July, 2007 Archive

July 25, 2007, 9:18 am

The Best of Emergiblog: The Circadian Rhythm Caper

[Emergiblog will celebrate it’s second anniversary on August 1, 2007. I was having fun looking back at some of the first posts, so I thought I would highlight a few of the earliest.

This particular post, my second, led to Emergiblog being seen by Cotournix (Bora – aka Circadiana, now at “A Blog Around the Clock“) and to Emergiblog’s very first link! It went from 35 hits to over 100 that day!

Oh, and keep in mind as you read this, I have not done a day shift since and don’t plan on doing one ever again!]


“Department Store Nurse”???

You mean I could have worked for Nordstroms? Saks Fifth Avenue? Neiman Marcus?

All these years I’ve missed out on employee discounts?

What on earth would the job description say?

“Wanted: young, beautiful RN to standby in case someone faints in Hosiery. Ability to pose in white uniform and cap so that doorman can administer side-long ogles a plus. Advanced training in analgesia for headaches secondary to over-enthusiastic fragrance sprayers required”.

I bet she even got to park up front…..


I am so exhausted I can’t feel my fingers on the keyboard.

Why, you ask? Another emotionally exhausting day saving lives? A whirlwind of one emergency after another, juggling critical patient after critical patient with nary a thought for myself, doctors requesting my expertise at every turn and patients clinging to my arm, thanking me for just….being?


I worked a day shift.

Let’s get one thing clear right off the bat.

I am what is known as a night owl, a vampire, a creature of the dark. To me, 0700 is the middle of the night! I don’t even go to bed until 0300 and that’s only if I’m ill. I have not voluntarily worked a day shift in years. It’s easier for me to STAY up until sunrise than to GET up at sunrise. You get the picture. So… when my sick colleague called to ask if I would work a twelve-hour-shift commencing at 0700 this morning I said, “what the heck”!

He’s pitched in for me a few times and it’s so hard to find coverage when you need a day off. I could do this favor.

I thought.


Had I been able to get any sleep, it might have worked.

Early to rise means early to bed, and being the holistic-homeopathic-earth-nature-mother that I am, I decided to dope myself up to high heaven with my drug of choice, Benadryl! Fifty freakin’ milligrams down the hatch.

Nothing. Wide awake. 11:00. Have to get up in four hours. This called for drastic measures. Yes, I went for the Melatonin. Figured “Mel” would meet “Ben” and I’d be comatose.

Nothing. Up to the couch. Two episodes of “Aqua-Teen Hunger Force” on the Cartoon Network. Ever seen that cartoon? It’s a milkshake, a meatball and a large order of fries (with a goatee) who live together. See what you miss going to bed early? Finally, the faint stirrings of fatigue floated into consciousness. I was asleep.


Four hours later I was jolted awake by an alarm playing “Wake Up Little Susie”. Staggered to the mirror. Hair not sticking up. Good. A quick fluff with the blow dryer and I’m outta here. No make up. They’re lucky I put on clothes.

No traffic. Thank god. Too early for rock and roll. Too early for talk radio. Too early for sound.

I dragged my senseless self into my department. Only one patient and she’s ready to admit. Big sigh – time for some coffee to start the day. It is then that I discovered I was scheduled to work with Miss Susie Sunshine, RN! Bright, cheery, energetic, caring, compassionate, competent. She is the sweetest woman I know.

I wanted to wring her neck.

I’ve seen methamphetamine addicts with less energy.


I never did recover.

My patients were great; I only had a few as it was not busy. Spent 90 minutes in a class on JACHO accreditation. Stimulating.


Then my very own Florence Nightengale arrived to take over at 4:00 pm. Bless her everloving heart. I didn’t have to do twelve hours after all. I was released. I was exhausted.

In retrospect, my day was very productive.

I made the decision that I will never, ever do a day shift again.


I learned that you can take the nurse off the night shift, but you can’t take the innate circadian rhythm out of the nurse. I’ll stick to PMs and Nights.

Oh, and I’ll take vacation during JACHO accreditation.

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8:55 am

Extra! Extra! Read All About Grand Rounds!


For those who read Tuesday’s paper on Wednesday morning, take a look at this week’s Grand Rounds!

Miss Laurie Edwards, proprietor extraordinarire of A Chronic Dose has taken on hosting duties for the week in the grand newspaper tradition!

Emergiblog is on the “front page”! Below the fold…..

Lots of juicy science articles in this edition, too!


Change of Shift has a new host this week as Monkey Girl gets ready to host tomorrow’s edition at Musings of a Highly Trained Monkey!

Have you sent in your submission yet? I’m writing mine…in about five minutes! Send your nursing related posts through Blog Carnival or to “ermonkeygirl at hotmail dot com”.


My column on nursing research up over at Nursing Jobs. org..

Nursing research is interesting. There is so much nursing research available it is hard to narrow a topic down to a short column.

I have found a lot of research that looks at nurses (as opposed to research actually done by nurses) and I have a news flash for ya:

There is a nursing shortage and by 2020 we will be in deep…..trouble unless we fix it.

Just in case you hadn’t heard.

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July 22, 2007, 5:00 am

When to Say “It’s Okay”


Holy cow!

What the heck is this?

“Hey! I can see your brain from here!”

Is this what they did before tiny otoscopes were invented?

If they tried to irrigate through that thing they’d blow the brain out of the opposite ear!

It looks like a toilet plunger.

A bit of overkill for ear wax….


Remember the literary project that Maria put together at Intueri? #1 Dinosaur at Musings of a Dinosaur jumped in with a great addition! Here is Dinosaur’s take on “A Picture is Worth a Thousand Words“.


I think I finally figured something out.

Every now and then I sense a feeling of suspicion or wariness from a patient or family member.

The feeling that they are watching me like a hawk.

Like they don’t quite believe what they are being told.

No matter how many times you reassure them that everything is okay, there is an unspoken response of “Oh really?”

And that is the problem right there.



If a patient is concerned enough to come to an emergency department, they want validation that seeking treatment was the correct thing to do.

They want to know that we empathize with their concerns, that we understand.

If the first thing out of our mouth is something to the effect of “oh, this is nothing”, the patient may believe they are not being taken seriously. They believe there is something to be concerned about and it makes them anxious that we don’t seem to see it.


I know a physician who handles this type of situation naturally, and I’ve learned by watching and listening.

First, acknowledge that the patient’s symptoms present a concern to them and it is understandable why they would seek treatment. Even if it is a non-urgent issue – it is an issue to the patient.

Second, discuss why the patient is concerned (for example, the patient fears they are having a CVA when it is Bell’s Palsy or a heart attack when it is really costochondritis) and explain why the patient does not fit the criteria for that particular problem.

Finally, explain what the diagnosis actually is and what can be done to make the patient feel better, at that point reassuring the patient that everything is okay.


I guess the moral of the story here is not to be so quick to hand out those reassurance platitudes. For some patients it is a sign that their concerns are being trivialized.

It is hard to view every situation from the patient’s perspective, especially in a busy emergency department. For some, the gift of empathy comes easily. Others need to occasionally remind themselves to empathize.

Being able to do so goes a long way in diffusing suspicion and gaining the patient’s trust.

I’ve seen it in action.

Read »

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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