getoverit, BSN, RN, EMT-P 5,628 Views
Joined: Dec 30, '07;
Posts: 448 (50% Liked)
; Likes: 782
MICU/CCU, fire department paramedic
18 year(s) of experience in ER/ICU/Flight
I don't see it as you trying to "lighten" anything up. You seem pretty salty. Your initial response to me was that you thought I was wrong. Your flawed logic has been countered by a few other posters on this board. It had nothing to do with being the popular opinion, which is how you (mis)interpreted what I wrote.
And "characterized and judged" you? Can we say drama? You are the one who has been judging those who don't want to precept. Please follow the posts you wrote and what others have responded to your post. But nice try at playing the victim here.
Good. I'm not sure when this turned into you being petty about people disagreeing with your comments, but good for you.
Feel free to do so, but based on the comments responding to your posts, it would seem you're in the minority.
Your professional observation is derisive...
yeah but people like you and the OP are the ones who are judging. If someone doesn't want to precept they don't want to precept. I'm not sure why that is a hard concept to grasp. If I don't want to precept, I don't feel indentured to do so simply because another nurse taught me when I was new, which is basically your philosophy on this topic given what you wrote. Everybody has a part to play in the organization. This is why there are nurse educators and nurse preceptors: people who apply for and accept positions that allow them to do what they want. Where the line gets blurry (and has been pointed out here too) is when people who do not want to do so are tasked to do so - so they're forced to do something they don't like, are not even compensated fairly for it, and are tasked with taking on a full patient load of their own. That is not called being selfish or not being a team player or any of the other derisive adjectives that I've seen thrown around in this thread; it's unfair and unsafe.
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.
Quote by LLG:
Just because I have needed work done by a plumber (or substitute electrician, dentist, lawyer, car mechanic, etc.) in the past doesn't mean I am obligated to provide that service to others who need it now.
I agree with your response with the above exception, I think you're kind of comparing apples to oranges on this one but here's another step to the progression of your comparison: if you happened to have used a plumber for work, then in the future needed a different plumber who seemed to have difficulty completing the job...if you knew a pointer or tip to help them you would be wise to do so. but I agree that you are not technically "obligated".
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
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."
The needles we use take about 0.7cc to prime. We don't "push" the epi with saline, epinephrine is the only thing going through the needle. We have 10cc of 1:10,000 and we inject until the MD tells us to stop. We determine how much epi is left in the syringe, account for the 0.7cc remaining in the needle tubing, subtract from 10cc and that's how we calculate the amount of epi.
We rarely ever give a full mg of epinephrine to a single site for a bleed. Often I give between 0.3-0.5mg to a bleeding site.
Hope that helps.
MunoRN asks a good questions, just DNR or comfort care? Huge difference. 4 mg MSO4 q15m isn't that much and with an order like that I'm assuming they were comfort care. Also still intubated at time of death? Was he trying to extubate himself as he died? Some details aren't real clear.
As far as dealing with death, it may sound callous but it comes with repeated exposure. The few times when I've felt like I was somehow responsible for a patient's death I've spoken with the physician to get their impression and opinion. I've always been glad for those conversations and they stay with you for the next time something similar happens. Believe me, I've had plenty of shifts where I thought I was going to go insane if I had to work another code. Some of the things we do or say during those events are ways of dealing with it, things we say to each other we'd never say in front of a family member (or certain MDs for that matter!!)
File these experiences away, lock them in the vault or however you call it because eventually you will be the preceptor and a new grad will be looking toward you the same way. The wisdom and experience you gain between now and then will be what shapes your response.
It's a very broad test for general critical care knowledge. I took the PassCCRN review CD, the areas I scored the lowest on I studied for a couple weeks (Ignoring areas I scored >90%). I took the test quite awhile ago and don't know if/how it's changed since then but it was MUCH easier than I thought it would be. If you have a general working knowledge of ICU nursing you should be fine. the questions are not intricate or detailed, just very general. Here's an example: I have never taken care of a patient with a ventriculostomy but the questions about neuro were easy to understand and without the experience you can still figure out what they're getting at (e.g. troubleshooting, anatomy, etc).
I've been deposed once. Kid in a car wreck, ejected through the open side window. Agonal when we arrived and dead within a couple minutes from a terrible head injury. Don't assume that being deposed guarantees being named in a suit. One advice I haven't seen given here is to ABSOLUTELY get a copy of your incident report. That's the only thing you should refer to, if it isn't contained in the report then there's no way/reason to comment about it. Especially after 3 years.
Minimalistic answers are usually the best idea. I did elaborate in my deposition, but only because the details were very ingrained in my mind. After I provided a brutal description of the child's head and the moments preceding his death the family elected to not pursue any further. I hope your case goes well.
You're right, it isn't easy to pick up on subtle hints at times.
Respiratory acidosis is a pCO2>45, regardless of the pH. If the pH is normal, then the acidosis is being compensated. Your body wants to blow off the excess carbon dioxide so tachypnea is an early sign. Along with tachycardia as the heart tries to increase it's output to meet an inadequately supplied metabolic demand.
Remember one of the important things about blood pH is that it affects the oxyhemoglobin dissociation. when the blood becomes acidic, the RBC has an increased affinity for oxygen and won't exchange gas at the cellular level as effectively. So if you have a patient that is ventilating well and complaining of "smothering", one of the first things to consider is an ABG. these problems are often vicious circles and the patient will continue to decompensate until we intervene. Because of this, the O2 saturation is often of little use because the hemoglobin is well-saturated with oxygen but it doesn't release it to the cells in exchange for CO2. Hence the build up in the blood reflected in the ABG.
Hope this helps somewhat, I'm sure someone else can come along and give a more complete answer.
I've heard the same thing from instructors, the only rationale anyone ever provided was that checking the pulse on the opposite side may increase the risk of occluding the vessel or manipulating his larynx. I don't buy either argument.
As for the left hand, I would want to know how it could possibly make any difference which hand you used. If someone were able to palpate it with their big toe it would be fine with me.
Advertise With Us