Evidence Based Medicine

Light posting today. I am under a deadline to finish an evidence based project to evaluate one of our medication administration policies. I found an error in the way that we administer and document medicine, and I have been assigned the project of reviewing the evidence and submitting it to management so that the policy can be changed.

Good Questions

Some good questions to my security post of this morning, so let’s take a look:

  • I’m curious as to what you use as a training load equivalent?

I don’t for the higher powered 45 loads. How I address this, is nearly every pistol (as opposed to revolver) that I have is a S&W M&P: I have M&P40s, M&P9s, M&P45s, a Shield 380EZ, several Shield pluses, as well as Shields in 9mm, .380, .40S&W, and .45ACP. I also have a few Glock 19s and 19 clones, but I rarely shoot them and can’t remember ever carrying one.

Having the same models as carry pieces simplifies the manual of arms, makes repairs easy as they all look the same on the inside, and makes switching firearms and calibers smoother and easier. I know that full power loads don’t shoot the same, but it’s close enough for what I am doing here. I can still do A-zone shots quickly and effectively out to 15 or 20 yards with little effort, and that is all I am concerned with.

  • IDK if I’d go to a full size .45 tho, a single stack 9mm is very svelte, easy to carry, and similar capacity. A subcompact .40 a bit thicker, but smaller than the .45 and similar power/effect.
  • Open carry is legal in Florida on your own property. But wear a light cover garment anyway; they don’t need to know until it’s time for them to know, and you’re still “legal” if you step into the street.
  • It wouldn’t hurt to have a Glock 19-26 ish type pistol concealed appendix ish.

All handguns are a tradeoff. They have low power, not as much firepower as a long gun like an AR-10 or an AR-15, and not as much punch as say, a shotgun. We carry handguns because we aren’t sure whether or not we will need one, but it is useful to have one just in case. When I am at home, I have more freedom to carry a large handgun, hence the double stack .45.

One firearm on me at a time is all I need, especially when at home. All I need is something to bridge the gap that exists between me and a long gun. Remember, you carry a handgun in case you might be in a gun fight. If you KNOW you will be in a gun fight, endeavor to not be there. If that is impossible, bring a long gun, and bring a friend with a long gun, if possible.

When working on my property but outside, I just wear a baggy t-shirt and pull it over my OWB holster (a DeSantis Speed Scabbard that I used to use back when I was an IDPA competitor. A funny story about that below the divider)

When I am away from home, I avoid areas where I am likely to need a firearm, but just in case, I carry a pistol or revolver that is easy to carry and easy to conceal. Think a Smith and Wesson Shield, Shield plus, or J frame revolver. My EDC is usually a Shield plus (they hold 13 rounds of 9mm), or a J frame .38 loaded with wadcutters.

  • Have you made realistic plans for the “temporary” removal of your firearms after a “Good Shoot”?

I have caches of firearms. I have guns in safes. I’m not opening or revealing either to the cops.

I have a Tshirt that says “DeSantis, Concealment Perfected” on it that I bought some years ago. One of my wife’s coworkers saw me while I was wearing it out with her and some coworkers at an event. She told me that seeing DeSantis’ name on a shirt was a trigger for her because he was an evil fascist. I told her not to worry, that the shirt had absolutely nothing to do with the Governor, it was a brand of holsters that I liked carrying my pistols in, “and in fact I am carrying a handgun in one of their holsters now.”

She practically ran out of the venue and hasn’t spoken to my wife since. My wife says that she didn’t like the woman anyhow, but that saying what I said was hunting over bait, even if it was funny.


A group of young men were seen in my neighborhood on at least three days last week. They were walking up to houses and knocking on the front doors. On the first day, if the homeowners answered, they would ask them a series of (in my opinion) intrusive questions, like how many people lived there, how much they made, how much they paid for the house, those sorts of thing. The second time they were seen, they were acting like they were selling solar systems, and when they came by yesterday, the same guys were selling home improvement supplies. Each time, the cops were called, but twice the guys were gone when the cops got here, and once the cops talked to them but they left- only to return the next day.

I was at work for the third day, and I told my wife not to open the door, and to tell them through the video doorbell that they were trespassing. She knows how to shoot, and I told her to then call the cops, and if the person tried to enter the house, to defend herself.

This is sketchy as hell. A bunch of us talk, and we have pictures of the three men involved, pictures of the two vehicles they were seen driving, and pictures of license plates. I will be keeping an eye out for those guys. Our neighbor’s husband works during weekdays, so I will keep watch over the house and wife while he is off at work.

I also pulled an outside the pants holster and mag holder out of the closet and will be wearing a larger firearm than my usual EDC whilst I am home. I will be open carrying an M&P 45, loaded with a 10 round mag filled with Speer Gold Dot G2 230grain +P hollow points while I am home (I got a great deal on a case of the GDHP last year from Lucky Gunner). Add a couple of spare mags to my belt, and I have 30 rounds of “you aren’t robbing MY fucking house without sustaining a sucking chest wound, asshole.”

Also available are shotguns, rifles, and other assorted mayhem should they give me a couple of seconds to get all of my shit in one sock.

I will keep an increased security lookout for the next few days.

Side note: The Speer G2 is a good looking load. 230 grains moving at 950 feet per second gives you 461 foot pounds of energy at close range. Expansion looks good. Check it out.

More Pay BS

Keeping up with my current problems at work, with them requiring us to perform training on our own time but not wanting to pay us. They are saying that any training hours claimed in excess of four hours in any two week pay period will not be approved. At the same time, we are REQUIRED to complete this training, or we will be taken off of the schedule and not permitted to work.

Here is a list of the training that I have been assigned over the next few pay periods:

May 5-18

  • Patient Experience Class- increasing customer satisfaction- 4 hours
  • Preceptor’s monthly TEAMS meeting (preceptors are required to attend 10 of these per year) 2 hours

May 19-June 1

  • Training- The Business of Healthcare, Lecture F, 4 hours
  • Preceptor monthly TEAMS meeting for June, 2 hours

June 2-15

  • Business of healthcare, lecture B, 4 hours
  • June Skills fair, 1 hour
  • Annual megacode simulation, 2 hours
  • Strokes, 2024 Refresher training, 6 course series (Due 24 June) 8 hours

June 16-29

  • Business of Healthcare, lecture E, 4 hours
  • Preceptor workshop, 4 hours
  • Quarterly HAZMAT Decon training, 4 hours

So as you can see, they are only willing to pay for four hours per two week pay period, but they assign you an average of 10 hours of training per pay period. Over the course of a year, that adds up to 240 hours of training, but they are willing pay us for less than half of it. That means I am being cheated out of about 130 hours of overtime each year, if not more. They are getting a month of free labor out of each nurse, each year. It adds up. If all of the nurses who work there are being similarly treated, and listening to the grumbling, they are, the hospital is saving almost $3 million a year by cheating the overtime rules.

For Example

I am sitting at home, taking a mandatory online training course on “preventing medication errors.” The class lasts from 0800-1200. Let’s see if I get approved to be paid for this course.

Shady Practices: You Can’t Refuse to Pay Employees

My posts are delayed this morning because I am arguing with the payroll woman at my job.

The hospital where I work has a lot of training requirements. We are assigned mandatory training every month. Some of it is in the form of traditional, in-person classes, some of it is online training, and some of it is simulation training that must be done at the hospital. We are not given time to do this while we are on our regular shift, because that time is taken up providing patient care. For the month of May, that comes to about

If we clock in (using a time clock on site, or if we clock in virtually by signing in online) to do this training at a date and time that is outside of our scheduled shift, it has to be approved. I just got a call from work and was told that some of my training hours were not approved, and I would not be getting paid for them.

The Department of Labor says that an employer doesn’t have to pay you for training time if that training meets four criteria:

  • it is outside normal hours
  • it is voluntary
  • it is not job related, and
  • no other work is concurrently performed.

We have a problem. Actually, WE don’t have a problem, my employer does. When an employer tells you that completing training is mandatory, they don’t have the option of telling you that the hours need to be approved. They have to pay you, it’s the law. Here is a handy guide for employers that explains it:

As we mentioned earlier, the FLSA requires that employees be paid at least one and a half times the regular wage rate for all hours worked over 40 in one workweek. When calculating the number of hours an employee works, you’ll need to include all compensable time, which includes unauthorized work time if you know or have reason to know about it. Essentially, if the employee works over 40 hours a week in any way, you’re liable for compensating them for it.

So, even if you have a policy in your employee handbook that states overtime must be approved by a manager in advance, if an employee works it anyway – in violation of the policy – you still must pay them. That’s because the FLSA considers “work not requested but suffered or permitted” to be work time. The reason doesn’t matter; if you know or have reason to believe the employee is continuing to work, that time is working time.

In this case, they made the training mandatory, but leave it to the employee to schedule and complete the training on their own time. The employee has to clock in and out, then has to list the hours, date, and time on a spreadsheet in the company computer system so training can verify that it was legitimate. Then after the fact, the training department “validates” the hours so that payroll can approve it. In many cases, the training people will “deny” the hours, and the employee just doesn’t get paid for completing the training.

That isn’t what the law says. I don’t have to get overtime approved if my employer knows that I am working it. They have to pay me. Period. Now they are free to fire me if I am working unauthorized overtime, but it still has to be paid.

Now many of you will say “Well, just don’t do the training, then.” If you don’t complete the training for a given month, you get removed from the schedule and are not permitted to come to work until you complete that training. That is part of how they make it mandatory. Here is an example of a required training notice, directly from an email that I received this morning:

This is a notice to help remind you that your NIH Stroke Scale Certification is due to expire in approximately 90 days. It is your responsibility to renew and provide the appropriate documentation to Human Resources in order to continue to work after 08/17/2024. In accordance with your facility’s policy, if you do not renew prior to the expiration date you may be subject to suspension and possible termination.

While we are on that topic, some of the training that they make us attend is held at another location/hospital. This requires drives that are up to an hour long to get to the other location. The law says that they have to pay you for the time spend driving to the other location. This is what the DOL has to say about that:

An employee who regularly works at a fixed location in one city is given a special one day assignment in another city and returns home the same day. The time spent in traveling to and returning from the other city is work time, except that the employer may deduct/not count that time the employee would normally spend commuting to the regular work site.

Since I have been working there, I have been told to go to another hospital for training on 12 different occasions. The total travel time for those 12 occasions is about 35 hours, and I can prove it because I keep records. It normally takes me 40 minutes round trip to get to and from work at my normal hospital, so that means that they owe me 28 hours of pay for travel time for those 12 days. That means they owe me money that is roughly equivalent to a week’s pay. So far.

I am going to see the ED department head about this the next time I am there for work. If they aren’t willing to pay me for those hours, my next step will be filing a complaint with the Florida Department of Labor’s wage and hour division. As soon as I file the complaint, they can’t fire me for working the overtime, because it then becomes unlawful retaliation.

As long as I am filing the complaint for the declined hours, I may as well include all of the travel time to the other hospitals while we are at it. If my complaint is investigated by DOL and shown to be true, the penalties can be expensive:

If you don’t pay overtime when it’s due, you have to pay back wages for the time worked. If you neglect to pay overtime properly and a complaint is filed with the DOL, you’ll pay damages, penalties, and a fine. For employers who willfully or repeatedly violate the overtime requirements, you could face a civil monetary penalty of up to $1,000 for each violation.

Now consider that there are 250 nurses who work in just the emergency department in just the one hospital where I work, with each one of those nurses being tasked with the same training requirements that I have. How many violations do you think there are? Two thousand? More? Those fines get expensive.

Adding Skills Can Hurt Sometimes

Now that I have completed my latest degree, our move, and my rental has tenants again, I now find myself in possession of spare time. I decided to fill some of that time by taking up Brazilian Jiu-jitsu. The gym that I joined lets you attend unlimited sessions for $200 per month, with an extra $100 if you want to add Muay Thai. The two together are what comprises MMA. There is no contract, it is a simple month to month deal.

For now, I signed up for the BJJ, with the intention of adding the Muay Thai at a later date. There are two types of classes: one group practices with the intent of competition, the other with the intent of self defense. Different approaches. There are different classes at different times each day, so you can go every day, if you so choose.

I have only gone to a couple of classes so far. The classes in the middle of the day are small, with the instructor and just three or four students. They last 90 minutes, and we spend most of the class mastering a move and the counter for it. We end each class by sparring in 5 minute rounds. (Called ‘rolling’ in BJJ). The rules for rolling are simple:

  • No striking. That includes knees, feet, hands.
  • No gouging of eyes, or grabbing the throat.
  • No genital strikes.
  • Nothing that is intended to injure or disable your opponent. This isn’t a street fight, its practice.

It makes the fight purely one of strength, endurance, and skill. Skill is a HUGE part, and a good fight is like a chess match. Move, countermove. The more skill the two fighters have, the faster and more complicated the ordeal.

Today, I was matched up with a 20 something year old who had more experience with MMA, but was about 70 pounds lighter than I am. I am very flexible and I weigh over 200 pounds, so I have advantages there. He was younger and more skilled, so there were his advantages. It turns out that his biggest advantage was endurance.

He made first contact, and I managed to throw him to the mat and land on him before he could react. I had him pinned and kept my base wide, so he couldn’t reverse or throw me off. He tried several joint locks and throws, but I was stronger than he was and kept him pinned for the next 3 and a half minutes. Then he managed to reverse before pinning me to the mat and I had to tap out. He was surprised that I was strong and flexible enough to get out of most of the holds he tried to use. In the end, he just outlasted me because my endurance ran out.

It was a lot of fun, but was very tiring. I was completely out of breath by the end of the five minutes.

By the time I got home, the right side of my chest hurts every time I move. It hurts to breathe, to bend over, and it’s even somewhat uncomfortable to type this post.

I really hope I didn’t break a rib. Even if I am still hurting, I will still go tomorrow. Today’s biggest lesson was that I need to do more cardio. I am going to work on that.

Finals Are Over

I have been offline for a couple of days because I just took the final exam for my last class to get (yet another) Bachelor’s Degree. This time, it was a Bachelor of Science in Nursing. When I went to campus to take those exams, I carried a can of pepper spray and an expandable baton on my person and a firearm locked in my truck. Why? Because of the behavior in the video that JKB over at GFZ posted. Watch the video on the right:

As I posted in the comments there, Florida law says:

A person is justified in using or threatening to use force, except deadly force, against another when and to the extent that the person reasonably believes that such conduct is necessary to defend himself or herself or another against the other’s imminent use of unlawful force. A person who uses or threatens to use force in accordance with this subsection does not have a duty to retreat before using or threatening to use such force.

Assault doesn’t include a physical touch:

An “assault” is an intentional, unlawful threat by word or act to do violence to the person of another, coupled with an apparent ability to do so, and doing some act which creates a well-founded fear in such other person that such violence is imminent.

What is battery? While assault is defined as the threat to cause physical bodily harm, battery is the actual act of doing so. it is the crime of battery if you touch another person against his or her will or deliberately cause an injury to another person, however temporary or minor that injury may be. From the state statute:

The offense of battery occurs when a person:
1. Actually and intentionally touches or strikes another person against the will of the other; or
2. Intentionally causes bodily harm to another person.

Under section 784.03 of the Florida Statutes, indirect contact, such as throwing an object, can constitute battery if the indirect contact was intentionally caused by the accused and was against the other person’s will. Even spitting can constitute a battery. Mohansingh v. State, 824 So.2d 1053 (Fla. 5th DCA 2002) For that reason, I believe that shining a strobe in someone’s eye is either battery (the strobe is causing pain and disorientation), or assault (shining the light is intended to temporarily blind the victim and make it impossible for that victim to detect or defend against an attack).

Note that the law requires intent to touch, strike, or cause injury. That is referred to as mens rea.

All the law requires for nonlethal self defense is that you be in a place where you lawfully can be, and are the recipient of someone else’s imminent delivery of unlawful force. So:

  1. Are you where you can lawfully be? Yes. I am a student here to take an exam.
  2. Is the other person threatening to imminently use, or are they using unlawful force?
  3. Would a reasonable person believe that the attacker intended to touch, strike, or injure you in any way?
  4. Would a reasonable person believe that the person was about to (or was already attempting to) carry out that intent?

This meets the absolute lowest threshold for self defense. The real issue here is that you probably will get arrested, and it will cost you some money to defend yourself in court. Make sure that you have good CCW insurance, so it will pay for your legal defense.

I want you to note that there are perhaps half a dozen people that are assaulting him. That means the attackers will likely gang up on you, and that will likely mean that someone will be shot by the end of the fight.

Think about where this is headed.

Stories From the ED

A young adult woman comes to the ED, having been brought there by her mother for having abnormal behavior. Displaying many of the classic signs of mental illness, she is obviously having a mental health crisis. The mother even said that she woke up in the middle of the night with her daughter standing over her with a large knife in her hand. The doctor considered her to be a threat to her own or someone else’s safety, and subsequently signed the Baker Act paperwork.

As I always do, I am explaining to the young lady that she is being held on an involuntary 72 hour psychiatric hold. I am trying to explain the rules to her- she can’t wear her own clothes, can’t have any of her possessions with her, she will be searched, and she can’t go home.

As I am doing that, the mother keeps hovering and trying to talk to her. The girl keeps trying to negotiate and delay: begging her mother to take her home, asking to go to the bathroom, and looking over my shoulder at the exit, obviously planning an escape. The mother keeps insisting that the girl can’t change clothes with me in the room, needs to be permitted to use the bathroom without a male present, kept blathering on about the woman’s rights, and said that she wanted to “take it all back” and sign her daughter out. I explained that it doesn’t work like that. Legally, once the doctor signs that order, the only person who can cancel it is a psychologist, and that is after the patient is examined by that psychologist. The doctor who signed the order can’t even rescind it.

After over an hour of trying to deal with this, I finally told the mother that she needed to be quiet for a minute so I could do my job. She replied with: “Wow! You’re rude.” I called security to come over so we would have someone that is wearing a body camera there for backup. Then I told the mother: “This is how it’s going to be: Your daughter, my patient, needs to be supervised and has to be within sight of a staff member at all times for her own safety. She doesn’t get to decide who or how that is going to happen, as that is all done according to state law and hospital policy. She is going to take her clothes off and put on these paper clothes voluntarily, or I am going to cut her clothes off and dress her by force. If she resists, I will sedate her. If you continue to impede my ability to provide patient care, I will have you removed. This isn’t a debate, it isn’t a negotiation, and this isn’t a courtroom. That’s how it’s going to be. You can either let me do my job in caring for your daughter and I will allow you to stay, or you can keep getting in the way and I will ask you to leave.”

The patient continued to argue and resist, so I gave her 10mg of Haldol after which we got her dressed in the paper gown, and put her down for her nappy nap. I put a hospital employee in her room as a safety sitter. Mom filed a complaint, and when the charge nurse came over to talk to me about it, she said, “I was waiting for you to have enough of that. You were more patient than I would have been.”