October, 2007 Archive

October 17, 2007, 11:23 pm

Change of Shift: Volume Two, No. 10


Welcome to the latest edition of Change of Shift!

I’m happy to be hosting once again here at Emergiblog. During the week, I discovered something interesting via both Nick at Blogborygmi and Susan from DonorCycle and the blog at NursingJobs.org. While I’m busy learning how to cite various sources for my papers, Emergiblog is being used as an example on how to cite blogs as a source! Isn’t it ironic, doncha think?

We have a winner! Three of them in fact! The Nursing Voices iPhone contest is over and the winners have been announced. You can find out who won here at Nursing Voices.com.

Now for our submissions!


I’m sure for every patient cared for by a nurse, there are thousands more cared for at home by a member of their family. Mother Jones starts us off this week with a personal anecdote and a new resource for caregivers. Check out Strength for Caring found at, of course, Nurse Ratched’s Place.

Juggling a nursing career with teenagers at home? Shhhhh….keep this between you and me, but Therapy Doc has some great advice regarding how to deal with, um, family secrets and youthful indiscretions Secrets and Therapy posted at Everyone Needs Therapy. Find out how not being a saint can help your kids.

Here is a fantastic post on one of my favorite parts of nursing: documentation (seriously, I enjoy it!). ER Murse looks at the dark side of electronic medical record charting in Templated Charting: the Slippery Slope to Fraudulent Charting.


Max E. Nurse has something to get off his chest. Find out what it is in Really(!?) Don’t Mention it… After you’ve done that, go immediately to Max’s hangout on Facebook called the Nurse Blogger’s Lounge! It’s a cool hang out and the only place in the world I’m actually a “Celebrity”! So far, there has been no cow throwing in the lounge (and if you don’t know what that means, you really need to visit!)Go on over, we’ll wait for you here!

Welcome back! Have you suspected that deep down in places you don’t talk about at parties, Laura from Adventures in Juggling is actually a good, moral, ethical person? I have proof! It’s right here in Because We Should Learn Something New Everyday? I love it when I’m right! And Laura, I fully intend to get to that meme…really!

It’s a big Change of Shift “Happy Birthday” to our favorite Ambulance Driver over at A Day in the Life of an Ambulance Driver (I’m not sure if I’m supposed to use your real name!). And what a post this is, everything you never knew about HIPAA because they never told you and then some! Check out HIPAA Hysteria for the real deal. (And I just want you to know that this anal-retentive, pretentious old biddy never thought of EMT’s as knuckle-dragging stretcher jockeys! : D Sorry, I couldn’t resist…)


DisappearingJohn RN sends in a post that has my blood boiling just reading it. I’ve had similar experiences but it still burns me up when I hear other stories. How would you have responded to the patient in What do you do, or say… And you aren’t imagining it, that is your wallet getting lighter and lighter…

The elections are getting closer and the Nursing Online Education Database dives into the debate with a Comparison: Presidential Candidates on Major Healthcare Issues | NOEDb. Both parties’ candidates are summarized with associated links for further study. You can find it posted at NOEDb: Nursing Online Education Database.

Faith at The Oracle gives us a hilarious look at her first lecture on homeostatis. She manages to stay awake and when you look at the content of the lecture, you’ll understand why. Visit as she learns that she is Supporting Lives, Basically.


ER Nursey lays it on the line in The Public’s Perception of a Nurse. It’s an uphill battle, but we have to fight the media version of what they think we do (or don’t do) by telling everyone what we really do.

Patients don’t always behave as we expect them to, but what do you do when they didn’t get the you’re-off-the-vent-it’s-time-to-die memo? Anonymous Therapist wonders the same thing in A Terminal Wean…or is it?, found at Respiratory Therapy 101: Just Keep Breathing.

Alvaro Fernandez paid a visit to Colorado and returns with 10 Highlights from the 2007 Aspen Health Forum posted at Brain Fitness Blog. Interesting information!


I like to keep up with what is going on over at Medscape. They have their nursing blog, “In Our Own Words”, and a medical student blog called “The Differential”. On the nursing front Beka wants to know how intravenous lines were constructed before plastic was invented. If you are a nurse of a, uh, “certain age” and can answer the question, we’d love to hear it! Julie talks of her garden as a way to heal and sounds like she is doing very well! Let’s put it this way – she tested for her black belt in Tae Kwan Do and I can barely get through a Jazzercise routine!

I’m stealing this link directly from “In Our Own Words” because I think it is an important post. The way we treat medical students today will impact the relationship we have with doctors tomorrow. Anna Burkhead is a medical student at the University of North Carolina School of Medicine at Chapel Hill. She writes of her experience with nurses in A Funny Thing Happened on the Way to the Nurses’ Station. It’s embarrassing to read. Surely we can do better in helping support our future medical colleagues.


Many, many thanks to all who submitted this week.

The next Change of Shift will be hosted at its home-away-from-home.  Yep, Mother Jones will take on hosting duties over at Nurse Ratched’s Place for the November 1st edition.  Blog Carnival can be used or submissions sent to nurseratcheds place at yahoo dot com.




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4:52 pm

Lost in the Translation


Thought I’d include a new photo of myself today.

At first I didn’t like this ornament. Thought it was too cutesy and waitress-like.

Today I looked at it and realized I’d become it!

The uniform and stethoscope are because I’m working as a nurse.

The tray with coffee and a flower represents my family’s selfish, unrealistic idea that I’m supposed to serve dinner every night. Who married/raised these people?

The book and clipboard represent my classes, although you’d have to add about another foot-and-a-half of books, a calculator and a Day Runner to be really accurate.

The hot water bottle is for my aching back and the pillow is just in case I get a chance to sleep.

The only thing missing is my MacBookPro which is welded to my hip and I swear I’ve developed an electrical outlet behind my left ear.

Such is my life.

Okay, okay. There’s an iPod in the pocket that you can’t see.

A girl has got to have some fun, you know. Cyndy Lauper said so!



You have got to check out these old ad/comics at James Lileks’ site!

They are for Wonder Bread, there is a nurse in them and they are a hoot!

There are three in total, the first one starts here, but be sure to check out all of them.

And now for the feature presentation:


Almost all of them speak English, but only a handful understand the language.

The majority of them were born in the United States, but only a few of them understand the culture.

Most of them have been educated, but not all of them understand what they are told.

Every one of them is scared, worried, anxious or afraid.


They…….are emergency room patients.

When they walk through our doors, they are entering a foreign country in the world called “medicine”.

Our world. Our country.

We have our own culture: language, traditions, customs, expectations. Taboos.

We fully expect each and every “visitor” to the country to abide by our cultural mores.

Even if they have no idea what they are.


The first tradition the new citizen will encounter is the tradition of triage.

Yes, even if their head is exploding, they are doubled over in abdominal pain or wincing in agony with an ankle the size of a football, they must answer all the questions in order to decide what part of the country they will be admitted into. They might try to defer to a family member, but no, in our country they must answer the questions. That is the expectation of our culture. How dare the family or friend intervene with this delicate interaction!

We do acknowledge faster processing for those who say. “My chest hurts.” and “I can’t breathe.” These allow the visitor immediate access to our vast resources and the rapid assistance of our population.


It is customary to draw blood on most of the visitors, and some will ask what we are testing. Responding with such terminology as “Oh, we’re looking at your CBC, drawing a Chem 14, looking for an elevated amylase and trying to evaluate your cardiac response via troponin levels.” will be incomprehensible to anyone who is not a native citizen of “Medicine”.

We must remember to speak in our “outsider language” and translate to the best of our ability.

But I mean really, do they have to say “I hate needles!”? They want our resources but then gripe when we use them. What a whiny group these visitors are!


It is the custom to limit visitors in the department at any time. What’s that? Oh, in your “outside” culture it’s the norm to have ten family members at the sick bed? I’m sorry, you’re on our turf now. Yes, I know we asked you if there were any cultural needs we could help you with when you first came in, but we’re required to do that by law.

Sorry for any confusion, but this is ER country and our needs take precedence.


And the taboos!

No lookie-loos into other rooms! How rude!

No discussion of other patients! How crass of you to ask!

Demanding to be seen first! How thoughtless can you be?


We expect them to wait without griping.

We expect them to take the treatments we give without whining.

We expect no exhibits of frustration or anger.

We expect them to know what constitutes an “emergency” and what does not.

We expect them to have complete and total understanding/compassion for the other patients in the department, even though they are sick and worried about themselves or a family member.

Conversely, we expect them not to ask about or show any outward curiosity about the other patients.

We expect them to follow all rules, abide by all customs, meet all expectations.

And never, ever break a taboo.


We expect full and complete cooperation.

Only nobody has explained to our guests what is expected of them.

That makes for a scary, stressful experience and the chance that the “natives” are perceived as uncaring, short-fused, and terse individuals.

Maybe if the rationale behind certain customs, traditions and rules were explained in a timely manner so the patient could understand, things would go a lot smoother for them and for the “natives”.

On arrival, our patients are essentially given a green card in the form of a wristband that allows them entry into Emergency country.

We call it home. To them it is foreign soil.

How well they assimilate into the culture is up to us.

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October 16, 2007, 9:40 pm

Rumors of My Demise Were Greatly Exaggerated!

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I could use an Apple Martini right now!

It seems Emergiblog was off line for part of today, only I didn’t know it because my entire internet service was off line for eight hours!

Shane assures me it was a server glitch.

I’m still here. It’ll be a cold day in Hades before this blog shuts down.

Now all I need is a good, long Starbucks visit and I’ll get all caught up!

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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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