Friday, December 31, 2010

Early New Year's Resolutions

1. MOVE! Asap. My puppy needs a yard
2. No dating anyone seriously or exclusively for *a while*
3. Finish 2nd year
4. ROCK Step I
5. Stay away from guys (well, guy. singular) that aren't good for me.
6. Plan a trip that I actually WANT to go on. France, anyone?
7. Keep going to the gym. It helps me study
8. Study
9. Remember to live the present
10. Be grateful. Always.

And yours?

Medical Schools in Saudi Arabia

Following are the top leading medical schools in Saudi Arabia:

King Faisal University, College of Medicine
- The College pioneered postgraduate medical education in the Kingdom. Its postgraduate programmes were first to be recognized by the Arab Board for Medical Specialties and the Royal College of Surgeons in Ireland.
- King Faisal University is ranked 683rd in the world university

Thursday, December 30, 2010

MLK day, a national day of service is coming. Where will you be?

Things I would love to say

Just once I would like to tell these patients and relatives how it is, without worrying about getting fired.

Why? You ask....

Because I get fed up with relatives who think that Nurses are in some kind of position to stop and chit chat.   I am sick of the constant hammering we get from these people who don't seem to realise that we have a job to do or that there are people dying all around us.  We don't have time to explain things to them properly.  They don't have enough medical knowledge to understand what they are being told.  They stop every single random member of staff that they see (all of whom are going to view the patient's situation from a different angle-if they know the patient at all) and demand information. 

Then they accuse the Nursing staff of telling them "a different story".  It is a medical ward full of older patients.  These people are going to have one medical problem after another...sometimes the pneumonia is the biggest problem.  Sometimes renal failure is....Just because the patient was ?UTI on admission and we are now focused on her anemia does not mean that the staff is "lying" to you about "what is wrong".  She's a medical patient for Christ's sake.  They are never EVER simple, cut and dried. The diagnosis, prognosis, plan of treatment etc change faster than Tiger Wood's girlfriends. Most elderly people will be in their own waste, and in a real bad way of they are left unsupervised....leaving them to tend to other patients and duties is something every nurse has to do no matter how caring she happens to be.

For once I want to be direct and say exactly what I think in my sweetest little sarcastic baby doll voice. Or maybe just in a very matter of fact voice.

I take a big risk on the back of my patients by answering the phone at all.....many of my patients should not have been left for me to answer the phone.  I could get in big amounts of trouble if something happens to a patient and I don't catch it because I am answering relative enquiries.   Instead of being grateful to the Nurse for taking such a risk and leaving her patients to chat, all these relatives do is bitch about how long they waited to speak to someone.  Yes, there should be a member of staff who can update families without neglecting patients to do so....BUT THERE ISN'T.   And it isn't the fault of the Nursing profession.  We don't have any say in how to staff the ward.  No not even the sisters and the matrons get a say on that.

Thanks to hospital dramas the public has an unrealistic, ignorant and very unfair expectation of what they can expect in the hospital.  They don't understand what it means to share their doctor and nurse between multiple other patients.  They have no understanding of the true nature of prioritization. They don't understand why or how doctors and nurses prioritise as they do.  They refuse to acknowledge or accept that old age is a multi faceted  terminal illness that cannot be cured.  They refuse to accept that old age, sickness and death is crude, sad and ugly.  And they deal with it by lashing out at caregivers.

I had the most sympathy and empathy in the world when I started out. But the facts are this.  Even the most compassionate Nurses are having their caring natures sucked right out of them after more than a few months of Nursing.  I have seen some of the nicest people become Nurses.....only to become stone cold automatons after 6 months on the job.  It happens to most of them.   At times I have felt that I could walk past a bus full of children on fire and not bat an eyelash.  That is how bad burn out is.  When my grandmother died of the usual old age medical problems, in the usual old age medical way....I felt nothing Nothing.  I just shut down. And we were very close.  I think we survive working in health care by shutting off.

Sigh. Things I would love to say and get away with.  Management wouldn't back us up.  I have been told by managers "yes you are right and you did right but the relatives would never be capable of understanding this issue nor will we accept liability so we have to apologise and let you take the blame".

 I never would say these awful things because I constantly remind myself that patients and relatives DO NOT HAVE A CLUE and live in a fantasy world.  They mean well.  But their emotional state and ability to reason is usually not good. But at the end of a long day I cannot help thinking these things.

Here we go:

"I am so sorry you were on hold for 15 minutes when you phoned to call about your mother. This is an acute medical ward you see, there are sick people here. Actually, I was in your mother's room taking care of her when you called. She is having trouble breathing and we are trying to prevent her from getting re-intubated. I didn't think answering the phone was priority over that, but I know for next time that I should stop taking care of her, come to answer the phone and chit-chat with you for 15 minutes answering all the same questions I answered for your brother an hour ago  while she goes into respiratory failure and dies. I now know what is important here, thank you for reminding me. Oh and you called 15 min before and your were put on hold then as well.  Yes you are soooooo are right to imply that the patient I was taking care of at the time doesn't matter either.   My sincerest apologies. Next time I will know better.  Thank you for making me a better Nurse and showing me what is important."

I am sorry you do not like bariatric bed and feel the need to ring your call bell every 5 seconds to tell me this. I am sorry that you feel like your bariatric bed makes you stand out in the bay. Maybe you should have thought of this before you let yourself get to 30 stone thus requiring a bariatric bed.

You see honey, when you ask me for an blanket, water, whatever after I'm in the room, I am going to have to LEAVE the room to get the blanket, water, whatever. Trust me - I don't have one shoved down my cleavage just it case you want one. And management are not going to let us store them somewhere convenient or even allow us to have enough of those things for all the patients.  I am going to have to walk past 2 bays of people shouting for help just to get you more stuff.  If I stop to help them you will be waiting a long time. Yes, you miserable bitch, you are welcome.

Flashing your police badge at me will not make me let you up before visiting hours. Your wife is not dying, in severe pain, or a post op, she is sleeping.  Your constant demands and inane questions over and over again will seriously impair my ability to care for your wife and my 12 other patients. And from what I can tell she is probably happy to get away from you for a night seeing how rude, annoying, and belittling you are.

I'm sorry that sandwich the kitchen gave your husband expires today but I do have 7 other patients I want to at least eyeball to make sure they are alive and breathing before I hunt down some more food for him. No I'm not going to "just take a pudding" from the bereavement cart across the hall for you. Their family member is dying and you are absolutely ridiculous.

How could you not know that it is illegal, immoral and unethical for a health care professional to give you private information and test results about a patient over the phone?  Even if you are family, and the patient is out of it I can get fired for giving you private information.  Neither the hospitals, the doctors or the nurses make these rules.  We just have to follow them.  And my job isn't worth it.  What would posses anyone to call an ask the Nurses these things anyway?  Why would you do this rather than arranging a conference with the medical team?  You need a fucking psychiatric referral.  Unless you are brain dead you must know that we can lose our jobs for violating confidentiality.  Do you really think I am going to risk the loss of my job and home for you when you could get off of your fat ass and get the information you need just by contacting the medical team rather than harassing the Nurse and delaying the care given to other patients?

To family members: Just because you call out and say, "Nan has to go RIGHT NOW," does not mean that I can come and help her to the bathroom RIGHT NOW. Believe it or not, I am not going to leave my new patient with chest pain, just because Nan needs to pee. If Nan were my only patient, I would be by her side helping her all day.  BUT SHE ISN'T.   This doesn't mean that I don't care about your nan or do not like the idea of dealing with pee.  I do not know of a board of Nursing that exists in any country that wouldn't jump at the chance to strike off a nurse for leaving a chest pain patient to help another patient to the toilet.  They would fall all over themselves to strike off a Nurse who did that.  I am serious.  If Nurses don't prioritise people die.  Better to get in trouble for leaving someone in wee than to get done for manslaughter.  If you don't like this view, it may be time to consider hiring a one to one private duty nurse for your loved one.  And yes I am at the Nurse's filling in paperwork whilst your dad needs the loo!  You know why?  Because the patient in the next bed is bleeding to death.  The doctor has ordered a blood transfusion.  And the fucking path lab will not give me the blood unless they get their fucking paperwork.  I need to get it done and faxed before I take someone to the loo.  Otherwise I might find that my patient has bleed to death because I delayed his paperwork and connsequently his blood transfusion by taking people to the toilet.  I don't want that on my shoulders. Yeah go ahead.  Jump up and down and scream because dad needs the toilet and his nurse is at the station faxing blood order forms.  Temper tantrums and nurse abuse are easier and more fun than thinking and understanding aren't they.

To the patient I discharged last week: Please don't call the ward to ask me for health advice. You are not under my care any more, and I am not allowed to give health advice over the phone FOR SAFETY REASONS.  Your notes were gone from this ward 10 minutes after you were out the door and I wasn't even on duty when you were here. Even if I know the answer to your question, the most I will say is "Go to your GP or to A&E," to cover myself. I'm sorry if that makes you angry....maybe you should have kept that follow up appointment with your doctor we made for you. 

To my angry patient: I'm truly sorry that you had to wait for two hours for pain medication last night. The Powers That Be at my hospital have decided that "no one will notice" if they cut staff at night. Sure you can complain about the nurse, but I know for a fact that she was doing the best she could. Maybe you should direct your complaints towards the management, instead of the nursing staff. Maybe if patients directed their anger towards management  in the first place our hospitals wouldn't be such a fucking mess and this kind of shit wouldn't keep happening. 

 STOP GETTING OUT OF BED. That annoying, high pitched loud beeping sound is going off because YOU'RE GETTING OUT OF BED.

Stop bending your arm.  For the 500th time. That annoying high pitched beeping sound is going off because you are bending your arm causing your IV line to occlude.  No I cannot just "shut it off".  It is heparin for Christ's sake.  Do you want to die?  Just keep your arm straight.  That is all you have to do.  That is all you have to do.  If you keep bending that arm and then screaming at me because the IV pump alarm is beeping I am going to go into the treatment room and inject my veins with something that will kill me super fast.  Then who are you going to bitch at?

 No, that person constantly with your roommate is not a private nurse the hospital is providing because we "like him better". It's security watching him at all times to make sure he doesn't try to kill himself or attack staff and other patients again.  He already gave a medical doctor a fractured skull when he was brought in for an overdose last night. And then he tried to jump on top of a patient and smother him in AAU. ( telling the patient this would violet the confidentiality of the combative patient, therefore I have to put up with the moaner complaining that he doesn't get a "private duty nurse" because " we don't like him".  The I have to put up with the family calling 10 times a day wanting to know why the other man in the bay gets a private nurse but not dad".

These are the drugs the doctor prescribed for you to make you better.  If I were really trying to poison you, you'd be dead already.

 If your pain is a 10/10 and you are asleep, or talking on the phone  complaining about the food. we need to clone your DNA for our race of superhumans we're working on down in the lab.

 Yes, it is your fault that your baby was born at 28 weeks. It had something to do with the crack you were smoking.

Yes, I did go to University to do this.  No that does not mean that I am "just like a wannabe doctor".  Degree nurses are prepared to work on the wards as a direct care Nurse.  They are not any closer to being a doctor than an old style training Nurse. A person needs to be pretty on the ball and knowledgeable to deliver the health care prescribed by doctors.  And that is what nurses do, we deliver health care. No, I do not think I should go back to school and become a doctor. Delivering health care is tough enough.  I have no interest in prescribing it.  If that makes a person stupid then so be it.

I will not get you another glass of water because you threw the last three cups I gave you at me.  Three strikes and you are out. You are not confused or suffering from dementia therefore you can't get away with it.  Yeah go ahead, call your daughter and tell her we are trying to kill you via dehydration.  Here is the phone.  You will look like a tit. She knows what you are like. And if you can go out to smoke every 10 minutes you can get your own water anyway.

If you are going to refuse to comply with any treatment recommendations given to you, you will keep getting sick, and I will continue having to deal with you. It's not a conspiracy against you, trust me, we're sick of you.

 You're crazy and so is your family. We can't wait for you to go home either. Unfortunately, the consultant decides that, not us.  And it is going to take him 8 hours to get here.

Get off your fucking mobile phone.  I have a grand 46 seconds with you to make sure that your blood glucose is stable and  get your prescribed drug regime that is due now into your system before I have to run back down the hall to make sure to special that patient who is going downhill. I will be stuck at his bedside for hours once I get there and there is no one else to cover you or my 10 other patients from that point onwards .   Lets make sure that I use this 46 seconds to make sure that you and my other 10 patients are stable and alive because I won't get another chance to check on you.  And no I am not going to make you a cup of tea because that will take 30 seconds thus leaving only 16 seconds to eyeball and action my other patients.

If you're in here for "COPD exacerbation", getting regular ativan because you're "nervous" because you can't breathe, maybe you need to stop going outside to smoke a pack of cigs every day. I'll give you a nicotine patch, but I won't help you go kill yourself, so feel free to "report me to the doctor" for not taking you out to smoke at 3 in the morning -- and if you DO go out, I'm taking your  nicotine patch off, I don't want to have to code you for no other reason than you wanted a buzz.

How can you be so nice when your family are so feral?  And my god, not only are they feral but they are stupid too.

This isn't a hotel and despite the uniforms we are not your maids/servants. We cannot wait on people and do our jobs at the same time.  And if I don't do my job people die. This is why I am NOT coming into your room every two minutes to change the TV channels. If I could do that for you I would.  But I can't.  If you think that this means I am mean and uncaring, you are a tit.  Anyway, if you can go outside to smoke every 6 minutes why do you need the nurse to change your TV channels? And no, I do not need a lecture about treating people like people and not numbers from someone who killed 3 people in two different accidents as a result of drunk driving.  If I can't get in here to change the channels for you then I can't get in here to change channels for you. Deal with it.  Maybe if you didn't watch so much damn TV you would not have such stupid ideas about what Nurses are here to do.

 Hell yes I took your father back to his room and shut the door in his face. I did, and I would do it again. He was looking in other pt's room's (females) while they were undressing.  He came in to a room to stare at a woman I was catheterizing.. He's alert and oriented, and able to walk and he knows how to use the call light, and he has no right to go into other pt's rooms and stare at them.

She accused me of making him feeling like a peeping tom..


But I didn't have the heart to tell her so.

Your complaints about 'the service' I am giving you aren't going to get you anywhere because I CAN'T HELP IT. There are 2 of us and 30 of you!  The goddman cadets sat at the station in their "just like a real nurse" uniforms aren't going to help! Here I am rushing around like crazy- you see me flying up and down the hall- and you, an alert, continent, and fairly able-bodied person, have the nerve to make whiny little passive-aggressive comments about how long you've been waiting for 'service'. All because you are jealous that the other man in your bay was getting constant attention!  He is a head injury requiring 15 minute neuro checks.  People like you are what is going to crash the NHS.  YOU. Not immigrants, single mothers and "overpaid" doctors.

To the adult son of the little old lady who just rolled onto the unit a little while ago....why no, there isn't a phone in this room, which I hadn't noticed because I've been too busy making sure your mother's pacemaker is capturing, that her incisions are WNL, that her observations are stable, that her pain is controlled, and that I can hear breath sounds on both sides. Sorry you were calling and calling and nobody was picking up...I guess I should get my priorities straight, huh?

I am a professional with a degree. Two of them, in fact. I am likely more educated than you and was also one of 70 accepted into a nursing school program with over 400 applicants.   I got you a blanket because you said you were cold and I had time to hunt one down.  I made some cups of tea for you guys because I lucked out this evening with all stable patients on very little drugs and drips. This does not mean that you should assume that I have nothing more than a high school education since I gave your good "service".  I actually am one of those degree nurses that you seem to detest. And I would love to tell you that. I would also like to tell you that you are an idiot.

I am just the person who checks your blood sugar and administers your insulin according to the results. Why don't you get pissed off with yourself instead of me when I have to call the medici about your blood sugar of 23 mmols.. I guess you think I have amnesia and don't remember that you already told me off earlier in the day when I tried to teach you that eating 10 burger king whoppers, with onion rings, while washing it all down with a liter of Coke might not be a good idea.  You also ignored me when I told you not to eat those donuts that your family brought in because it would raise your blood sugar.  And your family told me to fuck off when I reminded that that we were trying to keep your blood sugars under control.  And now that your blood sugar is so high that the meter cannot even give a reading you want to call me and your doctor "incompetents".  And still you are stuffing your face junk food.

Is this some kind of a joke?  I actually think most of your family members possessions are gross and I have no interest in stealing any of their clothing or shoes. So please stop drilling me with questions regarding their missing underpants or socks that probably got carried away with the laundry. Trust me I don't want them!  And I am not leaving the post op bleeder in room 17 to hunt down your mother's nightdress. And 9 times out 10 the care assistants and I are moving way to fast to even consider worrying about a stray sock that may have been taken away with the bedding.  Your mother is in hospital....why they hell are you worrying about socks and nightdresses?  I will happily give you £40 out of my own pocket to replace them.  As long as you promise to fuck off and stop asking me stupid questions about lost items when I have blood to hang and doctors orders to implement.

Sir, let me tell you -- you are ONE nasty old man. Yes, we "forgot" your breakfast, and for that, I apologized up and down and sideways, even ran to the kitchen to personally see to it you got a lunch tray. And how did you reward me? You lit into me about every single injustice done to you at this hospital, including, :HORRORS: having to be "last in line" in the x-ray line because YOU had a sepsis infection.  Well you wouldn't want us to spread your infection to everyone else  via the xray machine would you?   I mean -- dude, you are getting out alive. Yes, little things were missed. There was probably a team of 100 or more taking care of you these last 3 weeks. Do you ever wonder that perhaps just everyday human error in a large organization COULD result in a few glitches in your care? Are YOU fricking perfect? You certainly expect everyone else to be.

The truth is -- you were well taken care of in this hospital at a much higher cost than what you ever paid in. Most of the work that is done for you by the Nurses and Doctors goes unseen and happens out of your line of site. People waited on you at your beck and call, every god damn 15 minutes. You have been nothing but nasty to everyone.  Well, I hope people like you get what you deserve - whatever that may be. You are nasty and rotten to the core. You see people in service to you and you simply choose to demean them. I hope where ever you're going, that it's not someplace good. You are evil to the core. You live a great country, get decent health care from a struggling and overburdened system free at the point of delivery, yet you continue to complain because the hospital doesn't revolve around you and your wants and needs. Ugh. You make me SICK.  Violently so.

To the relatives of patient in bed 60, I'm sorry but I cant give him back his call bell,dressing gown cord,belt or tie as he keeps trying to hang himself with them. No I also will not give him his shoes,book or flask back as he keeps throwing them at the nursing staff.  Don't fucking ask me again or accuse me of "taking his stuff" or I will smack the fucking shit out of you. 

I'm sorry you got bumped for an emergent case, but the fact that you are not the emergency is a good thing to be grateful for, no?  I mean seriously...would you really want your hospital to refuse to give you a lifesaving operation right away when you have just been brought in from a car accident that ruptured your spleen because "the guy waiting for the hernia repair all day doesn't want to wait".  No you wouldn't.  So get a life. I just lost all respect for you.

I realise you don't want to care for your father because he's an incredible areshole. I don't blame you. However, I have a legal, ethical and moral duty  to take care of him, so stop with your guilt-driven inane complaints and requests, because unlike you, I have to actually make something happen for him and I can't go home and just blame everyone else when it gets too hard. Thanks.

Dude, honestly, do you really HAVE to drink over a GALLON of alcohol PER DAY? How do you do it? Do you also really have to smoke 2 packs a day on top of it? And, if you hate this place sooooooo much, and want to leave SOOOOO badly, why did you EVER present yourself to A&E in the first place??  Why do you keep doing this to yourself and then present yourself in A&E?  Why?  Why?  If the food is so bad and we are all stupid and worthless stop getting yourself admitted to hospital over and over and over again. We both know that there is nothing that the doctors can actually do for you and that you are only here for the free food, warm bed and morphine fix.

To my little old sweet lady in green bay you are SO sweet, SO well mannered. You were a joy today. And compared to the 3 rabble rousing drunks I had to deal with all day, you were like sugar and kittens. I thank you, and if the world had more like you, we'd all be so much better off.  I love you and I want to take you home with me.

I really don't care whether or not you take your damned pills. Do it or don't, but let's be quick about it because I have 8 more patients to see before I can pee.  No I can't leave them here and walk away.

No, sir. I can completely understand why you don't want to do your treatments. Yes, sir. It does suck. Literally. And I'm tired of trying to talk you into doing it. After all, it's your health, not mine. I will try to talk you into it three times everytime I come around to you.  And after that I will document that you refused.  Then I am off the hook when you try to sue over your hospital acquired chest infection or some other complication. 

OK, sir. I absolutely understand that you don't want me bothering you overnight to cough and deep breath, use your incentive spirometer, check your glucose, put your oxygen back on or turn you on your other side. But if I went away and left you alone as you desire, you'd get pneumonia, be reintubated, become hypo (or hyperglycemic) and develop a bedsore.   Really, there is not need for calling me a bitch for disturbing you when I am just trying to prevent the above complications.  I hope your next nurse does get pissed off and ignore you and you get bedsores and pneumonia.  You will really be calling the Nurses some awful names then.  But she won't because we always try to do our jobs despite your nastiness. And I will continue to be in here over night to make sure you are okay even though you are a jerk.

No, I'm afraid I can't tell you anything more about Daddy's bowel movement that he had at 1 a.m. as I wasn't here and all that was documented by the night nurse was that he had one. I'm sorry I have no further information." Darling daughter went all the way up to the VP of nursing to complain about this. What I wanted to say was, "Are you SERIOUS?" Your father isn't having any GI problems and this has nothing to do with why he's here. I think you are one sick cookie to block my way in the hall and ask was it runny? How many cups was it? What color was it? Did he grunt when he had it? Get a life!! It's people like you that give the whole human race a bad name."

For God's sake, let your mother get some rest. The quality of the care I give will not be improved by you sitting there and GLARING at me all day. Yes, I do know what I'm doing. As a matter of fact, I KNOW HOW TO DO MY JOB BETTER THAN YOU KNOW HOW TO DO MY JOB. No, I'm not just going to let your mom die, unattended, without doing anything, because we are not of the same ethnicity. If you can do better, take her home. Otherwise, get out of my way and stop asking the same stupid questions over and over again. And pass that on to your brothers and sisters while you're at it.

You have a pain rating of ten? Really? Wow, you must handle pain really well. The only time I had a pain of ten was during unmedicated childbirth, and during the height of that, there was no way I could have been talking on the phone, eating hamburgers or sleeping the way you are doing! Congratulations, you have a seriously high tolerance for pain!"

That's great that you'd like a diet black cherry vanilla coke with a little umbrella in it. I'd like a Martini after dealing with your fluid overload and high blood sugar that resulted from your non compliance with your doctors orders. . If wishes were horses, we'd all ride.

No, I don't know when the doctor is coming in. They don't answer to us. We are not in control of them. Sorry that you only come in for ten minutes a day with Grandma Millie and want the physician here to answer your questions right away so you're not late for your nail appointment.  You are so right.  Nurses and Doctors should always drop what they are doing and come running so that you are not late for your nail appointment.  I am glad you brought this complaint to our attention.

I realize you are claiming that we never gave you your call bell, but the truth is that your call ball was lost in your abdominal skin folds. Yes, it might be time to think about weight reduction.

We always give your grandfather your call bell, and he always knocks it out of reach.  And there is no way it is physically possible for me to get around to him as soon as he knocks the bell onto the floor.

We did show your grandmother how to use the call bell but as her dementia causes her to forget everything within 5 fucking seconds SHE FORGETS.

Hello, welcome to XYZ hospital: let's get three things straight off the bat: We don't control doctors, we don't control dietary, and we don't even know what is going to come through the door let alone what we will be doing 5 minutes from now.

Lets get realistic here. Supervisors and administration staff the place just well enough to keep people alive, that's it. Call bells are for "emergencies" and "immediate needs" only. Not for getting a tissue box moved to the other side of the table or having the temp. in the room changed.   Everyone loves the story "Little Boy who cried wolf" except when it applies to them. So many people abuse the bell so often for insignificant requests, when the request that actually justifies using the bell comes around they wonder why nurses aren't quick to respond.

For Christ's sake we do not have fucking GPS tracking on the doctors.  They have scores of patients to see, all over the place and if we page them to ask when they are coming it will only slow them down.  If anyone asks me again when the doctor is coming I am going to kill myself by sticking my head into the macerator.

For Christ's sake the doctors have scores of patients on multiple wards with many different Nurses.  They do not have time to check in with is usually.  I can usually only find out their plans by abandoning the patients to bury my head in notes.  Then you will accuse me of abandoning patients to bury my head in "paperwork".

Lady, if you haven't noticed, hospitals are short staffed. I am ONE woman to at least 12 patients and NO help. You perhaps could have called in and reminded me -- that would have been courteous. But the immediate needs of survival, pain, meds, and immediate care of my other  patients trumps your husband's need to get a better pillow for now.  Why yes I AM on the computer while your husband is "waiting for his pillow".  How else do you think I am going to be able to order and obtain the life saving drugs for the patient who is going to die today without them?  I get one shot at ordering and obtaining this stuff for that patient and I am not going to blow it searching the ward for a pillow.  Sue me. 

I do not appreciate your glares and your short attitude with me. You should be grateful that your husband is receiving care at all in this hospital, that you have access to health care and that doctors are working SO hard to find out why he's having repetitive fevers. Your husband is wonderful and very appreciative -- you, however, are an ungrateful wretch of a woman who thinks the world must revolve around you. You and others like you are the reason for problems in health care, in my opinion. But go ahead and bitch.  I feel the days are numbered as to how long hospitals and this economy can support bending over backwards for folks like you. There's going to come a breaking point -- and mark my words, you will be on the wrong side of it.

No I cant get your dad home any quicker as we are waiting for transport to get back to us. There is 5 inches of snow on the roads and the county has a shortage of grit so I kind of doubt he will be coming home today. Ringing us every 5 minutes will not get him home any faster, if anything it slows things down as transport can't get through as you are on the blinking line!!!Trust us, we want him out of here as much as you do.   How the fuck could we possible know when the ambulance will get here when they don't have anyway of even knowing that themselves?  Why do you refuse to accept any kind of explanation? Get a life.

I have no idea where your doctor is at this moment, and No, I cannot "get him on the phone" for you to complain about your minor "back spasms" you all of a sudden decided you have in addition to the million pound workup you're getting to rule out your other issues. Your doc will round when all the other doctors round, and he will be in here eventually. One doctor does NOT report into each and every nurse who is taking care of his 80 patients -- he truly does not. He also does not sit around all day waiting for us to call him about your hangnail -- I mean -- it's about the WAIT. And don't worry, when the time comes, you WILL be routed OUT of this place, as soon as is humanly possible. So, why don't you just lay back, enjoy the free room, TV, food service and nurse, and just go with the flow. Honestly, I'd give ANYTHING to be able to lie there for 3 days and do absolutely nothing but watch TV, eat, and be waited on. Why can't you just enjoy that? I mean, dude, I'd give ANYTHING to be able to do that -- what is so wrong about it?

On treating patients like they are my own family members; I have already warned my family members that if they mistreat hospital staff, I will personally strangle them. When my aunt was in the hospital my dad interrupted her Nurse while she was doing drug calculations for another patient to ask a dumb question.  Nurse Anne ripped her daddy a new asshole for doing that.
So, if I were in a situation where I was taking care of a relative, I would hope I would not over prioritize their "personal" needs (TV turned off and on for them, two water pitchers kept full at all times, dialing the phone for them) over the "medical" needs of other patients my relative's Nurse was caring for.   

The doctor told me to get you walking.  I know that we need to get you walking.   We must get you walking.  So when I asked you to walk to the toilet 5 feet away I wasn't being mean and I do not need lectures on "what you deserve because you have friends on the board" and " lack of compassion in Nursing". If I fetch and deliver things for you rather than making you do it for yourself you will get a blood clot and die, or you will get pneumonia and die.   You won't get better if your don't grit your teeth and start trying to move around.  Yes, I know it isn't fun.  But you are not an elderly patient who really cannot do these things for herself. You are a 39 year old woman!!

I know your mother wants to go to bed. She already told me. There is no need to follow me down the hall. I am dealing with a man who just transferred himself to the toilet. That's why the alarm went off. I can't drop everything and leave him sitting here unattended just to put your mother to bed. He is confused, unsteady on his feet and he WILL fall... SHE understands that- why can't you? And don't you dare waddle down the nurses' station and start bugging them about it while they are in handover trying to ensure that all bases are covered with all the patients. The oncoming shift has ONE shot to get all the info they need to start their shift.  An omission thanks to interruptions could lead to a fatal error. GO HOME. Also, when i do put your mother to bed please don't stand there and watch me like a hawk. This room is small and every time I turn around you are standing directly in front of something I need. Again, GO HOOOOOOOOOME.

Are you really sure you want your 100 yr old grandma that you left in the nursing home for the last 20 years to be for full and active resuscitation? Even though she has a feeding tube,is getting dialysis everyday, has all four extremities contracted, a very large unstageable pressure ulcer on her bottom that requires a urostomy AND a colonostomy, and hasn't been awake in 4 years?? So, You really want us to try and roll her to her back while her legs are curled up in the air and we can't pry her contracted arms away from her chest and then crack her ribs while we do CPR on her???  Okay then.  If my grandchildren do that to me rather than letting me go with dignity I will come back and haunt them to death.  I mean, my god........  What do your poor old grandmother ever do to you to you?  Why do you want to torture her with all this medical intervention?

Since you want us to call and ask permission for EVERY SINGLE thing that we do to your mom, I am just calling to ask you if we can put her on a bedpan now or would you like her to shit on herself in the bed? (this after daughter threw a fit when we took an emergency chest xray of her mom because she has pneumonia, copd, and chf and we didn't call her to ask permission) And YES you ARE allowed to come in every other day and throw a fit with the nurses and managers and DEMAND that the CEO come to the room RIGHT NOW to straighten out exactly WHYYYY your mom is getting omeprazole 40mg IV every morning. Please please talk to the managers and CEO right now actually. That way the managers and CEO will already know you are whacked out and crazy as a loon when you complain about me trying to reposition your mom every two hours.  There are patients and relatives making legit complaints and they don't get listened to because lunatics like yourself outnumber the people with genuine complaints 10 to 1.

If you can reach the call light that often, you can reach the

1. Kleenex

2. Water

3. Your magazine

4. Snacks

5. Blanket to pull up

6. Miscellaneous

since they are right next to the call light.

Seriously I have something like 8 minutes per patient per 12 hour shift.  And I need to cover about 1000 bases during those 8 minutes with you.Use your time wisely.

NO. This is actually YOUR job. There is nothing wrong with your hands. You are completely independent. The nurses help out people who can't do things for themselves. You can empty your own pouch. And when you leave here, who is going to do it for you at home? I understand you are frustrated but please don't blame it on me or the other nurses. It's an important part of your therapy that you be as independent as possible. I won't hesitate to help you but I won't do things for you that you perfectly capable of because it would only hurt you in the long run.

For relatives/visitors: we are not sitting here chatting, we are in handover. Would be nice if I could magically know all about my patients without it, but I can not. When you interrupt handover, it takes longer for me to get to your family member for their (non-urgent) request. When I tell you to go press the patient buzzer so the nurse looking after the patient can help you, the key phrase is nurse looking after the patient, who is not me - so don't come back in 5 minutes to give me an update.  If I am not assigned to a particular patient I cannot get involved for SAFETY reasons.  This isn't 1952.  I have enough liability and work on my shoulders just with my assigned patients. It has nothing to do with "not wanting to be bothered" you freak.

When I tell you that I can't make icepacks for you because we have an emergency with another patient, but you're welcome to make one up yourself:

1) don't tell me you don't know how - I worked it out and so can you; hint, they involve ice, a plastic bag and a pillowcase;

2) don't come wandering up to where all the drama is to have a look and get in the way - go back to your room;

3) don't buzz for me again 5 minutes later, I'm still trying to help this nearly dead girl by actioning her doctors orders.  Quickly.  At minimum it is going to be hours before I can get back to my other patients. This girl is ill. 
4) oh, she doesn't look that sick to you? I'll just tell the crash team that the patient in bed 24 thinks that the young girl with a blood sugar of  0.7mmol/L (27mg/dL) and a core temp of 31.4C (88.35F) is fine and they can leave.

All in a days work.  Sigh.

Thanks to for making this post possible.
Details have been changed to protect confidentiality.  You will not be able to identify anyone from these posts.

University of Florida - Rankings

The University of Florida (UF) is a top public research university located in Gainesville, Florida, United States. It is one of the "research flagship universities" within the State University System of Florida designated by the Florida Legislature.

The University of Florida has the following Colleges: College of Agricultural and Life Sciences; College of Dentistry; Warrington College of

Wednesday, December 29, 2010

Nurse Practitioner Jobs Advanced Practice Jobs PA jobs

NP jobs Nurse Practitioner Jobs, PA jobs Physician
Assistant jobs, Advanced Practice Jobs, ARNP jobs, Nurse Practitioner
Resumes, Nurse Jobs, Physician Jobs, CRNA jobs, Advanced Registered
Nurse Practitioner Jobs,Advanced Practice Provider,Advanced Practice


A day in the life of an ER nurse part 1

What a day!

Every day in public health nursing is a new day with new challenges, new faces and loads of obstacles! Having come from LTC – it’s a whirlwind to say the least!

After a Holiday and a Monday at that, I begin to wonder if I will ever see the bottom of my paperwork pile… probably not today. The phone rings and another patient need more medication. I place them on hold, just long enough time, that my provider asks me to check the vaccination record. The patient on the phone gives me her number and her pharmacy information – I give her a promise that I will speak with her Doctor and call her back. With that cleared up, I begin to getting the Childs vaccinations, first by checking the child’s name through the state registry. It shows that the child is due for her regular 6 month shots and is due for the flu vaccine as well. I step into the patient’s room and ask the young mother if she would like the flu vaccine. To which I get a puzzled look and an “I don’t know if I should or not”.

Sitting down next to her I begin to carefully explain the pros and cons of flu vaccine. Eventually the patients’ mother agrees to the vaccine. I leave the room to go to the lab to draw up her daughters’ vaccines ready, As I finish preparing the vaccines and having them double checked by another nurse. As I grab Information for the patient’s mother, I hear behind me, “Hey Chrissie… I think I’m going to give willingly!” there sits behind me, a patient in the blood draw area!

WHEW It’s only been an hour… but I love it!!!

What Would Wee Fergus Say

IT IS one of those games which congregations of fans of a particular team indulge in at this time of year, perhaps when they are forced to sit in a pub of a Saturday afternoon, because their team's game has been called off. That game is: pick your all-time greats.

Greatest manager/goal/captain/win/whatever; the discussion will make many a slow afternoon pass quickly, cause a few real arguments and test friendships to the limit.

The ultimate form of the game is - pick your greatest team, wherein one guys shoo-in will surely be on another guy's list of biggest diddies ever to shame the jersey.

I doubt if the fans have ever played: pick your greatest director, after all, it is the lot of the men who back their club with hard cash, who have to make some of the hardest decisions, to be universally despised by the paying punters, most of whom would give their eye teeth for the kudos, while running a mile from the responsibilities.

I suppose, in any debate about who was Scotland's greatest club director, wee Fergus McCann would be on most short leets. After all, that mighty Scottish institution Glasgow Celtic FC was minutes away from bankruptcy when the slight wee man from Croy, no doubt wearing his trade mark bunnet, stepped in to take charge.

Celtic has never been the same since, as the sleeping monolith, seemingly dedicated to providing a nice life style for "the families" was shaken-up, kicked into life and finally began to make real money.

Fergus was one director who kept his word - he said he would step-in, put Celtic's woes right, set the club in the right direction, then get-out, but only after allowing the fans to have their say.

He opened-up the shareholding and if a good proportion of the fans whom he converted into shareholders subsequently sold out, allowing another small cadre of money men to take control, well that wasn't Fergus's fault.

Fergus also drove a hard bargain in negotiations, as an accountant he knew the price of everything, but, unlike so many others in his profession, he also knew the value of things.

Sure, he sanctioned the purchase of some big-name players, notably the "Three Amigos" - Cadete, De Canio and Van Hoojdonk, but he knew enough about running a football club to insist on good management.

I don't for a moment think Fergus would have handed the reins to such an untried tyro as Neil Lennon, after all, Tommy Burns was already cutting his managerial teeth at Killie when handed control at Celtic Park. With hindsight, the job probably came too-soon for one of the all-time Celtic legends, but, it was never the gamble appointing the ginger one was.

I also don't think Fergus would have tholed the recent transfer activity which Lennon and Tony Mowbray indulged in. It seems to some of us that over the past couple of seasons, Celtic's buys have all-too-often been buying for buying's sake, rather than a studied approach to getting a winning team onto the park.

Fergus would certainly have approved of developing and opening Lennoxtown and of that relatively unpublicised Celtic initiative of getting some hand-picked youngsters into a Kirkintilloch school and into Lennoxtown on a daily basis.

But, I also feel, having made the financial commitment to Lennoxtown and youth development, he would have insisted that the top youngsters be thrown onto the park far more readily than Neil Lennon seems prepared to do.

I know all about the argument that neither half of the Old Firm can gamble on youth, that they have to win every match and that winning matches calls for experienced players. That said, I also believe: if they're good enough, they're old enough and when you look at the impact which just one unheard of Lennoxtown product, James Forrest, made when introduced at the start of the season, you wonder: surely there are others out there worth giving a chance.

David Marshall, Paul Caddis, Scott Cuthbert, Marc Miller, Rocco Quinn, Rod Wallace, Des Lafferty, Michael McGovern,Cillian Sheridan - just a few of the Celtic youngsters to have won Under-21 or full caps in the last five years, who have been allowed to leave. I accept that not all might have matured to be "Celtic Class", but I vouch, they would not have been the waste of money which too many recent foreign acquisitions have proved to be.

In short, if he was still in charge, I feel wee Fergus would be saying plenty to Neil Lennon about his acquisitions policy - and not all of it would be complimentary.

MBA Programs in Norway

List of top MBA programs in Norway:

BI Norwegian School of Management
- BI's Executive MBA programmes in Norway are offered in partnership with internationally recognised institutions. The programmes are taught entirely in English.
- BI is accredited by EQUIS (European Quality Improvement System), one of the leading international business school accreditation systems within the global community.

Tuesday, December 28, 2010

Physical Therapist (Bethel Connecticut United States)

Attention: Great Salary, licensed Physical Therapist, Apply Now!
Location: Bethel, Connecticut (local candidates preferred)
Job Description: Licensed Physical therapist will be working with rehab
patients for a great company.
Job Requirements: Licensed Physical Therapist.
Benefits: Highly competitive base salary plus full benefits.

To apply to this job or to get more information on this or many other Great Jobs please visit Or email your resume to


IBI/ABA Therapist (Greater Toronto Ontario Canada)

Looking to hire a instructional Therapist to work with children with Autism using principles of Applied behavior analysis (ABA) and to implement Intensive behavior intervention (IBI). Individual hired for this position will be working in homes providing one on one therapy.
Candidates must have experience working with children on the ASD spectrum and 1-2 years experience working with young children in IBI setting environment. Training provided.
Permanent, part-time position. All candidates must have a vehicle and be willing to travel to York region and GTA.
Please visit and apply through the link or email your resumes to

Cleaner (ottawa Ontario Canada)

Immediate position for cleaners. Positions available include day, full time and part time to clean commercial and residential clients. Must possess a valid G or G2 drivers licence. Must have an outgoing personality with a good command of English. Bilingual is an asset and not a requirement. Must be able to work well with others as well as under pressure. No experience necessary. Various positions available as follows:   Carpet and Furniture cleaning Duct cleaning Window cleaning House cleaning Office cleaning Post construction clean up Move in/move out clean up Strip and wax floors.

How to Apply:-

To apply to this job or to get more information on this or many other Great Jobs please visit Or email your resume to


Registered Practical Nurse. (Barrie Ontario Canada)

How to apply please go to the link below.

Healthcare and Caregivers needed worldwide

Hi and good day,

Find a Better Job Faster at or let us know if you need more help.

CC: to

Have a great day

The Price of Freedom is Eternal Vigilance

ONE of the advantages of a classical Scots education is, those of us schooled north of the Solway, who sat O Grades and Highers, rather than O and A Levels are aware that England and Great Britain or the United Kingdom are separate entities.

This fact is often lost on our Sassenach neighbours, who seem to have immense difficulty figuring out where England ends and Great Britain begins. Even Shakespeare, arguably England's greatest man of letters thought England was "a sceptred isle", rather than one of three distinct parts of said island.

This England/Britain thing is currently to be seen in regard to the presence of "British" football teams at the forthcoming 2012 London Olympiad. We have all seen the political machinations regarding this team, which eventually brought the compromise, whereby the "British" football teams, men's and women's in action in 2012 will be English teams, playing under the GB banner.

The compromise which brought this team into being is designed to ensure the independence of the four United Kingdom football associations is recognised by FIFA, while allowing the British Olympic Association to field football teams.

Fair enough, the negotiations were long and at times fraught. but, in the end London got what it wanted - a "British" football team at their Olympics, while the independence of the Irish, Scottish and Welsh FA's was recognised.

But, were the English happy? Apparently not, for, while we up here have been navel-gazing and debating whether we should have a 10, 12, 14 or 16-club SPL, down south, the sports pages are buzzing with stories that factions within the FA, who are football's representatives within the BOA, not to mention non-football people within the BOA itself, are suggesting that individual Irish, Scottish and Welsh footballers should be approached to put themselves forward for selection in 2012 - to ensure a proper British football team.

Given that Allan McGregor and Craig Gordon of Scotland are arguably Britain's top two goalkeepers at present, while Welshman Gareth Bale has been the stand-out British player in the English Premiership this season and given further than Bale plays for a London club, Spurs, who are keen to move into the Olympic Stadium once the Games close - pressure will surely be exerted to ignore their 0wn FAs and make themselves available for the 2012 team.

Given further, the way club football apparently trumps international football in this country just now, it is not beyond he realms of possibility that one or more player from the three Celtic nations will break ranks and declare him or herself willing to pull on a Great Britain strip in 2012.

Such a move will be manna from heaven to the likes of the odious Jack Warner and his acolytes, that faction within FIFA determined to see the four British FAs cut-back to a single British FA. With Mr Warner no doubt thinking he is the perfect man to claim one of the three British places on IFAB, the supreme law-making body in football, which would become surplus if the four "Home Nations" were to become one Home Nation.

This cannot be allowed to happen. But, the trouble is, while the English would surely make all the right noises about, how sorry they were that, after the success of the Great Britain team at 2012, it was inevitable that there should only be one British team playing in the World Cup, the European Championships and so forth and this British team HAS to be English-dominated.

They would surely be outraged that FIFA had gone back on its solemn promise to respect the independence of the four Home Nations, but, after all, the FIFA guys who have decided that four should be one, thereby breaking their promise of continued independence for all four, are the same guys who promised "the future King of England" that England would host the 2018 World Cup.

Should, as a result of one or more individual Irish, Scottish or Welsh players caving-in to English "come and join us" blandishments, a "British" team be legitimised and the nightmare scenario of FIFA declaring that henceforth the (English) FA, IFA, SFA and FAW would be no more and a single GBFA would run the game in these islands, then the English would surely, since they cannot distinguish between England and Great Britain, think they'd be running things.

Then, it would be up to the three "Celtic" nations to stand together and put as many spanners in the English works as they possibly could. Stopping the English FA steamroller will be difficult, but, for the sake of Scottish and Irish and Welsh football, stopped it must be.

Medical Schools in Italy

Following are some of the top leading medical schools in Italy:

University of Bologna
- The Faculty of Medicine of the University of Bologna is ready to compete with other leading European universities in the vocational training of doctors, both in cultural and in organisational terms.
- University of Bologna is ranked 176th among world's top universities (QS World University Rankings 2010).

Anxiety | Nursing Care Plan for Glaucoma

Nursing diagnosis: anxiety physiological factors, change in health status, presence of pain, possibility or reality of loss of vision; unmet needs; negative self-talk

Possibly evidenced by
Apprehension, uncertainty
Expressed concern regarding changes in life events

Desired Outcomes/Evaluation Criteria—Client Will
Anxiety Self-Control
Appear relaxed and report anxiety is reduced to a manageable level.
Demonstrate positive problem-solving skills.
Use resources effectively.

Nursing intervention with rationale:
1. Assess anxiety level, degree of pain experienced, suddenness of onset of symptoms, and current knowledge of condition.
Rationale: These factors affect client’s perception of threat to self, potentiate the cycle of anxiety, and may interfere with medical attempts to control IOP.

2. Provide accurate, honest information. Discuss probability that careful monitoring and treatment can prevent additional loss of vision.
Rationale: Reduces anxiety related to unknown or future expectations and provides factual basis for making informed choices about treatment.

3. Encourage client to acknowledge concerns and express feelings.
Rationale: Provides opportunity for client to deal with reality of situation, clarify misconceptions, and problem-solve concerns.

4. Identify helpful resources.
Rationale: Provides reassurance that client is not alone in dealing with problems.

Disturbed Visual Sensory Perception | Nursing Care Plan for Glaucoma

Nursing diagnosis: disturbed visual Sensory Perception related to altered sensory reception: altered status of sense organs—increased IOP, ocular trauma or infection, cataracts; biochemical imbalances—hyperglycemia/diabetes

Possibly evidenced by
Reported change in sensory acuity—photosensitivity, visual distortions, progressive loss of visual field; measured change in sensory acuity

Desired Outcomes/Evaluation Criteria—Client Will
Sensory Function: Vision
Maintain current visual field and acuity without further loss.
Risk Control: Visual Impairment
Participate in therapeutic regimen.
Follow prescribed medication regimen.

Nursing intervention with rationale:
1. Ascertain type and degree of visual loss.
Rationale: Affects choice of interventions and client’s future expectations.

2. Encourage expression of feelings about loss or possibility of loss of vision.
Rationale: Although early intervention may prevent blindness, client faces the possibility of or may have already experienced partial or complete loss of vision. Although vision loss cannot be restored (even with treatment), further loss can be prevented.

3. Recommend measures to assist client to manage visual limitations and provide safety, including reducing clutter, arranging furniture out of travel path, turning head to view subjects or objects, correcting for dim light, and problems of night vision.
Rationale: Reduces safety hazards related to changes in visual fields or loss of vision and papillary accommodation to environmental light.

4. Explain the importance of medication administration as ordered by the physician.
Rationale: Proper understanding may increase the client’s motivation and participation in treatment plan.

5. Demonstrate and have client or significant other (SO) administer eye drops using correct procedures—placement of drop, counting drops, adhering to schedule, and not missing doses.
Rationale: Although burdensome, lifelong treatment is needed to control IOP and prevent further loss of vision.

6. Miotics, also called cholinergic agonists: for example, pilocarpine (Isopto Carpine, Ocusert, Pilopine HS gel)
Rationale: These drugs cause pupillary constriction, facilitating the outflow of aqueous humor and lowering IOP. Note: Ocusert is a disc (similar to a contact lens) that is placed in the lower
eyelid, where it can remain for up to 1 week before being replaced.

7. Anticholinesterase miotics: for example, demecarium (Humorsol), echothiophate (Phospholine Iodide), and isoflurophate (Floropryl)
Rationale: These drugs are used for management of glaucoma not controlled with short-acting miotics. Note: Because of their potential for serious side effects, some authorities prefer
surgery rather than use of the drugs (Glaucoma Research Foundation, n.d.).

8. Beta-blockers: for example, timolol (Timoptic), betaxolol (Betoptic), levobetaxolol (Betaxon), and carteolol (Ocupress)
Rationale: These drugs decrease formation of aqueous humor without changing pupil size, vision, or accommodation. Note: These drugs may be contraindicated or require close monitoring
for systemic effects in the presence of bradycardia or asthma.

9. Carbonic anhydrase inhibitors: for example, brinzolamide (Azopt) and dorzolamide (Trusopt)
Rationale: These drugs decrease the amount and rate of production of aqueous humor. Note: Systemic adverse effects are common, including mood disturbances, gastrointestinal
(GI) upset, and fatigue.

10. Prostaglandin agonists: for example, bimataprost (Lumigan), Latanaprost (Xalatan), and travaprost (Travatan)
Rationale: Drugs in this class are commonly prescribed drops for increasing outflow drainage of aqueous humor. Note: May be preferred over beta-blockers because of lesser degree of systemic affect; however, may cause more redness of the eye than other drugs.

Monday, December 27, 2010

Do not buy an infrared sauna products that are in front of you, before you read this article

Various infrared sauna products on the market. But you need to know some major things that become infrared sauna guide you select is indeed the best product.

Infrared sauna are recommended by many doctors to help cure various diseases such as inflammation, lose weight, lower cholesterol and reduce blood, while also as a detoxification of the body. Toxins that enter the body such as mercury, lead, car emissions, tobacco, hundreds of other pollutants that come every day, can be eliminated through the use of infrared sauna. Detoxification using infrared sauna can also be intended to increase the energy in the body, burns calories, lowers blood pressure as well as pain relief.

Of the various benefits that can be obtained from the infrared sauna is, of course you do not want one vote, which resulted in you waste a lot of money and not getting the maximum results.

Then, what must be considered to be able to determine a product's infrared sauna is actually the product that provides benefits or not?

1. There are two types of infrared sauna sold in the market, made of ceramic and carbon based. Infrared sauna are made from ceramics to produce infrared through small glass tubes that are placed strategically throughout the sauna. Unfortunately they can only produce so much heat and they do it by running at very high temperatures. This causes there are areas that have sufficient infrared heat, while others do not. But it is different infrared sauna is made from carbon, producing heat much better and evenly, even up to 572 square inches infrared heat, compared infrared sauna are made from ceramics only 56 inches square.

2. Whether or not the seal ETL. ETL stands for Electrical Testing Laboratories This is one of the seven most difficult materials to obtain approval. It basically convince you that your sauna is 100% electrically sound from the control panel to the wire. Without this seal, it is possible sauna you are not in accordance with certain electrical code and can be electrical hazards.

3. Make sure the company that offers infrared products to you, use Carbon technology ave 360 in component infrared sauna products.

Want to be healthy, not hurt you to understand the guide above.

Hospice Nursing: The reason you became a nurse. (Wellesley, Newton, Quincy, Braintree) USA

Hi Danvers based Hospice of the North Shore is the largest not-for-profit hospice in Massachusetts. With hospice care, palliative care, the Kaplan Family Hospice House and the Center for Grief and Healing, we provide a continuum of services that are unmatched in Massachusetts for the last 30 years! Hospice of the North Shore is a desirable place to work; with extremely low employee turnover, incredible job stability and an employee focused philosophy that makes us one of the most highly rated hospices in Massachusetts.
Frquently heard by our recruiter when nurses call about our jobs: "I became a nurse to care for patients, but I feel like I don't take care of patients anymore. I miss the hands on experience". If this is you, perhaps hospice is the calling you are now ready for. Hospice nurses not only provide medical care for the patients, they also coordinate the support and many times, provide the shoulder for family members to cry on when their loved ones pass. Hospice nursing is not sad, it's an EMPOWERING PROFESSION! We make a postive difference in the lives of patients and family members every day. It's not uncommon for our staff to be recognized and get hugs from the families of patients years after their loved ones have died.

If you:

Love patient care
Know your meds
Are not shy about taking charge in chaotic situations
Love to laugh
And drink deeply from the cup of life
Then you are ready to become a hospice nurse!
We have immediate needs for RN Case Managers to provide end of life care to our patients. Some of our patients are being cared for in their homes, others are being cared for in LTC and ALF facilities and we also have the priviledge of caring for hospice patients in our hospice house, the Kaplan Family Hospice House. We've split our homecare and ALF/LTC teams into two North Shore areas: one from Tewksbury to Salisbury, the other is from Bedford to Everett. Call us and we will further explain how the areas are broken down for our travelling staff.

Here's a brief list of the nurses we need:

RN, WE Admissions/Liaison, 24hrs/wk, Sat-Sun, 8A-8P
RN, On Call, Nursing, 70hrs biwkly 4:30p-8am, 7 days on, 7 days off
RN, Homecare-South, 40hrs/wk, M-F 8A to 4:30P, Beverly, Peabody, Lynn, Salem and neighboring towns
RN, Homecare, 40hrs/wk, M-F 8A to 4:30P, Wellesley, Waltham, Milton, Needham, Norwood, Quincy, Braintree, Boston, Newton and surrounding towns (3 positions)
RN, LTC/ALF, 40hrs/wk, M-F 8A to 4:30P, Wellesley, Waltham, Milton, Needham, Norwood, Quincy, Braintree, Boston, Newton and surrounding towns (3 positions)
Admission Liaison RN, , 40hrs/wk, M-F 8A to 4:30P, Wellesley, Waltham, Milton, Needham, Norwood, Quincy, Braintree, Boston, Newton and surrounding towns (3 positions)
Float RN, Homecare/ALF/LTC, 40hrs/wk, M-F 8A to 4:30P, Wellesley, Waltham, Milton, Needham, Norwood, Quincy, Braintree, Boston, Newton and surrounding towns (1 position)
As a member of the interdisciplinary team, the Registered Nurse works under the supervision of a Clinical Manager and the attending physician in the provision of skilled nursing assessment, planning and care in order to maximize the comfort and health of patients and families.
Professional Registered Nurse, currently licensed in Massachusetts.
Responsible for identifying patient/family needs and for providing supportive care in accordance with the attending physician's orders and plan of care and Hospice of the North Shore policies and procedures.
Preferably a bachelor's degree in nursing.
Minimum three years of varied work experience as a professional nurse, with a minimum of 1 year in a LTC or Assisted Living facility.
Demonstrated ability to assess and respond to the needs of patients and families in varied settings.
Skilled in nursing practice, able to cope with family emotional stress and tolerant of individual lifestyles.
Demonstrated understanding of hospice philosophy and principles.
Demonstrated ability to be self-directed, flexible and cooperative in fulfilling role obligation.
and ability to work effectively within an interdisciplinary team.
Must be a licensed driver with an automobile that is insured in accordance with state and/or organization requirements and in good working order.
We demand a lot from our staff, but Hospice of the North Shore is committed to giving a lot back as well. We offer an incredible time off allowance for you to re-charge your batteries, a solid compensation and benefits package that includes a 403B AND a pension plan (very rare these days!), all in a very supportive and collaborative environment. We have pizza parties, recognition programs, drop of the hat celebrations and we even field a pretty decent softball team! Work is work, but we know the kind of work we're in, so we have a little fun when we can. We take our work seriously (we just don't take ourselves that seriously) and feel honored to be in the field that we're in.

Not sure if you qualify? Interested RNs (we respectfully request that only RNs call at this time, please), call 978-223-9722, or email your resume to the email listed above. Feel free to check out our website career page at

When Should You "Give Up" on trying to become a doctor?

Yucky question huh?

Well, contrary to popular belief, I don't think it has anything to do with taking the MCAT a certain number of times, or with how many times you've applied to med school. I personally know a physician that I used to work with that applied 12 times to medical school. Granted, that must have been at least 20 years ago... I am not even sure if you can do that now... but the point is that the time to give up has nothing to do with how many times or how long you've tried to get in.

But there is a time when you SHOULD give up. I bet you didn't think I was going to say that, did you? Well, there is. It's when you know, in your gut, that your priorities in life have changed... and pursuing doctordom is more about ego and proving you can do it than it is about actually becoming a doctor. The main thing I want to convey is that THAT IS OK! Nothing to be ashamed of. Everyone changes everyday... as do your wants and goals. I look back on lists of things I said I wanted to do in life. Many of them I've done. Many I haven't. Like "get my pilot's license". I haven't done that. But I don't consider it a failure because I no longer have any desire to do it. What-so-ever.

I think it takes true courage to be able to detect the difference between being determined and feeding your ego. I struggled with this alot because I think I was on the cusp when I applied the last time. Thankfully, I still really want to be a physician and I am loving it. But maybe 5 years from now I wouldn't have felt the same about the admissions process.

So ask yourself the tough questions. And assess your true desires. The REAL ones. Would you rather get married asap? Have a family now? Let things stay simple? Pursue a creative or entrepreneurial career? Do you REALLY want to give up the next 10 years for this? Any answer is ok... as long as it really reflects you and not your ego.

MSc Nursing Raj Kumari Amrit Kaur College Admission 2011

The Raj Kumari Amrit Kaur College of Nursing, Lajpath Nagar, New Delhi- 110024, has invited applications for admission to two-year Master of Nursing Course commencing on 16th July, 2011.

Applicant must have passed B.Sc Nursing. B.Sc (Hons) Nursing (12+4 years) of the University of Delhi/B.Sc Examination in Nursing (12+4 years) of a recognised as equivalent thereto with 55% marks in the aggregate and should have one year experience in Nursing in an approved hospital/educational Institution or public health agency OR must have passed B.Sc. (Hons) Nursing examination (11+4 years) of the University of Delhi/B.Sc. Examination in Nursing (11+4) years of a recognised as equivalent thereto with 55% marks in the aggregate and two years of experience in Nursing is an approved hospital/educational institution or public health agency.

Application form and Prospectus will be available from 3.1.2011. They can be obtained from The Raj Kumari Amrit Kaur College of Nursing, Lajpath Nagar, New Delhi-110024, till 15th February, 2011, on production of a Postal Order or Bank Draft for Rs.400/- taken in favour of the Principal, Raj Kumari Amrit Kaur College of Nursing, Lajpath Nagar, New Delhi-110024. Request for applications by Post should reach the Institute latest by 7th February 2011.

Filled applications with necessary documents would be accepted at the Institute between 2 pm and 5 pm on all working days. The last date for receipt of filled applications is 19th March, 2011 (Saturday). Selection will be based on a test to be conducted on 19th March, 2011.

More details can be had from website of the Institute is

A clear telephone voice and high speed internet from a single product, will it?

Have telephone access at home is fast, reliable, no noise, no drops, and do not resonate, certainly a desire of each family. Sometimes the phone is noisy, echoing drops and, likely affected the weather in the area where you are or also from the cable installation is not perfect, also did not rule from the product itself.

On the other hand, has a high-speed internet network also becomes a necessity in the era of advanced today. Almost all the houses, including you would want unlimited internet connection and with a high speed.

Did you know? Call an audible voice and high-speed Internet connection can be obtained from the product Ooma Hub. Additionally, Unlimited calls to U.S. phone numbers, Caller - ID, Call Waiting, Voice Mail with access from another phone, high-level audio quality, reliability, ease and very quickly in the install, except that there are up to 1 year warranty for you, is benefits offered by the Ooma Hub. In addition, during the sixty days given probation worth $ 12.95 per month.

If in the past and even today, you pay monthly for each of your phone features: such as long distance calls, local toll calls, taxes, additional fees, call waiting voice message now using the Ooma hub-that's all you have to pay for everything. No special handset is required. You do not need to enter the complex call.

With the installation of an easy, clear voice quality, and speed Internet connection, is expected to be able to solve problems in your relationship to anyone.

Sometimes Faster, It's Much Better

Buying a new car or a motorcycle, has a new home, will certainly be a very fun, happy and proud for everyone, including his family. But do you ever think to maintain the condition of something you already have is still better.

Of course, anyone would really want something which he had bought with great difficulty, will remain well preserved. There is a saying from most people, if your goods will not damaged it should not be used! If you want is not lost, just stored in warehouse!

But from a different point of view, it turns out there is a reliable solution that can be selected to protect the vehicle, home, your wealth. Use Insurance!. Not just insurance.But insurance issued by a company really guarantee the benefits granted to their customers. Car insurance seattle for instance, browse further. Find out more testimony on car insurance seattle. Do not wait for an unwanted incident happen to you. And soon Insure a car, motorcycle or your home. Because of faster, sometimes much better.

Top Biosciences Programs

Top leading UK universities for Biosciences programs:

University of Birmingham
- The School of Biosciences was rated 5 in the 2001 Research Assessment Exercise and has been consistently rated ‘excellent’ for teaching quality.
- The School has major high-technology facilities for research in genomics, proteomics, metabolomics, structural biology and optical imaging.

University of Salford
- The

Sunday, December 26, 2010

If You Know Their History

I AM from a generation who were actually taught Scottish History at school - not just Wallace, Bruce, Mary Queen of Scots and John Knox. Sadly much of it has now "gone" from memory, but, there is one constant throughout the history of: "Ra greatest wee peeple Goad ever pit braith intae" - feuding and fighting.

Forget Montagu and Capulet, Hatfields and McCoys, English and Germans; if you want to see real mutual animosity, simply stand in the middle of any resedential street in Scotland - we truly are a war-like people, and if we cannot finttish nobles d an excuse to have a go at the common enemy, those awfully nice people south of the Tweed and the Solway, well, we'll simply fight amongst ourselves.

The clan wars gave way to Ayrshire Junior Football; the Border Reivers used to steal each other's cattle, now they make do with enticing rugby players to the next town to play; the religious wars of the 16th century are still fought at least four times per year at Ibrox and Celtic Park.

Braveheart was, in truth, a lot of tosh, but, that bit towards the end when the Scottish nobles rode away, leaving Mel and ra boays to face certain defeat at the hands of the English sort of sums Scotland up. Nothing in it for me, I'm out.

And that's the still-alive position which will in all probability derail hopes of real change in Scottish football. Rangers and Celtic will, as ever, do what best suits their common purpose, to lord it over everyone else: the diddy SPL teams, whose only goal is to keep their snouts in the Old Firm money bowl, will scream and scream until they are sick, to stay at the top table; we'll atrophy further, until, probably when we've nowhere else to go - the English will step in and bail us out, at vast cost to us.

Football in Scotland is in a real mess, the McLeish proposals were not perfect, but they offered us a possible way out of that mess - I just don't think the guys running the game have the wit to do what needs to be done.

Forget history, forget self-interest, just do what's best.

MPH/MBA Dual Degree Program

Top universities offering MPH/MBA dual degree programs:

University at Buffalo
- The School of Management and the School of Public Health and Health Professions at the University at Buffalo offer a collaborative program leading to the award of Master of Business Administration (MBA) and Master of Public Health (MPH).
- The Wall Street Journal ranked the UB School of Management No. 9 in the nation

Saturday, December 25, 2010

9 Tips for Creating the Not Forgotten Party with DJ Services

Sadly, if your special event, just forgotten. Especially by people who came to meet your invitation. Moreover, by some people from your distant family. Weddings are mediocre, perhaps it is commonly done using a single organ or orchestra wither as entertainment.

If you like something different, using DJ Services, can be used as alternative options. As did most people in Atlanta, there are many people who use DJ to enliven the atmosphere of their party. That way rental business DJs in Atlanta mushroomed. One of Atlanta DJ Premier.

However, like the others, rental of DJ also experienced the same thing, it is not impossible with the number of persons or companies providing such services, will be increasingly difficult to determine which is best. If you choose the wrong, not just money that will be lost, but your event will be destroyed, and not remembered for a festive atmosphere, but because your event is not fun.

Well, there are 9 simple tips that can be used as a guide to choosing a professional DJ rental service, especially DJs in Atlanta, and can be used in your area.

1. Experience
Do you ever use the services of DJ before? If so, what is the deficiency or excess of your previous choices. Use this as a consideration to select the DJ at your next activity.

2. Reference
It would be nice, there are people who refer to the experience of one of the best DJ for your use. The strength of the testimony of people close to you based on experience that does not disappoint, will have an impact both on the show you created.

3. Backup Tools
Is the DJ that you rent, have backup equipment they will bring in during the day of your event? This gives you the assurance that there would be problems because of damage to equipment. In the event of equipment failure, could be replaced with backup equipment.

4. Detailed Planning
Very little, planning the details about how the DJ will carry out their duties. How does their song list? How many songs and music provided? The more details you know, it's getting easier to determine which DJ you'll use.

5. Beware of middlemen
In any case, sure that his name brokers are very upset. We are fooled by their sweet promise, but in reality, not the same as what he was talking about. He uses personal DJ service with a relatively very cheap price, even below the standard price. But you will be charged a relatively high. You lose money, your event would be destroyed. Make sure you use a DJ that will truly professional, do not use the services of middlemen who promote their services.

6. Source Music
Various types of music that covers all styles of danceable music, like from the Big Band Swing Era, is something to be said compulsory to carry. Reliable DJ will not only convincing to yourself that they have many sources of music, but they'll convince yourself with the ability and musical knowledge they possess.

7. Wedding
If a DJ service that you rent you use to perform the ceremony, reception and also provide entertainment. Make sure that the sound system setting they are really good, if need be separate, so that the resulting sound does not collide. Setting sound system should be first, and try not to impede the flow of visitors. Make sure the beginning about this before you make a choice.
8. Price
Price will determine the extent to which DJ service that will rent. But you do not be afraid, in the Premier Atlanta DJs, costs will not be a problem, there are various option packages that you can customize to your budget. Be open with a DJ service that will choose, if he is really professional and reliable, he would give the best to customers, including their price.

9. Choose carefully and wisely.
Too expensive, not necessarily good results. Very expensive, not necessarily a good outcome. Too Low or Very Expensive is not enough. But with the various considerations and openness to your needs, professional DJ equipment will put the best possible outcome for customers. Compare services from one another. But the DJ set on the services that really help your dreams come true, the event is not forgotten. Good luck in choosing!

Christmas at My House!!

Top Universities in Venezuela

Central University of Venezuela is the highest ranked institution in Venezuela (ranked 400th in the world) according to the world university rankings 2010, followed by University of the Andes (rated 702nd globally). The Central University of Venezuela (or Universidad Central de Venezuela) is the oldest university in Venezuela and one of the oldest in the Western Hemisphere. The

Impaired Gas Exchange | Nursing Care Plan for Respiratory Alkalosis

Nursing diagnosis: impaired Gas Exchange related to ventilation-perfusion imbalance, such as altered oxygen supply, altered blood flow, altered oxygen-carrying capacity of blood,
alveolar-capillary membrane changes

Possibly evidenced by
Dyspnea, tachypnea
Changes in mentation
Hypocapnia, tachycardia

Desired Outcomes/Evaluation Criteria—Client Will
Electrolyte and Acid-Base Balance
Demonstrate improved ventilation and adequate oxygenation of tissue as evidenced by ABGs within client’s acceptable limits and absence of symptoms of respiratory distress.
Verbalize understanding of causative factors and appropriate interventions.
Participate in treatment regimen within level of ability or situation.

Nursing intervention with rationale:
1. Monitor respiratory rate, depth, and effort; ascertain cause of hyperventilation if possible, for example, anxiety, pain, and improper ventilator settings.
Rationale: Identifies alterations from usual breathing pattern and influences choice of intervention.

2. Assess level of awareness and cognition. Note neuromuscular status—strength, tone, reflexes, sensation, and presence of tremors.
Rationale: Decreased mentation (mild to severe) and tetany or seizures may occur when alkalosis is severe due to shifts in calcium.

3. Instruct and encourage client to breathe slowly and deeply. Speak in a low, calm tone of voice. Provide safe environment.
Rationale: May help reassure and calm the agitated client, thereby aiding the reduction of respiratory rate. Assists client to regain control. Note: Clients with hyperventilation syndrome as a cause of their respiratory alkalosis may particularly benefit from reassurance and client education in breathing techniques.

4. Demonstrate appropriate breathing patterns, if appropriate, and assist with respiratory aids, such as rebreathing mask or bag.
Rationale: Decreasing the rate of respirations can halt the “blowing off” of CO2, elevating PaCO2 level and normalizing pH.

5. Provide comfort measures; encourage use of meditation and visualization. Use tepid sponge bath or cool cloths.
Rationale: Promotes relaxation and reduces stress. Control and reduction of fever reduces potential for seizures and helps reduce respiration rate.

6. Provide safety and seizure precautions, such as bed in low position, padded side rails, frequent observation.
Rationale: Changes in mentation and CNS and neuromuscular hyperirritability may result in client harm, especially if tetany or convulsions occur.

7. Discuss cause of condition, if known, and appropriate interventions and self-care activities.
Rationale: Promotes participation in therapeutic regimen and may reduce recurrence of disorder.

8. Assist with identification and treatment of underlying cause.
Rationale: Respiratory alkalosis is a complication, not an isolated occurrence and rarely requires emergent treatment (unless pH is greater than 7.5); thus, correction of alkalosis is undertaken by addressing the primary condition, such as hyperventilation of panic attack, organ failure, severe anemia, and drug effect. Because respiratory alkalosis usually occurs in
response to some stimulus, treatment is unsuccessful unless the stimulus is controlled.

9. Monitor and graph serial ABGs and pulse oximetry.
Rationale: Identifies therapy needs and effectiveness. Note: Rapid correction of PaCO2 in individual with chronic respiratory alkalosis (has a lower serum bicarbonate) may cause metabolic acidosis to develop.

10. Monitor serum potassium and replace, as indicated.
Rationale: Hypokalemia may occur as potassium is lost via urine or shifted into the cell in exchange for hydrogen in an attempt to correct alkalosis.