More About Money

I don't normally state plainly what country I'm blogging from following the closure of GeekNurse, although it's fairly easy to look up which is why I don't try too hard. Hence the ambiguity of my previous post on finances.

In that post I was out by quite a long way. Told you I was bad with money! I make $37 613 in US dollars before tax. I lose 25% in tax and a further 7% in student loan repayment, so by subtracting 32% we get the unhealthy net amount of $25 577 USD. This is after 8 years of clinical experience.

As you can see, it wouldn't be hard to do better on US RN wages, even taking cost of living into account. In fact, with rentals the way they are where I live, and with accommodation often provided for in travel nursing contracts, I'd probably be quite a bit better off. But I love my country, I love the way we practice intensive care here, and it's just not the right time. So I should stop complaining!

I can increase my earning slightly by 'upgrading' myself according to our hospital's mind-numbing grade system, which ranks how competent I am by asking me to produce a large body of 'evidence' and fill out a vast form. Sheer laziness on my part (and a certain amount of resentment at having to do it in the first place) has so far prevented me from complying.

If you don't mind disclosing, how about posting your own income from nursing (converted to USD) in the comments section? Here's a currency converter if you need one.

New Sink

I've been working on the house, I guess I took on a lot because I'm still not finished - but then again I'm sort of slowing down after the holiday. The kitchen isn't quite finished yet, but it's completely operable and missing mostly (mostly....) cosmetic details. I'll post more pics when I've really got it done.

The story behind the sink is that I bought it off of Craigslist for $50. It was the original sink out of a torn-down 1910 farmhouse and the grandson of the owner kept it to resell. It was sitting in his field when I got there, but the rust spots weren't rotted and it was fixable. A few people laughed when I showed them my "new sink" for my new kitchen, but my husband has enough belief in my funny ideas to merely say "Wow, thats big!" and leave me to work some magic on it. After 2 weeks in the refinishing shop and $320 later here are the pics to prove it was well worth it. It is a full 4" long so I had to get two smaller 24" under-sink counters for it. The basin on the right is standard depth and the basin on the left is about 12" deep! Huge!! :)

Here are some before and after pics of the kitchen and sink (the album called "sink" is the public album). The new kitchen isn't really this orange - more like a spice color. Counters are black and the cabinets are pure white. That's a new window too. The old kitchen was even fuglier than the pictures show (and very used). I had to take it down to the studs to replace all of the plumbing, wiring, and insulation - the house is 80 years old, after all.

So whatcha you think - you like-a de sink?

-HK

Literature Review: Severe Sepsis in Children

Watson, R.S., Carcillo, J.A. (2005). Scope and epidemiology of pediatric sepsis. Pediatric Critical Care Medicine, 6 (supplement) S3-S5.

WHO defines "severe" sepsis as that which causes acidosis and/or hypotension (low blood pressure). There are four major killers of children worldwide:

• pneumonia


• diarrhoea


• malaria


• measles

(in order of deaths per year, highest to lowest.) People in developed countries don't think of diarrhoea as a deadly condition, but it kills children like you wouldn't believe. Check out what WHO has to say about it:

Amongst the poor and especially in developing countries, diarrhoea is a major killer. In 1998, diarrhoea was estimated to have killed 2.2 million people, most of whom were under 5 years of age (WHO, 2000). Each year there are approximately 4 billion cases of diarrhoea worldwide.

4 billion. Crazy, huh? If it were spread evenly throughout the year (unlikely), that'd be almost eleven million a day. Anyhoo, moving right along...

Low & Very Low Birth Weight (VLBW) infants made up one quarter of all paediatric sepsis cases in the US in 1995.

Sepsis in children often occurs with an underlying condition. In babies, it's usually chronic lung disease or congenital heart disease. In the 1-9 years bracket, neuromuscular disease is more common. In adolescents, cancer.

Severe sepsis is associated with a 10.3% hospital mortality in children. 7.8% in those who were previously healthy, and 12.8% in kids with underlying disease. Overall 4 400 deaths associated with severe sepsis. Endocarditis and infections of the CNS had the highest mortality. (All US figures from 1995.)

Sepsis is expensive. 1.7 billion total hospital cost associated with severe sepsis nationally.

A preliminary look at 1999 data shows a pattern of increased incidence and decreased mortality. The authors postulate increase in VLBW babies and increased rate of sepsis among those babies.

One of the difficulties of getting better at treating children who are vulnerable to infection because of underlying diseases is that they survive longer, which increases the 'at risk' population. That probably sounds horribly callous, but it's a reality of healthcare today: we've gotten better at keeping people alive, so we need to deal with patients who are more vulnerable to infections--in every age group, not just paediatrics. Everybody's got their 'frequent flyer' stories... patients who present again and again with pneumonia, bronchiolitis, vomiting and diarrhoea, name your poison.

1.6 million neonates die worldwide every year from infection. That's not solely premature babies, folks... that's any baby under 28 days old. Newborns, in other words.

They point out that sepsis can usually be identified in developing countries without sophisticated laboratory facilities. Tachycardia (a faster than usual heart rate) and other physical signs can be predictive of sepsis, and the use of cheap antibiotics in patients identified in this way has significantly reduced mortality rate.

Shock is the most important risk factor for mortality in septic children.

The authors warn about the difficulty of generalising results in adult studies to paediatric populations. This is not a new problem. It's often difficult to justify doing trials on kids. Getting ethics approval is fraught, and parents are obviously worried about the safety of their children so obtaining consent is no picnic either.

Trouble is, adults and babies are different (duh). What works for severe sepsis in adults may not be as effective in children, or have unforseen consequences particularly when you take the differences in their underlying diseases into account.

ED med review by Pharmacy 1st?

Dear Colleague:

Your response to the JCAHO survey dealing with pharmacist first-dose review of non-urgent medications administered in the ED is URGENTLY needed. Despite ENA's efforts along with colleague organizations AAEM and ACEP, we have been unable to convince JCAHO of the lack of necessity for its Proposed Revisions to the Medication Management Standards MM 4.10. ENA believes the JCAHO revisions are not evidence-based and that they will overburden the ED and compromise patient care.

For a link to the JCAHO survey, click here,

Background information on ENA's position can be accessed by clicking here.

The survey deadline is January 24, 2007. Please act today!

Donna Mason, RN, MS, CEN
President
Emergency Nurses Association

The Overdraft Blues

I wanted to do a few papers towards my masters degree this semester. After Christmas it's become clear that not only do I not have the money, I barely have enough to pay the bills.

Let me be plain, this is not because I'm paid just on or above the poverty line. I earn something like $40 000 per year, gross. Not US dollars (if only!) It's enough to live, if not comfortably, then at least without worry over where the next meal is coming from. If I worked at a comparable job in a PICU in the US I would make between twice to three times what I make here, depending on location and bonuses. In the UAE, about the same once you discount the taxation differences. Still, I get a reasonable wage. I think it should be more, but I'm aware that there is not a whole lot of extra money flying around in our national health budget and I'm (somewhat) resigned to that.

The trouble is, I'm not terribly good at managing what I earn. Real estate is extremely expensive here, and at my current rate of saving I'll be fortunate to be able to afford to put a deposit on a house sometime in my fourties. Very fortunate, actually. I may need to become resigned to something else: renting for the rest of my life.

So, further education is on hold for at least the first half of the year. It's becoming more and more tempting to take a working holiday overseas to build up some reserves, although right now it's the last thing I want to do.

Home

Well, I'm back again. A great rest.

I learned quite a bit about our country over the past month. Particularly, it's very beautiful, and has fickle weather!

Back to work soon, and about time too. I suspect I'll have to learn everything from scratch. I dimly recall the general principles... something about any patient you can walk away from is a good one?

Happy New Year!

I'm nowhere near home right now, and Internet access is sporadic hence... oh, I could use it as an excuse but mainly I'm just skiving off and not doing useful things like blogging and, well, shaving. Touring some favourite areas of national park and spending time with extended family.

Here's hoping you and yours are enjoying a holiday too, if that's what you do at this time of year, and best wishes for 2007.