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ixchel, BSN, RN 53,087 Views

Joined Jun 3, '11. Posts: 5,163 (75% Liked) Likes: 19,912

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  • Nov 14

    BY LAW, your facility is required to make reasonable accommodations, which includes allowing you light duty. For more information, you can look this up under EEOC's ADA online. Any conversation you have regarding this should take place in writing. Trust me on this.

  • Nov 12

    Let me word that differently. If you are holding epi based on telemetry reading alone, you're doing it wrong. If the patient is in PEA, you've just killed them. Treat the patient, not the monitor.

  • Nov 7

    How much you wanna bet the guy looking through the microscope was like..... "I know there's one here somewhere..... These people won't believe me if I say zero..... I'm putting one, final answer. I'm sure it's there somewhere."

  • Nov 3

    Story time! With mood music. [emoji5]️



    I count myself blessed to have been raised largely in part by my grandparents. My grandfather, a newly-minted 80-year old, conservative, successful man, taught me there is pride in self-sufficiency, and honor in good qualities such as honesty and humility. You earned what you have, and you certainly never asked for help, as that would admit weakness, or even worse, failure.

    Society has changed a lot in the U.S. as we've adopted new ideas of what weakness and honor should mean. I don't think the ideas of Grandpa's values are obsolete, though my own values have evolved as society has. In fact, as much as I'm able, I still stick to those things that I know he placed in this heart of mine. I also think having the experience of being raised by his generation (as opposed to my mom's, which in the strictest of technical terms, is actually my own, if we go by years born) has helped me communicate and advocate for the patients of his demographic (whom I quietly refer to in my mind as "Men of a Certain Age") a little better than I would otherwise.

    We have a frequent flyer on my unit. He is also a Man of a Certain Age (let's call him MOCA, or Moca). I first met him shortly after I was licensed. By then, he'd already experienced an event that severely impaired his ability to communicate. He was extremely frustrated with this, as anyone would be, but he was making it work.

    The next time we met, not a huge amount of time later, Moca had had an emergent, but not overly complicated surgical procedure that included getting a prosthetic. Recovery was short, life resumed.

    Until, it didn't. Moca started getting sick. Just sick. That's it. Fevers. Really high fevers. Multiple admissions. Decline in overall condition. Nervous system responses to the high fevers. Tremors, altered mental status, failure to thrive, profound weakness. He was just so sick, over and over, but no answers pointing at what was causing it.

    The toll this took on Moca emotionally was profound. He'd deteriorated to a point that communication was impossible, and he needed someone to feed him. On one of my last shifts with him, I saw we were sending Moca a clear liquid diet. Clear liquids for a man with debilitating tremors. I watched this man's pride and dignity leave him. He traded health for a bedpan, full meals for broth spilled down the front of him.

    I fought hard for him to be advanced to finger foods. I saw Moca brighten up. It wasn't a massive brightening up, but it was successful. The Man of a Certain Age, who was robbed of all independence by his brain and body, could do this ONE THING for himself.

    So, Moca sunk into a deep despair. He let go completely. He gave up. The sadness in his eyes, as he cried over something so simple as putting the broth in a cup with a lid instead, stayed in my mind and my heart. I'd never seen such sadness, such defeat.

    On the last admission, Moca had imaging that might be the key to it all - some vegetation was spotted on his prosthetic. Finally! A year of this back and fourth, a year of his life, a year of the loss of things that give Men of a Certain Age their spark. Gone.

    The last time I saw him, he was on an EMS stretcher to get the infection removed surgically. He said to me, "I know I'm going to die on the table." He didn't say it with fear. He said it with despair because he actually, 100% believed it. Getting on that stretcher, in his mind, EMS might as well have been hitching a ride to his funeral. All pride gone. All honor lost. Just a man robbed of the things that he'd taken for granted. His eyes showed the depth of loss and humiliation he felt.

    I've waited. He'd been there enough that if he died, I know it would have been talked about. There was no word. Months passed.

    As I wrapped up my charting my last shift, I heard him. His speech pattern is unmistakable given the injury he had affecting his speech. After I wrapped up the last details of charting, I went to see him.

    When he saw me, his eyes welled up. I hugged him fiercely, and like a couple of old fools, we sobbed happy tears as he told me how recent months have been. Never in my life had I seen despair run so deeply, and here he was, back again, but BETTER. Not only did he look better, but his speech improved exponentially, and all other assaults that had been suffered by his nervous system was reversed. GONE! He's better! He's LIVING his life!

    This week, I learned that a nurse can cry happy tears on the ride home from work. What a beautiful joy! I'd go through months of horrible shifts just to experience that joy again! Victory!

    I remembered why I became a nurse.

    It's rare we get to know the end of the story. But this time, I got to. [emoji173]️

    I love being a nurse!

    You guys learn anything good?

  • Oct 31

    Dear Soon to be Applicant to Nursing School,

    So here you are on allnurses, looking for the best option for you. After all, you're a kind and caring person. You're good looking, and gosh darn it, people like you. You want this. You're committed to it.

    How committed to it are you? Let's look at this, point by point.

    You want....

    ***cheap! You can't afford this. For whatever reason, you can't get much in aid or loans, and you don't make much money. So you're looking for cheap.

    Here's the deal - everyone wants cheap, and that means more competition. Also, cheap may decrease value. Does the cheapest option have a decent reputation? Or does the cheapest option terrify HR departments everywhere? Unless Dr. Kervorkian is getting out anytime soon (hmmm.... Maybe he is already out? Anyone know?) cheaper may be a terrible idea. Research. Don't just sign the dotted line.

    ***fast! You can't walk away from life for years. You have responsibilities. You also can't fathom spending years in school.

    Dude. Step back for a second. Let's say you've had an embarrassing accident involving a skyscraper, a rusty nail and a poorly placed eyelid. You go to the ER and you get the dynamic duo!!!!! The MD and RN both landed the fastest programs they could find just to get licensed and come care for YOU!!!!

    Wonder twin powers! ACTIVATE!!!!!

    ......wait. Do you want a nurse who did a 3-4 year educational process in 10 months? Would you want a doc who crammed 8 years of school into 2, and 4 years of residency into 10 months? Maybe it feels okay to get your educational as quickly as possible, but would you want to be cared for by the nurse who picked the fastest program possible?

    (The answer to that is "no". You do not want that nurse or that doctor. I took the longest possible option for my degree and I won't even start to admit how much (little???) I was actually able to remember from it two weeks after graduation. Faster means less time to actually lean LIFE SAVING INFORMATION.)

    ***low GPA!!!

    Look, I'll be the first to say you probably don't need an amazing grade in world history to be a good nurse. It's nice to be smart, knowledgable, and all that fun stuff, but not all of it is vital.

    But....... A lot of it is, in ways you haven't figured out yet. Additionally, programs use your GPA as a prediction of how you will commit yourself and subsequently perform at their program. Their accreditation actually is weighed in part by their students' successes.

    Maybe you don't test well, maybe you never applied yourself because you didn't know what you wanted to do when you grew up. (God knows I didn't.) Even if the truth is that you don't need straight As to be successful in nursing school, those who have them will be accepted first. You HAVE to accept that. You'll find programs that will have a cohort whose average is lower than 3.5 sometimes, but to look for it and expect to find it is not necessarily realistic.

    Another thing to consider with this, though, is, again, reputation of your school. Is your school known for accepting low GPAs? You might not be very valued as an applicant with that school's name on your degree. Go retake those classes. Get better grades.

    If you are a person who genuinely struggles with school, take advantage of campus resources. But even before that, go talk to nurses. Talk to nurses who will be honest with you, and bring your thick skin. The sad truth is that some people, no matter how badly they want it, aren't meant for nursing. The good news is there are other avenues in healthcare that don't require the same education or skill set. Research!

    ****online!!!!!!

    Okay, really?

    No, REALLY?!

    How are you going to learn patient care without caring for patients? Look, even after a nursing program, you're going to be awful at doing everything, but at least you've had basic instruction, face to face, on actual PEOPLE. Nursing school, at the LPN or RN level, cannot be done online. Stop looking.

    I offer my support as you get started on this journey. There may be times when my answers aren't sweet and loving. Nursing school will teach you that direct and clear communication (as off-putting as it may be) is required sometimes. I will, however, promise to be honest. I promise to be thorough. I promise I will try to always be patient. I will take responsibility when I misjudge or misspeak. And I will always expect the same of you.

    Congratulations on embarking on this tumultuous journey, and remember to always keep your expectations realistic.

    Hugs and kisses,
    ixchel

  • Oct 31

    Dear Soon to be Applicant to Nursing School,

    So here you are on allnurses, looking for the best option for you. After all, you're a kind and caring person. You're good looking, and gosh darn it, people like you. You want this. You're committed to it.

    How committed to it are you? Let's look at this, point by point.

    You want....

    ***cheap! You can't afford this. For whatever reason, you can't get much in aid or loans, and you don't make much money. So you're looking for cheap.

    Here's the deal - everyone wants cheap, and that means more competition. Also, cheap may decrease value. Does the cheapest option have a decent reputation? Or does the cheapest option terrify HR departments everywhere? Unless Dr. Kervorkian is getting out anytime soon (hmmm.... Maybe he is already out? Anyone know?) cheaper may be a terrible idea. Research. Don't just sign the dotted line.

    ***fast! You can't walk away from life for years. You have responsibilities. You also can't fathom spending years in school.

    Dude. Step back for a second. Let's say you've had an embarrassing accident involving a skyscraper, a rusty nail and a poorly placed eyelid. You go to the ER and you get the dynamic duo!!!!! The MD and RN both landed the fastest programs they could find just to get licensed and come care for YOU!!!!

    Wonder twin powers! ACTIVATE!!!!!

    ......wait. Do you want a nurse who did a 3-4 year educational process in 10 months? Would you want a doc who crammed 8 years of school into 2, and 4 years of residency into 10 months? Maybe it feels okay to get your educational as quickly as possible, but would you want to be cared for by the nurse who picked the fastest program possible?

    (The answer to that is "no". You do not want that nurse or that doctor. I took the longest possible option for my degree and I won't even start to admit how much (little???) I was actually able to remember from it two weeks after graduation. Faster means less time to actually lean LIFE SAVING INFORMATION.)

    ***low GPA!!!

    Look, I'll be the first to say you probably don't need an amazing grade in world history to be a good nurse. It's nice to be smart, knowledgable, and all that fun stuff, but not all of it is vital.

    But....... A lot of it is, in ways you haven't figured out yet. Additionally, programs use your GPA as a prediction of how you will commit yourself and subsequently perform at their program. Their accreditation actually is weighed in part by their students' successes.

    Maybe you don't test well, maybe you never applied yourself because you didn't know what you wanted to do when you grew up. (God knows I didn't.) Even if the truth is that you don't need straight As to be successful in nursing school, those who have them will be accepted first. You HAVE to accept that. You'll find programs that will have a cohort whose average is lower than 3.5 sometimes, but to look for it and expect to find it is not necessarily realistic.

    Another thing to consider with this, though, is, again, reputation of your school. Is your school known for accepting low GPAs? You might not be very valued as an applicant with that school's name on your degree. Go retake those classes. Get better grades.

    If you are a person who genuinely struggles with school, take advantage of campus resources. But even before that, go talk to nurses. Talk to nurses who will be honest with you, and bring your thick skin. The sad truth is that some people, no matter how badly they want it, aren't meant for nursing. The good news is there are other avenues in healthcare that don't require the same education or skill set. Research!

    ****online!!!!!!

    Okay, really?

    No, REALLY?!

    How are you going to learn patient care without caring for patients? Look, even after a nursing program, you're going to be awful at doing everything, but at least you've had basic instruction, face to face, on actual PEOPLE. Nursing school, at the LPN or RN level, cannot be done online. Stop looking.

    I offer my support as you get started on this journey. There may be times when my answers aren't sweet and loving. Nursing school will teach you that direct and clear communication (as off-putting as it may be) is required sometimes. I will, however, promise to be honest. I promise to be thorough. I promise I will try to always be patient. I will take responsibility when I misjudge or misspeak. And I will always expect the same of you.

    Congratulations on embarking on this tumultuous journey, and remember to always keep your expectations realistic.

    Hugs and kisses,
    ixchel

  • Oct 29

    As a legitimate pain management patient, no one feels that stigma more than your patients. I feel awkward and uncomfortable discussing my pain management needs because I am so afraid of getting that seeker label. What if I really do need a higher dosage right now? What are they going to think about that? What if they tell me no? But I really need help to get through this. So if they happens, and I go somewhere else, will the new place be told I'm a seeker by the old place? Then what?

    Trust me when I say it - the fear of being perceived as a seeker probably rivals the feelings you have that we are viewed as seekers. And it doesn't help when prescribers are being put through the ringer for writing too many scripts for narcotics. I've heard recently of a pharmacy being shut down because they filled too many narcotic prescriptions. A pharmacy! I don't think there are any easy answers to your question.

    I had a professor tell me last semester when talking about prescription med abuse: "maybe they are addicted and using more than they should, but if it is in response to their pain, you should work through that in a supportive way and address the addiction when the pain is under control." Heck, if the pain is that bad, when their doctors abandon them, they'll find other sources of pills. That's a whole new can of worms.

  • Oct 24

    I'm putting my money on a tick being in there. Bug extraction should happen easily with a flush, except an attached tick. Damn, that sucks.


    Sent from my TARDIS using Tapatalk

  • Oct 22

    Quote from No Stars In My Eyes
    Not just in new grads! I worked a PDN case with a woman who was 70-ish, she was a CNA who did night shift.....and I recall several times when she drew herself up to her full height and proclaimed to me, "Well, MY father was a DOCTOR!"
    Oh, pardon ME!
    I never did understand that mentality. It's like the doctors' wives at my kids' school. They're cliquish and think they're ahhhhhhhmazing, as though marrying up made them better. Sorry, but you don't earn street cred by marrying into the mob. You get street cred by shanking someone yourself. (Or by BEING a doctor, rather than MARRYING one.)

  • Oct 21

    Quote from No Stars In My Eyes
    Not just in new grads! I worked a PDN case with a woman who was 70-ish, she was a CNA who did night shift.....and I recall several times when she drew herself up to her full height and proclaimed to me, "Well, MY father was a DOCTOR!"
    Oh, pardon ME!
    I never did understand that mentality. It's like the doctors' wives at my kids' school. They're cliquish and think they're ahhhhhhhmazing, as though marrying up made them better. Sorry, but you don't earn street cred by marrying into the mob. You get street cred by shanking someone yourself. (Or by BEING a doctor, rather than MARRYING one.)

  • Oct 21

    This reminds me of a conversation I had with a surgeon when I asked for parameters that might warrant calling him over night. He said, "don't contact me. Contact Doctor Aware."

    Anytime you EVER see the words "no new orders received" in my charting, it means one of two things:

    1. The patient is being unbelievably impossible regarding something either dangerous or not at all medically indicated, and thankfully the MD agrees

    2. The hospitalist is being an asshat

    "No orders received" is my polite way of saying, "are you effing kidding me," and other variations of, "what the eff, man."

    As for the rest of my list, AN will asterisk out enough words that it would make no sense.

  • Oct 16

    You guys watch ST:TNG? Man, I loved that show. Jean Luc was gonna save the galaxy. I'd totally vote Picard/Riker every single election. (This might actually happen this year.)

    But Deanna.... She was my girl. Strong, sensitive, empathic. I was going to BE her when I grew up. I actively sought to connect with people, to know what their feelings were, what motivated them. To be honest, I already knew how to read people pretty well. My pre-teen self just enjoyed the imaginative fantasy.

    As a Nurse, we tend to channel our inner Deanna Troi a little. Well, I do, at least. Especially around discharge, when thinking is adjusted to what's next for this person and their loved ones. What do they want? What are they burdened with?

    What a crap week for this way of thinking to come back.

    This week, I have learned....

    1. Grandma is in LTC now and her Alzheimers has been declining rapidly. We all know how those first nights will be.

    2. Grandpa is home alone, albeit busy right now, and he is refusing help.

    3. My surgeon has me out until August 22.

    4. My short-term disability company is currently refusing to extend my claim beyond Wednesday.

    5. My employer has decided to terminate my benefits as of Wednesday.

    6. Have you ever heard that rumor that short-term disability company long term disability companies will send out private investigators to monitor and photograph the movements of those people they think abuse claims? They do. This is actually a thing.

    Rockwell - Somebody's Watching Me - YouTube

    7. This ad inspires NO DESIRE WHATSOEVER to be a nurse. The intern/resident is treating someone like crap while the nurse next to him gives the "I want you now" eyes.



    8. After participating in facebook live chats and PMs with Zdogg since his 7 Years release, being berated by my mother in law for admitting patient suffering and tragedy destroys me a little, and THEN turning to a loved hospitalist that I am thankful to have in my life... It's painfully obvious that those of us, ALL of us, on the front lines of healthcare feel our hearts break time and time again, and yet, we can't admit it to our colleague. Our hands are not meant to be held. We go home to the hands and arms that hold us, knowing that some shifts really do isolate us. We are forced to be alone. I watch my colleagues take their SSRIs, benzos, norcos, whatever it takes to bring them back to a shift. No one hides it. And why should they? We all understand WHY. So why don't we talk about it?

    7 Years (A Life In Medicine) | ZDoggMD.com - YouTube

    9. Today I decided paying a babysitter is cheaper than paying bail. I mean, c'mon parents, AMIRITE?!

    10. morte would rather ditch the spacebar than be decisive about a computer.

    If anyone is interested in hosting next week, get in touch via PM.

    What have you learned this week?

    Remember, cheers, jeers and camaraderie are always loved and appreciated in the WILTW threads. Just try hard to stay close or on the nursing path so this thread stays here.




    Sent from my Federation Starship using Tapatalk

  • Oct 15

    My own personal motto:

    "I may not be the smartest person in the room, but I am the most determined."

    Feel free to adapt it to your world as needed

  • Oct 14
  • Oct 14

    Quote from James W.
    Well, I'd jest love to spill the beans - on some of the ah, shenanigans..
    the likes of what we young psych nurses got up to, after work, back in the day..
    ..but I'll have to plead the 5th..

    Dang, they was real good times.. but likely, hangin' offenses now though, huh..
    You guys say "plead the 5th" over there?

    I can't drink with colleagues. I'd hate to end my uptight, scary-twisted, dark sense of humor persona. Buzzed makes me giggly, drunk makes me awesome. I have a reputation to maintain.

    Attachment 21876


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