February 4, 2011, 12:57 pm

Change of Shift: Volume 5, No. 16

Welcome once again to Change of Shift!

This week our themes lean to education and the art of “being there” and we have two new bloggers submitting! Welcome!!

Man, that was a fast two weeks!

So….let’s get started!

As a profession, nursing has been criticized for not having a standardized entry level into practice. But we nurses seem to spend an inordinate amount of time criticizing each other for the same thing. In this week’s Editor’s Pick, Nurse Teeny takes on The Myth of the Second Degree Nurse at The Makings of a Nurse.

If you read nothing else this week, please read this post from Suzanne Gordon – she reviews a new book: My Imaginary Illness: A Journey Into Uncertainty and Prejudice in Medical Diagnosis. It looks at the phenomenon of doctors (and nurses) becoming angry and blaming the patient when problems persist and/or diagnoses cannot be made. My copy of the book will be here in two days (thank you, Amazon Prime!)


Running Wildly‘s compassionate care encourages a patient to open up about their past in this touching post entitled Helping Hand. I hope her patient was able to get the help she needed. (And here is a submission I missed for the last edition, an ode to workin’ the ER on the holiday: Emergency New Years!)

Shrtstormtrooper knows exactly what a patient needs, and it isn’t high tech in Reassurance posted at New Nurse Insanity: Fundus Chop!.

The latest Insights in Nursing is up, with host Jamie Davis and panelists Terri Pollick and Terri Schmitt taking on health care fraud, nurse practitioners/primary care and virtual beds! Check out Virtual Nursing in Tron-land.


Maureen “Shawn” Kennedy, editor-in-chief of the AJN, reports from the 2011 Clinical Nurse Leader Summit in Florida for AJN’s Off the Charts blog. Does your facility use CNLs?

KMorales discusses why she is Working on my MSN and has gotten me all inspired with her description of her friend/colleague “CB”. I bet you’ll be signing up for school after you read it, too! Thanks, Katie, I needed this! : ) It’s posted at NursesNetwork.

Lisa Ordway discusses end of life care (or lack of same) in the ICU in Palliative Care – Devil of Defeat or Humane Patient Care? posted at Experiences of an ICU Nurse. You can always depend on an ICU nurse to tell in like it is.


Elle Bieling, RN notes that hearing and understanding metaphors used by patients are important when assessing pain in Chronic Pain ~ Why Physical, Emotional and Spiritual Pain are Inseparable posted at The Body Window.

Michelle Walter has started NurseNRecovery, a website to help nurses struggling with narcotic addiction. Michelle is a recovering addict and shares what she has learned with her readers. Her story is an eye opener about just how insidiously an addiction can take hold.


Many thanks to those who submitted this week and many, many thanks for reading and linking each week!

Be sure to send in your submissions for the next edition of Change of Shift, here, at Emergiblog. Use the Contact button at the top of the page or submit via Blog Carnival!

See you there!

February 2, 2011, 11:47 am

I Believe This is Killing Me

It didn’t take long for Doctor Throwafit to realize he had some ‘splainin’ to do.

You don’t tug on Superman’s cape,

You don’t spit into the wind…

And you don’t ever, EVER mess with the nurses in the emergency department!



Oh my god. I need a long vacation.

I am sitting here in Starbucks for the first time in months – I can’t even remember the last time I blogged over coffee – and their microwave kept alarming. I got out of my chair to go check the alarm!

Yeah, my nerves are on edge. They are playing this finger-snapping Vegas-jazz stuff over the speakers that has me buzzing like my finger is in a socket. Hey, guys, what does a girl gotta do for a little Motown ’round these parts?


Ah, but there is a silver lining on the horizon!

I am looking forward to attending the ENA Leadership Conference in Portland, Oregon in just a couple of weeks, which I will cover here at Emergiblog. The link will take you to the live blog for the event.

The ENA always puts on stunning programs – literally “attend today, use in practice tomorrow” information. You don’t have to be a manager to attend the Leadership Conference, either. All nurses are leaders, and there is more than enough in this conference for every nurse, from newbie to veteran.


The department is chaotic.

Every bed full.

The hallways are impacted.

With patients. Family members. Lab techs. Portable xray machines and those who wield them.

Three ambulances waiting to give report.


What the hell do they want?

Doctors. Hospitalists. Cardiologists. Intensivists. A rare primary physician who admits their own patients.


Who want everything….STAT.

Even though nothing about their patients require STAT.

Somewhere in there is the ER physician. And the PA.

We’re on divert, except no one told the three ambulances.


No place to sit.

No place to chart.

No place to stand.


And in the middle of all this…

In the middle of this bedlam.

Comes the order.

To give the first dose all the prescribed medications to the ambulatory, playing, giggling child with otitis media, who is with a totally ambulatory, fully functional, totally-capable-of-going-to-the-pharmacy-and-starting-the-medication-at-home adult parent.

So what, you say?

Well, this means that instead of being able to discharge this ambulatory, capable parent with discharge instructions and a prescription right then and there, the RN must now engage in the preparation and administration of a pediatric medication.

Which means:

  • Going to the Pyxis and removing the medications, say Tylenol and Zithromax, from the machine.
  • Because the Hilton Hospital has no Pharmacy at night, the Zithromax must be reconstituted by the RN – yep, we measure it, we mix it, we shake it, we pour it.
  • Calculating the appropriate dose based on the child’s weight (yes, we have to do that, even if the doctor has written a dose).
  • Pour the meds, draw them up into a dosing syringe.

No biggie so far? Remember all the hell going on in the rest of the department? One nurse is tied up doing this totally unnecessary function. But it gets better because…

They have decided that decades of nursing experience is not enough to ensure appropriate safeguards in pediatric medication administration so…

  • A second nurse has to calculate and double check everything the first nurse has done and sign off on the calculations before the medication is given.

And there you have it! Two nurses taken from much more critical work to make sure ambulatory, playing, giggling child with otitis media gets their first dose of medication, when there is no reason on God’s green earth Mommy and Daddy cannot go get the medication and start it themselves.

And why?

Because it all has to do with patient satisfaction!

If we don’t do this, they don’t think we treated their child. And gosh, it’s the middle of the night and who wants to wait with a tired kid at the pharmacy and what if the pharmacist is on break and what if they don’t have the cash and what if the ATM machine is broken and…..


Seriously, people, this is the minutiae that we have to deal with.

I want to take good care of my patients, I really do. I like my patients, I want to make their stay in the ER easier and more comfortable and as pain free as I can possibly make it.

I’m a good nurse. No. I’m a damn, excellent nurse.

But this bullshit is killing me.

Killing me.

Oh, and someday, let’s go out and have a drink and I’ll tell you about the time I got the order to irrigate my patient’s ears. In fact, it was on the same night. She was having a bit of trouble hearing, you see. Berated me because I wasn’t doing it fast enough. She didn’t care that hypotension and a cath lab patient trumped ear wax.

Yeah, I definitely need a margarita to tell that one…..

January 21, 2011, 11:42 am

Change of Shift: Volume 5, No. 15

Welcome to Change of Shift!

This is a miniature edition!

The quantity is tiny, the quality is superb!

Grab some coffee, kick back

Change of Shift is in da house!


Editor’s Pick: At the AJN Off the Charts blog, Juliana Paradisi pens a fantastic post on privacy, both personal and for patients, in Nurses, Hospitals and Social Media: It Depends What Business You’re In.

Oh, SNAP! The Muse, RN, gives a new meaning to “left” and “right” in her post RNs…Skilled or Unskilled. Choose your path, my colleagues, there is no room for compromise in this debate.

Meet new blogger and first time Change of Shift contributor Andrea, author of journeytothefarm.com. Andrea is an OB nurse who traded suburbia for life on the farm and has penned a beautiful post on nursing and The Cycle of Life. Welcome to the blogosphere, Andrea, and welcome to Change of Shift!


Do people hear what we say or do they “hear what they see”? How much does the image we present affect the advice we give our patients? IsntSheLovlei wonders just that in? Do As I Say Not As I Do? posted at The Dog Ate My Care Plan….

I found this post at EDNurseasauras, Still in the Trenches. “TyRANTasauras Regina” hits it out of the park in A Comment on Drug Seeking Behavior. This is how we know. This. Is. It. Exactly.

Our paychecks got a little larger recently and Dr. Dean at The Millionaire Nurse Blog has a great idea on where that “found” money should go. See a Painless Way To Increase Your Retirement Savings. I made the call!


Change of Shift will return here in two weeks, so get your submissions in for the next edition! Use Blog Carnival or the Contact button at the top of this page.

Thanks for reading!

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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