Monday, January 31, 2011


I just found out that my best friend's dad has pancreatic cancer. I can't believe it. I saw him at her wedding in October and he looked healthy and a very young 61. Of all fucking cancers, of all fucking people. I can't believe it. I can't believe it.

Work As A Registered Nurse, The Emotional Rewards Are Awesome

Why should someone become a registered nurse? The largest health care job in the United States today is nursing. Nurses (RNs) are in very high demand and short supply in today's healthcare industry, largely due to to an increasing consideration on preventive care, the expected long-term care needs of a growing elderly population, and technological advances in patient care, causing a greater number of health problems to need treatment.

Those wishing to enter this demanding but satisfying profession should first take a little time to become familiar with what registered nurses do and also with the necessary steps a person will need to take in order to become a registered nurse.

So what exactly does a registered nurse do you might ask? If you want to become a registered nurse, you'll be in a job that allows you to have an large impact on the life and health of people. Depending on specialization, the nurse can work in a big array of medical specialties.

Those specializing in a particular ailment, disease, or health condition can work in virtually any type of setting, including physicians' offices, outpatient treatment facilities, home health care agencies, and hospitals. Do you want to become a registered nurse yet?

Whether you enjoy working with the geriatric or pediatric population, they all have their emotional rewards and challenges.

A certain subset of Nurses, known as Nurse Practitioners (Nps), have an advanced level of nursing education after they become a registered nurse and provide a broad range of more advanced health care services.

These specialized registered nurses can write prescriptions in most states. They can open their own clinics too. They are considered primary health care providers as they conduct physical assessments, order tests and x-rays, and diagnose depending on their defined their particular scope of practice.

According to the United States Department of Labor Bureau of Labor Statistics, the average earnings of the registered nurse was $61,450, this was for 2009. If you work in education when you become a registered nurse the earnings decline by about $10,000 a year.

Those working in education (often as school registered nurses) earn about $10,000 less than their peers working in hospitals, but may have the advantage of more vacation and daytime work hours. Become a nurse to enjoy these benefits!

If you want to get more information about the registered nurse job description click over to now

The Progress Of Registered Nurse Careers In These Times

You've been thinking for some time now of whether to become a nurse or not. You would like to understand the details of what being a nurse has for you and will you actually be joyful in it.

Take a look to discover what will make a registered nurse so self-fulfilling. Below are chief aspects of why a person may take a job as an RN:

1) Great returns for your investment. Because of the invaluable bestowal of the nursing staff to the medical business, policy makers make sure nurses are adequately rewarded for the skills they bring to the work place. The salary can further increase depending on skills added as well as the length of employment.

As well, a registered nurse is afforded with several allowances especially in terms of health care for their family and them. More good news is that presently administrators are lobbying to advance the pay of health care professionals to increase retention and to lower the high turnover.

2) High demand for RN's. There is no denying that everyone at some point of their lives needs medical care. Especially today with the number of newer diseases being discovered along with the type of lifestyles that persons practice, medical efforts should be increased more than ever.

An Rn works as an invaluable member of the health care team in regulating the function of CNAs and LPNs to give the best care possible. Furthermore, there is also an always increasing old citizenry which will need constant health care to maintain optimum health or to die in comfort.

3) Skill based employment. As an RN, you can work in a wide range of settings from long term facilities to hospitals depending on what you want to do. For folks wanting a chance to learn new things everyday and diversity, seeking a job in hospitals gives you a wide range of situations where you can increase your bag of knowledge and skills.

For those wanting constancy and structure in their work, being in a skilled nursing facility will give you a more relaxed job which will come with getting good at the many skills you will need to work adroitly.

If you want to get more information about being a registered nurse salary click over to now

The Awesome And Interesting Arena Of A Forensic Registered Nurse

Forensic nursing is a Course that involves both the person's understanding of nursing and forensic sciences. Their chief calling is to draw together attestation from the suspects or survivors of violent crimes to support in the processing of a crime case prior to the handing out of law.

Because of the fact that crimes are constantly occurring, possible even in the deprivation of the public, the registered nurse who has the forensic knowledge are in great demand. For example, there are forensic gerontology specialist, forensic nurse investigator, sexual assault nurse examiner and many more to professionally handle crime cases.

Probably, the more distinctive activity that requires forensic nursing is sexual assault, coming before death investigation, medical-legal consulting and forensic psychiatric nursing. Usually the nursing will take photos and gather evidence if there is rape or sexual assault cases.

The information collected will be imperative into determining the possible suspect. it's also the job of the nursing to cross referencing the DNA component into the database to check if the criminal has a record. But if the victim knows the criminal then taking the person into custody would be easier as they can couple the DNA with the fragment obtained from the suspect.

for cases that involve death, forensic nursing will have the duty of assisting the coroner in the crime scene. they'll collaborate to decide the death cause of the victim, more distinctly the coroner would. So fundamentally the nurse has the calling of directing psychiatric evaluation of a convict or suspect.

Their evaluations will be evidence to determine if a culprit is justifiable for a trial. Even inmates who've been released and pardoned from jail can be subjected to similar tests in order for them to seek employment.

To get enrolled for the forensic nursing course, you need to first be aware the content of forensic study. The summary emphasizes on criminal justice system, perpetrator theory, interpersonal violence, victimology, and forensic mental health.

Also, students will be required to practice experience under the preceptor of a forensic doctor or professional nurse. From the curriculum, you can further advance your studies into your master's degree or go into education.

To get more information about becoming a registered nurse click over to today

Have You Been Thinking About Becoming A Peds Nurse?

Being a pediatric nurse is one of the distinctive types among the assorted nurse jobs that distinguish the nursing profession from all the other occupations. A pediatric nurse can specialize in emergency departments, performing important procedures such as catheters for collecting stool and urine samples, conducting eye exams, starting IV's, and getting vital signs of temperature, heart rate, respiratory rate, and blood pressure.

They are responsible for giving intramuscular and intravenous medications and are involved in a great deal of parent and patient counseling. Apart from these, the other duties of a peds nurse comprise blood administering, performing toe to head assessments and helping patients with broken bones or splinting. It's recognizable due to the area and scope of their job that a pediatric nurse performs a number of multiple procedures, so, having a crucial function in treating all types of patients.

A pediatric nurse needs basic tools that are important for earning success and expertise in the concerned industry. It's also important for a peds nurse to make the best use of the sense organs for effective and better assessments.

Peds nurses usually use sphygmomanometers and stethoscopes for the examination of the various organs of the patient such as lungs, heart, and abdomen. They also check blood pressure. The other common tools used by the pediatrics department include cardiopulmonary monitors for tracking respiratory and heart rates, the Snellen eye chart for checking the patients' vision, and thermometers for getting temps.

Specialized training is needed for being employed as a peds registered nurse that can be attained by taking internal training programs given by the health care facility where the nurse is currently employed. Certified programs are also available after commencement for nurses who are interested in specializing in peds.

Various schools give special classes addressing Pediatrics. Some of the courses include Peds Advanced Life Support (PALS), through the American Heart Association and Emergency Nurse Pediatric Course through the ER Nurses Association. Nurses may also get involved in varied nursing societies of pediatric registered nurses.

To get more information about becoming a registered nurse click over to now

The Critical Care Registered Nurse - Helping The Patient With Life Threatening Issues

The Critical care nurse nurse has the role of helping individuals who need difficult care, the high intense therapy, and continuous care. This type of nurse should have specialized knowledge, skills, and experience to give the patient and the family members the correct treatment . Its also important that critical care nurses can create the correct environment to help the patient so the patient can be healed. To make it simple, the critical care nurse is the patient's supporter.

Critical care nurses fill assorted roles from nurse educators, bedside clinicians, nurse managers, up to the nurse practitioner. The job of nurses now is not only to cure the patients.

If you want to become a critical care registered nurse, you will practice in the assorted fields like pediatric, adult, and even neonatal nursing practice. You will find the nurses in the area with critically ill patients such as intensive care (ICU), pediatric ICUs, the Cath lab, telemetry units, progressive care, emergency departments, etc.

There will be a critical-care training course that you must pass prior to becoming a critical care nurse. The training will provide you the information and the knowledge you need to treat the critical patients. It is also a good idea if you have the certification since many prospective employers like to hire certified registered nurses. The certification refers to the higher level of intellectual grasp and has more specialized experience.

Relating to the task, the registered nurses are educated with the ability beyond their basic education as the RN or the Registered Nurse. The advanced ability is a must since they deal with critically ill patient and family members which sometimes have more needs than ordinary patients.

As it is stated above, until you can be a critical care nurse, you have to be a RN or Registered Nurse. However, the requirement is different from country to country. You can see the student's exposure in many nursing schools. To become a registered nurse means you have to get an ADN or bachelor degree in nursing (BSN) and successfully pass the exam for your state license.

If you want to get more information about becoming a registered nurse go to now

Become A Legal Registered Nurse Consultant

Being a registered nurse requires compassion for people and medical knowledge. These two skill sets a combination of career qualifications. Altogether the area of patient care in a health service or location such as a nursing home or hospital facility is another aspect of registered nursing that can be a lucrative and highly in demand career known as legal nurse consultant.

These practitioners are highly sought by attorneys who need their expertise in the reading of medical records and evaluation of those records and how they may relate to the case facts under litigation.

What are the demands to become a certified legal nurse specialist? Certainly the education of a nurse and the complete accreditation and licensure of the bodies in your locale are wanted, the same as any nursing program. In addition to that background there are many classes that deal with the law and the legal system that are needed to get the profession change on track.

If you wonder what type of programs are at one's disposal, you can very easily locate them by checking online. There many registered nurse programs that give the coursework needed to make the break from direct patient care to the court room and all of the research and preparation that'll be required to testify as an knowledgeable witness when called to do it.

Some of the things that are conducted by certified law registered nurse specialists are preparation and research of legal papers that can be used in a trial or proceeding to support a client's responsibility concerning medical claims or health related issues. There are a variety of case forms that can require the service of the nurse and those types of cases can include, worker's compensation, medical malpractice, product liability, or injury claims.

Recognized Legal Nurse specialist jobs are well compensation and the base pay is taking in to account the hours that the professional has spent in training and preparing to present their evidence to the judge. This is a career that offers a mix of health and legal ability, and it is a alluring part of the registered nursing field.

If you want to get more information about being a registered nurse go to today

Exactly What Is The Nurse Symbol?

In the registered nursing field the registered nurse symbol is used to display the accomplishment of completing nursing school. It has come to be a symbolic representation of how the nursing profession, and health care in general, is a caring and nurturing one for over the last century.

The Registered nurse Symbol, or caduceus, is really a wing-topped staff, with two snakes winding about it, carried by Hermes of Ancient mythology, given to him By Apollo.

The symbolic representation of separate intertwined snakes appeared early in Babylonia and is related to other serpent symbols of fertility, wisdom, and healing, and of sun gods. This staff of Hermes was carried by Greek heralds and ambassadors and became a Roman mark for neutrality, truce, and noncombatant status.

This symbol has been the insignia of the healthcare branch of the U.S. Army since 1902. The nurse symbol, or caduceus, is much used for this purpose much like any other symbol would be used for services such as the Postal Service, commerce or ambassador positions. Since the 16th Century it has replaced the Asclepius one serpent symbol as the image of choice for medicine.

Even though the registered nurse symbol is thought by some to be a negative mark on the profession, it's still a positive symbol for those of us who work as a registered nurse in the field. No matter what the nurse symbol might seem like to others, to the common public it still remains a image from the nursing and medical fields generally.

This goes on to give the public a comforting feeling as they know how it's linked to healthcare in general. No matter the association with ancient mythology, the nurse symbol is regarded by most to be a positive image.

Many medical organizations use the Caduceus, or nurse symbol, of two winding serpents around a staff, topped by two wings, which is the staff carried by the god messenger Hermes. This symbol was the protector of merchants and thieves, and conductor of the dead. Its meaning is 'heralds staff' from the Greek word karykeion. Itself based on the word 'eruko' meaning restrain or control.

The registered nurse symbol or caduceus is used by other types of organizations, these are generally commercial or military in the U.S. Countries like New Zealand uses include pharmaceutical companies. A study confirmed that the connection of the caduceus and medicine was solidified around the 7th century A.D.

The link between the caduceus of Hermes (Mercury) and medicine seems to have come about by the seventh century A.D., when Hermes had come to be linked with alchemy. Alchemists were referred to as the sons of Hermes, as Hermetists or Hermeticists and as "practitioners of the hermetic arts". There are occult associations with the caduceus.

The caduceus, or nurse symbol, was the magic staff of Hermes (Mercury), the god of commerce, eloquence, invention, theft and travel, and so was a symbol of commerce and heralds, not medicine. The words caduceus and caduity mean temporality, perishable and senility, while the medical profession espouses renewal, vitality and health.

If you want to get more information about being a registered nurse click over to today

Being A Pediatric Registered Nurse Can Be A Wonderful Experience

Any job in nursing requires a high level of compassion, knowledge and caring of the field. There are different registered nursing specialties available to these health professionals all of which are arduous in their own right. Those choosing pediatric nursing answer the call to care for the youngest patients.

The age range that the pediatric nurse is historically responsible for is from birth until the age of 18. The pediatric nurse is usually the primary education resource for the parents, and can work in such varied areas as physicians offices, clinics and even home health.

In addition to basic registered nursing qualities, pediatric nurses must possess other unique qualities in order to deal with this patient population. Patience is a virtue for sure for the pediatric nurse. Everyone knows how frightened and unpredictable a child can be when it comes to getting a shot, or if blood needs to be drawn.

The pediatric registered nurse has to be able to be a great communicator with the care givers, and also be compassionate of their needs, of the children they take care of. The pediatric nurse can be instrumental in calming the parent of the child during an ill visit, because parents will sometimes be more distraught than the child.

In a helping profession like nursing, the main benefit is caring for people, and problem solving. This reward can be intensified in pediatric registered nursing. Pediatric registered nursing gives people the opportunity to care for a patient population that generally can't care for themselves. Pediatric registered nurses give knowledge to parents on how to properly care for their children's health needs, and they ease the concerns of new parents.

One of the common misconceptions about the career of the pediatric registered nurse is that their job is not as stressful as other areas of nursing. This could not be further from the truth. As a pediatric registered nurse you face stress daily in your job. For some the stress is greater. In any career where your job is caring for the well being and health of another human being, there will always be stress.

As a pediatric nurse there are several certifications you can attain through training such as the Pediatric Advanced Life Support (PALS) and the certified pediatric nurse certification from the Pediatric Nurses Association.

If you want to learn more about the registered nurse job description go to today

The Nice Benefits Of Being A Registered Nurse

Because of the want of registered nurses nationwide, the medical community is on the lookout for individuals who want to step up for the vacant jobs. Fortunately, discovering men and women who are willing to become part of the registered nurse community is not that hard, because of the numerous inducements which are known to accompany this job.

In the beginning, a registered nurse was paid a comparably lower pay in exchange for taking care of the ill and helping in medical situations. Years ago, they were bestowed lowly tasks, which were at any rate relevant to the way that hospitals were run.

Fortunately, current years have borne out a large difference on the exceptional responsibilities that a nurse has; and with this change in duty description comes a change in which registered nurses are given, too.

Being a registered nurse requires one to get through the echelon of registered nursing tasks, every level of which has its own challenges. One could begin as a certified nurse assistant, for example, before they make their way to being a nurse. Progressing this way will arm one with the exposure that he needs to do the job well.

additionally, getting the accolades for being such a integral role in the medical community, a registered nurse also gets satisfaction out of understanding that she has played a large part in providing the patient the assurance that they need during different situations. In addition to this, nurses also get satisfaction in the notion that hospitals cannot operate without them, mainly because they tend to the paper work and other tasks that the other members of the health care community fails to attend to.

For their efforts, the nurse will receive higher pay and benefits. One might not get a salary that's as lucrative as that of doctors, but there's no doubt that a nurse will receive enough for the work that will be required of him. There are also times when perks are offered, like with winter seasons and for graveyard shifts, for example.

To learn more about becoming a registered nurse click over to now

Work As A Registered Nurse, The Benefits Are Awesome

Why would you want to be a registered nurse? One reason is because registered nurses make up the biggest segment of health care workers in the United States. In today's health care community, its never been a greater time to become a registered nurse due to the emphasis on preventative care, an ever increasing elderly population, and increases in technology. Which all come together to make an environment that is starved of registered nurses.

Those wanting to enter this demanding, but noble, career should take some time first to familiarize themselves with what the registered nurse does before trying to become a registered nurse.

So what does a nurse do you may ask? If you want to become a registered nurse, you'll be in a career that enables you to have an big impact on the health and life of people. Depending on specialization, the nurse can work in a large array of health acre specialties.

Become a nurse and you can work in such settings as physicians offices, outpatient clinics, hospital facilities, home health and anything in between. You can also specialize in specific ailments and illnesses.

Also, as you become a registered nurse you may decide to specialize in a certain organ, and find yourself working in research or in an ICU. The sky's the limit when you become a registered nurse because you can work for a surgeon, for example, and your 'office' would be a surgical suite in an outpatient or hospital surgery center. Love older people? Then specialize in geriatrics and reward yourself emotionally by helping this unique population.

Some registered nurses go on to become registered nurse practitioners. These are registered nurses who have advanced masters' degrees who can not only prescribe medications, but in some states open their own clinics. They are considered primary care givers doing a lot of what a physician would do as a primary care giver.

These specialized nurses can even write prescriptions in many states. They can even open their own clinics as well. They are considered primary health care providers as they conduct physical assessments, order tests and x-rays, and diagnose depending upon their defined their defined scope of practice.

According to the U.S. Department of Labor Bureau of Labor Statistics , median annual earnings of nurses were $62,450 as of May 2010. Median income for nurses who work in hospitals (where 60% of all RNs work) was $63,890.

Those working in education (often as school registered nurses) earn about $10,000 less than their counterparts working in hospitals, but may have the advantage of additional vacation and daytime work hours. Become a nurse to enjoy these inducements!

To get additional information about the registered nurse job description click over to today

NP jobs Advanced Practice Jobs PA jobs

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Assistant jobs, Advanced Practice Jobs, ARNP jobs, Nurse Practitioner
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Nurse Practitioner Jobs,Advanced Practice Provider,Advanced Practice


Central Michigan University - Rankings

Central Michigan University (CMU) is a leading coeducational state university located in the U.S. state of Michigan. It is one of the nation’s 100 largest public universities.

Central Michigan University is accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools, one of six regional accrediting associations in the United States. The College of

Sunday, January 30, 2011

Medical billing and Receptionist for berlin Germany (Germany jobs)

Cornerstone Assisted Living, an 84-unit assisted living and memory care facility located in World Wide, has a wonderful part-time opportunity for a Billing Clerk/Receptionist. Primary focus will be payroll and billing with secondary backup receptionist duties and tasks. The position offers up to 30 hours per week, including every other Saturday.As a ministry of Elim Care, we work hard to be an employer of choice within the senior housing and healthcare industry. We have a wonderful culture and personality at Cornerstone which includes a dedicated, talented and caring staff.Join our mission of compassion,innovation and excellence.

Visit Us:

Online Nursing Degree Programs

Institutions offering online nursing degrees and programs:

Florida Hospital College of Health Sciences
- The online Bachelor’s degree in nursing allows students to learn completely at a distance and earn the degree without traveling to a campus.
- Florida Hospital College of Health Sciences is regionally accredited by the Southern Association of Colleges and Schools, Commission on Colleges.

Saturday, January 29, 2011

Risk for Ineffective Breathing Pattern | Nursing Care Plan for Spinal Cord Injury

Nursing diagnosis: risk for ineffective Breathing Pattern

Risk factors may include
Impairment of innervation of diaphragm (lesions at or above C5)
Complete or mixed loss of intercostal muscle function
Reflex abdominal spasms; gastric distention

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Respiratory Status: Ventilation
Maintain adequate ventilation as evidenced by absence of respiratory distress and ABGs within acceptable limits and pulse oximetry maintained at 90% or greater.
Demonstrate appropriate behaviors to support respiratory effort.

Nursing intervention with rationale:
1. Note client’s level of injury when assessing respiratory function. Note presence or absence of spontaneous effort and quality of respirations—labored, using accessory muscles.
Rationale: C1 to C3 injuries result in complete loss of respiratory function. Injuries at C4 or C5 can result in variable loss of respiratory function, depending on phrenic nerve involvement and diaphragmatic function, but generally cause decreased vital capacity and inspiratory effort. For injuries below C6 or C7, respiratory muscle function is preserved; however, weakness and impairment of intercostal muscles may reduce effectiveness of cough, ability to sigh, and deep breaths.

2. Auscultate breath sounds. Note areas of absent or decreased breath sounds or development of adventitious sounds, such as rhonchi.
Rationale: Hypoventilation is common and leads to accumulation of secretions, atelectasis, and pneumonia—frequent complications. Note: Respiratory complications are among the leading causes of mortality, not only during the acute stage, but also later in life.

3. Note strength and effectiveness of cough.
Rationale: Level of injury determines function of intercostal muscles and ability to cough spontaneously and move secretions. Highlevel paraplegics and all tetraplegics lose the ability to cough and are at greatest risk of developing atelectasis and respiratory failure.

4. Observe skin color for developing cyanosis or duskiness.
Rationale: Skin color may reveal impending respiratory failure and need for immediate medical evaluation and intervention.

5. Assess for abdominal distention and muscle spasm.
Rationale: Abdominal fullness may impede diaphragmatic excursion, thus reducing lung expansion and further compromising respiratory function.

6. Monitor and limit visitors, as indicated.
Rationale: General debilitation and respiratory compromise place client at increased risk for acquiring upper respiratory infections (URIs).

7. Monitor diaphragmatic movement if phrenic pacemaker is implanted.
Rationale: Stimulation of phrenic nerve may enhance respiratory effort and decrease dependency on mechanical ventilator.

8. Elicit concerns or questions regarding mechanical ventilation devices.
Rationale: Open discussion acknowledges reality of situation.

9. Provide honest answers.
Rationale: Future respiratory function and support needs will not be totally known until spinal shock resolves and acute rehabilitative phase is completed. Even though respiratory support may be required, alternative devices and techniques may be used to enhance mobility and promote independence.

10. Maintain client airway: keep head in neutral position, elevate head of bed slightly if tolerated, and use airway adjuncts, as indicated.
Rationale: Clients with high cervical injury and impaired gag or cough reflex require assistance in preventing aspiration and maintaining patent airway.

Risk for Urinary Retention | Nursing Care Plan for Disc Surgery

Nursing diagnosis: risk for Urinary Retention

Risk factors may include
Pain and swelling in operative area
Need for remaining flat in bed

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Urinary Elimination
Empty bladder in sufficient amounts.
Be free of bladder distention, with residuals after voiding within normal limits (WNL).

Nursing intervention with rationale:
1. Observe and record amount and time of voiding.
Rationale: Determines adequate voiding and bladder function.

2. Palpate for bladder distention.
Rationale: May indicate urinary retention.

3. Force fluids.
Rationale: Fluid intake helps maintain fluid balance and renal perfusion.

4. Stimulate bladder emptying by running water, pouring warm water over perineum, or having client put hand in warm water.
Rationale: These maneuvers relax the urinary sphincter thus stimulating urination.

5. Perform ultrasound bladder scan or catheterize for residual after voiding, when indicated. Insert and maintain indwelling catheter as needed.
Rationale: Helps determine the amount of urine in the bladder. Intermittent or continuous catheterization may be necessary for several days postoperatively until swelling is decreased.

Constipation | Nursing Care Plan for Disc Surgery

Nursing diagonsis: Constipation related to pain and swelling in surgical area, immobilization, decreased physical activity, altered nerve stimulation, ileus, emotional stress, lack of privacy, changes and restriction of dietary intake

Possibly evidenced by
Decreased bowel sounds
Increased abdominal girth
Abdominal pain or rectal fullness, nausea
Change in frequency, consistency, and amount of stool

Desired Outcomes/Evaluation Criteria—Client Will
Bowel Elimination
Reestablish normal patterns of bowel functioning.
Pass stool of soft or semiformed consistency without straining.

Nursing intervention with rationale:
1. Note abdominal distention and auscultate bowel sounds.
Rationale: Abdominal distention and absence of bowel sounds indicate that bowel is not functioning. Possible cause would be the sudden loss of parasympathetic innervation of the gastrointestinal (GI) system.

2. Use fracture or child-size bedpan until allowed out of bed.
Rationale: Careful movement promotes comfort and reduces muscle tension.

3. Provide privacy.
Rationale: Promotes psychological comfort.

4. Encourage early ambulation.
Rationale: Stimulates peristalsis and thereby facilitates passage of flatus.

5. Begin progressive diet, as tolerated.
Rationale: Solid foods are not started until bowel sounds have returned, flatus has been passed, and danger of ileus formation has abated.

6. Provide rectal tube, suppositories, and enemas, as needed.
Rationale: May be necessary to relieve abdominal distention and promote resumption of normal bowel habits.

7. Administer laxatives or stool softeners, as indicated.
Rationale: Soften stools, promote normal bowel habits or evacuation, and decrease straining.

Medical Schools in Uganda

List of top medical schools in Uganda:

Makerere University School of Medicine
- It is the school of medicine of Makerere University, Uganda's oldest university.
- The School of Medicine is made up of the following units/departments: Department of Internal Medicine; Department of Surgery; Department of Obstetrics and Gynecology; Department of Pediatrics and Child Health; Department of Radiology

Friday, January 28, 2011

What it is like.

Back to the Medical Ward. Yay.


My 13 hour night shift was due to end  at 0700; at which time I have to be ready to give report to the oncoming Nurse.

Starting  at 5AM I had to:

Start a magnesium infusion, give calcium gluconate and  start an IVI with K then an addiphos infusion and take off a whole load of other doctors orders for a patient with deranged U+E's.  The addiphos probably won't go up till day shift. He could have crashed at any moment with a K that low and I didn't want to leave him.  He had bloods done over night and the results came back at 04:30. The doc wrote the new orders just afterward.  I had to run around like a nut just to find some magnesium to start and of course document every aspect of all of this.  All had to go through a central line.  As you know this is time consuming. 

I needed to get vital signs and obs on all 19 of  my patients by 7 AM.  If you wake the patients up before 6 to start getting all their obs they get angry.  If I didn't start before 6 they would never got done and we would potentially miss the signs of a deteriorating patient.

I had to IV fluids on someone with renal failure.  I had noticed his rubbish output at midnight but it took until 04:30 to get the doctor as he was the only doc on for multiple wards.  Bloods hadn't been done for days on this patient and I needed to draw them.

I was also trying  to keep the 02 on another patient, a confused patient who was desaturating without it and kept taking it off his face.  He has disorientation secondary to sepsis so he could not understand me when I asked him to keep it on.  He needed a mask rather than a nasal cannula.

At this time I also had to obtain,, mix, and administer 15 (yes fifteen) IV antibiotics for 8 patients that were prescribed them.  This has to be done by 0800.  Day shift starts at 0700 but doesn't even get out of handover until nearly 0800 so they can't do it. I had to do them and finish them by 07:30 AM.

I had 5 patients ask for controlled analgesia during this two hour window.  This again is very time consuming.  The system for obtaining and administering controlled drugs is a joke.

During this window I also had to be up to date on the current status of all my 19 patients. For example any little thing that changed with them on my shift I need to be onto right away.  Examples of this include changes in observations, neuro observations. fluid balance, blood sugars etc.  I had 5 diabetics.  I need to act on every little thing and document it and it all needs to be done right now.
I had to act on the fact that I just noticed that my patient who is being treated for a UTI is completely unresponsive with a low BP.  Had to call the doctor and wait for him to get around to calling me back.  Fast IV fluids ordered as well as a million other things that needed to be done ASAP.
Two patients who needed IV antibiotics woke up and pulled their IV cannulas out.  Two others pulled out their urinary catheters.  It was like a blood bath for all 4. 

I needed to monitor the patient on the IV insulin infusion closely.  His blood glucose still isn't right.  Something is wrong about this.  Her consultant wanted her to stay on this infusion over the weekend.  All night long I had told the house officer that the insulin infusion and the iv fluids that get hung with them were running out and that he needed to prescribe more so that I could hang more on the patient.  The only time the doctor came was at 4:30 in the morning.  I handed him the chart but he put it down and "forgot" to prescribe it before he got bleeped away somewhere else.  Called him again and he said that he couldn't "come back to your ward" for awhile.

I had to deal with the fact that a patient woke up in agony with a blocked catheter.  It needs irrigating.  It was draining a few hours ago.

Remember all this is what got thrown my way between 5 AM and 7 AM. I was the only RN for double digit patients.

There were two lots of IV frusemide to give. 80mg. They need to be set through a pump.  Got to watch those BPs because even though they are borderline (and I wouldn't give it if they were a smidge lower) these two chaps really need it.

I didn't want to leave the side of any one of these patients.  But my god.  Just standing in the treatment room mixing and preparing all these IV drugs is extremely time consuming.

I had to leave a few of the antibiotics for day shift.  Day shift was so busy that they didn't give the 8AM meds that I didn't give until nearly noon.

I got a phone call at 0600 to take a direct admission from A+E as there are no beds anywhere else.  The A&E nurse gave me report on my new patient. He is a drunk and combative alcohol patient who fell and hit his head. They  want neuro obs every 15 minutes.  He is sleepy but when he wakes up he knocks stuff over and hits. I didn't want to take this patient because the only empty bed I have is in a bay with 5 nice but frail confused elderly men.  He will need a lot of admission stuff doing as soon as he gets to the ward i.e. paperwork to get his admission orders sorted..  The rest of the admission paperwork and all other legally required documentation I will knock out after my shift ends by staying over unpaid.

And that is just some of it.  If I went into all the knowledge I have to have to manage those things we would be here all day.   If I fucked any of that up just this much I could be held responsible for someone's death.   Nurses are legally responsible for delivering the orders given by a doctor and monitoring patients.  And my list reflects my doing just that.

That was my lot to carry and carry alone.  I was the only qualified Nurse for those 19 20 patients There is no way that I can articulate on this blog how long it takes to prepare and mix and infuse and flush etc etc all those IV meds that were prescribed and due.  It takes a lot of time away from the patients.  Real hospitals have 24 hour pharmacies that make it their job to stay on top of new orders and mix and prepare and get to the Nurse these IV meds when they are do to be given.  My NHS hospital DOES NOT have this.  Even during the 9-5 hours that they are open they do not do that.  They just develop more paperwork for the Nurses to fill in so that we can actually get the drugs and not get fired for a med error by omission (not giving a prescribed drug to a patient on time).

The only help I had was a teenage cadet called Beth.  There was nothing in the above list that she could help me with.  Nothing. She cannot even do observations/vital signs or check blood sugars.  She is not a Health care assistant or a Nurse. I wish I had that lovely HCA from the surgical ward with me.  He was mint. Beth  refused to empty the catheters so that we could monitor an accurate fluid balance  because "that's gross".

Between 5AM and 7AM this is what Beth had to do:

Change a few beds
Help people to the toilet.
Answer call lights and tell patients that the Nurse will be there as soon as possible.  This confuses them since they think that she is a Nurse.  She is wearing the same uniform as me after all.
Serve hot drinks at 7AM (she puts a trolley together and just blows past anyone who appears to be asleep rather than waking them up and encouraging fluids). 

I would rather just do the drinks myself have seen my list of jobs happening at this time.
If anyone pees or drinks she needs to measure it and write the value on the fluid balance chart.  She didn't bother because she doesn't understand the point. As a matter of fact I asked her to do just that whilst my arms were loaded with IV meds, vital signs equipment, and new admission orders.   She just rolled her eyes at me and said she was "too busy" because she was "serving drinks".Doctors and Nurses could kill a patient if they don't have an accurate fluid balance.  Serving drinks took her all of 5 minutes since she ran past any patient who was sleeping or quiet.  Then she sat at the station on her mobile.

Beth cannot help me with anything on my list as she is not a Nurse.  But I must help her change those beds on top of everything else otherwise we get the cries of "those damn new fangled to posh to wash RN's leave all the real work to the care assistants".  And I just don't want to fucking hear it.

And at 07:30 she will be out the door on her way home regardless of what is going on in that ward.   She is not a Nurse, she is not licensed.  What does she care?  I will still be giving report.  Giving report on 20 patients takes a long time.  Who is looking out for my patients while I am handing over?  Beth will be on the Bus.  She doesn't understand what I have on my shoulders with those patients...she doesn't even understand what addiphos, deranged U+Es, hypoglycemia and sliding scale insulin means.  She has no idea what a Nurse does she just sees me flying in and out of rooms.   She tells the patients that she is a "real nurse" and a "nice nurse" because she is the one who serves them tea.  And they suck it up.  Most of what I am doing for them goes unseen by them.

Cadet Beth is real pissed off because she had to do the bed changes on her own mostly.  She will piss and moan to anyone she who will listen about how she was left to do all the real work (8 out of 14 bed changes; I managed to assist with 6 of them) because the Nurse "wouldn't help her".  The patients will tell her that she is the "nice nurse" who was kind enough to provide them with a drink and say "some others cannot be bothered with that because they think they are so high and mighty".  And the patients will say this too Beth whilst looking daggers at me.  They have absolutely no fucking clue what needs to be done to keep them alive and who is doing it.;  They get that the doctors are the brains who prescribe treatment.  And they get that nice nurses  staff like Beth "care" enough to give them a drink.  But they totally miss the knowledge bus on everything that is smack in between of that.  The bus took off and the patients are still at the station.

Beth was on her way home at 07:30.  I was still there on the ward tying up legally required loose ends at 9:30.  They stopped paying me at 07:30.  I think that without the new admission I may have made it out of there by 8:30 but nevermind.  My daughter was late for school.  Again.

Fuck this shit.  I want a clipboard job.  And when I leave I will be replaced with another cadet. And when that happens there will be one RN to 40 beds rather than one RN to  20 beds.

I love bedside Nursing but this is just too damn much.  It isn't Nursing that is the problems it is the working conditions.  The day shift nurse will be in for it.  When the consultants come in and see that the fluid balance charts are blank from the night shift (thanks Beth, you worthless slut) they will smackdown on the Nurse who happens to be standing the closest to them.

Imagine how different things would have been if this was the scenario:  Instead of just Beth and I for those 20 patients IMAGINE IF we had the recommended ratio of one nurse to 4 patients.  Imagine if each of those 4 patients were sharing one Nurse rather than all 20 sharing one Nurse and one cadet?  Imagine if each Nurse was able to do total care for her 4 patients......everything from dealing with IV infusions to changing their beds and encouraging a drink of tea.

I would stay in the job if that was the case.  But it will never be the case here.  NHS hospitals do not want to hire qualified Nurses to work at the bedside.  They do not want to pay for that.

When I finally left the ward at 09:30 I was near tears.  I was so rushed during those hours I was terrified that I made  a mistake and killed somebody.  I was afraid that maybe I hung the wrong meds on the wrong patients. I was afraid I missed somethingm like a low BP or a patient who had stopped fucking breathing.  OMG I hope that patient finally kept his 02 mask on.   I was afraid that one of the patients would go down to PALS and tell them about how I was the mean nurse who ran past them as they were shouting for help (I had to).  Oh but that Beth, she was lovely and made us tea....

“Except When Medically Necessary” : Making informed choices about induction of labor

by Amy Romano, CNMThis post was originally published on Science and Sensibility for Lamaze International.It’s not hard for women to find advice and recommendations to avoid induction of labor “except when medically necessary.” But what do those words mean and who decides when an induction is medically necessary? Lamaze’s Healthy Birth Practice Paper cites ACOG Guidelines that define medical

Peds NP jobs Ortho NP jobs ARNP jobs PA jobs

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University of Hawaii - West Oahu

The University of Hawai‘i - West O‘ahu (UHWO) is a public four-year university located in the leeward O‘ahu area.

The Division of Humanities offers students with the option of concentrating in Hawaiian-Pacific Studies, English, History, or Philosophy.

The Division of Social Sciences allows students to concentrate in Anthropology, Political Science, Early Childhood Education, Economics,

Thursday, January 27, 2011

Danielle's Picks from the Literature - January 2011

Here are my picks from the nursing literature published over the last few months. Staff at St. Joseph Hospital or Children's Hospital of Orange County may be able to access some of the full text articles through the Burlew Medical Library.

1. Implementation of evidence-based nursing practice: nurses' personal and professional factors?
Eizenberg MM
Journal of Advanced Nursing, 2011 Jan; 67 (1): 33-42
Abstract: Aims. This paper is a report of a study conducted to explore the relationship between nurses' personal and professional factors and evidence-based nursing practice. Background. Like most health-related professions, nursing is shifting from the traditional intuition-based paradigm to evidence-based nursing practice. Methods. A cross-sectional survey was conducted in 2007 with a convenience sample of 243 nurses from northern Israel, who worked in hospitals or in the community. Associations between background variables and evidence-based nursing practice were examined. For the purpose of finding factors that predicted behaviour, a logistic regression analysis was conducted. Results. The self-reported professional behaviour of nurses with a degree was more evidence-based than that of those without a degree. Moreover, evidence-based nursing practice was more likely where there was access to a rich library with nursing and medical journals, and opportunities for working with a computer and for searching the Internet in the workplace. The variables emerging as predicting evidence-based nursing practice were: education, skills in locating various research sources, support of the organization for searching and reading professional literature, knowledge sources based on colleagues and system procedures (inhibiting variable), knowledge sources based on reading professional literature, and knowledge sources based on experience or intuition. Conclusion. The findings point to the need for research-based information, exposure to professional journals and, in particular, organizational support for evidence-based nursing practice.

2. The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study.
Ploeg J; Skelly J; Rowan M; Edwards N; Davies B; Grinspun D; Bajnok I; Downey A
Worldviews on Evidence-Based Nursing, 2010 4th QUARTER; 7 (4): 238-51
Abstract: Background: While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system. Aim: To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations. Methods: A mixed method sequential triangulation design was used involving two phases: (1) key informant interviews with 23 champions between February and July 2006 and (2) a survey of champions (N = 191) and administrators (N = 41) from September to October 2007. Qualitative findings informed the development of surveys and were used in interpreting quantitative information collected in phase 2. Results: Most interview and survey participants were female, employed full-time, and had worked in practice for over 20 years. Qualitative and quantitative findings suggest that champions influence the use of Best Practice Guideline recommendations most readily through: (1) dissemination of information about clinical practice guidelines, specifically through education and mentoring; (2) being persuasive practice leaders at interdisciplinary committees; and (3) tailoring the guideline implementation strategies to the organizational context. Conclusions and Implications: Our research suggests that nursing best practice champions have a multidimensional role that is well suited to navigating the complexities of a dynamic health system to create positive change. Understanding of this role can help service organizations and the nursing profession more fully capitalize on the potential of champions to influence and implement evidencebased practices to advance positive patient, organizational, and system outcomes.

3. Evidence-based nursing practice in the perioperative setting: a Magnet journey to eliminate sacred cows.
Mellinger E; McCanless L
AORN Journal, 2010 Nov; 92 (5): 572-8

4. Critical care: does profusion of evidence lead to confusion in practice?
McKenna H
Nursing in Critical Care, 2010 Nov-Dec; 15 (6): 285-90
Abstract: There have been a plethora of articles on evidence-based practice or its many derivative terms (evidence-based nursing, evidence-based medicine, evidence-based health care, etc.). However, the word 'based' implies an almost unquestioning belief in evidence. I will argue that the term 'Evidence Informed Practice' is probably more accurate. This argument will be underpinned by Archie Cochrane's 'road to Damascus' questioning of the value of soft over hard interventions and challenge what is held up as gold-standard evidence. The differences in definitions of evidence-based practice will also be discussed. Carper's identification of ethical, aesthetic and personal knowing will be used to debunk the myth that empirical evidence is always the gold standard for care and treatment. It will be argued that empirical evidence can be ignored when it clashes with other types of evidence. Finally, the tension between certainty and agreement with evidence will be explored.

5. Recognizing the evidence and changing practice on injection sites.
Cocoman A; Murray J
British Journal of Nursing (BJN), 2010 Oct 14; 19 (18): 1170-4
Abstract: Evidence-based practice requires the integration of the best available evidence in conjunction with clinical expertise to make decisions about patient care. At times new research and evidence will contradict established or traditional methods and clinical textbooks: this is in the nature of progress, and the challenge lies in disseminating this new evidence throughout the profession as quickly and widely as possible. The nursing literature cites a number of barriers to evidence-based nursing, and notes that the research evidence for clinical practice utilization does not always percolate down to the clinical setting. This article considers the attitudes of nurses to evidence that challenges traditional practice, focusing in particular on conventional and contemporary best practice regarding injection sites. Nurses in clinical practice continue to use and instruct student nurses in the use of the dorsogluteal (the large gluteal muscle in the buttocks) injection site as the site of choice for intramuscular injections, despite abundant evidence regarding the complications associated with using this site. Advancing the use of the ventrogluteal (located in the hip) injection site is a challenge, primarily owing to nurses' lack of familiarity with its anatomical landmarks and the published evidence on its benefits. The authors of this article present the current evidence on the dorsogluteal and ventrogluteal intramuscular injection sites in an attempt to assist nurse decision-making and guarantee the integration of evidence-based knowledge in order to improve patient care.

6. Exploring the effect of conducting sensitive research.
McGarry J
Nurse Researcher, 2010; 18 (1): 8-14

Abstract: The term 'sensitive research' has become recognised in health and social care research literature generally. It has been used to describe a wide range of topics, undertaken across a variety of disciplines and settings, using a range of methods. Drawing on evidence from other disciplines, this article examines the particular issues and effects that arise for nurses in carrying out sensitive research as the field continues to evolve.

7. Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care.
Schindler CA; Mikhailov TA; Kuhn EM; Christopher J; Conway P; Ridling D; Scott AM; Simpson VS
American Journal of Critical Care, 2011 Jan; 20 (1): 26-35
Abstract: Background: The reported incidence of pressure ulcers in critically ill infants and children is 18% to 27%. Patients at risk for pressure ulcers and nursing interventions to prevent the development of the ulcers have not been established. Objectives: To determine the incidence of pressure ulcers in critically ill children, to compare the characteristics of patients in whom pressure ulcers do and do not develop, and to identify prevention strategies associated with less frequent development of pressure ulcers. Methods: Characteristics of 5346 patients in pediatric intensive care units in whom pressure ulcers did and did not develop were compared. Multiple logistic regression was used to determine which prevention strategies were associated with less frequent development of pressure ulcers. Results: The overall incidence of pressure ulcers was 10.2%. Patients at greatest risk were those who were more than 2 years old; who were in the intensive care unit 4 days or longer; or who required mechanical ventilation, noninvasive ventilation, or extracorporeal membrane oxygenation. Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable underpads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets. Conclusions: The overall incidence of pressure ulcers among critically ill infants and children is greater than 10%. Nursing interventions play an important role in the prevention of pressure ulcers.

8. Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16.
Harris J; Kearley K; Heneghan C; Meats E; Roberts N; Perera R; Kearley-Shiers K
Medical Teacher, 2011 Jan; 33 (1): 9-23
Abstract: Background: Journal clubs (JCs) are a common form of interactive education in health care aiming to promote the uptake of research evidence into practice, but their effectiveness has not been established. Objective: This systematic review aimed to determine whether the JC is an effective intervention in supporting clinical decision making. Methods: We searched for studies which evaluated whether clubs promote changes in learner reaction, attitudes, knowledge, skills, behaviour or patient outcomes. We included undergraduate, postgraduate and practice JCs and excluded studies evaluating video/internet meetings or single meetings. Results: Eighteen studies were included. Studies reported improvements in reading behaviour ( N = 5/11), confidence in critical appraisal ( N = 7/7), critical appraisal test scores ( N = 5/7) and ability to use findings ( N = 5/7). No studies reported on patient outcomes. Sixteen studies used self-reported measures, but only four studies used validated tests. Interventions were too heterogeneous to allow pooling. Realist synthesis identified potentially 'active educational ingredients', including mentoring, brief training in clinical epidemiology, structured critical appraisal tools, adult-learning principles, multifaceted teaching approaches and integration of the JC with other clinical and academic activities. Conclusion: The effectiveness of JCs in supporting evidence-based decision making is not clear. Better reporting of the intervention and a mixed methods approach to evaluating active ingredients are needed in order to understand how JCs may support evidence-based practice.

9. A 15-step model for writing a research proposal.
Martin CJH; Fleming V
British Journal of Midwifery, 2010 Dec; 18 (12): 791-8
Abstract: On occasion midwives may be required to construct a research proposal. In the current climate of evidence-based practice. Such activity is considered an elemental skill for career progression in both education and service. Examples of where writing a research proposal may be required include: writing an assessment for under and post graduate research modules or designing a dissertation, MPhil, Prof Doc or PhD. Within clinical practice there are also audit and evaluation of practice responsibilities. With these factors at the forefront, this article provides a template specifically designed to direct midwives through the procedures of constructing a research proposal. The purpose of a research proposal is to produce a template of common understanding from which tasks are allocated, divided and discussed by researchers, clinical staff and in some cases participants. The finished product is then used to communicate intent to the ethics committees and grant funding bodies before authorization and money are awarded.

10. Clinical librarians as facilitators of nurses' evidence-based practice.
Määttä S; Wallmyr G
Journal of Clinical Nursing, 2010 Dec; 19 (23/24): 3427-34

Abstract: The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice.

11. Teaching Research and Evidence-Based Practice Using a Service-Learning Approach.
Balakas K; Sparks L
Journal of Nursing Education, 2010 Dec; 49 (12): 691-5
Abstract: Because nurses are expected to engage in evidence-based practice (EBP), nursing students must learn to critically evaluate and apply research findings to prepare for professional practice. To connect research and EBP, the focus of a baccalaureate research course was changed from a traditional format to one of evidence appraisal and synthesis. Using an approach that incorporated service-learning and collaborative learning resulted in a new hybrid course that provided students with an opportunity to apply concepts in the real world. Working with a community partner, students were able to develop PICO (Population, Intervention, Comparison, and Outcome) questions and critically appraise the literature to establish the evidence base for three pediatric programs. Students reported that working with a community partner was a meaningful experience because course assignments had a direct impact on current practice. Research courses taught from an EBP perspective can provide motivation for students to incorporate research into their practice as professional nurses.

12. Professional nursing societies and evidence-based practice: Strategies to cross the quality chasm.
Mallory GA
Nursing Outlook, 2010 Nov; 58 (6): 279-86
Abstract: The Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health Care System for the 21st Century nearly 10 years ago. Nursing societies are in a unique position to promote evidence-based practice (EBP). The purpose of this article is to describe EBP strategies that nursing societies can use to improve the quality of health care, thus decreasing the gap between research knowledge and practice. Nursing societies can take the lead in two key EBP activities: (1) development of evidence-based syntheses, systematic reviews, and guidelines for EBP; and (2) development, implementation, and testing strategies for these EBP resources to become available and used in clinical decision-making. The Oncology Nursing Society will be discussed as an exemplar of developing EBP programs and increasing knowledge of EBP and practice change resources for its members. The discussion stresses the importance of nursing society members and leaders in guiding their societies to contribute to the closing of the US health care quality chasm.

13. Interdisciplinary evidence-based practice: Moving from silos to synergy.
Newhouse RP; Spring B
Nursing Outlook, 2010 Nov; 58 (6): 309-17
Abstract: Despite the assumption that health care providers work synergistically in practice, professions have tended to be more exclusive than inclusive when it comes to educating students in a collaborative approach to interdisciplinary evidence-based practice (EBP). This article explores the state of academic and clinical training regarding interdisciplinary EBP, describes efforts to foster interdisciplinary EBP, and suggests strategies to accelerate the translation of EBP across disciplines. Moving from silos to synergy in interdisciplinary EBP will require a paradigm shift. Changes can be leveraged professionally and politically using national initiatives currently in place on improving quality and health care reform.

Nursing Education Loan Repayment Program

For more information and to find out if you are eligible click here to go to the U.S. Department of Health and Human Services website.
From their website"Apply Today! Applications are due February 8, 5 pm ET."

Impaired Physical Mobility | Nursing Care Plan for Disc Surgery

Nursing diagnosis: impaired physical Mobility related to neuromuscular impairment, limitations imposed by condition; pain

Possibly evidenced by
Impaired coordination, limited ROM
Reluctance to attempt movement
Decreased muscle strength and control

Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Personal Safety
Demonstrate techniques or behaviors that enable resumption of activities.
Maintain or increase strength and function of affected body part.

Nursing intervention with rationale
1. Schedule activity or procedures with rest periods. Encourage participation in ADLs within individual limitations.
Rationale: Activity and rest enhance healing and build muscle strength and endurance. Client participation promotes sense of independence and control.

2. Provide or assist with passive and active ROM and strengthening exercises, depending on surgical procedure.
Rationale: Strengthen abdominal muscles and flexors of spine and promote good body mechanics.

3. Assist with activity or progressive ambulation.
Rationale: Until healing occurs, activity is limited and advanced slowly according to individual tolerance.

4. Review proper body mechanics or techniques for participation in activities.
Rationale: Proper body mechanics reduces the risk of muscle strain, injury, or pain. It also increases client participation and motivation in progressive activity.

Acute Pain | Nursing Care Plan for Disc Surgery

Nursing diagnosis: acute Pain related to physical agent: surgical manipulation, edema, inflammation, or harvesting of bone graft

Possibly evidenced by
Reports of pain
Autonomic responses: diaphoresis, changes in vital signs, pallor
Alteration in muscle tone
Guarding, distraction behaviors or restlessness

Desired Outcomes/Evaluation Criteria—Client Will
Pain Self-Control
Report pain is relieved or controlled.
Verbalize methods that provide relief.
Demonstrate use of relaxation skills and diversional activities.

Nursing intervention with rationale
1. Assess intensity, description, location, radiation of pain, and changes in sensation.
Rationale: Pain may be mild to severe with radiation to shoulders and occipital area (cervical) or hips and buttocks (lumbar). If bone graft has been taken from the iliac crest, pain may be more severe at the donor site. Numbness or tingling discomfort may reflect return of sensation after nerve root decompression or result from developing edema causing nerve compression.

2. Instruct in regular use of rating scale, such as 0 to 10.
Rationale: Standardized tool for rating pain helps in assessment and management of pain.

3. Review expected manifestations or changes in intensity of pain.
Rationale: Development or resolution of edema and inflammation during the immediate postoperative phase can affect pressure on various nerves and cause changes in degree of pain. Muscle spasms and improved nerve root sensation intensify pain, especially 3 days after procedure.

4. Encourage client to assume position of comfort, as indicated. Use logrolling for position change.
Rationale: Positioning is dictated by physical preference and type of operation; for example, head of bed may be slightly elevated after cervical laminectomy. Readjustment of position aids in relieving muscle fatigue and discomfort. Logrolling avoids tension in the operative areas, maintains straight spinal alignment, and reduces risk of displacing epidural patient-controlled analgesia (PCA) when used.

5. Provide back rub or massage. Avoid the operative site.
Rationale: Back rubs and massages relieve or reduce pain by alteration of sensory neurons and muscle relaxation.

6. Demonstrate and encourage use of relaxation skills, such as deep breathing, visualization, and so on.
Rationale: Deep breathing and visualization refocus attention, reduce muscle tension, promote sense of well-being, and control or decrease discomfort.

7. Provide liquid or soft diet; provide room humidifier; and encourage voice rest.
Rationale: Following anterior cervical laminectomy, such measures reduce discomfort associated with sore throat and difficulty swallowing.

8. Investigate client reports of return of radicular pain.
Rationale: Radicular pain suggests complications, such as collapsing of disc space and shifting of bone graft, which require further medical evaluation and intervention. Note: Sciatica and muscle spasms often recur after laminectomy, but should resolve within several days or weeks.

9. Administer analgesics, as indicated, for example: Opioids, such as morphine sulfate (MS), codeine, meperidine (Demerol), tramadol (Ultram), oxycodone (Percocet), and hydrocodone (Vicodin, Lortab)
Rationale: Opioids are used during the first few postoperative days. Nonopioid agents are incorporated as intensity of pain diminishes. Note: Opioids may be administered via epidural catheter and PCA.

10. Instruct client in use of PCA.
Rationale: PCA gives client control of medication administration (usually opioids) to achieve a more constant level of comfort, which may enhance healing and sense of well-being.

Top Liberal Arts Colleges in Florida

Following are some of the leading liberal arts colleges in the state of Florida:

Eckerd College
- In 2003, a NAFSA: Association of International Educators study reported in The Chronicle of Higher Education that Eckerd College was ranked the No. 1 U.S. baccalaureate institution with the highest proportion of students who study abroad during their undergraduate career.
- It is one of the youngest

Wednesday, January 26, 2011

The Life of a Mormon Anarchist Housewife

I never knew there were Mormon anarchist housewives in the world until Kristina emailed SQUAT a few months ago to tell us about her upcoming zine. I was pretty surprised at her openness in identifying as a Mormon anarchist housewife as I know many anarchists would balk at that mixture of beliefs. I think I even labeled the email 'Holy Shit' (yes, this is a label that we use occasionally for exceptionally noteworthy emails -  no pun intended) and made a note to remember Kristen, because she is doing something really powerful by saying who she is and sticking to it. No doubt she'll receive some criticism, but I hope she gets the support she deserves.

Kristina describes herself in her zine as "...a mom to a two and a half year old boy named, August, and a five month old baby girl named Hazel. I am a friend, lover, and partner to a man who does juggle mormonism and anarchism with absolute grace; maybe you know him? We live in the Virginia suburbs (which we lovingly call "Babylon") outside of DC. I make my money as a doula, a childbirth educator, and a yoga teacher. I was raised in a queer family and in the DC punk community in which I got to play in a couple of bands. I don't eat animals. I am anti-war but I do not identify with "pacifism". I am a convert to the Church of Jesus Christ of Latter-day Saints. I am a feminist. I am an Anarchist. Hello, my name is kristina and it's nice to meet you. Now, let's get on with it."

On top of being bold enough to spell out her beliefs as plainly as she does, she is also a fantastic writer and I'm really looking forward to what she puts out in the future. She has a lot of potential to make waves in both the birth community and anarchist community (and I'll venture to guess the Mormon community too) simply by being who she is, which is what she states her motivation behind the zine is: a place to be herself.

Her new zine The Life of a Mormon Anarchist Housewife Issue 1: It's a Girl! is available for downloading via her website and it features her birth story, definitions of both Anarchism and Mormonism, a vegan muffin recipe, an essay on homophobia and religion and Outlaw Midwives: a Manifesta by Mai'a. It is a great read and worth having in every zine library.

 This blog was written by Meghan Guthrie, the art director and co-editor of SQUAT.

Scholarship alert! The Scholarships for Disadvantaged Students program

The Scholarships for Disadvantaged Students program is for students that want to go in to health careers. To see eligiblity requirements and for more information click here. This will take you to the US Government Health and Human Resources site.

Family NP jobs, ARNP Oncology, Peds, Jobs

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Mobile Health Professional (Nurse, Medical tech) (jobs in canada, Montreal)

For more than 20 years, Medisys has been reinventing health services in Canada. We could reinvent your career.

Medisys aims to be Canada's leading healthcare services company by providing outstanding service to a client base that includes individuals, corporations and referring physicians. By going above and beyond in delivering quality healthcare services, by treating clients and staff the way we would want to be treated by putting the word service back into healthcarewe aim to create lasting value for our clients, partners, employees and shareholders.

For further info visit:

Job Description:

Medisys Mobile Insurance Medical Service is looking for Health Service Professionals in Montreal. If you are currently a Registered Nurse, LPN (Auxiliary Nurse), Paramedic or Medical Laboratory Technician, we have the perfect opportunity for you!

As a mobile health professional your primary responsibility would be to conduct an independent medical evaluation of a candidate that we would assign to you. You would gather information on the proposed insured's medical history as well as their physical health data based upon a questionnaire developed and supplied by their respective insurance company. The services that would be required for these individuals depend on the age and the size of the policy that the client has applied for. The information obtained throughout this collection process is to remain objective and impartial.

The nature of the work is flexible as you would be an independent contractor. You would let us know on a weekly basis how many bookings you are available for in your assigned area and we would work with your schedule. You would be responsible for scheduling appointments directly with the client as this guarantees that both parties are fully satisfied with the time and date. Some of the many services we offer to clients include paramedical, blood, urine, ECG. Wages for this position are based on a fee schedule, which varies depending on the service provided.

Requirements for Position:

„« Phlebotomy skills
„« Available to work daytime, evening or week-end hours
„« Access to e-mail or fax machine
„« Access to an automobile
„« Organizational skills
„« People skills

Please submit your resume by email Health Professional (Nurse, Medical tech) (Montreal)&body= or fax to the attention of Nancy Couture

Fax: 1 (800) 787-2414

Top MHA/MBA Degree Program

Top universities offering MHA/MBA dual degree program:

Saint Louis University (SLU)
- The MHA/MBA is a dual degree program jointly offered by the School of Public Health and the Cook School of Business of Saint Louis University. Candidates must apply to and be accepted by both schools.
- The John Cook School of Business graduate programs are accredited by AACSB International (the Association to

Tuesday, January 25, 2011



OCCUPATIONAL THERAPISTS wanted for US based healthcare company - *immediate deployment to USA* - Must have at least 1 year post-graduate experience in acute or sub-acute rehabilitation setting. Must have NBCOT exam. Must have Visa Screen Certificate. FREE airfare to USA. FREE Legal fees associated with H1B filing for OT, spouse and dependents under the age of 21 years (H4 Visa). Petitioner will reimburse cost of NBCOT exam. $400 USD sign-on Bonus upon arrival to USA. Base pay rate of $31 USD per hour = $64,480 USD per annum. Annual salary increases per company policy. One week paid vacation plus, 10 days unpaid vacation per annum. Overtime is paid at 1.5 times base hourly rate for any hours in excess of 40 hours per week and the following holidays: New Year's, Memorial Day, Independence Day, Labor Day, Thanksgiving and Xmas. Participation in companies health, dental, life insurance and 401(k) plan. Contract duration: 3 years.
Please contact:
Sondra Trust, RN, BSN, President - International Healthcare Recruiters, Inc.
email: Fax: (954)530-0618
Take care

Kuwait Nurse Job Hiring

Two POEA licensed recruitment agencies are now accepting applications for their POEA approved Kuwait Nurse Job Hiring. These Kuwait nurse job hiring got the approval of the POEA last January 12, 2011 for Omanfil International Manpower Development Corp. and Best One International Services and Consultancy Inc. Stated below are the job order balances for each of the said Kuwait Nurse Job Hiring.

Omanfil International Manpower Development Corp. ---- OPEN
Best One International Services and Consultancy Inc. ---- 49 vacancies

For your resume and application, submit it directly to the offices of Omanfil International Manpower Development Corp. or Best One International Services and Consultancy Inc. For any question regarding the said Kuwait nurse job hiring, you may contact the recruiting agency thru their telephone numbers or email address provided below.

Omanfil International Manpower Development Corp.
Rodeo Bldg., 802 Km.18
West Service Road, South Super Highway
Tel. Nos: 8211650-55/ 8222141-45
Email Address:

Best One International Services and Consultancy Inc.
1810-B San Marcelino Street, Malate
Tel Nos: 5243907 / 5243909 / 5243910
Email Add:


Rm. 303, 3F Benjo’s Building
Bonifacio St., Vigan
Tel Nos: 077-7221103

Well there's that

So remember the grumpy French cardiologist I told you about way back when? Somewhere I'm sure. He hates everyone. Seriously. Except me. He's the one that offered me $4k to put together the IRB proposals for 2 of his studies last year bc he thought his assigned research coordinator "wasn't right in the head". Lol.

Anyway, I saw him in the elevator the other day and this is the conversation. I should probs add this to my elevator post but whatever.

Him: Hi Ella. How's second year going?

Me: Eh pretty good. Could be worse I guess.

Him: Yeah you could be in jail. That's about all there is worse than being in medicine.

Me: Hmm... well, there's always that.

Playing Dress Up

So for whatever reason there are like a bizillion things to get dressed up for in the next few weeks. Plus last weekend was Rin's wedding, this weekend was a benefit party, next weekend a party at an art gallery and a banquet at the Ritz (two different nights), week after is a formal event and the Internal Medicine banquet, week after is the History of Medicine Banquet.

Holy crap. Let's just say that some dress shopping has taken place.

Been a While, Eh?

Sorry I haven't posted in forever, but I was studying my buttinksy off. After (serious) concern that I may be failing 2nd year... (well there is still a lot to go)... I had to get my ass in gear and bring up my grade on my last neuro exam. Which I did, thank fucking god. Because seriously, folks... it was a concern.

Secondly, I started hanging out with a group of med students which tends to make studying much more bearable. Rica and Ritt. They are pretty awesome girls, and we relate to each other on lots of levels.

Thirdly, boy troubles have been getting me distracted a bit... but I think that is coming to an end soon. Hopefully.

I'll try my best to be better at posting.

Had a Blast on the Surgical Ward. part 2

I just remembered one of the best things I experienced during my little shift on the short stay surgical ward.

His name was Sam.

No no no stop thinking like that.  Nurse Anne is a happily married woman.

Sam is an utterly fabulous health care assistant.  By the end of the day I called him Saint Sam.  Nurse Anne is a bit rusty with Surgical Nursing but I couldn't have failed with Sam on my team.

He was good with the patients.  He could do observations, blood sugars and he cared enough to let me know of any problems he felt were arising with a patient.  He even brought people back from theatre.

A good HCA is worth their weight in gold.  They may not be able to help with drugs and all that kind of stuff.  If I am the only Nurse on a medical ward for the shift I may have over 80 IV drugs to give.  That takes hours.  And Nurse's make drug errors and cannot get to their patients when they have that many IV's to do.  So even if I had a hundred Sam's working with me in a situation like that I would still be struggling and short staffed.

But if I  knew that Sam was keeping a careful, knowledgeable and watchful eye on my patients whilst I was tied up with Nursing stuff it would make me feel a whole lot better.  I wish we had people like Sam on our medical wards.  It would be a real help to know at least there was someone reliable to look at my patients whilst I was preparing over 80 IV meds and getting dragged on doctor's rounds and to the phone.  But we do not get Sam types on the medical wards.  We used to have Sam type HCA's but as they quit and retired they were not replaced.  And we got the kids instead. Sucks.  We have a couple excellent HCA's left in medicine but the rest of the care assistants are all kids/cadets/apprentices/auxillaries with serious knowledge and common sense deficits and a whole lot of attitude.

I asked Sam why he doesn't do his Nurse training.  He gave me a wry smile and laughed out loud.  " I am happy as I am.  From  my vantage point Nursing looks like a nightmare.   I used to work on a medical ward as an HCA and I know how the qualified nurses suffer.  As an HCA I don't have to fuck about with drugs, assessments, orders, doctors or take any responsibility.  And on the surgical wards things run more smoothly than on a medical ward. I just enjoy interacting with the patients and helping them out.  And it is great.  Why would I want to give up a job I love ?"

Our medical wards need to have good RN's and health care assistants.  I think the ideal ratio is 80% RN's to 20% health care assistants in the composition of ward staff.

But the current ratios we are working with are something like 30% of staff are RN's and 70% are cadets/kids/apprentices/axilliaries.  

The hospital lies and tells people that on any given shift their medical wards are staffed with 65% Nurses and 35% care assistants.  This is a lie. 

Anyway I tried to get Sam to beg for a transfer to my ward and he nearly fainted because he laughed so hard.

Forest Gump GPs and hospital Consultants all across the land are telling anyone who will listen that the problem is "degree nurses who don't want to work on the wards".  Bullshit.  Managers are turning away both older trained and newly qualified Nurses when they apply for jobs as bedside Nurses on the wards.  They would rather hire kids.  Cheapo cheapo productions.

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Had a Blast on the Surgical Ward.

When Gladys is admitted to hospital she ends up on a medical ward due to her chronic COPD, diabetes, and Anemia.  She is sick and tired of the way these general wards are underesourced and has decided to make her feelings known to management with a nice hand gesture. 

Lucky lucky LUCKY me.  I showed up to work a shift on my usual medical ward last week. 

But the surgical ward downstairs was short staffed.  And we had 3 RN's.  They had one. And it was my turn to "float".  So I was ordered by the bed manager to work on the surgical ward. He didn't have to order me to go there.  I ran away from my ward and ran down there skipping and laughing,  so full of glee and joy was I.

It was I thought it would be.  Bloody fantastic.

Surgical wards are fantastic compared to medical wards.  Less patients, less drugs, virtually no confused and total care patients.....all in all it means that the Nurse is more in control of her workload on a surgical ward and can do the job better.  Surgical ward Nurses are not as destroyed emotionally, physically and mentally as Medical ward nurses.

We recently discussed this over on a fantastic blog called Diary of Benefit Scrounger.  The author of that blog is a woman named Sue.  She had recently had experience of an incompent medical ward.  Not long after she was admitted to a surgical ward and was shocked at the difference in care.  She felt secure and happy on the surgical ward.

I weighed in on Sue's comment section with my opinion on why the surgical ward Nurses have it together so much  more than medical nurses:

Again this doesn't surprise me in the least.

We have talked a lot on militant medical nurse about medical wards vs surgical wards.

I once worked on a surgical ward. Never was I so happy. I was one RN to 6 young, sensible, reasonably healthy stable patients having minor to moderate surgery and we had all the equipment and to resources we needed. We had a charge nurse without an assignment to back us up and we always had clerical support.

Then that unit was shut and my colleagues and I were moved to medical wards. That is when I began blogging.

On surgical wards not only do the nurses have less patients but their patients are less confused, less ill and less demanding. If the surgical ward nurse with only 5 easy patients gets an admission of a demented elderly patient pulling out his lines and tubes and spreading shit everywhere she sends him to a medical ward where the Nurse already has 20 such patients.

Medical ward nurses are NOT allowed to dump a patient somewhere else because they cannot handle him.

If a patient becomes medically unwell on a surgical ward he immediately gets sent over to the overwhelmed already medical nurse who already has more patients and more difficult patients than the surgical nurse has.

There is a lot that surgical nurses don't have to deal with.

A drug round on a surg ward is simple since most of the patients are not as acute or chronically ill as medical patients. It took me 15 minutes to get through the 8AM drugs on my 6 patients in the surgical ward. It takes me over an hour to get through the 8AM meds for 6 patients on a medical ward. And I have about 16 of them.

Surgical patients bring money into the hospital. Medical patients cause the hospital to lose money. It was explained to me that this is the reason for the discrepencies.  This is why medical wards are so underesourced causing medical nurses to struggle.

Surgical ward nurses also think that they are superior to medical nurses since they get better patient feedback and make less mistakes.

I thought this too when I was a surgical nurse. My eyes were really opened when I went to work on a medical ward.

Once another surgical ward at my hospital was shut and their nurses were sent to my ward to work. They were making wisecracks about "now we are on a medical ward we will do nothing but babysit and hand out commodes" and "It will be like a nursing home".

I came in for a night shift the next day and two surgical nurses had been on for the entire medical ward alone during the afternoon and evening. They were in tears. They couldn't manage the demented, the high patient load. One of the patients deteriorated with a severe medical condition and they didn't know what to do. They couldn't figure out a lot of what needed to be done and patients really suffered.

The wisecracks soon stopped after they got a taste of general medicine.

Care assistants on a surgical ward have a smaller easier work load and get paid at band 3. Care assistants on a medical ward break their backs and get paid at a lower rate on band 2.

There are no geriatric wards anymore. Geriatric patients go to general medical where they are mixed up with critically ill patients, psych patients, hospice patients,surgical patients who had a medical emergency on the surgical ward and social admissions for lack of coping at home etc etc.   The staffing levels of Nurses on these wards would shame a third world country.  The real Nurses are few.  The untrained care assistants are many. 

In short there is less chaos in surgery and what chaos that exists is easy to control. The surgeons round twice a day on the surgical wards. The medical consultants twice a week.

So you perceptions are very accurate.

and I should add to this that surgical wards deal with the same thing and over again with little variation. They refuse to accept patients that dont fit into a criteria that they don't want or do not feel like they can handle. Medical nurses are unable to do this and have to take anything and everything no matter how overwhelmed they all ready are.

Surgical ward nursing was fun but general medicine has made me burn out and lose my mind.

Then DinoNurse, an ITU Sister who often comments on Militant Medical Nurse, gave her tuppence worth.  As usual, Dino was right on the money and did a better job of explaining it all than I ever could:

Medicine is the blackhole of well, medicine lol.

On a more serious note- google "medical ward" and "foundation trust" and the number of closed wards seems to be growing. My own foundation trust lost an entire ward when the former hospitals merged. Last winter we had to open 2 entire wards to cope with the influx- pushed our agency budget through the roof. This year, had the powers that be learned anything? Of course not- yet again medical wards are full to bursting and the backlog is impacting on everything else. Our admissions units are warzones, quite literally.

This is the same UK wide. If you really want to raise awareness Sue, you need to be pointing out that in general surgical patients are younger, fitter and spend on average a week or less in an NHS hospital bed. If you have a chronic condition, by and large you will be treated on a medical ward unless you need surgery. Our ICU emergency admissions are generally medical in origin- chest infections, GI bleeds, DKAs, epilepsy complications- the list is endless.

Most surgical admissions are either elective ( because they have need for 24-48 hours ventilationn) or due to unpredicted bleeding (although obviously life threatening, fluid resus normally sorts this out quite quickly and they come to us for monitoring and inotropes.)Surgical wards do not do inotropes...however medical wards are expected to manage.

Any surgical patient who develops a "medical problem" will be turfed to medicine...the chest infections, UTIs- generally elderly and mostly leading to confusion and agression... Generally speaking, medical patients take longer to recover and require more input from nurses, physios, social services etc...Surgery can make money for a trust and medicine cannot.

Medical wards literally suck the life out of you ( staff and patients). What we need is guaranteed SAFE RN TO PATIENT RATIOS. I cannot stress this enough. 1 RN to 6 patients would be a step in the right direction. Ideally this should be reduced to 4 in an acute setting. A little story happening in an average trust every day- allegedly...28 bedded medical ward has 3 RNs on duty along with 2 HCAs. So each RN gets just over half an HCA and 9 and a bit patients. Ward has 6 bays of 4 beds and the rest are siderooms. So each RN has 2 bays and the siderooms are shared, so to speak.

 In one bay we have a confused old man who keeps climbing out of bed, the trust have helpfully provided a buzzing mat that goes off everytime he does this. There is also a very sick young diabetic in DKA in the next bed with multiple drips, sliding scale insulin and he should be on half hourly observations (minimum). Thats just one bay. The RN for this bay will should basically never have to leave the bay. In the other bay she is responsible for we have a GI bleed who is actively bleeding, having transfusions and has just been started on inotropes. He also needs a MINIMUM of half hourly observations. So the RN will bust her tail trying to keep up to date with the GI bleed and the DKA and hope that the old guy doesn't fall out of bed. As for the other 6 or so patients she is responsible for, well....need I go on?

Oh, and halfway through the shift the ward will lose an RN and an HCA to "help out" on a medical ward with even worse ratios. In the "bad" old days we would have created an "obs" bay and put all the medically unstable patients here, next to the nurses station- and we would have had 6 RNs/ENs on duty ( alot more trained staff than we have now). The DKA patient would most likely have been transferred to the ICU. This is the biggest problem today- patients are older, sicker and more complex. Many of those on medical wards would have been in the ICU 20 years ao. Unless we get safe ratios we are heading for the biggest fall imaginable. The NHS will dissolve into "social enterprises" that are still private in nature...and if you were the CEO would you want to waste all your resources on the medical blackhole? Didn't think so....

My day at the surgical ward was fantastic.  I had 8 patients.  All of whom were stable.  I had two post op lap chole patients who were doing great.  I was able to spend a lot of time with them talking about post op care and ensuring that they were safe and comfortable.  I had several pre op patients and admissions who were healthy and compus mentus.  This allowed me to spend time making sure that everything was in order for their procedures and also explaining to them what they could expect.  The drug round took 10 minutes. 
I couldn't help noticing the wall behind the Nurse's station on the newly redecorated, modern and refurbished surgical ward.  They had trust awards for "best at completing careplans" and "best at completing risk assessments" and all that.  They even had an award for "least falls".  Probably because all of their patients are youngish, not confused and have no mobility problems.  Yes, managment actually gave the short stay surgical ward an award for "least falls". No wonder they don't have any falls.  They have no fall risk patients and lots more staff.

 My medical ward has no awards.  Our confused elderly patients outnumber the staff 20 to 1 and there are lots of falls.  And we sure do not have time to complete care plans or risk assessments because we have critically ill patients that need 150 IV meds mixed up and given whilst we are trying to stop the confused elderly ones from falling, peeing on the floor and attacking other patients.  My ward looks exactly like something out of 1950's Russia except that it is a whole lot dirtier.  The cleaners on my ward like to flip off the Nurses and go for tea breaks.
 God, I hope that when I am old and confused that I have saved enough money for my family to hire a one to one carer to stay with me when I am in hospital.  Lord knows that my poor  ward RN, with a 150 IV meds to give and more patients than she can keep track of won't be able to help me.  I do have a savings account set up for that you know. 
General medical wards: The red haired step child of the NHS.