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Anna Flaxis, ASN 25,260 Views

Joined Oct 15, '10. Posts: 2,864 (67% Liked) Likes: 8,613

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  • Jan 10

    Lots and lots of practice exams. :-)

  • Jan 9

    Peritoneal dialysis isn't that difficult. People do it at home all the time. In fact, many of your PD patients can probably show you how to do it.

    Do you happen to work in a small-ish community hospital with a nephrology clinic nearby? If that's the case, I'll bet you a nickel that your hospital has an agreement with them, and it's an important source of revenue that your hospital doesn't want to lose, as well as an important service that the patients in the community need and would not have available if not for your hospital's willingness to make this arrangement.

    Is it the ideal situation? No, for a lot of different reasons that I don't need to elaborate on.

    However, I think you'll have a lot more success trying to find ways to streamline the process so that you can move these patients through as efficiently as possible while still prioritizing your ED patients than you will by putting up a lot of resistance to it. If it's education you need, then request education.

  • Dec 24 '16

    I found these:

    floccillation
    /floc-cil-la-tion/ (flok″sĭ-la´shun) the aimless picking at bedclothes by a patient with delirium, dementia, fever, or exhaustion.
    Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

    carphology

    (kăr-fō-lō′jē-ă)
    [Pronunciation]
    (-fŏl′ō-jē)
    [Gr. karphos, dry twig, + legein, to pluck]

    Involuntary picking at bedclothes, seen esp. in febrile delirium.

    SYN: floccillation

  • Dec 23 '16

    Patient comes in by ambulance for Unspecified. On the way in, EMS throws in an 18g and draws blood for labs. Patient looks good, is completely with it, condition seems pretty benign, but need to check a few things. Order CBC, Comp, EKG, do orthostatics, send blood to lab, hang 2nd liter of NS. New ED Doc That I've Never Worked With Before picks up the chart. Orders something that makes sense (but I couldn't order it myself), and something else that seems unnecessary. But whatever. I don't have "M.D." after my name, so I don't question, I just do, and order the test that seems unnecessary.

    A while later, Family Member comes out of room, interrupting report I'm giving to Esteemed Colleague so I can go to my federally mandated meal break 6 hours into my 8 hour shift (and I'm starving).

    Family Member: "Um, yeah, I was wondering if anyone is ever going to come in and take some blood?"
    Me: "They took blood in the ambulance on the way in. It's already in the lab."
    Family Member: "Oh, okay, well I was just wondering because the doctor said he was going to order XYZ test, and I'm a Nurse Practitioner, and nobody ever came in and got blood."
    Me: "Yeah, they got it in the ambulance. It's in the lab. XYZ test is being done right now."
    Family Member: "Okay, well I just thought I'd check, because I'm a Nurse Practitioner...."
    Me: Blank stare.
    Family Member: Goes back into room.

    I finish report and go for a latte since nothing's open at this hour, and I didn't bring a meal.

    While I'm on my federally mandated meal break drinking my Latte Dinner, New ED Doc That I've Never Worked With Before apparently tells patient and Family Member that he's going to keep the patient for overnight observation, and Family Member goes home. NEDDTINWWB then asks me to do orthostatics and order another unnecessary test.

    Me: "I did orthostatics already (pointing at the chart where I had clearly documented orthostatics on arrival, which were negative), his pressure was rock solid, but I guess I can do them again if you want..."
    NEDDTINWWB: (Seeing my documented orthostatics for the first time and barely glancing at them) "Yeah, I think we should repeat them, and get ABC test."
    Me: "Okay, but he's not on any blah blah blah medication for his blahbitty blah blah, because yadda yadda, so are you sure we really need this test?"
    NEDDTINWWB: (Looking irritated) "Yes, the admitting doctor wants it."
    Me, to myself: "Yeah, but if the admitting doctor knew what I just told you, he would think this test was just as unnecessary as I do."
    Me, in reality: "Sure, no problem."

    Sigh. So, I repeat orthostatics and order ABC test, a bit surprised that this A&O, reasonably healthy, middle aged, walkie talkie patient is going to be admitted for observation of his Benign Condition. This should be a slam dunk treat and street. There is nothing to observe.

    Admitting Doctor Genius (really, no sarcasm here; he is brilliant and I'd let him take care of me and mine any day) comes and sees the patient, and says the patient does not need to be admitted (surprise). He does a great job of explaining the Benign Condition to the patient, and the patient is satisfied with the explanation and his disposition.

    Next thing I know, my phone is ringing.
    Me: "Hi, this is Stargazer."
    Voice on Phone: "Yeah, this is the Family Member for Patient X. I want to know what's going on, because I thought he was going to be admitted and he just called me to say he's being discharged, and I'm a Nurse Practitioner, so..."
    Me: "I'm sorry, but I can't give out personal medical information over the phone. I can tell you that we've run some tests, everything looks fine, and he's being discharged."
    Voice: "Well, I'm not satisfied with that. Did they do Test X? I'm a Nurse Practitioner, so I know they should do Test X."
    Me: "I'm sorry, I can't give out specific medical information over the phone. All I can tell you is that we ran some tests and everything looks fine, and he's being discharged."
    Voice: "That's not good enough. Did they do Test X or didn't they? I'm a Nurse Practitioner and..."
    Me: "Ma'am, I can't give out confidential medical information over the phone. I can let you talk to your family member if you like."
    Voice: "I already talked to him. I want to know why he's not going to be admitted. I'm a Nurse Practitioner and I know he's "At Risk", plus I just had surgery."
    Me: "Two Medical Doctors have examined him and have determined that it's not medically necessary to admit him. All of his test results are normal. He is being discharged. That's all I can tell you."
    Voice: "Blahbitty blah blah Nurse Practioner yakkity schmakkity blah blah blip blip."
    Me, to myself: "I don't care if you're the Queen of England, I'm not divulging PHI. You can go jump in a lake."
    Me, in reality: "Well, maybe when you come pick him up, the doctor will still be here and you can ask him your questions."

    I then very efficiently discharged the patient to the lobby.

  • Dec 23 '16

    Quote from prnqday
    The ER is no place for warm, fuzzy, hold your hand nurses.
    Oh, I don't think that's true at all. You can be warm and fuzzy and still be efficient. I strive to do this on a regular basis. In fact, I held someone's hand just yesterday! It is true that there is rarely time to have a prolonged conversation with any patient- usually you're in and out as fast as possible because you've got a million things on your plate- but that does not in any way, shape, or form, mean that you have to be anything less than empathetic.

    To the OP, I am, however, concerned that you think it's okay to spend 30 minutes let alone TWO AND A HALF HOURS (really????) at an ED patient's bedside. There is so much to be learning as a student that you could be using that time for. I don't mean to sound uncaring about that patient, but as I said before, you don't have to sit at the bedside for an extended period of time to show compassion and empathy.

  • Dec 17 '16

    Quote from Rocknurse
    One hard lesson I had to learn (and it took me over 20 years to learn it) is that it doesn't matter how good a nurse you are, and it doesn't matter how much you know. It's all about if people like you and how you are perceived.
    There is so much truth to this. If you are well-liked by patients, peers, and supervisors, often you will be given many opportunities for remediation, as opposed to someone who makes the same mistakes that is not well-liked.

    I've seen some really shoddy care, but the patients had no idea- they just thought that nurse was "so nice". And you absolutely shouldn't try and correct their misperception, as this undermines the patient's confidence in the care they are receiving. Talking about the nurse behind their back is also a very bad idea, because you never know who they are best friends with or related to- for all you know, they could be besties with your unit manager, or the sister in law of the CEO.

    Of course we should intervene if we see something dangerous or unsafe- but as a new grad, you don't know what you don't know. Unless something is blatantly dangerous, you need to keep your head down and get through your orientation. If something makes you uncomfortable or you don't understand, ask questions before judging. Keep an open mind that there is more than one way to get something done.

  • Dec 14 '16

    Why should any further study be done?
    Assuming this is not a rhetorical question, to put it simply, the smaller the sample size, the less precise the information is.

    Say, for example, you receive a shipment of 500 widgets, and the supplier guarantees you that no more than 10% will be defective. You can't check every single widget, so you take a sample of 10 and find two defective widgets. You could conclude that 20% of the entire shipment of widgets is defective, or you could understand that perhaps you just happened to pull out 2 defective widgets when selecting your sample.

    Now, what if, instead, you select 50 widgets as your sample, and 2 of them are defective? That would be 4%, and consistent with your supplier's guarantee of 10% or less.

    You can apply this principle to individual experiments as well as what we call the "body of evidence". Two studies (with small sample sizes, no less) is not a large body of evidence upon which to form a strong conclusion, it is merely a starting point for further research.

  • Dec 9 '16

    The doctors do it where I work.

  • Dec 9 '16

    The doctors do it where I work.

  • Dec 8 '16

    The doctors do it where I work.

  • Dec 8 '16

    I've been a CNA, LPN, and RN, and I've worked in Home Health, Skilled Nursing, and Acute Care. Across this entire spectrum, communication is what it frequently boils down to. HOW you communicate, not WHAT you communicate, is often the key. You can say just about anything to just about anyone, if you say it just right.

    On the surface, I don't see anything wrong with what or how this RN communicated with you. As you know, in the ED, we are often less concerned with people's feelings than we are with getting the job done. It's part of our "tough" ED personas- a survival mechanism that most of us who have spent any time in the ED are familiar with. Sometimes we are brusque with one another, or we snap at one another- but we cut each other slack because we understand. Sometimes we might talk it out, other times we just let it be and move on. In the end, we have each other's backs.

    I know the kind of nurse you're talking about- the "tech hog", or "needy nurse" who delegates to the tech more than their fair share, while the other nurses just do things they could be asking the tech to do, and just suck it up. When these nurses ask for your help, you know they really need it. And then, when you have to say no because you're doing something the "needy nurse" has asked you to do, they are crestfallen.

    Every ED has them. You are not alone.

  • Dec 8 '16

    Okay, so this particular student was frustrating. But don't let it spoil you on all students. Many, many students are respectful and grateful for the learning opportunity and will be more than happy to follow your direction and learn from you what they can. Remember how when you were a student, there were some nurses that you held in awe, who treated you with courtesy and were happy to teach you. You can be one of those nurses. Chin up. Move on. Better luck next time!

  • Dec 7 '16

    The doctors do it where I work.

  • Dec 7 '16

    The doctors do it where I work.

  • Dec 4 '16

    Why should any further study be done?
    Assuming this is not a rhetorical question, to put it simply, the smaller the sample size, the less precise the information is.

    Say, for example, you receive a shipment of 500 widgets, and the supplier guarantees you that no more than 10% will be defective. You can't check every single widget, so you take a sample of 10 and find two defective widgets. You could conclude that 20% of the entire shipment of widgets is defective, or you could understand that perhaps you just happened to pull out 2 defective widgets when selecting your sample.

    Now, what if, instead, you select 50 widgets as your sample, and 2 of them are defective? That would be 4%, and consistent with your supplier's guarantee of 10% or less.

    You can apply this principle to individual experiments as well as what we call the "body of evidence". Two studies (with small sample sizes, no less) is not a large body of evidence upon which to form a strong conclusion, it is merely a starting point for further research.


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