we've loved for three years
but all that time you annoyed
now i choose to leave

2008

Holiday funny

Registered Nurses needed - Homecare - Capreol, Ontario

Seeking Registered Nurses for homecare. The shifts available are eight-hour days, evenings and nights. Client is very flexible and able to accomodate staff with other nursing positions.

Nurses are needed for part-time and casual positions. Candidates must be certified in CPR and have a validated nursing liscence with the CNO.

RN's who are interested in the positions available can contact Darrell MacKinnon via telephone @ 705-858-0073 or by e-mail @ digger40@sympatico.ca.

the missed connection
was due to her stuffy nose
and fourteen hours

grease drips from the car
john writes with crayon on the wall
planning his future

tingle in the feet
pinch between the shoulder blades
I'm a working slob

What are RSS feeds?

Not really sure what RSS feeds are or how they might help you keep updated? If your library has OVID databases, the new OVID SP has the capability to subscribe to tables of contents of OVID journals through the RSS technology.

Burlew Medical Library at St. Joseph Hospital in Orange, California has developed a brief document that will explain the RSS technology and give you some ideas as to how you might use RSS.

For instance, some of the RSS feeds to which I subscribe are:

Nursing Research table of contents
Krafty Librarian blog
Pubmed search on autistic disorder
Shifted Librarian blog
Consumer Health Forum
Reuters Health

I valiantly try to set time aside once a week to visit my bloglines reader and catch up on all my new feeds. It's really a " one stop" approach to shopping for the new information that meets your particular interests.

Does anyone in the blogosphere want to share how they use RSS technology and what their favorite nursing feeds are?

Maupin's tackle store
as cute as the trading post
like the tumbleweeds

as I drive to work
the snow comes on like Star Wars
an hypnotic split

tan hills by Vermeer
I never want to go out
framed by the window

Merry Christmas!

you smell rich as sleep
and fold around my body
like moon through the glass

Case Manager Registered Nurse - FOR NEW YORK!

Company: The Mount Sinai Hospital – We're known internationally for our excellence in clinical care, education, and research. Become part of our team!

Title: Case Manager-RN
Location: New York, New York – What can you say about one of the most cosmopolitan cities in the world? Whatever your tastes and whatever need you're looking to fill, you'll find it in New York, the city that never sleeps.



Responsible for determining the appropriateness of admission and continued stay, assisting and implementing in the development of plan of care and identifying the expected length of stay. You will work collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team as needed. You will also participate in specific clinical initiatives focused on reducing the length of stay, improved efficiency, quality and resource utilization.

Requires a NYS RN license. Utilization management/discharge planning experience and case management certification preferred.


We offer a competitive salary and benefits package.
nurse.recruitment@mountsinai.org
(212) 241-9061/(866) SinaiRN (outside NYC)
Visit our website: www.mountsinai.org/nursing.

chewing on a Bic
a way to stave off hunger
homeless cold and broke

the moon shines sky full
over the grocery store
shoppers do not see

frosted car windshields
red, silver, white, line by line
dog bites the snowball

Travel Nursing Questions

I recently received the following e-mail from a nursing school student with questions about travel nursing:

Hi Amy.

I *really* appreciate your blog. I have been looking for something like it for a while. Once I graduate, I am going to put in a year in the ER at one of the local hospitals. After that, I plan to jump straight into Travelling. So I have a question for you. When I see all those ads that say, "Make $XX,000 per year", or "$XX per hour", what do they really mean? Is this gross pay before benefits, or does it *include* benefits? For example: "Earn over $90,000 per year." Does that include the cost of benefits? And does that include planned overtime, or is that all straight pay? Same with the, "Earn up to $45 per hour." Gross pay? Or gross pay + housing costs + milage expenses + etc.? I know you are a busy person, and if you can't answer directly, that's okay. But hopefully you can at least blog an answer. I know there are others at my school that would love to have those answers, so I am sure there are many around the country that would too. Thanks for what you are doing!

[Name redacted]
Tacoma, WA

Let me see if I can answer most of the questions in this e-mail.

First, congratulations on your decision to go to nursing school. I didn't know when I decided to become a nurse almost two decades ago how much it would allow me to see the world. I'm sure you will find nursing much more flexible than most any other occupation you could have chosen.

Negotiate Your Package
Second, although each agency offers its own version of payments and benefits most of the packages are negotiable. For instance, you can choose to be paid hourly with or without benefits. If you choose not to have benefits you will receive a higher hourly rate of pay. If you choose to have the agency "provide" benefits then your rate of pay will be reduced. The same is true with the sign-on bonus. If you choose to have a sign on bonus (usually up to $3,000 for a 6 month assignment) your salary or hourly rate of pay will be decreased.

It has been my experience that when the ads say "Make $XX,000 per year", they are talking about the entire package (i.e. gross pay, benefits, sign-on bonus, moving and housing allowances, etc.).

Salary vs. Hourly
Most agencies will encourage you to stay with them long term by offering a higher yearly salary than you would make being paid hourly. I usually choose to be paid hourly because I like the freedom of going where I want when I want and don't like to be tied to one agency. It is really a matter of preference.

Overtime Usually Not Included
However, the ads are usually not calculating money you can make working overtime in their yearly figure. A standard work week is 36-40 hours. Most facilities will allow you to work overtime which is over and above what the ads are including.

I personally know of several travel nurses who work 5 twelve hour shifts per week for 3 months and then take two months off between assignments.

Congratulations
I offer my congratulations to all those who are graduating nursing school this semester. Good luck in the future and keep travel nursing in mind.

P.S. if you haven't found a nursing dress for graduation, check out these nursing dresses for sale.

she was a white snake
she's not crying in the rain
hope is love, Guanyin

christmas lights hung square
an apartment balcony
plastic begonias

Tattoo

I've been thinking about getting a tattoo for years! Especially since going with a friend when she got hers done.
I want something that represents Strength, Courage, Perseverance. Looked into it and found out that the Koi fish is the very think that does. Especially if done in a Yin and Yang form.
Found this pic online.. exactly what I am looking for and I think that this one is cute, feminine and simple.
I just have to figure out where to put it...

user interface
must log in to see your friends
fingers speak the words

RELIEF!

I got my results and I passed my OSCEs, my written final and clinical rotations! YIPPEE!

floral pattern sheet
pink and yellow stipple print
dappled with dog hair

On Christmas Break.. for 5 WEEKS!

I am on Christmas Break from Nursing school for the next 5 weeks! YAY!
Happy Holidays to all!

it's a mystery
the reason why you love me
through these several years

blue panel sunshine
diaphanous fuzz bucket
glitter of christmas

Registered Staff Nurses for Ontario, Nova Scotia and British Columbia

Trust / Employer Beresford Blake Thomas Nursing
City Toronto
Location Worldwide (Outside Europe)
Career Level Staff Nurse
Specialism Adult / General
Working Hours Full Time
Salary £35 - £40 per year
Vacancies 5

OFFERING UPTO $5000 (canadian) for relocation assistance, Free flights, Fully visa and registration assistance, Canada has one of the highest standards of living in the world.

Our clients in Ontario, Nova Scotia and British Columbia are looking for many ICU, NICU,ER and CCU nurses. Applicants must have at least two eyars experience in their speciality and to work in Ontario, applicants must have a minimum of a Bachelors degree in Nursing. Applicants must be eliigble for registration with the appropriate nursing board for whichever province they wish to work in.


Adrian Duffy
8th Floor, Southside
105 Victoria Street
London
SW1E 6QT

Freephone: 0808 143 6000

Nurse for Dubai now hiring!

Senior Staff Nurse - Prison Healthcare

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

We are currently recruiting for staff nursing positions throughout the United Arab Emirates, including Dubai, for various clients. You will benefit from extensive career development, generous tax free salary, sign on bonus, retention bonus, free accommodation, free transportation, free utilities, and visa application on your behalf,and many more.
In return, you will be willing to commit to a minimum of 1 year's contract.
The ideal candidate for this role, will have a minimum of 2 years post qualification experience. You will come equipped with valuable skills and experience, and an appetite for a successful career, and new opportunities and development.


Contact Details
Sharon Rumens
OES Healthcare Recruitment
Business Development Centrte
Eanam Wharf
Blackburn
BB1 5BL

Tel: 0808 118 1454

Systematic Review Made Simple for Nurses

There is an excellent article in SGH Proceedings v 16(2):104-110 2007 by Leong Siew Teing titled Systematic Review Made Simple for Nurses. This article is available as free full text. The SGH Proceedings is a refereed scientific journal of the Singapore General Hospital. The article also highlights a three phase lit search strategy recommended by the Joana Briggs Institute (JBI).

hair like her mother's
some day she'll pluck her eyebrows
square head paper doll

yogurt and spices
simmering on the stove top
hindi butter dish

Nurses Recruitment in Kuwait

An Agency company for the worker in Kuwait, Nurses Overseas Employment Corporation (NOEC) is looking for Diploma and Bachelor Nurse (RNs) with 2 years experienced working in hospital especially on emergency and medical department to fill the position of Staff Nurse for Private Hospital in Kuwait. NOEC has recruited many of Nurses from Philippine, India, Suria, Egypt, Jordania and also including Indonesian Nurses.

Those people who qualified for the position will get paid 200 - 350 KD (US 650$ - 1200$) as their salary. Successfuly applicants for Staff Nurse for private Kuwait hospital will have a great career in Nurses Overseas Employment Corporation.

Position : Staff Nurse
Country : Kuwait
Date Posted : Dec 05, 2007
# Requirements Must have a minimum age of 23 yrs. old
# Must have a maximum age of 45 yrs. old

Job Details : Have good relation with the others Staff Nurse and Doctor in colaburation to provide health care services for the patient as a Medical Team.

OSCE

O bjective
S tructured
C linical
E examination







This semesters are based on psychiatry and geriatrics and emergency procedures (life saving/CPR).

Exam Stress...

I am in finals week... 3 exams total, doesn't sound like much, considering I only have 2 classes, though nursing is 23 hrs a week (that's with 16 hrs of clinical), and I have a 3 hr sociology of health class.

Nursing final (written) is Tuesday and it covers 17 lectures worth 40%.. AHHHH!
Nursing practical (OSCE) are Thursday and frankly I have no idea what they will throw at us!
Sociology is a take home, an essay 2-3 pages long, sounds ok right? WRONG! This class is badly taught and we have to write the essay based on articles read for class. Problem is, we have NO IDEA what the heck he is talking about 3/4 of the time and he gives us HIS opinion and if you disagree he fails your paper...! ARGH!
I plan on writing it Tuesday afternoon AFTER the nsg written final.

she leans in to see
the smallest flaws of her pores
probing fingernails

father lifts her up
hands up her wrists a red grip
as he spins her high

it is probable
that I am not a writer
because I worry

Samford To Begin Offering A Doctoral Nursing Program

Samford University officials announced today that they will begin offering the Doctor of Nursing Practice degree next year to meet a need for advanced practice nurses. (article)

Cochrane Collaboration on YouTube

Evidenced based resources on YouTube-- who would have thought!!

View this brief 7 minute videotape that gives a great overview of the Cochrane Collaboration and the Cochrane Library.

take the grievance list
tape it in the complaint book
smug satisfaction

Abstract with Commentary

Abstract and Commentary

Robinson, S. et al. (2007). Development of an evidence-based protocol for reduction of indwelling urinary catheter usage. MEDSURG Nursing, 16, 157-161.

Author’s Abstract

Studies indicate 40% of indwelling urinary catheters are unnecessary in hospitalized patients (Gardam, Amihod, Orenstein, Consolacion, & Miller, 1998; Gokula, Hickner, & Smith, 2004). The results of a protocol developed to limit catheter use are described.

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

The project was framed in the Iowa Model of Evidence-Based Practice (EBP; Titler et al., 2001), the same model adopted at St. Joseph Hospital. Nurses at a large tertiary care center identified a potential problem: inappropriate use of indwelling urinary catheters. The trigger to action was guidelines developed by the Nurses Improving Care to Health System Elderly (NICHE). The guidelines recommend limiting catheters to elders with very specific problems such as urinary retention.

Chart audits of patients with indwelling catheters found 17% with documented urinary tract infections (UTI). A team was formed to develop a protocol to encourage more appropriate use of indwelling catheters. This group reviewed 32 articles on the topic, about half of which were rated as strong evidence sources. Based upon the evidence, they determined when urinary catheters are appropriate in hospitalized patients.[1]

A pre-protocol chart audit indicated that 35% of patients had a urinary catheter at some time during hospitalization. Of these, 42% had no appropriate reason for catheter use. Only 70% had an order for insertion. Almost 40% were inserted in the emergency department. Almost 2/3 were not removed until day of discharge. Symptoms of UTI developed in 38% of patients.

A 2-week pilot test was done with nurses requesting an order for removal of the catheter unless it was used for one of the criteria in the footnote below, along with use in patients 48 hours post surgery. Afterwards, mean days that catheters were in place dropped from 8.6 to 4.5 days, orders to remove increased (43% to 93%), documentation of removal increased (57% to 87%), and only 7% of patients had catheters in on discharge day. In the pilot group, only13% had UTI symptoms.

To institute this change in practice (nurses asking for catheter removal), a multi-method educational effort ensued. Pilot outcomes were disseminated, along with findings from the literature. Physicians were educated at several formal gatherings. This manuscript does not describe outcomes from the full scale implementation.

Can you think of which patients at SJH may have inappropriate urinary catheters? What methods could be used to decrease their use? What resources would be needed to implement these methods?

Titler, M.G. et al. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care.
Critical Care Nursing Clinics of North America, 13, 497-509.

[1] For bladder irrigation or instillation of medication; to provide relief of urinary tract obstruction; to permit drainage in persons with neurogenic bladder dysfunction or urinary retention not manageable by other means; to obtain accurate intake and output in critically ill patients; to aid in urologic or related surgery; to manage urinary incontinence in persons with stage 3 or 4 pressure ulcers; and to promote comfort care in the terminally ill

TravelNursing.tv

In this site you can find leading hospitals, travel nurse companies and recruitment agencies to help you find your dream travel nurse job!

brown slump-backed sofa
animal fur on the arms
a piece of heaven

Medcal Library Association's white paper on magnet recognition

Our blog is mentioned in the Medical Library Association's white paper: Magnet Recognition Program Collaboration Proposal: The American Nurses Credentialing Center and the Medical Library Association. One of the sections deals with Librarians' contributions to their institutions' magnet journey and gives examples of nurse/librarian collaborations. Our blog is mentioned at the end of this section and is the only activity of this kind listed in the contribution section. Way cool!!

Yale University School of Nursing

Yale University School of Nursing is a vibrant, exhilarating and rigorous place to study nursing at the graduate level. Students from diverse backgrounds meet in an environment that nurtures an appreciation for high standards and the pursuit of excellence in nursing practice.

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Rambling on About Care in the Community and bed blocking.

Have you heard about the care in the community shit?

There are no beds in hospital. There is no staff in hospital. The Burger King down the road is staffed better than my ward and that is the truth. There are not enough places in the community and/or nursing homes to care for people. Meanwhile 80% of new nursing grads cannot find jobs and money is getting pissed away on luncheons so that the managers can have another meeting to plan another meeting and never take any action.

I work on a ward that is primarily medical and we take a lot of exacerbation COPD patients. Many of these patients are anxious and cannot deal with the fact that their nurse has other patients who may be sicker. I would feel the same way if I had copd and was struggling to breathe.

They are often on the call bell every 30 seconds for reassurance etc. Many of them are elderly and can barely manage to get out of bed onto the commode without help.


They want to "care" for these people in the community. They cannot even care for them in the hospital. They come in. They get ignored by overwhelmed nursing staff whose heart is the in the right place but cannot do their jobs. They deteriorate.

But home care is not the answer, because it will be managed badly like everything else and their is a higher chance of the ball getting dropped. The hospitals should hire some of the 80% of nursing graduates who cannot find jobs and care for these people in hospital. The matrons and the "specialist nurses" who spend their days drinking tea and coming up with retarded 20 page forms for the bedside nurses to fill in should get their asses to the wards and give a hand. I have a hard time referring to our so called leadership as "nurses". They don't deserve the title.


I don't see how any of our patients could manage at home for any length of time. Even when they are declared medically stable they are still dependent. They would all need one to one community nurses. Hospital care is bad and often leaves these people with more problems BUT this situation is fixable.


At the moment 80% of our patients are medically stable but unable to care for themselves at home. WE have a lot of elderly folks around here and no elderly beds and too few nursing homes. The hospital picks up the slack.

Many many many of my patients have been there for months and months. We have some who are waiting for beds in nursing homes, some who are waiting for care packages to be sorted for at home care, most who are unable to walk thanks to being left in a chair with no moblization because their nurse is so overwhelmed. They have family that won't or can't provide care and yet refuse help from social services. We have these people for months on end and there is no answer.

We have one patient who has been with us for 6 months. It was determined that she couldnt go home and needed nursing home care. She and her daughter picked out a nice one with help from social services. She had a bed at a nursing home near her daughter. She really wanted to go to that nursing home and sat in the hospital for 3 months waiting for a bed at this facility. I shit you not.

The day before she was to go there she told her daughter that she changed her mind and wanted to go to another nursing home. Daughter cancelled the nursing home bed and then came and told us (nursing staff)about an hour before she was to go. A surgical admit was slated to come into that bed in the afternoon. I shit you not.

It will be another 2 weeks before the new nursing home will come to assess her, and then we can find out if they will accept her. Then she will wait for a bed. Social services want the nurses to fill in another 20 page nursing assessment form again that is complete bollocks. No one will have time on any shift to do this. I am sure she will be with us another month AT LEAST. It may very well be a lot longer.

Then she gets angry when we have acutely ill patients and she gets less attention. The patient in the bed across from her arrested and whilst we were doing CPR she was overheard complaining that she has been at our hospital for months and never received that kind of attention. Makes me go grrrrr. This is not one unusual patient. This is 40-60% of our patients at any given time.

Some do get discharged home without adequate care in place because they want to create free beds. 72 hours later they are back in casualty with dehydration and a fractured neck of femur.

http://news.bbc.co.uk/1/hi/health/7075381.stm
Meanwhile I could get the accident and emergency staff brought up on harassment charges for ringing every 30 seconds making threats. I don't blame them really. It's their ass if their patients breech the 4 hour rule. And it is all completely out of their control.


So we are getting constant bullying harrassment phonecalls from accident and emergency and the bed manager ordering us to "get people the hell out" because patients are breaching the 4 hour waiting times in Accident and Emergency and there are no beds. There are so many more patients coming to the hospital than they can deal with. We have a side room where the roof is leaking and tiles are caving in due to flooding and I was ordered to put a patient in there.

I have recieved a phone call at 0200 that a bed has become free in an outlying hospital and to pick a patient and get them transferred out there NOW because we are breaching. Why are we nursing targets and not patients? Not one of my patients are going to be happy about woken up at 0200 and transferred god knows where. I was threatened and told that if I don't walk away from what I am doing (never mind the 50 year old patient who has just suddenly developed expressive dysphagia and numbness and weakness on one side and I am trying to get a doctor up and I am the only nurse) that I will be disciplined.

And their relatives are going to fly into a rage about grandpa being woken up at 0200and getting shipped out to god knows where. They will chew out the nurses that's for sure.

I focused on the poorly patient first rather than deal with the transfer. I'll get busted for that you know. I was the only nurse and I couldn't leave the unwell patient to sort a transfer (transport, informing relatives who will go ballistic etc etc etc).

It is the same damn problem in every post I make.

This is ENA

The EMERGENCY NURSES ASSOCIATION (ENA) is the national Association for professional nurses dedicated to the advancement of emergency nursing practice.

1996 to 2007

Memories from 1996... I was there with my friend Irene. 15 days of Olympic fun!

why do I do this
every day laboring
over a few words

the wind has wide cheeks
wind beats on the door 'hello'
'who will let me in'

she purrs in octaves
chromatic alteration
A above A#