July, 2009 Archive

July 8, 2009, 9:16 pm

Change of Shift Begins Fourth Year: Volume Four, Number One

OffwhitelogoWelcome to the anniversary edition of Change of Shift!

The nursing blog carnival celebrates it’s third anniversary (and the beginning of its fourth year) here at Emergiblog (aka: “home base”).

CoS has been hosted by 33 different blogs, including 31 nurses and two physicians.

(The new year begins with a new logo! I finally found out how to make one that wasn’t a banner!)

The logo may be new; the format remains the same: blog posts by, for and about the nursing profession.

I am thrilled to be able to bring this anniversary edition of Change of Shift to you this week.

Let’s get started!


Code Blog: Tales of a Nurse has been host to Change of Shift three times.  This week, Gina muses over the oft-heard comment, I Don’t Know How You Can Do This.  What jobs would be difficult for you to do?

Mother Jones at Nurse Ratched’s Place has been like a second mother to CoS, having hosted nine times! She recently attended a Rally for Health Care in Washington, DC.  Howard Dean isn’t the only one who can fire up a crowd, Ma Jones! You do a pretty good job it it yourself! : )

I’ve been following the adventures of Nurse Bo for years. She submitted a post from her blog Exit 95 on the Yellow Brick Road about her adventures as a student nurse in one of the last diploma programs in the country. I suggested all three installments be included, and Bo graciously agreed. You’ll laugh, you’ll cry and you had better pad your laptop so you don’t hurt your jaw when it drops. Check out Who Ya Gonna Call: Part One Part Two , and Part Three.


Nursing most definitely meets the web at Crass Pollination, where Nurse K tells it like it is, and then some! One of my favorite themes involves a particular physician you will meet in Who Stuck the Intern With Dr. Big Work-Up?

Nurses are all over the TV lately, and Katie Bee, RN looks at the various portrayals in Nurses on TV Sitcoms at Young and Restless Nurse. My personal favorite TV nurse? Lavern on “Scrubs”. I have so worked with her!

Barbara Olson’s front door might not win over her Swedish relatives, but her posts definitely contribute to the discussions here at Change of Shift! In My Purple Door, Barbara compares and contrasts Swedish and American health care. Posted at Florence dot com.


Questions. As nurses, we all get them. Sean muses on the expectation that nurses should be all-knowing in  You’re A Nurse Right? | My Strong Medicine .  How do you handle the “medical advice” question?

Nurse blogger (and future Change of Shift host) Man-Nurse discovers the resilience of the human spirit (and body!) in New Lease on Life, posted at his blog The Man-Nurse Diaries. A truly amazing story!

Marc is a medic in the UK, owner of the blog Medic999. He recently cared for a patient whose story affected him deeply, as well as the nurse who was present. True Asylum, while not directly about nursing, is included here. It is not an easy story to read, and it will affect you, too.


Tracey at NightTimeNursing shares a great story of a patient who had a unique way of saying thanks, in Lifesaver.

Sometimes a nurse must just say “no” to a physician.  Doesn’t happen often often, but when it does, it needs to be done right.  Reality Rounds gives a wonderful overview on just how to do that in No, Doctor.

Over at NurseConnect, Laura wonders what keeps a nurse caring vs. what might cause burning out in Nurses Who Dare to Care. When someone asks you to recommend a doctor, what do you say? Kathy notes that what constitutes The “Good” Doctor may well reside in the eye of the beholder.


Found in my travels around the blogosphere:

Head Nurse Jo leaves her unit for critical care and she’ll tell you exactly why in I’m Ready for My Exit Interview, Mr. DeMille, or Don’t Ask if You Don’t Wanna Know.

PixelRN rediscovers her passion in Surprise! I Love Being A Nurse Again and reveals some wonderful news at the same time!

Ian at ImpactED Nurse uses a music analogy to describe what nurses must never forget in The Illusion of Repeats.

The Adventures of Bob the Nurse continue as the diminutive action figure gets a vacation. Hey Bob, where was my invitation?

Looking to make sense of health care reform? Slate has published Health Care Reform: An Online Guide, listing the go-to sites for good commentary and information.  Hat tip to Off the Charts, the blog of the American Journal of Nursing, for posting the link!

There is no such thing as “a little pregnant”, you either are or you aren’t. But…what if your body says one thing and reality says another? At Your Cervix looks at pseudocyesis (“false pregnancy”) in She Certainly Looked Pregnant.


Thanks for reading this anniversary edition of Change of Shift and for supporting the carnival through submissions and links for the last three years!  In two weeks, CoS will be hosted by Ross over at Nurse in Australia. Submissions can be sent to “admin at nurseinaustralia dot com”.

(Remember, Change of Shift now has subscription options; you can follow by email or RSS feed. An aggregated feed of credible, rotating health and medicine blog carnivals is also available. Many thanks to Walter Jesson at Highlight Health for setting those feeds up!)

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July 5, 2009, 8:23 pm

Think You Know the Answers, but the Questions Never End

Crutch WalkingWhat is this?

An illustration from “Physical Therapy for Zombies”?


The crutches are way too long and there is no banister on the stairs.

Actually, I don’t even see a second crutch.

Is the nurse is standing by or running up to rescue this guy?

If he is trying to elope, he isn’t going to get far!


Remember to send your Change of Shift submissions to me by Wednesday evening! The anniversary edition will go up this Thursday.


I figure if you are trying to understand something, begin with how it affects you. Make it personal, and it’s easier to grasp.

So I took on my health insurance coverage. I am covered through my employer, but surely I could get comparable coverage as an independent buyer.




I am covered by Anthem Blue Cross.  You know, Blue Cross. The company that used to be the Gold Standard of health insurance? The one my physician no longer accepts because of their reimbursement rates? I figured my best bet was to check out and compare coverage from the same company, so I hit the Anthem Blue Cross website to try and get a quote.

You can get an overview of policies, but they make you put in your phone number so a representative can call you. I didn’t mind, as I had some questions.  I spoke with Danny, who was very helpful.

But before I go any farther, you should know one thing.  Just in case you are looking to purchase a private plan.

If you have insulin-dependent diabetes, Anthem Blue Cross will not issue you a private policy.

Whoa. Found that out when I asked about pre-existing conditions. I had always heard that folks were denied coverage for pre-existing conditions, but to actually hear it coming from a representative floored me.


If I wanted to quit my nursing job tomorrow and make my living blogging (offers accepted), I would need to purchase insurance. I could go with COBRA and buy through my hospital for 18 months, or I could buy my own policy.

The payment for COBRA coverage for a family of three adults (ages 55, 52 and 19) is $2157.00 per month. That is $25884 per year, and includes everything from pediatric well-baby checks to maternity coverage.

Twenty Five Thousand, Eight Hundred and Eighty-Four dollars a year.

Pardon me while I go take a meclizine, just typing that number gave me vertigo.

Private PPO insurance for the same family of three, through the same company, with coverage for brand-name medications is $897, or $10,764 per year.

Huge difference.

On the surface.


To get the private-pay plan you must be vetted. Screened. They will take you if you have high blood pressure, but only if you are controlled and have been on meds for a certain amount of time. Same with high cholesterol.  Same with GERD.  I’ve already mentioned the diabetes. If you don’t meet their criteria, it’s “buh bye”.

My friend in Human Resources told me that our insurance coverage was “more robust” than what was offered in the private plan. Our deductibles are less, our out-of-pocket per-year expenses are less, our co-pays are much less.

She was right.

But I am still confused.

And I have a lot of questions.

  • Why is my employer paying for coverage I no longer need? I’m long past needing the services of a pediatrician and maternity coverage is not an issue (been there, done that, may my ovaries Rest in Peace). Why can I not opt out of these things, saving my employer money? What if I did not want coverage for mental health, for example? The private pay plan is available without maternity care.
  • Why can’t I have the money that is spent on my health insurance premiums (more than some people make in an entire year!) put in a savings account that allows me, as an individual, to choose what type of coverage I want to have?  And have whatever is left available to pay co-pays and deductibles? They are paying the money anyway – why not put it in the control of the patient/employee.
  • Where the hell does the private insurance industry get the authority to decide who they will and will not cover? Is that not discrimination?
  • What happens when/if I develop an illness that would have denied me private coverage to start with?  Am I dumped? Is the illness covered?  For how long?

And I still don’t understand…

  • Why my doctor charges $140 for a visit, I pay $15 and the insurance company pays another $40, and my doctor winds up with only 39% of his fee? No wonder he doesn’t take new patients with Blue Cross.  What other profession has no control over their reimbursement?
  • Why, with my background as a nurse, I still am unable to make sense of an “Explanation of Benefits” report. There is an actual fee, a negotiated fee, a deductible, a co-insurance portion and then what is left is for me to pay. And trust me, the amount paid by either the insurance and/or myself never, ever amounts to the actual fee.  Ever.
  • Why I have a bill for lab tests and screening exams that far exceeds what my deductible is for the year, and yet the deductible is not yet satisfied.  Seems to me I’ve paid out the deductible-times-five and yet it is still not satisfied.

I don’t even know where to start to try and get an handle on this.

Either I’m an idiot or the system is way out of control.

Maybe both.

But I do know this.  I am a 52-year-old woman who is welded to her employment solely for the medical benefits. I’m getting older, I am going to need coverage for conditions and diseases that I did not have to worry about in my 30s.  Every decision I make, whether it be a new job or attending school full-time at a university will be decided by the availability of health insurance and what it covers.

Thank god I have that coverage.

I just wish I had more control over how it was applied.

Lord knows I could do it more efficiently.

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July 2, 2009, 5:53 pm

Welcome to the World of the Entitled

109842-main_FullThis. Is. Pitiful.

This came from a site describing how to make a nursing costume.

Have I ever tried to make one?

Oh, hell yeah!

I’ve made a ton of them!
capAnd they look better than that one!

I have proof!

Is that cool, or what?

(This is what happens when I don’t have any classes to study for!)


Next Thursday will mark the 3rd anniversary of Change of Shift, which will be hosted right here at Emergiblog.  I’m out and about looking for submissions from the nursing blogs I have come to know over these many years, and would love to have as many nurses submit as possible! After all, Change of Shift doesn’t exist without YOU, be you doctor, nurse, administrator or patient!

I’ve been wasting time working hard on a permanent new logo to start off the new year, so join in the celebration! Click the “contact” button on the top bar and send in your nurse-related stories.  This has the makings of a great edition!


Why shouldn’t we have to pay for our health care?

Why….we don’t have that sort of money!!!  How dare you even suggest that we should pay!!!!

We manage to buy cigarettes. We manage to buy fast food.  Often. We manage to get all the channels we want via cable or satellite television. Some of us even have satellite radio in our cars. And GPS.  Our cell phones are really nice, but all that texting costs a pretty penny.   We drop a few bucks at Starbucks every week without thinking twice.

And then we roll our eyes when we have to pay for….god forbid…..health care!


Think I’m heartless?  Think I’m an elitist?

Think I’m talking about the Medicare patients in my ER who bring in a super-sized number 8 from McDonalds for the entire family and hold out their right arm for a BP while they text rapidly with their left hand?

I could be.

But I’m not.

The patient rolling their eyes at having to pay was me.




Showed up for a colonoscopy yesterday and the receptionist went over what would and would not be covered by my insurance.

My out-of-pocket payment would be $216.

And my first thought was “why the hell am I paying anything out of pocket for this? I have insurance!”

I was ticked.


But why was I ticked?

Why shouldn’t I have to incur out-of-pocket expenses?

I have insurance.  Good insurance. Insurance I don’t pay a single penny for. It’s a benefit I get from my employer for working 24 hours a week.

Did I think I was entitled to full coverage because I was insured?




Isn’t that term used to describe some patients who get their health care for “free” through a public plan?

Well, I get my coverage for “free”, too, and god help me, the emotion I felt in that office yesterday was “entitlement”.

Now I understand.

And I won’t use that term again.


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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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