more information about a career as a Staff Nurse (RGN), or to attend a presentation, contact our Nursing Liaison Team on 01400 266782, or email

Temper Tantrums

I think I am really losing it as a Nurse. I am still very compassionate but a hardened shell made of diamond has formed around every compassionate and empathetic bone in my body. I want to stand in the middle of my ward and shriek, scream at the top of my lungs: THIS IS REALITY. IT SUCKS BUT THIS IS HOW IT IS AND I CANNOT CHANGE IT. THIS IS NOT HOW THINGS ARE SUPPOSED TO BE AND I CANNOT CHANGE IT. NOW PUT ON YOUR BIG GIRL PANTIES, AND DEAL WITH IT LIKE A FUCKING GROWN UP.

The things some of these people bitch about...Their unrealistic expectations for one to one care....The belief that you are going to get one to one care in hospital.....the belief that the nurse you are sharing 35 patients with can revolve the world around you and your families schedule without fucking killing someone.......

I'm just a nurse who wants to do my job well and take care of my patients.

My assignment of patients wasn't so bad, that turned out to be a blessing later. My colleagues day sucked. It was her and myself for 28 patients. My 14 were in good shape. They were mostly walking wounded. One poorly patient went to ITU. No upcoming discharges. I was able to get in and do a good assessment on everyone at the beginning of my shift and get a good handle on everything. I was able to do this because I went into work early. Only 2 of them were on IV meds. No confused wanderers that day. It was good. I enjoy days like this because they are so rare. I recently got a couple of beautiful thank you notes from patients. The cards were waiting for me when I went into work. I feel bad because I know the care could be so much better.

My colleague had the other 14 patients who were tougher. She ended up with a death, 3 critically ill patients and 4 palliative care patients whose families were angry and inconsolable. I was able to spend most of my shift helping her out since my assignment was so good.

We have no free beds on the ward but are slated to get an admission at 3PM for minor surgery the next morning. The admission comes in and we sit her in lounge. She appears to be a very well lady. She is raging because there is not a bed yet. I told her it is okay as long as she is here and we can sort out her stuff and prepare her for theatre la de da. Called the bed manager and said please find this lady a bed.

Well a bed did become free around half past 3. We knew it would really. A patient in the side room died. The family was there. They were hysterical.

A relative of the dead patient was so distressed we nearly sent her to A&E..She was a young adult and when told that her dad died she lost control of her bladder. The rest of the family was no better. More family came in to say goodbye. We couldn't lay out the body and get it moved to the morgue because the family was laying on top of the corpse and couldn't bear to leave him. This went on for hours and hours. I was so heartbroken for them. It's not cool to say "look we have a new admit that needs this room, please leave". We gently tried to tell them that they could see him in the chapel of rest and encouraged them to get a cuppa while we sorted out dad and prepared him to leave the ward. They were having none of it. They would not budge. They would not converse with us. I don't think their English skills were great. This was the only bed we were going to have. There were no other beds free, or that could be made free.

Bed manager was aware of the situation there were no beds anywhere else. That's what she said anyway but she is also a well known liar.

Meanwhile the new admission in the lounge was getting increasingly PISSED OFF. WE were not going to tell her that there was a body in her upcoming bed
that we couldn't move. I could tell that she was the kind of person who would completely flip out about that.

By 5PM she was in the lounge crying because she was told to come into hospital for her op and expected to come into a bed and see her doctor straight away. She was to have a hernia repair the next day. I left 28 patients to hook her up with magazines, food, a TV some blankets to get comfortable and apologized profusely regarding the bed situation. I told her she wouldn't see her doc until tomorrow morning anyway even if she was in a bed. It did no good. Every 5 minutes she came out of the room to berate us, call us useless for not getting her bed ready. Then she called her husband and he came in ranting and swearing. Then she called her sons and they rang the ward every 5 minutes ranting swearing and threatening us. So did her sister. I guess they thought that this would get her in a bed faster.

This went on until 9PM. She had to go into the bed where the body was, there was nothing else we could do. We couldn't throw the recently bereaved family out. There was 7 of them and 2 of us. Site manager was aware and said his hands were tied. Thanks for the help you fucker. It was 9PM when we finally were able to lay the body out, get him transported to the morgue and clean the room for the new admit.

If you want to know why your nurse isn't answering your call bell, spending time with you etc is because they are messing around with this stuff.

This woman was crying and cursing saying that having to wait for a bed like this was the worst thing that ever happened to her in her life. I had to try so hard not to laugh at her. I brought her a dinner tray in the lounge and she threw it on the floor. I am sorry. The lounge she was in was nicer than the room itself. She had comfortable chairs etc. She wasn't ill. She had food, water, TV and a phone. She was coming in and out to smoke.

My colleague suggested that we should give her full responsibility of 3 bays by herself, then she could have something to really whine about.

By 8PM I came so close to grabbing her by the hair, digging my nails into the back of her head and dragging her to the room with the corpse in it so that I could point to it and the grieving relatives and say "NOW THAT IS A REAL FUCKING PROBLEM". "NOW THAT WOULD BE SOMETHING TO GET UPSET ABOUT".

I came damn close. Maybe it's time for sick leave.

Thank god my 14 patients were all right. They saw me for about 2 seconds each. If one of them had deteriorated, it would have been missed. If any of them peed the bed they sat in it for the duration of my shift.

Edited to Add: I just made a few phone calls and have an appointment with my GP tomorrow. I am now off sick. I hate complaining to my GP, since she probably has too deal with 100x more bullshit at work. I hate feeling this way.

I have had close relatives die horribly. I have had medical problems myself and as stressful as that was I feel ten times worse and more anxious about going into work. I can't handle the abuse and getting sworn at all the time. I don't get to throw tantrums and cry when I am feeling like that. I'll get complained about if I so much as forget to smile. Maybe if they just offer me a chocolate cookie that will make it all better and force me to smile.,,2087-2450166,00.html

I am not going to follow my own advice and put on my big girl panties and suck it up anymore. I am still job hunting so maybe something will turn up. I will even go and work at Asda if they are hiring. If the house sells first we are out of here.
long hair sweeps a line
I admire how she laughs
a treasure to prize

Wednesday, January 9, 2008

Libraries as "Information Commons"

I came across this really cool blog entry written by the Director of Medical Inforamtics at University of Colorado Hospital. In this entry, libraries are "information commons" and librarians are "knowledge navigators". A nice read on the new directions that medical libraries ahve pursued-- even the ones still called "libraries"
she likes to number
another list as rain drops
one through nine descend

Tuesday, January 8, 2008

he feels his baldness
the weakness of appearance
critical of thought

Monday, January 7, 2008

Tattoo II

I got my tattoo today! I love it! I am glad that I did it. Thank you Melissa for coming with me! You are one amazing person and friend!

Beauty Salon VS. General Medical/Surgical Ward

Okay guys check this out.

I was talking to my little sister yesterday. She is a hairdresser in the States. She works from 0900 to 1500 daily and makes WAY more money than I do because of the tips she gets. We had a conversation the other day.

Nurse Anne: So how many chairs do you have at your hair salon?

Little Sister: uuuuum like 10 chairs.

Anne: How many staff do you have on a normal day?

Little Sister: Um... like.... never any less than 4 or 5. Um like we take one hour lunches. And if customers don't like waiting it's tough titties. Um like and oh yeah we sit in the back and like smoke and shit and make them wait longer if they complain.

They can leave if they don't like it like okay? Yesterday Kiki and Emilio did my hair and my nails because it was like a totally slow day. We closed down the shop for an hour or 5 and had a little party. Like I think I am going blonde at work tomorrow. Emilio will fix it for me.

Jesus Christ where is their manager and/or owner?

But I digress...

Okay so let's go back and analyze this. They have 10 chairs. The maximum number of people being seen to at once is 10. They may also have customers waiting in the lounge. No harm comes to them as a result of waiting for awhile. They have 10 chairs and 4 to 5 staff.

My 35 bed (now 39 beds because the treatment rooms and day rooms are now patient rooms) ward considers itself lucky if we have 4 staff. We get on our knees thanking Jesus if at least 2 of those staff members are actual nurses. Our patients are acute, highly dependent,and many have dementia. They can die or have extremely bad complications because of one little fuck up or missed bit of information. I had 10 of them who needed to go off the ward for essential diagnostic tests the other day. At the same time. Why does god hate me?

All of them needed escorts because they were either on 02, they had dementia and would wander, fall and get lost if left alone in x-ray, or they were on drips that could not come down. All that stuff requires an escort from the ward staff to go with the Porter and stay with the patient.

We had 3 staff on duty. 10 patients needed to be off the ward with an escort (Nurse or HCA). No escort means no test basically. Radiology has a shit fit if they are asked to come to the ward to do a chest x-ray on someone who is too poorly to go down there and there are no escorts. The other departments constantly have shit fits because they want the nurses to revolve everything around their particular diagnositc department. Endoscopy is the worst for this by the way. Fuckers. Just kidding. ;)

Does anyone else think that any of this is completely sick?

We have been harassing the managers and matrons for months trying to get them to meet with us. The only response we have got from the powers that be recently went something like this "You are well staffed as far as we are concerned. Deal with it and cope".
what's that swing set doing
no seats, no children, so close
to the ripping tide

Sunday, January 6, 2008

moment in folding
the moonlit sand of winter
origami crane

Saturday, January 5, 2008

her hair long as now
head and shoulders flash forward
curving smoothly calm

10 Years Ago

In 1998, we had a huge ice storm. We lost power for 5 days, many homes lost power for up to 30 days...The area south of Montreal (Montérégie) was so affected that the triangle formed by Saint-Hyacinthe, Granby and Saint-Jean-sur-Richelieu was nicknamed the triangle noir ("dark or black triangle") by the French-language media for the total lack of electricity for weeks.

"Canadians had never before endured a natural disaster like the ice storm of 1998. A difficult morning of car scraping quickly turned into a state of emergency from eastern Ontario to southern Quebec. Millions huddled in the dark by their fireplaces. Many suffered from hypothermia and carbon monoxide poisoning. Heavy ice sheets toppled huge power pylons and in just six days an electrical system that took decades to create was razed."

Friday, January 4, 2008

Mental Health Nursing Jobs in Canada!

The Geneva Health is working with Capital Health, one of Canada’s largest integrated health care providers to recruit adult and child mental health nurses to work and live in Canada.

The employer provides educational and career opportunities along with a relocation package that will take all the stress out of your transition.
You will be living and working in a beautiful area of Canada, within easy reach of the Rocky Mountains, National Parks, beautiful lakes, and plenty of opportunities to enjoy the great Canadian outdoors.

You will have adult or child mental health nursing experience in the UK, and be happy to commit to at least a 12-month contract.

The Benefits

* Excellent relocation package
* Assistance with immigration
* High rates of pay
* Reimbursement of many relocation costs
* Accommodation assistance

Registration & Immigration
A valid work permit and eligibility to become registered with the provincial nurses association is a requirement for employment.

Apply on our website, contact our international team on: 020 7025 0096, or e-mail your CV to
the restless night time
before taking a journey
others are breathing

Thursday, January 3, 2008

he waits for coffee
spiraling shapes in the cup
waiting for respect


Welcome to Vickie’s Research Corner. I hope everyone had a wonderful holiday season. Well, here we are in 2008 and we are back to evidence-based practice (EBP) and research projects. This year should be really interesting so watch out for all the new projects coming your way.
For the first project of the year, I would like to introduce you to Amy Waunch. She is the Advanced Practice Nurse (APN) in the Emergency Department.

What is the name of your project?
Emergency Department Pediatric Temperature Study

What is your study about?
The purpose of my study is to compare temporal artery thermometer readings in emergency department patients 17 years and younger with oral, rectal, and axillary temperatures. A study sub-aim is in patients who have received antipyretics, to evaluate the presence of a “lag” in any measure compared to others due to physiologic responses to the antipyretic.

Is it EBP/Research study?
Research- a correlational comparative study.

What made you interested in this project?
Fever is the most common complaint of children seen in a pediatric emergency department (Poiriert et al. 2000). Temperature measurements reflect changes in physiologic status that may require clinical interventions. Accuracy of temperature readings and an understanding of different routes of temperature taking can affect health providers decisions concerning critically ill children and infants. In a busy ED, taking temperatures can be problematic and we were looking at the best method for taking temperatures in children.
A new thermometer, for temporal artery readings has been developed. The temporal thermometer (Exergen Corp., Walterton MA) computes temporal artery temperature by using a heat balance method. This method is noninvasive and more comfortable than rectal temperatures in infants. A representative from the company approached our ED about using this thermometer stating their studies demonstrated this is more or at least as accurate as rectal thermometry.
After looking into the research, I realized there has been no study found comparing temporal artery readings with oral, rectal, and axillary readings among children 17 years or younger admitted to emergency departments. I wanted to insure using the best method possible in our ED instead of taking a sales representatives word. I wanted to actually have research versus opinion. Therefore, I created a study.

How did you go about your research?
I started with a literature review and couldn’t find a clear-cut conclusion on the accuracy of temporal artery thermometry use on pediatric patients presenting to an emergency department. I then investigated the community standard of care for pediatric temperature attainment and learned that practice varies greatly form one hospital to another. I looked to expert opinion from professional organizations such as the American Association of Pediatrics and the American College of Emergency Physicians, again with no consensus.
So I decided to talk to Dana Rutledge to help me do a more extensive literature search. We found there is no gold standard or clear evidence for taking temperatures in pediatric patients. At this point we decided to create a research study. For the study I asked Beth Winokur, the Clinical Educator for the ED, and John Senteno, the Director of ED to help. Dana wrote the proposal and gave input. I formulated a team of interested persons: Christine Marshall, Clinical Nurse IV in the ED; Mike Vicioso, Pediatric Manager in ED; and Beth Winokur. We then applied for the IRB. For the last year we have been trying to accrue patients for the study.

What are your expected outcomes?
I believe we may find that the temporal artery thermometer is inconsistent. I also think we may find that axillary temperatures are inconsistent as well. Data from research states that rectal temperatures are the closest to the core temperature but unfortunately they are the most invasive. I hope to find that the temporal artery thermometer is a reliable and accurate means of obtaining temperatures in pediatric patients in the ED. This method is non-invasive and will cause less anxiety among parents compared to rectal thermometry.

Have you done research before? If so what did you learn?
I have co-investigated randomized clinical trials for asthma when I worked at an allergy office as a Nurse Practitioner. I learned that acquiring data is very detailed oriented. I also learned that the IRB is really designed to keep the best interest of the patients. I actually was pleasantly surprised going through the IRB that our study was approved for an expedited review due to the fact we worked with a vulnerable population.
Research can be very challenging, especially this study! We have had problems with data collection due to time of the RNs acquiring patients, making sure all the coinvestigators were compliant with the CITI training that CHOC’s IRB makes you complete prior to research, and the challenges of the administrative end of paperwork.

Will you do research/project again?
Yes, but next time I will get more help from the beginning and more people involved who are dedicated to the time issue.

Poirier, M.P., Davis. P.H., Gonzalez-del Ray, J.A., & Monroe, K.W. (2000). Pediatric emergency department nurses’ perspectives on fever in children [Abstract]. Pediatric Emergency Care, 16, 9-12.

Wednesday, January 2, 2008

the secret of life
failure is not the problem
expectations are


Between a destroyed computer and a sick kid I haven't been able to get on and post for awhile and for that I apologise!! I hope you all (if anyone still comes over here) had a Merry Christmas!!

Tuesday, January 1, 2008

The new 4-letter word ...


down the street they lit
the rockets whizzed into night
they leaned back to see

Senior Staff Nurse - Cardio / ICU - London

Job Title: Senior Staff Nurse - Cardio / ICU - London

Contract: Permanent

Hospital Type: Private Sector

Salary: to be confirmed by client

Location: Central London


Critical Care
NMC Registered
Registered General Nurse
Senior Staff Nurse
Staff Nurse

A prestigious private hospital in London is looking for an experienced intensive care nurse.

You will work in a busy cardiothoracic ICU unit as a Senior Staff Nurse. You will also coordinate the shifts.

This is a permanent full-time position.
Closing date: 8.01.08

Duties: Care of ventilated post operative cardiac patients and patients in multi organ failure, Shift coordinate a busy nine bedded ICU, carry the pager as the ICU 1st Responder for emergency events in the hospital.

- NMC registered with post registration experience
- Relevant cardiothoracic experience
- Relevant Intensive Care course.
- ALS Course is desirable.

*Please note, UK hospitals have been advised to consider applicants who do not require a work permit as their first priority.

Contact Name: Gaelle Henderson
Phone: + 44 (0) 1732 355 585 (fax: + 44 (0) 1732 369 043)