Change of Shift is changing the world

Change of Shift is up at Emergiblog. Take a look to find out what nurses are talking about.

I included a post I wrote last Sunday about how social media (SM) may be the equivalent of the "big reveal" on a reality TV show, only what we're revealing on blogs and Twitter is the culture of healthcare. Making healthcare more transparent by sharing not what should be done, ought to be done, or even what we wish we could have done. SM seems to be a vehicle in full-throttle that captures what's actually done.

That said, I'm wondering how professionals who blog and tweet feel about their stories being picked up and used to illustrate how well the systems frontline clinicians rely on work (or, in many cases, don't work.) The knowledge, attitudes, values, and beliefs of individuals are reflected in the accounts we share. This information is often very personal, and it may reflect organizations individuals chose to identify. There's a lot of "hot talk" about respecting the privacy rights of patients in social media, but what about others?

My work focuses on how people perform within a system. The goal is to improve outcomes by improving the fitness of the system, being mindful of the strengths and limitations that humans bring to high-stakes endeavors. But this is not a universal approach, and "blame, shame, and re-train" approaches to performance improvement remain operational (even if they are not tacitly endorsed). For this reason, I chose not to "hot link" the stories I shared lest it draw unwelcome attention to individuals who simply shared a "day in the life of" account.

I'd love to have some feedback. Am I being overly cautious? Is posting and tweeting a "let the buyer beware" endeavor?

Shift change again!

Change of Shift is up at This Crazy Miracle Called Life. You'll find an interesting array of stories, and lots of different views about what it means to nurse and to be a nurse.

Florence sat this one out, but I set my engineer's mind free and shared a post from my Medscape blog about medication errors in maternity settings. Unlike serious errors that occur in closed units and places where patients are already very sick, errors in OB are more visible and less likely to be mistaken for spontaneous changes in the condition of an already compromised person. These errors often harm two, and the results can be tragic.

Pop over to Medscape and check out Beyond 'Be Careful' in OB. The comment section has lots of feedback from maternity clinicians, many of whom are using strong safeguards in their medication use systems.

Change of Shift: A check up with your nurses

Change of Shift is up over at Emergiblog. A new blog, The Nursing Student Chronicles, caught my eye. How the next generation of healthcare providers harnesses the power of social media may say a lot about what providing and receiving healthcare will look like in the future.

I just can't picture a 22 year old--who, thanks to Guitar Hero, can play the riffs in "Dream On" better than Joe Perry--entering multiple passwords, then clicking on 8 screens to release a box of Depends from a med-surg supply room.

And you should definitely check out the student's post if you're worried that the next generation doesn't bring full hearts and the ability to see the big picture. Rock on!

Change of Shift: A Virtual Care Plan for Effective Communication

Welcome to Change of Shift, nursing's vibrant blog carnival! I'm thrilled to be your guest host this week and hope you'll find the posts embedded here as interesting as I have. If you're visiting my blog for the first time, I should warn you that I channel Florence Nightingale. I don't take extreme liberties with Miss Nightingale, just try and figure out what her work might say about ours. Sometimes I hit, sometimes I miss. Today, I'm weaving the voices of front line clinicians, consumers, and other interested (and interesting) bloggers around the theme of communication, showing, perhaps, where we are ("Can you hear me? Can you hear me now?") and what enhanced communication might do for us in the future.

Here's a story about engaging patients in their plan of care. It happened to me several years ago when I sought care in my local ED for unrelenting chest pain of 3 days duration, was diagnosed with bilateral pulmonary emboli and admitted for 5 days of inpatient anticoagulation. (This account, by the way, does not constitute medical advice from either Flo or Bo.)

In the early days, mostly spent waiting for a therapeutic INR to bubble up in my errant body-turned-chemistry set, I noticed a large whiteboard opposite my bed. The labels affixed to the board led me to believe that the date, weather, names of the people caring for me, plus key elements of my plan of care, could be written there. My boredom, spirits, and activity level increased in a linear fashion, and by day 3, I couldn't resist messing with the whiteboard which had remained uncluttered by any data save the preprinted labels. So I documented, as best I understood it, my plan of care: vegetate; oxygenate; medicate; anticoagulate; educate; ruminate; irritate; agitate; & dissipate.

Since that appeared to be an effective way to engage others (it certainly seemed to hasten my discharge), I thought I'd categorize words of wisdom from the blogosphere in a similar fashion.

If you haven't met e-Patient Dave, I'm happy to introduce you to this remarkable gentleman. Dave blogs about his personal journey surviving kidney cancer at The New Life of e-Patient Dave and e-patients.net. An IT professional, Dave recently attempted to interface his complicated medical history, housed in a patient-accessible hospital e-record, with Google Health. The outcome? A personal health record riddled with serious and significant errors. Dave's experience is being used to illustrate the primitive state of electronic medical records, even when high-end institutional and consumer products are used by an IT professional. You can read about his testimony at the National e-Health board meeting here. (Be sure to click on the slide show for a quick re-cap of Dave's compelling story.) Since I believe consumers and front line clinicians share many of the problems that arise when IT solutions perform poorly, I thought I'd put "automate" at the top of the communication care plan. I'd also like to acknowledge the efforts of Dave and others who share their personal journey in hopes of improving the system. So we could add "advocate" here, too.

I was happy to see a piece about proper use of pulse oximeters from AJN's Off the Charts blog. So, in a nod to the A-B-C's I decided to put "oxygenate" near the top of the plan of care. RehabRN's War Stories post talks about things that, while not oxygen, deserve top billing on a priorities list. (You'll have to take a deep breath while reading this one, another defense for indexing it here.)

See Jane Nurse adds "medicate" to the plan (or maybe she doesn't) in a post entitled No More Nitro for You. Ross, a Nurse in Australia, writes Medication Errors: Behind Closed Doors, putting the issue of medication errors on the chart (or, if you read what he correctly notes about under-reporting of errors and disclosure, maybe he doesn't).

If "medicate" hasn't yet made the care plan for improving communication, I'll add it myself. Really. I blog about medication safety on Medscape (at On Your Meds), where High-Alert Drugs: Eating the Elephant One Bite at a Time advises how to avoid mix-ups involving the most commonly confused drug name pair. (Spoiler alert: it's morphine and hydromorphone.)

Staying true to his "can do" approach, Sean Dent at My Strong Medicine puts his addition to the care plan to work, evaluating two new television shows about nurses: Nurse Jackie vs. HawthoRNe: The Battle of the TV Show Nurses Continues.

Sandy Summers at The Truth about Nursing also takes on Nurse Jackie in a detailed piece that includes a link to the first episode.

Shauna shares what it's been like to be handed a painful diagnosis, examining the best way to proceed when the words on the plan of care are unwelcome in The Six Words I Never Wanted to Speak.

And if you're looking for comprehensive ways to evaluate, check out 50 Fascinating Online Psychology Tests provided by The Forensic Scientist Blog. (Flo & Bo thinking, "TMI." But, hey, please yourself.)

While healthcare is full of interesting challenges, we're not short on thinkers contemplating solutions. Over at Digital Doorway, Keith, a seasoned blogger and mentor to many (including Flo & Bo), examines health coaching as a natural place for nurses to apply their knowledge and skills in Health Coaching and Multiple Chemical Sensitivity. Thanks for modeling out-of-the-box ways to nurse while dealing with personal health challenges. You get the first, but not only entry, under "Cognate," Keith!

Mother Jones at Nurse Ratched's Place considers the merits of microblogging and online networking in The Twitter People, while fessing up, Nurse Jackie-style, to a small addiction problem. (Okay, Twitter-addiction may not be in the same league as Nurse Jackie's problem.)

Kim at Emergiblog, the mothership of Change of Shift, offers words of wisdom in the "just think" department, too. She points to the value of civil discourse when communicating in the virtual realm. If you didn't know what, Jane, you ignorant $^&*! meant before now, you're in for a treat! Pick your words carefully when documenting on the care plan, too!

Finally, if you want a textbook approach for maximizing your cognitive abilities, check out The SharpBrains Guide to Brain Fitness.

Over at Nurse Connect, Nurse Kathy provides a spot-on list of things she thinks could transform nursing and asks, What's on your nurse's dream list?. Read it (especially if you need a laugh). I'll simply say I could have squeezed her into the care plan under "automate," "medicate," or "cognate." But since she's exceptionally creative, I'm going to give her a special place in the communication plan of care: innovate.

The systems we rely on (Paging, e-Patient Dave! Paging e-Patient Dave!) often don't set up healthcare workers to win. In My Garage, Your Checklists & Patient Safety, Joe Bormel at Healthcare Infomatics illustrates how other industries apply principles from human factors engineering to determine when and whether humans benefit from prompts. Flo & Bo are always interested in spreading the word about "the science behind the compliance" (e.g., Joint Commission standards).

I somehow felt "procreate" should fall near the bottom of the care plan. (And may your fingers turn black and rot off if you enter it on mine!) But the topic is surely on the minds of bloggers. As a long-time perinatal nurse, I'm always interested in these conversations. My engineer's mind simply cannot wrap itself around processes that yield such highly variable results as Cesarean birth rates (spanning from 20% to 40% in the course of my 25 year career). What's up with that?

Chris, from The Man-Nurse Diaries, sums up what's being said about home birth in the blogosphere with Home Birth Bonanza. And a host of communication-sensitive strategies for promoting healthy birth experiences can be found In A Maternity Care Utopia at Rebirth.

Over at Reality Rounds, we get to see how incomplete unit-to-unit communication impacts staff in The Pregnancy Secret (or as the author aptly observes, "how nurses get outed at work when they are pregnant").

Dave at The Back Pain Blog sends words of evidenced-based wisdom about Back Pain and Your Mattress setting the tone for "rejuvenate," a key component needed to communicate. Finally, Nurse Laura from Nurse Connect adds her prescriptive advice. You'll know exactly what should be next on your "to do" list once you've read Nurses: It's Time to Reorient Ourselves.

Thanks for visiting! Use the comment space to add to the virtual plan of care!

Change of Shift happens again on 6/25, hosted by RehabRN. Send submissions to hotelrehab@nyms.net.

Change of Shift: Coming Soon

Flo & Bo will be guest-hosting Change of Shift, nursing's vibrant blog-fest, here on June 11. You can expect a salute to communication, what the voices of front line clinicians, consumers, and other interested (and interesting) people mean to healthcare and healing.


As a new blogger, I've benefited from what you share every day and from the variety of engaging ways seasoned bloggers spread the word! I'm looking forward to "showing your stuff" here next week.

All submissions are welcomed. Please include:

Name of blog
URL to blog
Name of post you're submitting
URL/Permalink to the post
Blogger and/or post author
Twitter link (if you want to include one)
A few words about what you're submitting

Send via the blog carnival portal or directly using blynnolson at gmail. I'll be happy to include all received through 6/10 at 5 pm.

Change of Shift reflections

The nursing blog carnival Change of Shift is up this morning at Emergiblog, with links to posts that will inspire! There's some sort of post-Nurses Week, Trek-y thing going on over there that made me smile.

My favorite part of Nurses Week was cycling to Flo & Bo's Nurses Week playlist with my YMCA Group Cycling compatriots, most of whom had a nurse to honor. The warm-up began with Julie Andrews singing, "Just a Spoonful of Sugar" (which really freaked out the younger folks and caused non-cyclers to pop into the studio to assess the situation). But "Live and Let Die" and "Every Breath You Take" turned out to be surprisingly meaningful tributes to nursing care. Our talented leader, the daughter of a nurse, added Pink Floyd's "Comfortably Numb" to the list, a song which will definitely make the 2010 roster. (Warning: The current playlist made for a butt-kicking ride, and caused me to consider whether CPR would become part of Nurses Week celebrations at the Y.)

Flo & Bo are going to take a turn hosting Change of Shift in June, and I'm beginning to reflect on a theme. Current contenders include:

• What's Wrong with the Five Rights: System problems that prevent us from doing our best work. (My favorite involves a med-surg unit where the mean patient age was 82, the most common discharge site was a nursing home, and the most useless nursing activity involved going to Walmart on the evening shift to purchase adult diapers because materials management personnel had left for the day before unloading supplies.)
• Widgets We Love'd Love to Have: Technology solutions that make--or could make--your life (real or imagined) better. With so much twittering about stimulus funds and health IT solutions, nurses might want to share how practical, tech-medicated solutions could improve work-flow. Gena's CodeBlog post about a tough day in the ICU inspired this line of thinking.
• All Riding is Therapeutic Riding: Experiences and inspirations that make it easier to be a human.

Leave a comment here if you want to help select a theme. Here's my vote for "All Riding is Therapeutic Riding" from my May garden in Georgia:

Human Factors

The bi-weekly nursing blog carnival, Change of Shift, is up over at Emergiblog. I love the name "Change of Shift" because the view of healthcare that emerges there, like a Change of Shift hand-off, provides a window into the system we use to deliver care. The realities faced by clinicians on the front line are good reads for anyone interested in understanding the physical and mental challenges involved in providing care, and these accounts show how much relationships matter.

I especially loved a post by Drug Pusher (and not just because I have a keen interest in medication safety!).

The summary of nurses' views about barriers to providing safe care at Better Health is definitely worth reading, especially for people working to develop health IT products. I have an untested hypothesis that goes something like this: Few industries interested in producing reliable results or maintaining strong financial performance would support "humans babysitting machines" to the extent that we currently see in healthcare. Watching "safety" fight with "efficiency" is like watching "healthcare" fight "education" for scarce resources. These are not "pick one" issues. "Nurses dish on communication lapses that harm patients" seems to support my hypothesis.

I hope you'll visit Change of Shift every other Thursday: it's a good place to benchmark practices and keep an eye on emerging trends.

Next up: Deconstructing an error-prone IV medication set-up in a pediatric patient. Review Part 1 here.