November, 2010 Archive

November 11, 2010, 10:56 am

Change of Shift: Volume 5, No. 10

Welcome to the latest edition of Change of Shift!

Good stuff this week, so let’s get to it!


A warm Change of Shift welcome to Erin, a school nurse who blogs at Tales of a School Zoned Nurse. Every single one of Erin’s posts would make a wonderful addition to CoS, but I was taken by One.

How much of yourself should you share with your patients? NPs Save Lives presents Professional Boundaries Between Patients and NPs posted at

At Off the Charts,? AJN Clinical Editor Christine Moffa describes a great resource (CE available) on how to work with dysphagia dietary restrictions in A Tough Act to Swallow.


Rob Fraser has a great idea for boosting productivity in Nursing Ideas’ Blog | How Nursing Students can Study Better posted at Nursing Ideas.

I’m Not Furniture…I’m Glue is the latest Insights in Nursing podcast! This one includes Terri Polick, Cora Vizcarra, Lorry Schoenly and myself, hosted by the ever popular Jamie Davis!

Amy at Nursing Influence blogs about a controversial issue spurred by an article in the American Journal of Nursing. Namely, does a patient have a Right to Choose Healthcare Providers Based on Race?


Nurse Me gets all up in the face of Grey’s Anatomy creator Shonda Rhimes. Get ready to have your adrenaline rush for the day – you may need a hefty dose of lisinopril after you’re done! You GO, girl!

Ah, it’s all about aesthetics, as in Poop Brown Walls and a Muddy Colored Floor as described at Madness: Tales of an Emergency Room Nurse.

Over at The Doctor Stole My Stethoscope, RNRaquel is nearby when Dr. Handsome Throws a Fit. Seriously, it’s amazing we still witness these infantile outbursts and equally amazing that the doctors still get away with it.


Elaine is feeling the first hints of burn-out in Thoughts on Losing Enthusiasm at Miss-Elaine-ious, RN. Oh, I have so been there! You will get the enthusiasm back.

Wireless world – that’s what Not Nurse Ratched is seeing in Texting Toddlers, Tweeting Nonagenarians.

Call lights can be a real pain in the neck, as Tex at Weird Nursing Tales discovered in Snort, Snort. He’s right, you can’t make this stuff up!


Many thanks to those who submitted (and those who just realized they did! : D) and many thanks for reading.

Change of Shift will be taking a Thanksgiving Holiday – and will return to Emergiblog on December 9th.


You can submit your posts anytime via Blog Carnival or the contact button at the top of this page!

Keep posting!

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November 9, 2010, 9:47 am

Grand Rounds at Emergiblog: 11/16

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November 2, 2010, 2:55 pm

Don’t Speak, I’m Passing Meds

Oh, to have my own desk in the ER!

A place to think, to write without getting my chair jostled or my elbow knocked or my charts shifted.

Most of my ERs have been short on desk space. Chairs are at a premium. If you are charting and you get up to answer a call light, by the time you get back your charts are stacked and shoved to one side with someone else’s derriere warming the seat cushion.

Imagine a U-shaped “nursing” station. The EDMD desk takes up 33%. The unit secretary takes up about 33% This leaves the remaining 34% to divide between 3 – 4 nurses at any given time. And an ER tech. And any primary docs that show up.

It gets pretty cozy in there.

The NP/PA gets to have the little desk around the corner. The one with the computer. Not that I’m jealous.

Or anything.


Medication rooms have become sacred locations.

One is not to speak while engaged in the preparation of medication.

One is not to speak to anyone engaged in the preparation of medication.

It’s for safety. It helps prevent medication errors.

Signs are posted.

Do not disturb.

Silence is golden.


It’s a great policy, given the hectic atmosphere of an ER. Having quiet, uninterrupted time to focus on medications is a godsend.

In the med room.

So why are they saying we should prepare/draw up the medication at the bedside?

Have you ever heard what goes on at the bedside?

It’s something like this:

“Hello, Mrs. Jackson! I have medication here for your pain and something for your nausea.”

“What are you giving her?”

“She wants water.”

“It’s cold in here!”

“Can I have a blanket,too?”

“Are you calling her primary doctor? Is he coming in? When will he be here? What do you mean he isn’t on the way?”

The patient hasn’t even spoken yet.

“I’ll be giving you some Zofran for nausea and some Dilaudid for pain control. Do you have any allergies?”

“Zofran never works.”

“OMG, they are giving you Dilaudid? Grandma had hallucinations on that!”

“Are you sure you aren’t allergic to that? Wasn’t it something with a “d”?”

“She has a high threshold for pain medications, she’ll need more.”

The patient informs me that she has no allergies.

“What level is your pain right now?”

“It’s a 10. It’s more than a ten! Tell ’em it’s a 10, Betty!”

“Oh Betty, tell the truth, it’s much more than a four!”

“Be careful, Betty, you don’t want to get addicted!”

“Grandma hallucinated on that stuff!”

The patient has informed me her pain level is at a 4/10. I turn to draw up the medication.

“How long is she going to be here?”

“What’s wrong with her?”

“Can we use a cell phone in here?”

“Ooops, there goes my cell phone!”


“Jolene, take that outside right now!”

“Oh man, we are going to be here that long? I was hoping to get home before the game starts.”

“Will she be admitted?”

“We can’t take her home.”

And yadda, yadda, yadda; ad infinitum.


The bedside in an ER is not a place of peace and quiet; ERs can be chaotic places.

It is our duty to maintain patient safety in medication administration in all scenarios.

But if it has been shown that preparing medications in a quiet environment without distractions results in fewer medication errors, doesn’t it make sense that the majority of this preparation should be done in the quietest, least distracting location?

Like the med room.

Instead of at the bedside?

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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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