The Governator's plan to tax the shit out of California citizens to balance the budget doesn't seem to be working so now he is proposing deep cuts. Unfortunately, the cuts are to things like dental services for Medi-cal patients, Healthy Families which provides medical care to kids that don't have insurance and funding to rural health clinics. Yes once again the government is attempting to balance the budget on the backs of the poorest people with the least to give.
I don't know about my other California colleagues but my ER is running at about 120% capacity with about 70% of the necessary resources. Now in addition we will be seeing all the people who can't get services anywhere else.
I can hardly wait.
Friday, May 29, 2009
Friday, May 22, 2009
A little history lesson, Mr. President - We don't think you really need to apologize for America's actions and involvement in Europe
In alphabetical order -- Sacrifices Americans made just for Europe.
1. The American Cemetery at Aisne-Marne, France. A total of 2289 of our military dead.
We Apologize.
2. The American Cemetery at Ardennes, Belgium. A total of 5329 of our dead.
We are arrogant.
3. The American Cemetery at Brittany, France. A total of 4410 of our military dead.
Excuse us.
4. Brookwood, England American Cemetery. A total of 468 of our dead.
5. Cambridge, England. 3812 of our military dead.
6. Epinal, France American Cemetery. A total of 5525 of our Military dead.
7. Flanders Field, Belgium. A total of 368 of our military rest in peace here.
8. Florence, Italy. A total of 4402 of our military dead.
9. Henri-Chapelle, Belgium. A total of 7992 of our military dead.
10. Lorraine, France. A total of 10,489 of our military dead.
11. Luxembourg, Luxembourg. A total of 5076 of our military dead.
12. Meuse-Argonne. A total of 14246 of our military dead.
13. Netherlands. A total of 8301 of our military dead.
14. Normandy, France. A total of 9387 of our military dead.
15. Oise-Aisne, France. A total of 6012 of our military dead.
16. Rhone, France. A total of 861 of our military dead.
17. Sicily, Italy. A total of 7861 of our military dead.
18. Somme, France. A total of 1844 of our military dead.
19. St. Mihiel, France. A total of 4153 of our military dead.
20. Suresnes, France. a total of 1541 of our military dead.
Apologize to no one for our actions in Europe. Be proud of your heritage. At great expense of life and treasure,
we saved Europe during two World Wars. Remind them of our sacrifice and do not confuse arrogance with
leadership. As Americans, let's all look forward without forgetting the past.
IF I ADDED CORRECTLY, THE COUNT IS 104,366 Americans in Europe who will never come
home to the land they loved.
Thursday, May 21, 2009
Wednesday, May 13, 2009
ER visits by chronic drunks cost you billion's of dollars every year. I think I know why.
We have Joe. He is homeless and spends each day drinking until he passes out in puddles of his own bodily fluids. Often he is in a public place where some concerned citizen, fearing he is a corpse, calls 911. The jail nurses refuse to take drunks until they have the golden stamp of approval by an MD so that if the drunk croaks in a cell they can say they aren't liable.
Joe comes to our ER once or twice a week. Once he came three times in a 24-hour period because the jail was full and they kicked him out swiftly. He is filthy, aggressive and agitated since his nice stupor was so rudely interrupted. He kicks, he bites, he punches and spits. He has blackened a nurses eye, broken another ones glasses and broken a paramedics rib. Imagine how much fun it is to wrestle to restrain someone who is covered in urine, vomit and diarrhea.
Sometimes his visit basically consists of the doctor the doctor calling the cops and telling them to come make a pick up. But all too often it involves an IV, a banana bag, a head CT to make sure his mental status isn't from him falling and suffering a subdural hematoma, multiple labs and so on and so on.
In the meantime he is screaming obscenities and disrupting the entire ER. Taking up a gurney while someone ill has to sit in the lobby waiting for care. Often multiple staff members are involved in restraining him so that their own patients are neglected.
Why are we wasting resources on these people? They need to be institutionalized and cared for since they are incapable of caring for themselves. It would be much cheaper. And for those of you in the ACLU who think that the rights of one supersedes the rights of the rest of us I say:
BITE MY LILY WHITE ASS!
We have Joe. He is homeless and spends each day drinking until he passes out in puddles of his own bodily fluids. Often he is in a public place where some concerned citizen, fearing he is a corpse, calls 911. The jail nurses refuse to take drunks until they have the golden stamp of approval by an MD so that if the drunk croaks in a cell they can say they aren't liable.
Joe comes to our ER once or twice a week. Once he came three times in a 24-hour period because the jail was full and they kicked him out swiftly. He is filthy, aggressive and agitated since his nice stupor was so rudely interrupted. He kicks, he bites, he punches and spits. He has blackened a nurses eye, broken another ones glasses and broken a paramedics rib. Imagine how much fun it is to wrestle to restrain someone who is covered in urine, vomit and diarrhea.
Sometimes his visit basically consists of the doctor the doctor calling the cops and telling them to come make a pick up. But all too often it involves an IV, a banana bag, a head CT to make sure his mental status isn't from him falling and suffering a subdural hematoma, multiple labs and so on and so on.
In the meantime he is screaming obscenities and disrupting the entire ER. Taking up a gurney while someone ill has to sit in the lobby waiting for care. Often multiple staff members are involved in restraining him so that their own patients are neglected.
Why are we wasting resources on these people? They need to be institutionalized and cared for since they are incapable of caring for themselves. It would be much cheaper. And for those of you in the ACLU who think that the rights of one supersedes the rights of the rest of us I say:
BITE MY LILY WHITE ASS!
Sunday, May 10, 2009
God Bless my Mom
Since I have become the mother of a smart mouthed, moody, surly, sullen, eye-rolling teenager with the PMS from hell I just have to say:
Thanks mom for not killing me when i was that age!
Happy Mother's day to my wonderful mom who has always been there to prop me up and who amazingly took a smart-mouthed, moody, surly, sullen, eye-rolling teenager with the PMS from hell and somehow produced a reliable, responsible adult.
Happy Mother's day to all you mom's out there too. And if you didn't call your mom today and thank her for not killing you when you were a teenager........
Get on that damn phone right now!!!!
Thanks mom for not killing me when i was that age!
Happy Mother's day to my wonderful mom who has always been there to prop me up and who amazingly took a smart-mouthed, moody, surly, sullen, eye-rolling teenager with the PMS from hell and somehow produced a reliable, responsible adult.
Happy Mother's day to all you mom's out there too. And if you didn't call your mom today and thank her for not killing you when you were a teenager........
Get on that damn phone right now!!!!
Friday, May 8, 2009
This is why we are failing
last night we had 65 patients in the 12 hours I worked.
12 of them had chronic back pain
3 had migraines
7 dental pains
13 abdominal pains - 5 of which had more than one ER visit in the last 7 days
6 chest pains- one of these patients was a dialysis patient who had kidney failure d/t untreated HTN who would rather smoke crack than go to dialysis.
2 stroke symptoms
4 toddlers with fever, none of which were in any distress and none of which were given any tylenol or ibuprofen at home.
1 patient with new onset atrial fibrillation
4 senior citizens with pneumonia - one whose family wanted everything done despite the fact that she was severely demented - didn't recognize any of the family and was bed-ridden in a nursing home.
1 senior citizen with altered mental status d/t a UTI
the rest had various other complaints none of which needed an ER visit.
Out of 65 patients 12 were admitted. Of those twelve, 7 had severe chronic medical problems related to smoking, drug abuse or non-compliance with treatment.
At least 40 of them had no emergency medical condition at all. 27 of those visits were paid for by Med-i-cal - meaning you and me. Eight of those came in by ambulance - also paid for by you and me.
You can talk socialized medicine all you want - in my opinion we already have socialized medicine -EMTALA and Medi-Cal which has lead to rampant abuse of the ER. Socialized medicine will only make that worse unless something is done to fix the underlying problems, people need to be told NO sometimes.
NO, we are not going to continue paying for your dialysis since you chose to be non-compliant by not taking your med's or coming to your appointments.
NO, we are not going to provide millions of dollars of intensive care to treat a contracted, demented nursing home patient who has no cognitive abilities or quality of life. We are going to keep them pain free and let them die with some dignity.
NO, you can not come to the ER with your chronic pain. You can go to the clinic. Took your months worth of pain meds in two weeks? Too bad.
NO, we will not pay for anymore treatment for your smoking related problems as long as you continue to smoke.
NO, the government cannot cut any further mental health dollars and in fact - they shall be forced to fund a mental heath hospital with their own urgent care that is open 24 hours a day. There will be a clinic in every community of greater than 30,000 residents. Cutting funding to mental health has not saved a dollar. In fact it has cost us billions of dollars in repeated ER visits, increased drug abuse, incarcerations, homlessness and crime.
NO, drunks cannot come to the ER -they will go immediately to the drunk tank. BILLIONS of our tax dollars are spent every year on chronic drunks who drink themselves into a stupor daily then pass out on the sidewalk and end up in the ER. If you demonstrate a trend for this then you will be incarcerated since you obviously cannot take care of yourself.
NO, we will not pay for obesity related illnesses if you are doing nothing to help yourself. Trying to eat healthy and exercise OK otherwise you are on your own.
NO, you cannot call an ambulance for a non-urgent problem. It is ridiculous how many people come in by ambulance every day for non-emergencies.
Until we expect people to have some personal responsibility we will just continue bankrupting our country. Giving people unlimited access to free will just continue to allow them to have no responsibility for their actions. The government will continue to tax the hell out of those of us that work and are responsible to pay for those that are not. I don't know about you but I am getting a little tired of that.
12 of them had chronic back pain
3 had migraines
7 dental pains
13 abdominal pains - 5 of which had more than one ER visit in the last 7 days
6 chest pains- one of these patients was a dialysis patient who had kidney failure d/t untreated HTN who would rather smoke crack than go to dialysis.
2 stroke symptoms
4 toddlers with fever, none of which were in any distress and none of which were given any tylenol or ibuprofen at home.
1 patient with new onset atrial fibrillation
4 senior citizens with pneumonia - one whose family wanted everything done despite the fact that she was severely demented - didn't recognize any of the family and was bed-ridden in a nursing home.
1 senior citizen with altered mental status d/t a UTI
the rest had various other complaints none of which needed an ER visit.
Out of 65 patients 12 were admitted. Of those twelve, 7 had severe chronic medical problems related to smoking, drug abuse or non-compliance with treatment.
At least 40 of them had no emergency medical condition at all. 27 of those visits were paid for by Med-i-cal - meaning you and me. Eight of those came in by ambulance - also paid for by you and me.
You can talk socialized medicine all you want - in my opinion we already have socialized medicine -EMTALA and Medi-Cal which has lead to rampant abuse of the ER. Socialized medicine will only make that worse unless something is done to fix the underlying problems, people need to be told NO sometimes.
NO, we are not going to continue paying for your dialysis since you chose to be non-compliant by not taking your med's or coming to your appointments.
NO, we are not going to provide millions of dollars of intensive care to treat a contracted, demented nursing home patient who has no cognitive abilities or quality of life. We are going to keep them pain free and let them die with some dignity.
NO, you can not come to the ER with your chronic pain. You can go to the clinic. Took your months worth of pain meds in two weeks? Too bad.
NO, we will not pay for anymore treatment for your smoking related problems as long as you continue to smoke.
NO, the government cannot cut any further mental health dollars and in fact - they shall be forced to fund a mental heath hospital with their own urgent care that is open 24 hours a day. There will be a clinic in every community of greater than 30,000 residents. Cutting funding to mental health has not saved a dollar. In fact it has cost us billions of dollars in repeated ER visits, increased drug abuse, incarcerations, homlessness and crime.
NO, drunks cannot come to the ER -they will go immediately to the drunk tank. BILLIONS of our tax dollars are spent every year on chronic drunks who drink themselves into a stupor daily then pass out on the sidewalk and end up in the ER. If you demonstrate a trend for this then you will be incarcerated since you obviously cannot take care of yourself.
NO, we will not pay for obesity related illnesses if you are doing nothing to help yourself. Trying to eat healthy and exercise OK otherwise you are on your own.
NO, you cannot call an ambulance for a non-urgent problem. It is ridiculous how many people come in by ambulance every day for non-emergencies.
Until we expect people to have some personal responsibility we will just continue bankrupting our country. Giving people unlimited access to free will just continue to allow them to have no responsibility for their actions. The government will continue to tax the hell out of those of us that work and are responsible to pay for those that are not. I don't know about you but I am getting a little tired of that.
Thursday, May 7, 2009
What idiots are in charge?
Today it was announced that to cut Med-i-cal costs there would be no more reimbursement for adult dental services.
So it is going to be cheaper to not pay a couple hundred dollars for dental care and instead spend thousands upon thousands for repeated ER visits to treat recurrent dental abscesses.
Brilliant.
So it is going to be cheaper to not pay a couple hundred dollars for dental care and instead spend thousands upon thousands for repeated ER visits to treat recurrent dental abscesses.
Brilliant.
Happy Nurses Week 2009
This is why I am an ER nurse.
Today we had a visit from a very special person. She literally was brought back from the dead over 20 times.
The worst day of her life started on a routine trip to the local mall. She was found face down on the floor of the women's restroom -dead. The first person who found her immediately started CPR. There was an AED at the mall which was used and shocked her three times before EMS arrived. Thanks to the swift response of the EMS crew she was in our ER within 10 minutes of being found on the ground. She had CPR the entire time.
She had a pulse on arrival but when we moved her over to the gurney she went into pulseless v-tach and was shocked again. She spent thirteen minutes in the ER being resuscitated. The cardiologist was in the ER seeing another patient and made the decision to take her to the cath lab. She had a pulse when leaving the ER but went into v-fib in the elevator - one of the ER nurses climbed on top of the patient to perform chest compressions while the gurney was pushed swiftly into the cath lab.
The cath lab crew continued the resuscitation efforts while the cardiologist inserted a balloon pump. The patients hemodynamic status stabilized and she was taken to the cardio-pulmonary ICU in very critical condition. That evening she was taken to the cardiac OR where she underwent four vessel bypass.
Over the next couple of days her cardiac status continued to improve and she was weaned of the balloon pump and all her vaso-active and anti-arrhythmic drips. She began to wake up and show signs of neurologic improvement.
twelve days after she was found dead on the floor at the mall she walked out of our hospital unassisted on the way to a full recovery.
This is why I am an ER nurse.
Happy Nurse's Week everyone.
Today we had a visit from a very special person. She literally was brought back from the dead over 20 times.
The worst day of her life started on a routine trip to the local mall. She was found face down on the floor of the women's restroom -dead. The first person who found her immediately started CPR. There was an AED at the mall which was used and shocked her three times before EMS arrived. Thanks to the swift response of the EMS crew she was in our ER within 10 minutes of being found on the ground. She had CPR the entire time.
She had a pulse on arrival but when we moved her over to the gurney she went into pulseless v-tach and was shocked again. She spent thirteen minutes in the ER being resuscitated. The cardiologist was in the ER seeing another patient and made the decision to take her to the cath lab. She had a pulse when leaving the ER but went into v-fib in the elevator - one of the ER nurses climbed on top of the patient to perform chest compressions while the gurney was pushed swiftly into the cath lab.
The cath lab crew continued the resuscitation efforts while the cardiologist inserted a balloon pump. The patients hemodynamic status stabilized and she was taken to the cardio-pulmonary ICU in very critical condition. That evening she was taken to the cardiac OR where she underwent four vessel bypass.
Over the next couple of days her cardiac status continued to improve and she was weaned of the balloon pump and all her vaso-active and anti-arrhythmic drips. She began to wake up and show signs of neurologic improvement.
twelve days after she was found dead on the floor at the mall she walked out of our hospital unassisted on the way to a full recovery.
This is why I am an ER nurse.
Happy Nurse's Week everyone.
Monday, May 4, 2009
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