wooh 28,895 Views
Joined Feb 12, '04 - from 'GA, US'.
wooh is a RN & Critter Mama.
Posts: 4,988 (74% Liked)
The other night at 3am I called the endocrinologist with a blood sugar. I normally am so organized when I call for orders, especially at night, since you don't know if the doc is going to actually know who the patient is. But this time, you'd think I'd have been the one that was woken up based on the conversation. "Hi Dr. Endo, I'm calling about a.b., in for CF, had surgery today, has been on IVF since, along with her feed tonight. Her mid-feed blood sugar is 303, no, 305, no 335, (after the tech who'd taken the blood sugar overheard me making a fool of myself and reminding me what it really was), wait, 435!" He actually laughed (rare occurrence for all except one of our endocrinologists, and he's not that one.) Says, "Wellllll," So I said, "435! I'm sticking with that number. That's it. 435!"
He probably woke up and told his wife, "I had the weirdest dream that I was Bob Barker," because I sure sounded like a contestant on the Price is Right.
I love when they request another nurse. Someone else gets the distinct privilege of dealing with their crazy butt instead of me. Life becomes good again.
One day I heard a newer nurse happily chatting away in a room in the ICU and I heard her say....
"Oh..... I just kill everything I touch".
That reminds me of the time one of our family practice docs told a group of us "I'm not too good with living things."
Apparently she was referring to a houseplant, but still ---- the hilarity of that statement completely escaped her!
So here I am, on the other side of the OR bed helping the anesthesia care provider transfer my pt to the OR bed from the stretcher. My pt was quite sedated from the 2mg of Versed that was given in pre-op and seemed to be confused as to how to scoot himself over to the OR bed. So I patted the OR bed and said, "Bend up your knees and scoot your (another word for a donkey) on over here toward me." Umm....that kinda slipped out!
I just wish I had the same opportunities to have those wage increases on my floor. ... When I made the comment about just passing meds I was just coming off a shift on medsurg when that was all that I did. ... I have had over 150 hours of critical care class only to make $22/hr !
Its exacerbation NOT exasperation. That makes me crazy . Mrs.Smith dosen't have a exasperation of her asthma she has a exacerbation of her asthma.
Everyone that wants to close visitation, will YOU leave your family member alone in the hospital?
The answer isn't blanket rules forbidding visitation during whatever hours. It's allowing staff to kick out disruptive visitors. And management standing behind them when they do.
D5 1/2NS. Stickiest shower of my life.
I once had a pt that was admitted for tampering with her stoma to make it bleed and hurt so she could get pain meds (dilaudid, of course). ... Apparently she met a gentlemen out there smoking, ... she gave him a blow job.
Not around THAT long, but did work in a nursing home where we had to rinse the poo out of linens before they could go in the linen bag. That was a fun time after getting everyone up the morning after beef stew nights.
Interesting thoughts, but I'm going to agree with the poster that said that wouldn't be the sole explanation for complaints from 15-1900. Perhaps: staffing cut at 1500 (after all, it's not daytime anymore) and still all the hustle bustle of days? Doctors coming in after offices close and creating lots of orders to be done at the same time dinner trays hit the floor. Patients and visitors getting cranky at the end of the day because they're tired. I think boiling it down to "Type A" and "Type B" nurses is sometimes just another chance to blame staff for what is more of a system type problem.
The ADHD tendencies of the ED nurse finds the ICU while difficult and interesting...suffocating by tending to the same patients everyday.
Back to the topic at hand - if you all could only see the place we go for a beer in the mornings after work... between us and the guys from the plants it isn't usually pretty. But, we've all been working hard and just want to have a drink and shoot some pool.
I've been at work all day, knowing what rooms I need to wear gowns in to avoid the germs. You've been to Wal-Mart. Who knows who had the buggy before you. Who pawed the banana you're picking up. Who sneezed while looking at underwear. Who was just released from the hospital with a still oozing wound and picked up some gum on their way home.
If my scrubs keep you and your Wal-Mart worn FOMITE clothes sitting further away from me, all the better for me.
So many new grads start off on a Med-Surg floor. Either they want to, they think they should, someone else thinks they should, or it's the only job in town. Being a Med-Surg nurse at heart, and having great mentors in school and after graduation, I've become pretty good at Med-Surg, because I stick to a few basic rules. This series will be aimed at helping the new grad in Med-Surg (adult or pediatrics). I hope some it will prove useful to others as well, as some of the things I've learned have been from ED and ICU nurses. But I'm aiming at the "baby nurses" entering the big bad world of hospital floor nursing.
The two most important things a nurse in Med-Surg has to learn are PRIORITIZATION and ORGANIZATION. Nobody can organize like a Med-Surg nurse. Unfortunately, for the new grad, this is one of the hardest skills to develop. Being inexperienced, it's understandably difficult to look at the million tasks for the shift and say to yourself, "What do I do first? What can wait?"
An important point to remember is you can't organize without prioritizing, and you can't prioritize without organizing. You can have a beautiful sheet of paper with checklist after checklist that's brilliantly organized, but you'll barely have time to do everything you MUST do, much less time to do everything you want to do. So you'll have to prioritize. And you can know what's most important for each of your patients, but fitting it all into a 12 hour shift won't happen if you don't stay organized.
For Part 1 of this series, I'm going to share a few general ideas about that core concept of Prioritize and Organize.
First, you need to start the day figuring out what is most important for each patient. When you come in and get your patient information and get report, there will likely be a whirlwind of diagnoses and treatments and drugs. For each patient, step back from the trees to look at the forest. The trees are all the comorbidities and drugs and social issues. Step back and look at the forest, "Why is the patient in the hospital TODAY?" And with that thought in mind, look into the future and imagine the best outcome and imagine the worst outcome.
For example, you have an easy post-operative appendectomy. Best outcome? Pain is controlled on PO meds, they're eating and drinking without nausea, and they go home. What's the worst outcome? If you said, "Death!" then I'll give you bonus points, but let's think of the likely bad scenarios. For post-op patients, I always imagine post op ileus and some pneumonia.
So next is to think through, "What's the most important thing I can do today to increase the chances of that good outcome?" And then, "What's the most important thing I can do today to decrease the chances of a bad outcome?"
So for this post-op patient, I'm thinking, "Good pain/nausea control." And then I'm thinking, "Get their bootie out of bed and ambulate!" What has this done for me? Instead of a swirl of things to do and think about, I've now found what I need to focus on for that patient.
But wooh! None of my patients are a simple post-op! In this day and age of outpatient surgery, rarely will you have the easy post-op patient. But you'll still apply the same concepts. If my post-op appendectomy patient is 84 and has a history of COPD, I'm going to account for her lungs not working as well, and I'm going to focus even more on making sure they don't end up with pneumonia from inactivity caused atelectasis. The secret is to look at the big picture of the patient. Step back from the trees to see the forest.
It will take some practice at first, but soon it will become second nature. Next time we'll look at what we do once we've located the forests amongst the trees.
Advertise With Us