August 21, 2008, 7:09 am

Change of Shift Vol 3, Number Four

And it’s that time again, folks!

Welcome to Change of Shift!

Many thanks to those who volunteered to host CoS – there are still dates available, but they are filling up fast, so if you would like to host, check out the dates and drop me line.

Are you Twittering? Beth at Pixel RN has a great list of nurses on Twitter, so if you are looking for colleagues on the service, check out her list. I’m there under….wait for it…Emergiblog!


Suzanne at :: adventures in daily living :: starts us off with a very comprehensive post on How to Help a Family With a Medical Emergency That Lands Them in I.C.U. There are things here I never even thought of, and I’ve done the ICU vigil more times than I care to think about!

A big Change of Shift welcome to Denice, a self-described “reluctant” nurse manager who gets “the call” at a very inconvenient time in They came. They saw. They accredited! posted in her blog, Oh to be a Nurse Manager…. It’s great to see the view from the manager’s side of the aisle!

While you are admiring the new digs over at Nurse Ratched’s Place, check out the response to the Joint Commission at the Greatest Hospital in the World in JCAHO Reddiness Swat Team. She’s not kidding.


Oh geeze, just when you think you’ve heard everything…Janet at PixelOne,PurlTwo sends a story about a class on communication she was required to attend, entitled Nurses as Children. You have to read this. And then reach for the Tums. You’ll need them. I did.

Keith at Digital Doorway presents his third installment of his ValueCare, ValueNurses blogging scholarship series with a look at The Aging World. As I’m smack in the middle of the Boomer generation, so I’m not sure whether I’m depressed over the potential for economic hardship or the fact that Keith is younger than me! Over at NurseLinkUp, Keith discusses new legislation regarding nursing practice in Ohio Nurses Allowed to Administer Botox. Look for NurseLinkUp to host Change of Shift in the upcoming months!

I bet we all have some great stories about practical jokes at work. Nurse Kathy at NurseConnect tells us a few gems as she discusses the reason we should Lighten Up.


Has nursing changed you? How are you seen by friends and family now that you are a nurse? Nurse Laura, also from NurseConnect, ponders these questions in Have You Changed Since Becoming a Nurse? (In answer to one of her questions, I “veg” out so much on my days off, I’m growing roots!)

ERMurse has been to some meetings and he shares his version of the proceedings in Annoying Consultant Speak posted at ER Murse. Been there, heard that! What a pain.

NurseConnect continues their guest blogger series with Karen Siroky, a nurse and director of She shares her views on the nursing shortage and encourages all RNs out there to take some creative steps to do their part to help She details some of these steps in Pay It Forward.


Beka over at Medscape Nurses wonders just how much technology is enough in How High Tech Must We Go in ICU Today? She links to an article about an almost unbelievable ICU!

Alvaro at SharpBrains weighs in with a post on Neurogenesis and Brain Plasticity in Adult Brains. It seems you are never to old to learn and the act of learning is healthy for your brain (and your patients’ brains!)

You can find Heather Johnson in many places on the web, but this time she comes to us from with a quick look at Loan Tips for the New Grad. In the same vein, Sarah Scrafford offers guidance in Understanding Your U.S. Federal Financial Aid Options: Perkins and Stafford which can be found at Online I present these for our new grad colleagues and those about ready to embark on their nursing education (including my daughter!)

This looks intriguing! Sally Thompson presents 100 Open Courseware Collections in Health and Medicine over at Nursing Colleges & Training Schools.


Thanks for reading this edition of Change of Shift. The September 4th edition will be hosted at Nurse Ratched’s Place. You can submit via the Blog Carnival button or send your submissions to “motherjonesrn at yahoo dot com”.

See you then!

August 19, 2008, 10:52 am

Dewey or Don’t We? Grand Rounds Goes to the Library

Ever wonder what we did before the internet?

You’re looking at it.

The Dewey Decimal System.

If you have to look it up, you’re too young to remember it.

Let’s put it this way: it gave Kerri at Six Until Me a nightmare.

A nightmare that became the theme for this week’s Grand Rounds!

Melvil Dewey would be proud!


I’d like to thank Scrubs Gallery for their continued support of Emergiblog. You guys rock, and the site gets better and better!


The Healthcare Today site is growing fast! I’m proud to be in the company of some pretty heavy hitting bloggers over there, and you can easily sign up.

Then, you can submit your own posts to the headlines and vote on those already there. It’s not only a quick look at the blogosphere topics, but mainstream media links as well.

Find an article you like? Submit it for all of us to see.

It’s easy to read, easy to navigate and easy to submit anything you find interesting.

Something I found just a few minutes ago was a post from Clinical Cases and Images: Does Michael Phelps Have Marfan Syndrome? If not for Healthcare Today, I may have missed an interesting look at a phenomenal athlete.


You may have noticed the Johnson and Johnson widget on the sidebar. This connects directly to the J&J Health Channel on You Tube with Dr. Nancy Snyderman.

You may recognize Dr. Snyderman from the Today show – I remember when she was a local surgeon here in the San Francisco Bay Area.

The topics are varied and interesting, so do check them out.

And of course a HUGE thanks to J&J for sponsoring the medbloggers at BlogWorldExpo! The nursing profession is very lucky to have such a wonderful corporate supporter!


There is some furniture rearrangement going on at Emergiblog.

Apps are coming and going…

It all stems from BlogHer08. Lots of internet folks there with new things to try.


Yedda is an interesting app. You sign up and then folks ask you questions based on your stated areas of expertise/interest. I guess not too many people are interested in nursing, ERs or Jeff Scott Soto, because I’ve not gotten a single question.

Check it out if you are interested in learning more. Heck, you can even ask me a question!


Adoptic is an app in beta that I am looking at closely.

You sign up and join “communities”. Snippets of posts from those communities show up on your sidebar (as you can see here on Emergiblog) and your posts show up on other sites in the community, giving your blog more exposure.

You pick which posts to promote and which communities you belong to.

I belong to the entrepreneur, literature and writing, science and health communities, so the snippets you see on this blog will be related to one of those four areas.


And, it’s not too late to get those Change of Shift submission in! I’ll be putting it together tomorrow (along with getting the youngest ready for college – who needs sleep anyway?), so get those last minute submission in via the contact button or the Blog Carnival submission button.


PS – I’m on Twitter now! Yes, I have joined the Twitter Twiteration! I’m there under “Emergiblog” so if you’d like to follow me (or would like me to follow you), come on over!

August 16, 2008, 9:17 pm

Do-It-Yourself Medicine Shelf

Does your medicine cabinet look this neat?

Do you even have this many drugs?

My “medicine chest” is in my kitchen. Various and sundry medications and supplements share shelf space with Skippy Extra Chunky Peanut Butter, Smucker’s jelly, Starbucks coffee, Splenda, and CoffeeMate.

I’m ready for nasal congestion, runny nose, nausea, muscle spasms, inflammation, cough, insomnia, diarrhea, indigestion, allergic reactions, superficial boo-boos and headaches.

If I had the appropriate anatomical equipment,  I’d probably be prepared for erectile dysfunction.

And those aren’t even my prescription meds!

Oh, I don’t take them all, but just in case someone has a symptom, I am ready!

Better living through chemistry, that’s my motto!


Now that the asinine medication reconciliation sheet is an asinine intimate part of the medical record, it’s time to look past the inconvenience, the increase in paperwork and the loss of time at the bedside.

The bottom line is that when you are admitted to the hospital, you are writing your own prescriptions.

The medications you state you take, in the dosages you provide will be ordered, based on the medication form.

This is good, yes?

Only if you are dead certain of what you are saying. Only if you are not writhing in pain and are with it enough to remember all your medications. All of them. Only if you are absolutely certain of your dosages. Only if the list you “always carry” is up-to-date.

If not, then you run the risk of not getting your usual medications in the hospital, getting medications or dosages that were not part of your daily routine or new medications that interact with your old ones.


The whole point of the med rec form is to provide continuity between your pre-hospital, in-hospital and post discharge medication regime.

This wasn’t necessary back in the days of “Marcus Welby, MD”, when your primary doctor followed you in the hospital. She knew you well, knew your family, knew your medical history. Your medical record was the chart in her office, to which she always had access.

Today, you will most likely be admitted by a hospitalist who will coordinate your care and have (possibly multiple) consultants who will deal with specific medical issues. These doctors may or may not know you, and they rely on what is written on the medication sheet to guide their ordering.

They will base your medications on that and they will use the med sheet to avoid medication interactions when they write new orders.

  • That means, if you can’t remember your medication dose, and you guess at it, that guess becomes your dose. Maybe it’s right, maybe not.
  • That means that “I take a water pill, a blood pressure pill, a sugar pill and a stomach pill” will pretty much guarantee that your usual medications will not be ordered, at least in the beginning.
  • That means “my doctor has a list of all my meds” means nothing after office hours because (a) the office is closed and (b) your doctor is probably not on call and trust me, the on-call doc is not going to go to the office and look you up right then and there.

This means that in this day and age, you better have a list, it had better be accurate and it had better be up-to-date and in your wallet (not your wife’s purse or your husband’s papers) at all times.


You would be stunned at the number of alert, oriented, intelligent adults who honestly have no clue about their medications or are so stressed on admission that they cannot remember clearly.

The vast majority of physicians will move hell and high water to find out what you are taking and order appropriately. Then again, some will take that med rec sheet so literally that all they will do is check the “order” box next to what is written: medication names that you provided and medication dosages that you stated

So, it is to your advantage to make it as easy as possible for your hospital health care providers to make sure you receive the appropriate medications.

The majority of this responsibility is now on you, the patient.

Not the doctor. Not your family. Not the paramedic who has to go through your medicine chest.


Make a list of what you take, keep that list up-to-date and keep it with you at all times.

I know it sounds crazy, but under the medication reconciliation requirement, you are essentially writing your own prescriptions when you are initially hospitalized.

Make sure you know what they are.

You health, and your life, may depend on it.


Major hat tip to my (very) esteemed colleague who actually had the idea for this post and graciously let me use it!

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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