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getoverit, BSN, RN, EMT-P 5,557 Views

Joined Dec 30, '07. getoverit is a MICU/CCU, fire department paramedic. He has '18' year(s) of experience and specializes in 'ER/ICU/Flight'. Posts: 448 (50% Liked) Likes: 780

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  • Dec 9 '17

    Quote from Ruby Vee
    It's not that simple. Clearly you don't know what you don't know. Precepting is a very difficult job, especially if you're trying to do it well (rather than collecting your $.75/hour for "babysitting" while the new nurse flounders). Some folks are good at it, others aren't. Some enjoy it; others tolerate it and a few hate it. Some nurses who enjoyed precepting have been precepting continuously for YEARS on end and are burned out and have begun to hate it.

    Precepting used to be rewarding, but these days new grads are more and more entitled. They want the preceptor to change her schedule to accomodate the newbie's preferences. They want any feedback wrapped in rainbows and sprinkled with fairy dust to the point where any NEGATIVE feedback can be ignored. Everything is all about "my learning" to the point where even the patient is lost in the shuffle. They rush to "report someone" every time they have a negative interaction because they're certain that every negative interaction is "bullying." Preceptors are then bullied by their orientees who are rushing to complain to the manager because "Ruby wouldn't eat lunch with me, WAH!" (My sister was in town for 24 hours for a conference at my hospital and I chose to have lunch with her so we could talk about my mother's latest nursing home eviction and where we might place her instead. I explained that, even though I shouldn't have had to. The orientee is an adult -- she can eat one meal by herself!) Or "Anne didn't say hello to me in the lobby!" (Anne had driven to work wearing her sunglasses, left them in the car and was headed up to the unit more or less by braille to put in her contacts. She didn't SEE the orientee, but probably would have greeted her warmly had the orientee said hello first.)

    Until you have actually precepted -- and tried to do it well -- you have NO idea. Perhaps it would be best not to rush to judgement until you have actually walked a mile in a preceptor's shoes.
    Ruby Vee, I have read your posts for many years and am a little taken aback by this one. I have been a preceptor for over 20 years and have received more than a couple awards for teaching/precepting. Not bragging on myself, just giving a little context for me to use your words back to you: clearly YOU don't know what you don't know and it would be best for YOU not to rush to judgment.

  • Dec 9 '17

    I've always wondered if the nurses who don't like teaching or precepting also didn't like it when their teachers and preceptors were helping them learn new things.... Seems like a double standard at times

  • Dec 7 '17

    Quote from Ruby Vee
    It's not that simple. Clearly you don't know what you don't know. Precepting is a very difficult job, especially if you're trying to do it well (rather than collecting your $.75/hour for "babysitting" while the new nurse flounders). Some folks are good at it, others aren't. Some enjoy it; others tolerate it and a few hate it. Some nurses who enjoyed precepting have been precepting continuously for YEARS on end and are burned out and have begun to hate it.

    Precepting used to be rewarding, but these days new grads are more and more entitled. They want the preceptor to change her schedule to accomodate the newbie's preferences. They want any feedback wrapped in rainbows and sprinkled with fairy dust to the point where any NEGATIVE feedback can be ignored. Everything is all about "my learning" to the point where even the patient is lost in the shuffle. They rush to "report someone" every time they have a negative interaction because they're certain that every negative interaction is "bullying." Preceptors are then bullied by their orientees who are rushing to complain to the manager because "Ruby wouldn't eat lunch with me, WAH!" (My sister was in town for 24 hours for a conference at my hospital and I chose to have lunch with her so we could talk about my mother's latest nursing home eviction and where we might place her instead. I explained that, even though I shouldn't have had to. The orientee is an adult -- she can eat one meal by herself!) Or "Anne didn't say hello to me in the lobby!" (Anne had driven to work wearing her sunglasses, left them in the car and was headed up to the unit more or less by braille to put in her contacts. She didn't SEE the orientee, but probably would have greeted her warmly had the orientee said hello first.)

    Until you have actually precepted -- and tried to do it well -- you have NO idea. Perhaps it would be best not to rush to judgement until you have actually walked a mile in a preceptor's shoes.
    Ruby Vee, I have read your posts for many years and am a little taken aback by this one. I have been a preceptor for over 20 years and have received more than a couple awards for teaching/precepting. Not bragging on myself, just giving a little context for me to use your words back to you: clearly YOU don't know what you don't know and it would be best for YOU not to rush to judgment.

  • Nov 17 '17

    Before an exam a patient asked the doctor where they should put their clothes, the doctor said "Just leave them on the floor next to mine."

    I was introducing a patient to a different doctor (who wasn't paying any attention), I said "This is Mr. Smith." The doctor looked at the patient list, then said "How do you pronounce your name?" The patient said, "Um...Smith. Like he just said."

  • Nov 9 '17

    Before an exam a patient asked the doctor where they should put their clothes, the doctor said "Just leave them on the floor next to mine."

    I was introducing a patient to a different doctor (who wasn't paying any attention), I said "This is Mr. Smith." The doctor looked at the patient list, then said "How do you pronounce your name?" The patient said, "Um...Smith. Like he just said."

  • Nov 9 '17

    Before an exam a patient asked the doctor where they should put their clothes, the doctor said "Just leave them on the floor next to mine."

    I was introducing a patient to a different doctor (who wasn't paying any attention), I said "This is Mr. Smith." The doctor looked at the patient list, then said "How do you pronounce your name?" The patient said, "Um...Smith. Like he just said."

  • Sep 25 '17

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • Aug 29 '17

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • Aug 6 '17

    Quote from cfsleo812
    Can someone please break it down really simple, elementary my dear: what is cardiac preload, afterload? Feel free to give specific examples with drugs that affect each to make it crystal clear, thanks.
    Hey cfsleo812,
    So: really simple, elementary preload and afterload, huh? Good question.
    Basically, preload is stretch. The amount of volume being returned to the right side of the heart from systemic circulation. Afterload is squeeze. The amount of resistance the left side of the heart has to overcome in order to eject blood.
    Just look at the mechanism of action with different drugs to see what they do. e.g. a dilator will decrease, so the pressure comes down and the heart has less resistance to overcome, the catch is that it can also lead to less venous return, hypotension, ischemia. A pressor will increase, hopefully leading to better return to the heart. But it can also create too much resistance, which also can lead to problems.
    This is a very simplified definition, hope it helps. Sometimes the simplest things are the most useful.

  • May 3 '17

    The insulin injection is just a hormone that stimulates glucose to cross the cell membrane and provokes the uptake of potassium as well. I believe it has something to do with the size of the molecule (macro-). The high potassium you saw in your patient was serum k+ so it needs to be forced back into the cells. Remember that if all our potassium was in the extracellular space it would be immeasurably high: 50-100x the normal value.
    Within 30-60 minutes the potassium should begin to shift back into the cells. The glucose is given to prevent iatrogenic hypoglycemia. IV calcium should be given if any acute EKG changes are noted and most of the literature I've read lately doesn't support the effectiveness of NaHCO3 very much (in fact, we don't use it much anymore).
    Recent AHA guidelines don't recommend giving a potassium-binder like Kayexelate anymore for emergent treatment of hyperkalemia. It forms a composite of resin and potassium which is excreted in feces, but takes at least 24 hours. Occasionally we give them all in conjunction with each other, to provide immediate and extended treatment.
    Of course one of the fastest and most reliable ways of correcting the k+ is hemodialysis. It's interesting to note that albuterol also displaces the potassium back into the cell and can be used to potentiate the effect of the insulin.

  • Feb 21 '17

    I hear you, and all the posters who said you have to set limits and demand the respect you deserve are exactly right.
    We had a lady on the vent for 60+ days with pulmonary fibrosis, and every day you could tell what her family had looked up on WebMD the night before. Asking detailed, questions about vent setting trivia, acting angry the split second it seemed like she wasn't the center of attention at all times. Her husband yelled at one of my co-workers one afternoon about how "no one has been taking care of her". I went in the room and told him to google pressure ulcer when he got home and then ask himself how she had been laid up here for 2 months without having one....then see if he still thinks no one's been taking care of her.
    He must have done it because the next day he apologized and that was the end of them acting like that. Miraculously, without us ever taking care of her, she managed to survive her admission and went back home.



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