PICU Traveler

The life of a PICU traveler RN

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A New memo from Admin

Posted by martygrn on January 19, 2008

Ran across this at a website on medical/nursing humor. It is quite extreme, but is it really anymore extreme than some of the real ones that are seen everyday?


To: All Hospital Employees

From: Administration

Effective immediately, this hospital will no longer provide security. Each Charge Nurse will be issued with a .38 caliber revolver and 12 rounds of ammunition. An additional 12 rounds will be stored in the pharmacy. In addition to routine nursing duties, Charge Nurses will patrol the hospital grounds 3 times each shift. In light of the similarity of monitoring equipment, the Critical Care Units will now assume security surveillance duties. The unit secretary will be responsible for watching cardiac and security monitors, as well as continuing previous secretarial duties.

Food service will be discontinued. Patients wishing to be fed will need to let their families know to bring them something, or make arrangements with Subway, Dominos, Wendy’s, or another outside food preparation facility, prior to mealtime. Coin-operated telephones will be available in the patient rooms for this purpose, as well as for calls the patient may wish to make.

Housekeeping and Physical Therapy are being combined. Mops will be issued to those patients who are ambulatory, thus providing range of motion exercise, as well as a clean environment. Families and ambulatory patients may also register to clean the room of non-ambulatory patients for discounts on their bill. Time cards will be provided to those registered.

Nursing Administration is assuming the grounds keeping duties. If a Nursing Supervisor cannot be reached by phone or beeper, it is suggested to listen for the sound of the lawn mower, weed eater, or leaf blower.

Engineering will also be eliminated. The Hospital has subscribed to the Time-Life series of “How to…” maintenance books. These books may be checked out from Administration. Also, a toolbox of standard equipment will be issued to all Nursing Units. We will be receiving the volumes at a rate of one per month, and have received the volume on basic wiring. If a non-electrical problem occurs, please try to repair it as best as possible until that particular volume arrives.

Cutbacks in Phlebotomy staff will be accommodated by only performing blood-related laboratory studies on patients already bleeding.

Physicians will be informed that they may order no more than two (2) X-rays per patient per stay. This is due to the turn-around time required by the local Photomat. Two prints will be provided for the price of one and physicians are encouraged to clip coupons from the Sunday paper if more prints are desired. Photomat will also honor competitors coupons for one-hour processing in an emergency. If employees come across any coupons, they are encouraged to clip them and send them to the Emergency Room.

In light of the extremely hot summer temperatures, the local Electric Company has been asked to install individual meters in each patient room so that electrical consumption can be monitored and appropriately billed. Fans may be rented or purchased in the Gift Shop.

In addition to the current recycling programs, a bin for the collection of unused fruit and bread will soon be provided on each floor. Families, patients and the few remaining staff are encouraged to contribute discarded produce. The resulting moldy compost will be utilized by the pharmacy for nosocomial production of antibiotics. These antibiotics will be available for purchase though the hospital pharmacy, and will, coincidentally, soon be the only antibiotics listed in the hospital’s formulary.

Although these cutbacks and changes may appear drastic on the surface, the Administration feels that over time we will all benefit from this latest cost cutting measures.

Maybe I shouldn’t post this. It may give some admin-types too many ideas.

Original Source


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Moving Day

Posted by martygrn on January 16, 2008

As of today, I am moving my blog to a new host. This is being done primarily because the new location is where most of the blogs I am fans of are located as well as the fact that the new location allows me more personal freedom in design. With that being said, I will also move all of my posts from here to there. Here is my new home on the web:


Not too different now, is it.

Posted in Health Care, Illegal Immigration, nurse, nursing, pediatric, travel nursing | 2 Comments »

Docs vs Nurses vs Docs

Posted by martygrn on January 12, 2008

Notice I put nurses in the middle in the title? There is a reason for it. This is how things work at the hospital I am currently working at. We have our ICU docs who run things in the ICU. We also have the cardiologists and the cardiac surgeons. The problem comes in when they don’t seem to communicate with each other. I had a patient the other day that illustrated this the best.

They were in town on vacation and their daughter had a congenital heart condition that had been repaired surgically in their hometown. She was having some complications and was admitted to our ICU to manage. The cardiologist on-call was the one in the group with the largest ego. He was in the room discussing things with the family when the patients home cardiologist called, the one who had treated the child since birth. When Dr. M, as I’ll call our cardiologist, was asked if he wanted to speak with him, guess what his answer was? “No, just tell them to send the records.” Here begins the problems as this was stated in front of the family.

Later on that evening, the parents asked why he wouldn’t speak with their doc, the one they trusted totally. Let me also add that these parents were very knowledgeable about their daughters condition and very involved in her treatment. The kind of parents we love to have around. I had to honestly answer that I didn’t know. They had a few questions concerning what we were doing as far as treatment was concerned,so since it was a Sunday evening, I asked our ICU doc to speak with them as Dr. M had gone home. His answer to quite a few of their questions was that cardiology had to make that decision. So he had us page Dr. M at home and put him on the phone with the parents. Dr. M, from home, told the parents that the ICU docs should make those decisions. According to the parents, he seemed like he just wanted to get off the phone and get back to dinner with his family. He may have even said so, I don’t know why else they would have thought this.

In case you’re wondering, the big question was why was their child not receiving their home medications. I have to side with the ICU doc on this one as most of the home medications were cardiac medications. Something I think the cardiologist should be deciding. But then again, I’m just a nurse. What do I know. These medications were never ordered even though they were on all 3 medication reconciliation forms we had filled out, a subject for another post.

Bottom line is that I had a patient and family that had good, important questions concerning their child’s care at 5PM that were not addressed until the next morning. Not at all acceptable in my book. This is a facility that is totally run and controlled by the physicians for their comfort and convenience. I have yet to see anything done which in any way involves nursing at any point. Worse yet, many of their practices, in my opinion, endanger their patients. We can have patients being treated by 5 or 6+ specialties, all of whom can write orders and none of whom are ultimately managing the care.

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Change is a good thing

Posted by martygrn on January 11, 2008

I started this blog to make clear my feelings about the health care system, it’s reform and how to repair it. Those feelings have not changed, however I find there is a lack of new subject material. As I have been reading and following other nursing and medical blogs, I have decided to change the focus of this blog to my experiences as an RN. I work only PICU, Pediatric Intensive Care, for those non-medical types reading this. I also work as a traveller, so I move from city to city every 3-6 months. I will still post on political topics as the motivation strikes me, but no longer wish to restrict my writing to only those topics. I hope this new direction is a change for the better. I think it will be as I feel I will now be able to post more regularly and more generally about whatever may be on my mind on any given day. With that in mind, I am off to work on my next post. I cannot promise everyday as I have a full life with work, a wife and a two sons, 4 and 5, but will promise to do better than every 2 months. (where the h*ll did that time go).

Posted in nursing, pediatric, travel nursing | Tagged: , , | 1 Comment »

Beyond Those Health Care Numbers

Posted by martygrn on November 4, 2007

Found this interesting tidbit online today.  Interesting that there is actual research that backs up my own arguments.  It’s always a good feeling to find out you’re not alone in your beliefs.  I did not write this and the authors credit is at the end.

WITH the health care system at the center of the political debate, a lot of scary claims are being thrown around. The dangerous ones are not those that are false; watchdogs in the news media are quick to debunk them. Rather, the dangerous ones are those that are true but don’t mean what people think they mean.

Here are three of the true but misleading statements about health care that politicians and pundits love to use to frighten the public:

STATEMENT 1 The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance.

The differences between the neighbors are indeed significant. Life expectancy at birth is 2.6 years greater for Canadian men than for American men, and 2.3 years greater for Canadian women than American women. Infant mortality in the United States is 6.8 per 1,000 live births, versus 5.3 in Canada.

These facts are often taken as evidence for the inadequacy of the American health system. But a recent study by June and Dave O’Neill, economists at Baruch College, from which these numbers come, shows that the difference in health outcomes has more to do with broader social forces.

For example, Americans are more likely than Canadians to die by accident or by homicide. For men in their 20s, mortality rates are more than 50 percent higher in the United States than in Canada, but the O’Neills show that accidents and homicides account for most of that gap. Maybe these differences have lessons for traffic laws and gun control, but they teach us nothing about our system of health care.

Americans are also more likely to be obese, leading to heart disease and other medical problems. Among Americans, 31 percent of men and 33 percent of women have a body mass index of at least 30, a definition of obesity, versus 17 percent of men and 19 percent of women in Canada. Japan, which has the longest life expectancy among major nations, has obesity rates of about 3 percent.

The causes of American obesity are not fully understood, but they involve lifestyle choices we make every day, as well as our system of food delivery. Research by the Harvard economists David Cutler, Ed Glaeser and Jesse Shapiro concludes that America’s growing obesity problem is largely attributable to our economy’s ability to supply high-calorie foods cheaply. Lower prices increase food consumption, sometimes beyond the point of optimal health.

Infant mortality rates also reflect broader social trends, including the prevalence of infants with low birth weight. The health system in the United States gives low birth-weight babies slightly better survival chances than does Canada’s, but the more pronounced difference is the frequency of these cases. In the United States, 7.5 percent of babies are born weighing less than 2,500 grams (about 5.5 pounds), compared with 5.7 percent in Canada. In both nations, these infants have more than 10 times the mortality rate of larger babies. Low birth weights are in turn correlated with teenage motherhood. (One theory is that a teenage mother is still growing and thus competing with the fetus for nutrients.) The rate of teenage motherhood, according to the O’Neill study, is almost three times higher in the United States than it is in Canada.

Whatever its merits, a Canadian-style system of national health insurance is unlikely to change the sexual mores of American youth

The bottom line is that many statistics on health outcomes say little about our system of health care.

STATEMENT 2 Some 47 million Americans do not have health insurance.

This number from the Census Bureau is often cited as evidence that the health system is failing for many American families. Yet by masking tremendous heterogeneity in personal circumstances, the figure exaggerates the magnitude of the problem.

To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.

The number also fails to take full account of Medicaid, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.

The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.

Of course, millions of Americans have trouble getting health insurance. But they number far less than 47 million, and they make up only a few percent of the population of 300 million.

Any reform should carefully focus on this group to avoid disrupting the vast majority for whom the system is working. We do not nationalize an industry simply because a small percentage of the work force is unemployed. Similarly, we should be wary of sweeping reforms of our health system if they are motivated by the fact that a small percentage of the population is uninsured.

STATEMENT 3 Health costs are eating up an ever increasing share of American incomes.

In 1950, about 5 percent of United States national income was spent on health care, including both private and public health spending. Today the share is about 16 percent. Many pundits regard the increasing cost as evidence that the system is too expensive.

But increasing expenditures could just as well be a symptom of success. The reason that we spend more than our grandparents did is not waste, fraud and abuse, but advances in medical technology and growth in incomes. Science has consistently found new ways to extend and improve our lives. Wonderful as they are, they do not come cheap.

Fortunately, our incomes are growing, and it makes sense to spend this growing prosperity on better health. The rationality of this phenomenon is stressed in a recent article by the economists Charles I. Jones of the University of California, Berkeley, and Robert E. Hall of Stanford. They ask, “As we grow older and richer, which is more valuable: a third car, yet another television, more clothing — or an extra year of life?”

Mr. Hall and Mr. Jones forecast that the share of income devoted to health care will top 30 percent by 2050. But in their model, this is not a problem: It is the modern form of progress.

Even if the rise in health care spending turns out to be less than they forecast, it is important to get reform right. Our health care system is not perfect, but it has been a major source of advances in our standard of living, and it will be a large share of the economy we bequeath to our children.

As we look at reform plans, we should be careful not to be fooled by statistics into thinking that the problems we face are worse than they really are.

N. Gregory Mankiw is a professor of economics at Harvard. He was an adviser to President Bush and is advising Mitt Romney, the former governor of Massachusetts, in the campaign for the Republican presidential nomination.

Posted in Health Care | 3 Comments »


Posted by martygrn on November 3, 2007


Like a lot of folks in this state, I have a job. I work, they pay me. I
pay my taxes and the government distributes my taxes as it sees fit. In
order to get that paycheck, I am required to pass a random urine test
with which I have no problem. What I do have a problem with is the
distribution of my taxes to people who don’t have to pass a urine test.
Shouldn’t one have to pass a urine test to get a welfare check because I
have to pass one to earn it for them? Please understand, I have no
problem with helping people get back on their feet. I do, on the other
hand, have a problem with helping someone sitting on their ASS, doing
drugs, while I work. . . . Can you imagine how much money the state
would save if people had to pass a urine test to get a public assistance
check? Or perhaps require a urine test to get a prescription for your


painkillers at the local ER?

Posted in Health Care | 4 Comments »

My Absence

Posted by martygrn on October 6, 2007

I have been AWOL for a few weeks.  Just having started at a new hospital in a new city (Phoenix, AZ), I have had to spend some time acclimating to my new position.  I will be back and posting soon.  Sorry for seemingly disappearing.

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Everone looks, no one types

Posted by martygrn on September 24, 2007

I find it interesting that a link to my blog posted on the daily kos site


generated almost 120 “hits” to my blog, but not one single comment. How is it that these many people visited but not one had the courage to directly address my points/concerns? It seems that those with an agenda have no interest in intelligent dialog.I have no idea how to make something an actual link. You may have to copy/paste for the above link to work. If anyone can help me in this regard, I’d greatly appreciate it.

Posted in Health Care | 1 Comment »

On the Road Again

Posted by martygrn on September 16, 2007

The life of a travel nurse.  I am currently sitting in a hotel en route from the DC area to Phoenix, AZ.  I have to report to work in Phoenix next Monday and can move in to my apartment on Friday.  My goal is to be there on Friday.  It will be nice to spend the winter in Phoenix, though travelling cross country, 2300 miles, with my 2 sons, 4 and 5 yrs old, is a challenge in and of itself.  Also just shipped 12 boxes of clothes, etc. to myself as we have more than our poor little Camry can carry.  What an adventure this will be.  This time, instead of the county hospital in Phoenix, I will instead be working at the children’s hospital.  It will be interesting to see if there is much difference.  I started out traveling for many reasons, one being that having worked at Duke Hospital for my entire nursing career, I wanted to see if their ego was deserved.  To some degree, it is, but it mostly has to do with volume and experience.  We, my wife and I, also felt that with our children being the age they are, that now is the ideal time to do this.  They are old enough to appreciate what is happening, yet young enough to not have all the ‘I don’t want to leave my friends’ concerns.  For all the stress that moving every 13 weeks causes, I wouldn’t trade it for the world.  From a nursing perspective, it is heaven.  I do not get involved in the ‘politics’ of the hospital or unit I am working on.  I go to work, do my job and go home.  There is the downside of having to learn new systems, processes, etc. every place I go, but I treat it as a learning experience.  So, all in all, I come in, help fill staffing holes, ignore the pettiness of politics and have fun doing what I do.  All this and I, unfortunately, get paid more than the full-time employees.  Through all of it, my agency is my employer, so in a resume sense, I am not changing jobs at all.  I will continue to update on the ups and downs of traveling as time allows.

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American Cancer Society the Newest to be Misled

Posted by martygrn on September 15, 2007

Here is an interesting article found in the WSJ:

Cancer Killers

September 14, 2007; Page A12

Last week the American Cancer Society announced it will no longer run ads about the dangers of smoking and other cancer-causing behaviors and the benefits of regular screenings. Instead, the Society will devote this year’s entire advertising budget to a campaign for universal health coverage. John Seffrin, the Society’s chief executive, said, “[I]f we don’t fix the health-care system . . . lack of access will be a bigger cancer killer than tobacco.”

Sadly, these ads will waste money that should be used to continue the Society’s educational campaign about prevention and detection. The evidence shows that universal health coverage does not improve survival rates for cancer patients. Despite the large number of uninsured, cancer patients in the U.S. are most likely to be screened regularly, have the fastest access to treatment once they are diagnosed with the disease, and can get new, effective drugs long before they’re available in most other countries.

Last month, the largest ever international survey of cancer survival rates showed that in the U.S., women have a 63% chance of living at least five years after diagnosis, and men have a 66% chance — the highest survival rates in the world. These figures reflect the care available to all Americans, not just those with private health coverage. In Great Britain, which has had a government-run universal health-care system for half a century, the figures were 53% for women and 45% for men, near the bottom of the 23 countries surveyed.

A 2006 study in the journal Respiratory Medicine showed that lung cancer patients in the U.S. have the best chance of surviving five years — about 16%. Patients in Austria and France fare almost as well, and patients in the United Kingdom do much worse with only 5% living five years. A report released in May from the Commonwealth Fund showed that women in the U.S. are more likely to get a PAP test every two years than women in Australia, Canada, New Zealand and the U.K., where health insurance is guaranteed by the government. In the U.S. 85% of women ages 25-64 have regular PAP smears, compared with 58% in the U.K.

The same is true for mammograms. In the U.S., 84% of women ages 50-64 get them regularly, a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63% of women in the U.K. The high rate of screening in the U.S. reflects access as well as educational efforts by the American Cancer Society and others.

Early diagnosis is important, but survival also depends on getting effective treatment quickly. In the spring of 2007, 58-year-old Valerie Thorpe from Kent, England, went through the anguish of being diagnosed with cancer, and then was told she would have to wait four months before beginning radiation therapy. Her plight was reported in the newspaper because she appealed to her representative in Parliament. But her problem is not unusual. A study by the Royal College of Radiologists, published this June, showed that such waits are typical, and 13% of patients who need radiation never get it due to shortages of equipment and staff.

Long waits for treatment are “common devices used to restrict access to care in countries with universal health insurance,” according to a report in Health Affairs (July/August 2007). The British National Health Service has set a target for reducing waits. The goal is that patients will not have to wait more than 18 weeks between the time their general practitioner refers them to a specialist and they actually begin treatment.

Access to new, better drugs also explains differences in survival rates. In May, a report in the Annals of Oncology by two Swedish scientists found that cancer patients have the most access to 67 new drugs in France, the U.S., Switzerland and Austria. For example, erlotinib, a new lung cancer therapy, was 10 times more likely to be prescribed for a patient in the U.S. than in Europe. One of the report’s authors, Dr. Nils Wilking from the Karolinska Institute in Stockholm, explained that nearly half the improvement in survival rates in the U.S. in the 1990s was due to “the introduction of new oncology drugs,” and he urged other countries to make new drugs available faster.

International comparisons establish that the current method of financing health care in the U.S. is not a bigger killer than tobacco. What is deadly are delays in treatment and lack of access to the most effective drugs, problems encountered by some uninsured cancer patients in the U.S. but by a far larger proportion of cancer patients in the U.K. and Europe. Cancer patients do well in a few small countries with national health insurance, such as Sweden and Finland, but they do better in the U.S. than anywhere else on the globe.

With a track record like that, the American Cancer Society should continue its lifesaving messages about prevention and screening instead of switching to a political agenda. The goal should be to ensure that all cancer patients receive the timely care our current system provides, not to radically overhaul the system.

Ms. McCaughey, a former lieutenant governor of New York, is chairman of the Committee to Reduce Infection Deaths (www.hospitalinfection.org1).


And we WANT government-run, single-payer health care??????

Posted in Health Care | 3 Comments »