March, 2007 Archive

March 7, 2007, 10:07 pm

Change of Shift: Volume One, Number Nineteen


Welcome to the nineteenth edition of Change of Shift! An eclectic selection of posts can be found in this edition and we welcome some new nurse bloggers to the fold! Grab your coffee and dig in!


New blogger AZRN from Researchgrrl submits a heart-wrenching story of connection and loss in “Memories of Amy”. Welcome to the blogosphere, AZ and especially to Change of Shift! The rest of you go get your kleenex. You’ll need it.

Mama Mia presents the ins and outs of triage in What do you do with a Drunken Sailor?. I can so relate! Check it out, it’s posted at ~ Dust in the Wind ~. Still have your Kleenex with you? Good. Mama Mia gives us another side of ER nursing in Follow the Leader.

Flight nurse Emily, another first-time Change of Shift blogger discusses how our outer self is often at odds with our inner anxieties at Sometimes we just go fast posted at


If you’ve ever wondered why anyone would ever want to work in the Emergency Department, let me tell you we ED nurses often wonder the same thing. And then something happens and it all comes back to us. ERnursey gives a great example in Wheelchair to the parking lot posted at ERnursey.

Hey! I’ve got a theme going here! The ER nurses are out in force. Nurse William describes the difference a mere ten seconds can make to a life in For All the Marbles, posted at Nurse William. I had palpitations looking at the EKG strip!

Student nurse Markie presents a public health care dilemma in Free to be TB? posted at Mark On The World. How would you handle this scenario?


OH, HECK NO! I DID NOT JUST READ THIS! I am sputtering with indignation and can’t do the topic justice. Check out Marcia at Ant’s Marching and her report on corporate sponsorship in Fashion Emergency.

Nurse M takes on the ethical issues of High Risk Pregnancy ,posted over at Code Pink. We have the power to save the babies, but at what cost?

When will nurses start utilizing the power inherent in their very profession? You want to get jazzed about our profession? Don’t look to the big organizations. They have their job in promoting nursing and we have ours. Get informed. Get invigorated. Get involved. N=1 presents ?There were no nurses.? posted at Universal Health. And don’t stop with this post. Read and link this blog – it takes on issues and is written by an activist for the nursing profession!

What happens if we don’t become vocal? Who is going to take care of the nurses of today when it’s time for us to retire? Girlvet wonders Is Nursing Dying a Slow, Agonizing Death? over at Madness, Tales of an Emergency Room Nurse.


Pixel RN is still working in her MICU, but no matter what she writes about she is always entertaining. This week she shares her frustrations of a questionable gestational diabetes diagnosis in My Glucose Woes, Part 1 and My Glucose Woes, Part 2 posted at PixelRN. Did you know they made sugar-free Peeps?

Get a fresh Kleenex. First-year family medicine resident Liana tells a tale of a code and unexpected tenderness in On Codes, posted at her blog Med Valley High.

Ah….from Nurse Ratched’s Place comes a mmtake on the “compliant nurse” image. Check out Stepford Nurses. And pray we don’t recognize ourselves in the description.


Kudos to our favorite ER chaplain, Susan at Rickety Contrivances of Doing Good for going above and beyond the call of duty when asked for help by a total stranger. Read about it in the post entitled “Quitters”. Susan also runs the “Carnival of Hope” and the deadline for posts is today. If you have a recent post about hope or of a hopeful nature, the link can be sent to Susan. The directions are in the “Quitters” post.

The Medscape Nurse Bloggers are out in force, with three submissions this week! Julie takes stock of her life now that her cancer treatment is over in My Dear Readers. Priorities have a way of changing after an experience like this – find out how Julie’s blogging life will change.

Fellow blogger Beka finds a book in Barnes and Noble that reminds her of her first experience with mortality, which she shares in the eloquently written Final Exam. She also makes a decision regarding her nurse practitioner employment and looks for advice from other nurse practitioners in My NP Resignation.

My contribution for this edition equates a popular aerobic program with working in the emergency department. It’s called jazz-ER-cise.


There were a couple of unique entries this edition!

Senior nursing student Christine is working on a Power Point presentation about the right to live vs. the right to die for a healthcare issues class. She is soliciting opinions on this matter from both students and veteran nurses. Help our future colleagues!

  • Visit Exploring Constitutional Conflicts. A brief synopsis of the Cruzan case is on the left, the questions presented are on the right.
  • Please send your answers to these questions to cmprzystas at hotmail dot com
  • Christine notes that: any replies may be incorporated in our PowerPoint presentation to elicit group participation. We will present a scenario as well as questions to consider. And requests us to please post your responses regarding this matter based on how you feel the situation should have been managed.

Lillian Wald, RN has been chosen as the 2007 Honoree of the non-profit Jewish-American Hall of Fame. Ms. Esther Wacks, RN whose husband is the director of the Hall of Fame was nice enough to send me an email with the press release. The information is now in a post on Emergiblog. Here is the link to the biography and medal information.


The next edition of Change of Shift will be hosted on March 22nd by Geena at Code Blog: Tales of a Nurse.

Submissions can be sent to Geena via Blog Carnival or to “geena at codeblog dot com”.

Thanks to all who submitted and to all who visited this week!

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9:16 pm

Lillian Wald, RN (1867-1940): 2007 Honoree of the Jewish-American Hall of Fame


I received a very unusual submission to Change of Shift.

Esther Wacks is a 1963 graduate of Mt. Sinai in New York and currently practices as an RN in the Los Angeles Area.

Her husband is director of the non-profit Jewish-American Hall of Fame. This year the Hall of Fame Honoree is a nurse colleague from long ago who had a distinguished career of service, Ms. Lillian Wald.

The Jewish-American Hall of Fame issue commemorative medals for their honorees and the one you see pictured here is of Ms. Wald.

As Ms. Wacks does not have a blog I offered to produce a post showing the medals so it could be linked to from Change of Shift.

Ms. Sacks was nice enough to provide the press release and I will copy it here verbatim.  It’s a very nice biography of Ms. Wald.


Lillian Wald (1867-1940) was one of the most influential women in America in the 19th century. She became a legend to the hundreds of thousands of Jewish immigrants who streamed to the shores of the United States in the late 1890’s and early 1900’s.

She wanted to enter Medical School, but instead enrolled at New York Hospital’s School of Nursing.

Later, Ms. Wald recruited another nurse, Mary Brewster, and they made themselves available to anyone who needed help. They charged very little for their services and gave freely to those who could not afford to pay. Many times they would spend the night with a sick patient, and they would often fetch surgeons to come when a patient was too ill to be moved.

In 1893, Wald and Brewster created the Henry Street Visiting Nurse Service, which became the major model for visiting nursing in the United States.

Their headquarters at 265 Henry Street became the Henry Street Settlement House. In 1898, they had a staff of eleven full time workers, nine of them nurses, and by 1916 there were more than one hundred nurses.

Lillian Wald persuaded the city to begin a program of public nursing and the Board of Education to put nurses into the public schools.

She spoke out against the popular movement to restrict the immigrants, viewing the immigrants’ culture as a valuable contribution to the American way of life.

Ms. Wald was appointed to several government committees, and also found time to help found the National Association for the Advancement of Colored People.

She also persuaded President Theodore Roosevelt to create a Federal Children’s Bureau to protect children from abuse, especially in the form of improper child labor; Ms. Wald turned down President Taft’s offer to be bureau chief in 1912, believing herself more useful at Henry Street.

The Henry Street Settlement still stands on New York’s Lower East Side, now serving the neighborhood’s Asian, Negro, and Latino population.

And today, with over 9,500 highly skilled care providers, the Visiting Nurse Service of New York is the largest not-for-profit home health care agency in the nation, making over two million professional home visits to more than 100,000 patients each year.


Limited edition medals, designed by award-winning sculptor Virginia Janssen, have been issued to commemorate Lillian Wald’s induction into the Jewish-American Hall of Fame. They feature the words “She reacheth forth her hands to the needy” from Proverbs 31:20, which Wald quoted in a speech to Vassar students in 1915. For further information and orders call the non-profit Jewish-American Hall of Fame at (818) 225-1348 or email numismel at aol dot com.

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3:31 pm



She needs a chin girdle?

Or maybe her girdle is so tight that it just pressurizes her upper torso and lifts her chin into her jaws.

No…wait…this is a wartime ad and Nurse Floppy Chin just feels she can do her job on the home front better when she is looking “smooth and sleek”.

Oh, and the thought of having to give up her foundation garments made her so scared!

What? Were they sending bras and girdles to the Pacific Theater? Were they using the girdles for sling-shots?

Maybe I’m losing my grip on history, but I thought it was “Bundles for Britain” and not “Bras for Britain”….

She’s so attached to these garments, she wears them at home under her frilly robe. With high heels!


Well, I can say this.

The thought of having to give up my foundation garments would make me quite happy.

It should, however scare the heck out of you!

You’d be the one having to view the resulting spectacle!



As I mentioned yesterday, I’ve started Jazzercise.

The last time I did Jazzercise, it was in the mid ’80s and I was wearing leg warmers and french-cut leotards.

(Trust me guys, I didn’t look as good as it sounds….)

This is a picture of the Jazzercise “Perceived Exertion Chart”.

As I looked at the chart today in class (who knew there were muscles in your thighs?), I realized that a Jazzercise class was a lot like working in the Emergency Department.


First we have the “warm up” segment:

  • You arrive in the department, put your purse/backpack/iPod/SpongeBob Squarepants lunchbox away (you were out of lunch bags and borrowed your kid’s).
  • You check the bulletin boards for new notices and snicker at the wise-cracks written on the margins of the new memos.
  • You pour yourself a cup of coffee just the way you like it!

You’ll never even get a sip.

The (eight hour) aerobic segment begins with you finding out you are down an RN and then receiving report from the off-going staff:

  • Four sets of family members are staring at you from their respective doors.
  • Now watch that Perceived Exertion Chart! You should still be in the “very-very light” range!

Time to increase the intensity just a bit! You go into each of your four patients’ rooms/cubicles/hallway beds and say hello.

  • Mrs. Smith is yelling at you with slurred speech and around an NG tube because she didn’t get the ice chips she “ordered” two hours ago and her pain is 27.2 out of 10 and when the H*** is her next shot?
  • Mr. Jones is asleep, but his daughter (the attorney) is writing down everything in a little book and asks “what was your name, by the way?”
  • Mr. Johnson is antsy because he has not been able to void in “three years” and he needs a catheter STAT!
  • Ms. Pierpont is a fetal position in a dark room, sunglasses in place and face in a bath basin heaving loud enough to be heard in Iraq and asking you to please remember that she is allergic to:
    • Toradol and Stadol,
    • Morphine, Dilaudid and Fentanyl
    • Vicodin and Percocet/Percodan
    • Phenergan, Compazine, Tigan, Reglan, Pepcid and Zofran.
    • And, just for the record the only thing she isn’t allergic to is, “oh you know, that other ‘D’ one.” Demerol! That’s it! Two-hundred milligrams of it to be exact. Intravenous. Nothing less will take her pain.

Feel the intensity rising! Good, now let’s take it up a notch now that we’ve reached “Fairly light”!

You feel the warmth of your increased pulse as you return to each room and:

  • Tell Mrs. Smith that as soon as she is able to finish a sentence without snoring you can give her more pain medicine and she is NPO because her bowel is so obstructed it is tied in a bow, so the ice chips are not coming! She rouses from her stupor just long enough to cuss at you before you leave.
  • Grab a foley catheter kit and insert it into Mr. Johnson ASAP because you know that urinary retention is extremely painful and hell hath no fury like a man who can’t void. Especially if it has been three years. Ah, he feels immediate relief and is extremely grateful to you, which is nice. He has 200ccs of residual urine in the bag. This means he has produced exactly 0.18cc of urine per day for “three years”. (And yes, I did the math.)
  • Mr. Jones is still asleep but his daughter (the attorney) wants to know where you obtained your degree, how long you have been a nurse, how many jobs you have held and where you were on the night of March 9, 1987.
  • Ms. Pierpont needs her pain medication, so you
    • Start an IV and begin 1000 ccs of normal saline for hydration.
    • When she asks for something for nausea, remind her that she is allergic to every anti-emetic known to mankind.
    • Give her the first of her Demerol injections via IV.

Ah, now your heart is really pumping, especially when you realize you are working with Dr. Ten-milligrams-of-Demerol at-a-pop and that Ms. Pierpont will be with your for a loooooong time. Oops, there goes her buzzer now! That first dose didn’t work, she told you that was going to happen! Ninety seconds and no relief! What were you thinking?

Uh oh, the wife of Mr. Johnson is staring at you! Why hasn’t he been discharged yet? And where is his leg bag? You grab the chart and print out detailed instructions for “Urinary Retention”, discuss those instructions with the patient and his wife and suggest that it probably isn’t good to wait “three years” before seeking help. Why no, he doesn’t have a urologist so you go print out a list of the local uro guys and gals and no, you aren’t sure who takes medical or who takes what insurance. Have a nice day!

Now you’re up to the “Somewhat hard” level but you know you can take it higher. You start to breathe a sigh of relief at one empty room when it happens! Code Three! Cardiac arrest!

Not your patient, but you start heading into the Resus room to help when you see Mr. Jones’ daughter (the attorney) standing in the doorway, arms crossed and foot tapping because her father has just had diarrhea and where is everybody because no one has checked her dad in an hour! The ER tech informs you that indeed, the patient is covered from the axillary level to his metacarpals in a Code Brown of mega-proportions. You and the tech clean him up. He sleeps through the whole thing.

Mrs. Smith is awake enough to ring her bell, and hurl a sling of outrageous foul language at you for taking so long to answer her light and dammit, she WILL have ice chips. Ding. Ding. Ms. Pierpont is ready for her third dose of Demerol now. Oh, and your charge nurse has just put a patient with vag bleeding and a possible miscarriage in the room just vacated by Mr. Johnson.

You are working “Hard” but still in the ideal aerobic range. Where you stay for the next six hours.

Finally, it’s time to warm down:

  • The next shift arrives and you give them report. You note that the family members in three rooms are staring at you and your colleague. Ms. Pierpont is ringing. Mrs. Smith just went upstairs and Mr. Jones has slept through another Code Brown, as per his daughter (the attorney) who is writing down the name of your colleague…..
  • You go over to the coffee you poured at the beginning of your workout, say good-bye to the mold that is waving to you as you pour it down the sink.
  • You go grab your purse/backpack/iPod/and the SpongeBob Squarepants lunchbox that you were never able to open that shift and head for your car.

You get home and dive into a nice hot bubble bath.

Congratulations on another good work-out!

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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