January, 2010 Archive

January 7, 2010, 11:27 pm

Change of Shift – Volume Four, No. 14

OffwhitelogoHappy New Year and welcome to the first Change of Shift of the new decade!

Are you still writing “09”? I’m not! For some reason I have converted to “01”. Lord knows how many of my charts have the wrong dates on them!

It’s a new decade and the new year finds the nursing blogosphere is still going strong. Let’s get started!


Melody Stenrose is an RN and a writer. She and I graduated from nursing school together, and I am excited to announce her new book! Chronicling her 30 years as a critical care nurse and educator, Inside the ICU: A Nursing Perspective is now available. I knew the book would be great. What I did not know was just how hard it was to get published. Think bloggers face objections? Check out this page at Melody’s site for the full story.

Caroline at Brain Scramble, RN writes An Open Letter to the ICU. I can’t add a single thing; what a wonderful post!

Now let’s switch to a night in PICU as Laney of Nursing Student Chronicles notes that there is No Rest for the Weary! I’m pooped just reading it!

It’s unit time at Change of Shift! Jo at Head Nurse has completed her CCU internship and is now Off the Leash. Congratulations!


This is freaking hilarious! Shrtstormtrooper at New Nurse Insanity: Fundus Chop! manages to blend myocardial infarctions, practical jokes, tires and the Burger King getting hit in the, uh, groinal region in Crisis Averted. Warning: remove all liquids from your oral cavity before reading!

And a huge Change of Shift welcome to (relatively) new nurse blogger The Muse, RN! This is a post I wish I had written! Find out about Nursing’s Image & Ability to Influence Politics. And then give yourself ten minutes for your BP to return to normal.

The nursing blogosphere continues to expand as we give another first-time welcome to Voice of Reason, a nurse from Australia and author of the blog, Shades of Grey. This first submission is a beautiful poem on caring for a dying patient, entitled The Nurse’s Heart.


Nurse Practitioners Save Lives looks at the practice (or non-practice) of Using Nurse Practitioners to Reduce Emergency Room Waiting Times. Preachin’ to the choir here, honey! LOL! I think all EDs should utilize NPs!  Read for yourself at The Nurse Practitioner’s Place.

Dr. Dean, hubby to nurse and writer of the MillionaireNurse.com Blog has some observations about nurses who just can’t seem to stay on a budget in Blood From a Turnip: The Millionaire Nurse Way! All I can say is that I would die without RaceView during the NASCAR season…really

Mother Jones has been busy lately. Snowed in! Twelve hour shifts! Dogs and cats, living together…okay, not that last part. So I thought I’d dig into her archives and pull up a classic Nurse Ratched’s Place post. This is one of my favorites. See if you don’t agree after reading The Abandoned House.


Nosokomaniac is starting his nursing career as a CNA and gives a great description of Week One, the Awakening.  There is something about getting tied to a bed and a practice massage, but don’t take it from me. It’s over at Nosokomania.

Over at Code Blog, Geena has A Rambling and Some News and Some Other News! I don’t want to spill the beans here, but I will say a HUGE Happy Blogiversary as she enters her SEVENTH year as a blogger!  Seven! Holy cow! Gina was one of the first (if not THE first) nurse blogger I ever read! She blazed the trail upon which we hike! <– very poetic, yes? : )

I think we all better get over to see Max at It Shouldn’t Happen in Health Care, STAT! In Welcome to 2010, he’s making predictions and one of them is that he may stop blogging! I don’t think so, buddy! Don’t make me fly all the way to Australia and smack you!


Thanks for reading this edition of Change of Shift! If you would like to host an edition, drop me a line – I’ll be in contact with those who have expressed an interest already!  The next edition will be here at Emergiblog – submit using the contact button above or Blog Carnival. If you have issues with either one of those routes, you can always DM me through Twitter (@Emergiblog).

(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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1:32 pm

Speaking of Degrees…

cutiedollI love this doll!!!!

She’s so cuuuuuute!!!!!!!!

I should buy her. Found her at Ruby Lane, which has a bazillion shops, but if you type “nursing” into the search box you will find a treasure trove of nursing ephemera. Diplomas, pins, yearbooks, prints, journals – I’ve found stuff I didn’t even know existed.

Bought an entire year of the American Journal of Nursing (’58) and it is in my closet, just waiting for me to scan!

I see a resemblance.

Must be the freckles.


interviewLooking to hire nursing staff?

You might want to check out All Health Jobs and All Nursing Jobs. They will post your job openings for free – just use the coupon code “Emergiblog”.

Are you looking for a new job? They’ve got hundreds of positions listed. I know, I’ve checked it out. Not that I’m looking for a new job, or anything. Just like to keep an eye on what is going on out there.


The discussion regarding the entry level for nursing has been ongoing for decades. I have articles written in the 1940s extolling the virtues of the BSN long before the first ADN program opened in 1952.

Every now and then, someone broaches the topic of making the BSN the entry level and BAM! the flames that ensue make the health care reform debate look like Mr. Roger’s Neighborhood.

Why the rancor?

Well, if one states that the BSN should be the entry level for a registered nurse, then it follows there must be a reason why an ADN should not.

That does not sit well with ADN graduates.

It sure didn’t sit well with me.


Now, 5 months away from graduating with my BSN, I see a difference.

Or, I guess you can say I feel a difference.

I am a different nurse than I was 2 1/2 years ago.

Notice, I didn’t say “better”.


My clinical skills are the same.

If you want to define nursing as the ability to put the right tube in the right orifice using the right technique, the BSN gives no advantage. Clinical skills for the ADN and the BSN are taught in class but honed in practice. While the ADN program may include more clinical hours, it has been my experience that neither program produces nurses ready to “hit the road running”.

My understanding of nursing has broadened.

Some disdain nursing theory and say it has no basis in daily practice, but have they really looked at what theories are out there? All nursing programs are based on one. For me it was Sister Calista Roy’s Adaptation Model. Theories give a framework, a way of approaching assessment and care, a nursing philosophy.  You can argue that it’s useless, but you are using one every day, whether you realize it or not.  Now, it will be a cold day in Hades before I use “Energy Field Disturbance” as a nursing diagnosis but until I studied theory, I had no idea that Rogers’  Science of Unitary Human Beings even existed.  When I saw Jean Watson’s Theory of Human Caring, it was like getting hit by lightening. Watson’s theory, to me, is nursing.

Do my patients know which nursing theory I adopt? No. Do they care? No.

But I know. And I care. My nursing care has more depth, more perspective and a greater meaning to me because of the wider knowledge obtained through an in depth study of nursing theory.

I didn’t get that in my ADN program.

The nursing profession is more diverse than I imagined.

Okay, yeah I knew there was home health and public health was something done “out there” somewhere and some nurses worked 9-5 in a clinic, but like a horse wearing blinders, all I saw is what was right before me. Bedside hospital nursing.  That’s what I was educated to do.  Anything outside of bedside nursing required a BSN, minimum. No way was I going to do that! Blech! I lived nursing full time as it was.

As a result, I was never able to take advantage of opportunities that were there when I was so burnt out at the bedside I left crumbs when I walked.

Case management, nurse practitioner, becoming a nursing professor, home health, nursing research, school nursing and lord almighty, public health!!!!  I had no idea about public health – I thought it was visiting people in homes and running immunization clinics. It’s is that, but it is so much more!

You can advocate for patients, thousands at a time, in so many ways!

I was not exposed to that in my ADN program.


I guess you could say the last 2 1/2 years have been a transforming process for me. The BSN program has enriched my life, my practice and, although they would never know it, my patients.

So, do I think the BSN should be the entry level degree into nursing?

Well, if I said yes, I’d need Secret Service protection!

I would say if you are just entering the profession and it’s at all feasible for you, go the BSN route from the start.

I think it should be required – BUT (hold your fire!) there much to be said for being an ADN grad and then going for the BSN. In fact, I would almost recommend that. I know that I have gotten so much more out of the BSN education with many, many years of clinical practice behind it.

When you are an ADN and you are studying for the BSN, you have perspective, a place to assimilate what you are learning into your current practice. Subjects like nursing theory and research take on a clearer perspective, as opposed to being vague ideas and dull methodologies.

The BSN is worth getting.  I know I have developed both personally and professionally.

(Now, if I can just get through this last semester…)

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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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