December 26, 2008, 9:09 pm

Change of Shift and Grand Rounds, Holiday Style!

A day late and one respiratory virus after the fact, I’d like to thank Mother Jones over at Nurse Ratched’s Place for hosting the Christmas edition of Change of Shift!

This week, Curious George takes us on a visit to a children’s hospital, with posts cleverly woven into the fabric of the story.

The first edition of Change of Shift for 2009 will be hosted by our favorite flight nurse, Crzegrl!

Send your submissions to “emily at crzegrl dot net”.


Oh my!
With everything going on this week I came a wee bit late to the Grand Rounds party, but Walter over at HighlightHEALTH has put together a gorgeous holiday edition of the best of the granddaddy of medical blog carnivals.

But it gets better!

Walter has arranged for all the major health carnivals that rotate hosting duties to be syndicated by RSS!

You can subscribe to one, two or all of these carnivals with just one click.  So if you’re hosting, your edition will hit the feeds of everyone who subscribes!

What a great idea, and many, many thanks to Walter for setting this up!

Me?  I subscribed to the “MashUp”, of course!  I want them all!

December 18, 2008, 1:53 pm

Nurses Are From Mars, Doctors Are From…Some Other Galaxy

Here is another in the series of “IVs and the Nurses Who Love Them”.

First things first: the cap is definitely a 10/10 on the Emergiblog Cap Rating Scale. I do notice a bit of “occipital slip”. The cap should be visible at the top of the head when the wearer is standing in front of a mirror.

Then again, this looks like a student so I shall cut her some slack.

This looks like a classic photo of “goldfish therapy”.

Either that or that’s a water balloon hanging up there.

It doesn’t even have a drip chamber!

(Check out the wall paper. It’s early American Twilight Zone.)


Many thanks to Laurie Edwards at A Chronic Dose for including Emergiblog in last Tuesday’s Grand Rounds!

It’s a best-of-2008 edition, so be sure to check it out if you haven’t already!


Nurses and doctors do not perceive the emergency department in the same way.

This is not a knock on my medical colleagues, merely an observation.

Actually, it’s more a realization that hit me after a recent shift.

My jaw still hurts from hitting the floor.


In my county, hospitals are able to go on what is called “ambulance diversion”.

This means if the emergency department is overloaded with patients and cannot safely take another at that time, they are allowed to divert non-emergent ambulances to another facility.

It can help somewhat, but it isn’t perfect. Any cardiopulmonary arrests or life-threatening situation still go to the nearest hospital, even if they are “diverting”. And of course, there are always the patients who can walk in with a major STEMI (aka: heart attack).

But…it keeps routine ambulance traffic at bay until the department can safely handle another patient.

It’s something the night shift rarely has to invoke.


This particular shift was different.

The department was full, with patients who had been there 3-4 hours and 3-4 triages in the wings.

It was one of those situations. Everyone who walked in had a serious medical issue. Abdominal pain was the theme of the day.

Every patient required a substantial work up. Tests were coming back positive for everything from appendicitis to ovarian cysts, bowel obstructions to pancreatitis, severe gastroenteritis to Crohn’s flare ups. Patients were requiring admission, surgery, pelvics, ultrasounds, CT scans, lab work, EKGs, multiple doses of IV narcotics, IV anti-emetics, IV antibiotics, and IV anti-fungals

Interspersed throughout this scenario were patients whose lungs decided that an oxygen saturation of 80% was a good idea, or who needed multiple sutures to piece them back together after head/knee/arm vs. cement/table/knife.

It was busy.


The shift started with three nurses and an ER tech who work hard and work well together.

The doctor on duty was a great guy (and I’m not just saying that because my co-workers know I blog). He’s calm, friendly, unflappable and a great doc on top of it.

We do not get overwhelmed easily, but we were overwhelmed that night.

We approached the doc and told him we were going on divert unless he had any objections.

He didn’t and we diverted.


One caveat of the diversion policy is a six hour limit in a 24 hour period.

This means we don’t divert unless we have to and we divert sparingly.

We used a considerable chunk diversion time that night.


At 0330, our third nurse was off duty. Now we were down to two nurses. No dedicated triage nurse. No dedicated charge nurse. No nurses to call in for back up.

We were so out of ratio it was pathetic. We told the supervisor we were both filling out “Assignment Despite Objection” forms and we never ask for those. It was that busy and the patients were that sick.


We maintained a full department until around 0530 that morning, when we went off divert.

So we had a solid six hours of non-stop running. No breaks, no meal, no bathroom, and worse, no coffee!

When we advised that we were going off divert, our doc said something that floored me.

He said, and I’m paraphrasing, that he figured we knew when we were overloaded so he let us (the nurses) decide when we needed to go on divert, but if anyone asked him why we were on divert for five hours he would shrug his shoulders and say he could have taken care of another patient.

Essentially, if there was any question, it had nothing to do with him.

Excuse me?

It’s a good thing I like this guy or I’d have smacked him upside the head.


Let me state this diplomatically.

The nurses do the triaging of the patient and the rooming of the patients. We place the chart in the to-be-seen pile.

The ER doc examines the patient, decides what tests to order or confirms the tests we have already initiated per protocol, and then walks out of the room and onto the next patient.

All those orders that he writes?

They are carried out by the nurses.

The questions and requests from patients and family members? The continual assessment of the patient’s response, the continual reassessment of vital signs and symptoms? The placement of the IVs, the drawing of the labs, the placing of the foley catheters, the insertion of the NG tubes? The endless documentation of everything that goes on with the patient while they are in the ER? The running for ice chips, warm blankets, more pain medication, more nausea medication? The written report required before admission?

These are all done by the nurses.


So while the nurses (and tech and secretary) were running our butts off trying to meet the needs of multiple sick patients for the entire shift, in the doctor’s eyes, we weren’t that busy and he could have easily done more.

While we shared the same space, we were definitely working in parallel universes.

And that’s when it hit me. It’s something I fundamentally knew, but had never heard it so clearly stated.

Nurses are from Mars and doctors are from…

…some other galaxy all together.

Either way, we don’t see this world through the same eyes.

December 11, 2008, 8:38 pm

Just Dropped In, to See What Condition My Condition Was In

Ah, the many talents of the registered nurse!

Apparently this facility was so short of funds, the nurses had to function as IV poles…

…while opening the airway at the same time!

Is it just me or does the patient look like he just had breast implants?

And do NOT get me started on the coffee filter cap on her head. It’s either that or a urine strainer!

I shouldn’t be so critical. I’m embarrassed to say I had glasses just like that in 1966. Fire-engine red glasses.

Hip and groovy, I was not !


I’ve been off work for long stretches the last couple of months and one of the problems with being off the normal routine is that you get lazy.

Writing a ten-page paper was absolute torture, but it’s done and I’m done for the semester.

Feel free to ask me questions on the health of the Hispanic population – that was my topic!

School starts again on January 20th and I will be taking my ethnic course (Introduction to Muslim-American Relations) and my world culture course (Religions of the World). I am aiming for a Spring, 2010 graduation, but for the next four weeks I can get back to blogging and enjoying myself!


The latest edition of Change of Shift is now up over at Marijke: Nurse Turned Writer ! It comes complete with a video introduction; a CoS first! Many thanks to Marijke for hosting!

The Christmas edition of Change of Shift will be hosted at Nurse Ratched’s Place, so send submissions to “motherjonesrn at yahoo dot com” or use Blog Carnival (button on right sidebar)

If you haven’t had a chance to read this week’s Grand Rounds, Alvaro does a great job of hosting over at Sharp Brains.


The poll for topics at the future medblogger conference/track is done; many thanks to all who voted for their favorites. We should have more information on a 2009 conference soon.

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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