February 4, 2010, 3:05 pm

Change of Shift is Up; Next Edition Taking Submissions!

OffwhitelogoThe new edition of Change of Shift is up at Rehab RN!

The next edition will  be hosted at the Blog of the Interdisciplinary Nursing Quality Research Initiative, also known as the INQRI Blog. The Initiative is associated with the Robert Wood Johnson Foundation.

The theme for this edition of Change of Shift is nursing education.

Submissions can be sent to “INQRIChangeofShift at gmail dot com”.

5:31 am

The Kids Are Alright

iphoneapp:locNurse Jones was impressed with the NeoNatal App on her new iPad, but the device was much larger than she expected.

I plan to get an iPad.

I wonder if it comes with “wings”. Is the deluxe version called a Max-i-Pad?

Sorry, I had to get my feminine hygiene jokes out of the way.

I mean, Steve Jobs could hold up a toilet paper roll and I’d go into debt for it.

But, this time I’m waiting.

I will wait until the iPad runs OS X, supports video and runs more than one app at at time.

Don’t make me wait too long, Steve!


Speaking of Steve, he figures prominently in this week’s Grand Rounds over at Dr. Rob’s Musings of a Distractible Mind. Ground hogs and llamas and iPads, oh my!

Change of Shift will be up this evening at Rehab, RN!

Selena at Oh, My Aches and Pains is hosting the next Patients for a Moment carnival, so send your stories!


Something is in the air.

Work has been uncharacteristically crazy,nuts,bananas busy since I returned from my influenza-induced hiatus. Scores of very sick people, no real pattern. And a ton of pediatrics.

Feverish, coughing, runny-nose, wheezing, stridorous, vomiting, diarrhea-having, screaming, combative, medicine-spitting small humans.

It’s not easy triaging these little folks. You have to get the history over the crying/screaming, try and obtain vitals while they kick off any and all probes, do a rectal temperature if they are under 2 years old (wrestling to keep them still), and weigh them for medication dosing.

You have to do all this taking into account their developmental stage/age, which affects everything from how you approach a pediatric patient to what behaviors would be considered “normal”.

Then there is the “two-fer”. One child is sick? Well then, let’s check the other one, too! Never mind that the other one isn’t showing symptoms but might be incubating a virus as we speak, or had symptoms and is now on the mend, the logic of the parents is “might as well check them both!”


So that’s a double triage.

Time consuming. Energy consuming. Hearing-loss inducing. Nerve-grating.

And absolutely gratifying.


Didn’t expect that, did ya?

There is something about building a rapport with a child, starting at triage, that makes all the above worth it.

The smiles that you get when you first say hi (before they realize there is an assessment involved!)

The baby who verbalizes back when you talk to her.

The toddler who laughs when the oximeter probe falls off.

The tiny Disney Princess who is proud of her Ariel slippers.

The boy who scans the Wong-Baker pain scale with a serious expression so he can pick just the right number.

Giving Tylenol and/or Motrin to a cranky, miserable, feverish child and then watching them play peek-a-boo with the curtains 30 minutes later.

Hearing giggling from the room as they play with siblings.

Watching them snuggle the teddy bear you just gave them.

Seeing the look of excitement when they see you have a juice box (what is it about juice?)

The tiny hand waving good-bye as they leave the department.


In the midst of some hellacious nights, I’ve taken care of some wonderful kids.

It isn’t easy. Caring for kids can’t be rushed. They can be a challenge.

But when it’s all said and done, it is the most gratifying part of my work.

The kids are alright, indeed.

January 25, 2010, 6:25 pm

Grand Rounds – the LOL Edition!

Welcome!  Grand Rounds Kitteh is IN!Welcome to the LOL edition of Grand Rounds!

I just adore the I Can Has Cheeseburger – LOL Cat site and the kittehs provide our background theme for the week.

This is a great place to announce that the finalists of the 2009 Medical Weblog Awards are now up at Medgadget!

This is also a great place to let you know that the Med/health bloggers will be meeting again at BlogWorld/New Media Expo 10 in Las Vegas, October 14 – 16, 2010! Put in those time-off requests, save up the dough because what happened in Vegas is going to happen again in Vegas (okay, maybe not the serenading at dinner…)!

And now, without further ado, our Feature Presentation!


CPR Kitteh is pretty excited there! And I’m excited to showcase the Editor’s Picks of the Week, right here!

Evybody Cleerz!This submission from Bongi at other things amanzi is devastating. Be ready for an emotional roller-coaster, from anxiety to fuming anger, in the dogs of law.

Nurse Me works in a heavy-duty trauma center. In a poignant story written during the holiday season, during a moment of repose, Nurse Me ponders Neglect.

Dr. Rob at Musings of Distractible Mind will be hosting Grand Rounds next week. This week, Inspiring makes it into the Editor’s Picks. Great story.

Kent from the ICSI Health Care Blog discusses Why Smart People Don’t Learn From Failures. Be sure to download the article by Chris Argyris. A fascinating study what keeps us from learning from our mistakes.

This post should be titled “Lauren gettin down wit her bad self!”. The actual title is Wheelchair Dance and I dare anyone to keep their fingers from tappin’ while they read! Lauren, you are truly a Novel Patient!


HIPAA kitteh neber tells

HIPAA kitteh may never tell, but I found out some new things this week!

Allergy Notes posts that you can get Food Hypersensitivity by Inhalation. (And only 8 foods cause 90% of food allergies!)

Fibro Mom at the Fibromyalgia Blog has some advice for daughter Dot, who is dealing with repercussions from an MVA three years ago: Dot! Don’t Just Lie There, You Could Die — Well, Sort of…

The Cockroach Catcher views the source of a common medication (while on a cruise!) in Chile: Salar de Atacama & Bipolar Disorder. Interesting!

Terri sends in a sober look at racial profiling in The Ghost of Nurse Aiko Hamaguchi. At Nurse Ratched’s Place.


Health reform kitteh is pooped out; a kitteh will take any excuse for a nap!

Breaking News - Healthcare reform kitteh exhausted...

David at HealthBlawg doesn’t think we need to wait for the Feds to start working on improving access, cost and quality of health care and he has the ideas to prove it in Holy Mackarel: Scott Brown, Health Reform Redux and What Can (Should) Happen Next.

Over at Health Business Blog, David Williams posts that Oncologists Care About Costs, noting “Oncologists are already taking cost into account in treatment, so we might as well encourage objective comparative effectiveness research.”

In a post near and dear to my heart, the Robert Wood Johnson Foundation’s User’s Guide to the Health Reform Galaxy Blog looks at one group whose voices and opinions should be a larger part of the health care debate: nurses! Lots of folks agree, check out Call to Action: Tapping Nurses’ Leadership and Expertise.


itz tiem for yor  consultashun

Does stroke mortality vary by what day the symptoms occur? Research studies show opposite findings, as the ACP Hospitalist discovers in Stroke: Is There a Weekend Effect or Not?

Ever heard of Gaucher’s Disease? Me, neither. But it is rare, and treatment is breathtakingly expensive. Henry from InsureBlog explains what it is, and how the Orphan Drug Act works to help its victims.

From the “This job is killing me!” department Clinical Cases and Images reports that Night Shift/Calls May Lead to Increased Risk for Cardiovascular Disease.

Will Meek, PhD, takes a complex process and renders it understandable as he breaks down therapy into the Four Questions of Counseling.


Hammy gets a  cat scanSpeaking of rodents, Dr. Charles writes about mouse sperm cooperation and segues into maximizing human male reproduction capabilities in Mouse Sperm Cooperatively Swimming Together and Other Thoughts. I may never look at Mickey the same way, again.

If you only “scan” one You Tube video this week, let it be this one, submitted by How to Cope With Pain. It’s Inspiration for Living With a Challenge. Stunning!

Laika from Laika’s MedLiblog notes you can “scan” the Cochrane Collaboration for evidence on disaster interventions in Cochrane Evidence Aid for Catastrophes Like Haiti’s Earthquake. Did you know quick debriefings are not helpful?


i haz boo boo  call amblance

Hey docs! You have to see patients ASAP, it’s the law! Sorry, having a hard time getting my mind around this one. Sounds like the ACP Internist is, too. Check out The Doctor Will See You Shortly – by Law.

Over at Nursing Student Chronicles, Laney gets the short end of the entitlement attitude stick at her PICU in What a Dirty *!?$@.

Oh, this is freaking hilarious! Precordialthump at Life in the Fast Lane offers a list of Signs of Imminent Admission. Be sure to click on the links for more LOL posting!

Doc Gurley wants to spread the wellth! No, that’s not a typo! Get the scoop at ACL Injury, Lung Cancer, Free Classes for Your Health: A Get Wellth Round-up! (P.S. If you watch TV shows on the computer, does that count towards your demise?)

Mark Surgical Site  ur doin it wrong

Alison at Shoot Up or Put Up is “pancreatically impaired” and, as she notes in Why Are Insulin Pens So Ugly?“, It’s not life saving stuff, but having an insulin pen that’s vaguely attractive really wouldn’t be hard to do and would be very nice to have.”

Speaking of surgery, NPs Save Lives at The Nurse Practitioner’s Place notes that she is already doing what a recent study recommends in Nurse Practitioner Ahead of the Game in Treatment of MRSA. Seems to me we were having pre-op patients shower with anti-bacterial soap way back in the late ’70s…


You ordered WHAT?  not in dis lifetiem, palIf you are sick enough to be in a hospital, you are sick enough to need IV access. Ah, but what kind of IV access? The Happy Hospitalist takes on Vein Light Technology and IV Access. Always provocative, never boring, Happy lists the hierarchy of IV starters ; )

I love The Muse, RN! Did you read that RWJF post on nurses a few links above? Well, so did she and here is her great response: Robert Wood Johnson Foundation Wants Me. And I concur with her conclusion!


And that’s it for this week’s Grand Rounds. Many thanks to those who submitted. Thanks to Nick at Blogborygmi for organizing (drop him an email if you would like to host!) and Dr. Val at Better Health for promoting Grand Rounds.

Next week, your host will be Dr. Rob at Musings of a Distractible Mind.

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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