Changes, part 2

As I said last month, we are searching for a new location to be closer to my wife’s job. I am also tired of things where I work:

  • I was suspended without pay for a week because of a pending investigation when a delusional patient accused me of trying to kill him.
  • An incident just after New Year’s day where a patient threatened violence.
  • Three different incidents in January where patients either attacked or threatened to attack me.
  • My hospital claims to want 4 to 1 nurse to patient ratios* in the ED. That is rare. Now it’s usually 6 to 1. On one recent shift, I had 5 patients, but 2 of them were on ventilators. One of the other three was a sepsis patient who went into cardiac arrest just after EMS brought him in. The work load there is just too high.

So I also want to change jobs. Career specialists say that you should change every 2 to 3 years, so I think now is a good time to do so. I think we are close to answers on both.

We found a builder that will build us a 5 bedroom, 4 bath, 2900 square foot house for less than $190 a square foot. The place is gorgeous. Here are a couple of pictures from the model:

Master Bedroom
Living Room

Construction should take a bit. In the meantime, my wife’s job is moving in the fall, so if the house isn’t done by then, she will have a 45 minute commute. We are negotiating terms now.

On the job front, I just negotiated with a potential new employer. I spoke with people I know who work there, and they say it’s a good place. It looks good:

  • Patient to nurse ratios in the ED of 3:1, with occasional jumps to 4:1. I confirmed with friends that they aren’t blowing smoke with this claim.
  • Better neighborhood, so less of the violent psych and druggie patients.
  • A $12 per hour raise over what I am making now
  • Getting a $10,000 recruitment bonus for a 2 year contract doesn’t hurt (payable in 4 semi annual installments)

The downsides are twofold:

  • Because this hospital is properly staffed, there are no shift bonuses for pulling extra shifts. Of course, my hospital stopped paying them in September, so no real loss.
  • I can’t be PRN at the new place. I have to work full time for the time being. That’s OK, this will enable us to pay for this new house in 8 years and still keep the one we live in now as a rental.

The new hospital has sent the offer, and I have conditionally accepted for an August start date. (when the wife’s new job location starts) I should get the actual contract to look over some time in the next week. If it looks good, I will sign on. Hey, closer to the new place, less workload, and more money.


Explanation of the importance of patient/nurse ratios:

For those who don’t know, each patient needs to be assessed at intervals, plus needs medications, tests, and other related things coordinated. For “routine” patients on a medical floor, a nurse can handle as many as 6 or 7 patients at a time. The more things that are wrong with the patient, the more time it takes to care for them, so task loading becomes an issue- a nurse can only do so much without increasing the risk that they will miss something important, or make a mistake because they are pressed for time and rushing high risk tasks like selecting and dosing medications. For this reason, the sicker the patients, the fewer that a single nurse can effectively handle.

Some patients are so sick that they take up all of your time. A patient on a ventilator is one of those. In general, having two patients on a ventilator is all a nurse can handle, because those patients are also usually receiving a list of medications that are high risk, and this combination means spending a lot of time with that patient. This is why the more acute the unit, the lower the ratios need to be. In the ED, patients in general shouldn’t be more than 4:1 to the nurses, unless you want to compromise patient safety by not monitoring the patients closely enough. For that reason, the ICU is usually 2:1, the “step down” unit is normally 3 or 4 to 1, and so on.

This is why the ED usually has a unit called “fast track” where patients are less sick with things like toothaches or broken fingers. In fast track, you will see ratios of 6:1 because the patients require far less of the nurse’s time. Fast track is usually a separate subunit within the ED, usually staffed with a nurse or two and a midlevel practitioner (a PA or a nurse practitioner), and the goal there is to clear out as many low acuity patients in as short a time as possible, thus leaving the sicker patients (who take up more time and resources) for the doctors and the nurses with lower ratios.

Just Give Them What They Want

The antigun left’s mantra in self defense shootings is always one of a few responses, including:

  • Take Your Beating Like a Man
  • Just Give Them What They Want

Just give them what they want. The left claims that all you have to do is give them what they ask for, after all, they are probably just trying to feed their family. A few dollars isn’t worth killing over. Just comply. This clerk did, and he was executed for it. Even though it’s difficult to see, you should click on over and watch the video (sorry, can’t embed it).

This begs the question: What if what the criminal wants is your life? How do you know the difference? He is demonstrating the ability, the willingness, the means to kill you, over a few dollars. Remember.

Balloons

SIOP- The Single Integrated Operations Plan. It’s a war plan for the strategic assets of the US military. This plan, covering thousands of pages, is one of the most classified documents that the military has. It details targets, timing, and routes for the nation’s armed forces in the event of a nuclear war. The plan outlines where each cruise missile, land based ICBM, and bomber will strike, what paths they will take, and how they will be supported- tankers, fighter support, and more. The plan is meticulously timed so that no two weapons interfere with each other. A cruise missile might take out a SAM site, then an aircraft out of a European base might fly through the gap created to strike an airbase that allows other forces to reach a missile field. A bomber that is too close to a cruise missile detonation becomes useless when it’s downed by fratricide, so timing is important. SIOP gets updated constantly.

The US Air Force operates a wing of RC-135s whose mission is electronic reconnaissance. They map every single radio and radar transmitter that puts out more power than a toaster for hundreds of miles on each side of its flight path. For radars, it isn’t just location. The plane records the frequency, power, pulse width, and repetition rate of every radar. For radio, they record conversations, frequency, and other facts to determine whether or not those radios belong to command posts, air traffic controller sites, or other defense functions.

How does this tie in to the Chinese balloons? It’s very possible that the Chinese are preparing for a war. Yes, a nuclear one. It’s my feeling that, before invading Taiwan, the Chinese are updating their own version of SIOP. Any invasion of Taiwan has a possibility of involving the United States, and any nation that takes on the US military has to consider the possibility that the conflict will eventually involve a nuclear exchange. PLAN would not be doing their jobs if they did not have an updated picture of the capabilities of NORAD.

These drones, balloons, whatever they are, are mapping the defenses of this nation for a reason. Why now? Why so many? Why risk it? The risk is high, so the reward must be equally as high.

Othering

Two men threaten physical violence against a restaurant patron. One threatens deadly force (“I will stick yo ass, nigga.”). The comments to this video claim that they are in the right because the man said he is a racist.

I wouldn’t have turned my back on them. These thugs went there with the intention of starting a confrontation. They brought an expensive camera with them and are clearly goading him into a response. So they walked up to his table and started a scene, so they could record the it after they started the event by stealing a drink from the table. So given these facts:

  • Thug in hat: “I will beat yo ass right now. Here, hold this camera.”
  • Turns hat backwards.
  • Gets in the guys face.
  • Outnumbered two to one

In this case, I think that it is reasonable to believe that there is a real risk of imminently becoming the victim of violence. Keep in mind that he has already threatened deadly force. They stole a drink. That makes this armed robbery, a forcible felony.

Would a warning be in order: “Back off right now, or you are going to regret it?” Or, is the threat imminent enough that immediate force can be used?

If force can be used or threatened, is it enough for the presentation for a firearm, or would you be limited to pepper spray? If you are wrong, you either die or go to jail.

The Parents Must Pay

Three 13 year olds did over $200,000 in damages to a micro brewery that was under construction when they spent three consecutive nights breaking everything in the building. The owner says that he doesn’t think he can get the money from the children because they are so young, and the parents of the children are refusing to step up.

I don’t know what Michigan law says, but in most states the parents are responsible for whatever damages are caused by their crotch fruit. I would sue the parents. Any judgements in Michigan are good for ten years, and they can be renewed once. So these kids and their parents can be running from this for two decades, unless they want to declare bankruptcy. Wage garnishment, taking any property they have and selling it to recoup some damages are tools, unless they have nothing at all to take. For the next 20 years.