Content That ixchel Likes

Content That ixchel Likes

ixchel, BSN, RN 40,427 Views

Joined Jun 3, '11. Posts: 5,097 (75% Liked) Likes: 19,533

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  • Jul 24

    Quote from ixchel
    A little to the left, if you don't mind.
    *moves hand to the left* You are the best nurse eva!!!!!

  • Jul 24

    LOL, keep that one as a second. actually have a wireless key board, just never completed install. thinking of a Mac. this one is 5 years old, the other is at least 12, both lap tops.

    Quote from ixchel
    Hopefully the F remains intact, AMIRITE?!

    Stubbornness abounds. Keyboards (especially non-bluetooth) are crazy cheap now.

    (The stubbornness comment is meant light-heartedly. I'm battling a car that might as well be held together by duct tape, and has been that way for years. I still haven't stepped foot on a lot or opened a for sale section.)

  • Jul 23

    Quote from ixchel
    Morte, I think your space bar is broken.
    No!-Really(Q)....&_it_aint_the_only_key!

  • Jul 23

    Viva - I can't even imagine what you're going through. Hugs and support from my end.

    Today was my first day on the floor, and wow. It was unnaturally filled with craziness and drama, according to my preceptor (I absolutely LOVE her, by the way). 3 AMAs, angry residents arguing with our staff nurses, and nurses calling in are a few of things that happened.

    I learned that some residents actually value nurses's experiences and look to them for guidance.

    Oncology nurses are surprising upbeat and have a cheerful disposition. They have the same, dark sense of humor as I do, which is awesome.

    My family is no comparison to the crazy family dynamics that go on in these patients' lives.

    I love that I'm not the only one with a clueless look on my face with the new set of residents rotating in.

    Hearing the breaths of someone in the process of dying is terrifying and sobering. I've never heard anything like those death rattles.

    I just learned about Swabcap. These are freaking awesome.

    I was upfront with my preceptor about my current skills and what I want to learn. She was nice and understanding, commenting thst it just takes practice. She's been very supportive thus far, and I can't wait to see what else I learn from her.

  • Jul 22

    Viva- I'm so sorry for your loss. I am glad hospice was able to help you both have a more peaceful end. You'll be in my thoughts.

    Crackling- I was terrified when I started my 1st RN job- I felt like I didn't know how to do anything!! But most hospitals realize they don't emphasize skills in school & are prepared for you to learn them during orientation. You'll do great!

    Ixchel- I'm a huge Stephen King fan, definitely going to check out Stranger Things...and glad you are mending, slow is better that not at all.

    Since I'm not working, (waiting to hear back on a 2nd interview- fingers crossed) I didn't think I would have anything to contribute this week. However- today I learned you can do the Heimlich maneuver on a pygmy goat!!

    I have 2, and Ollie got choked on a goat
    'cookie', & couldn't breathe. I picked him up & guessed about where diaphragm was, squeezed hard a couple of times & green goo flew out! It took a few more bleats but he's fine now. Who knew?!

  • Jul 21

    Quote from ixchel
    1. Everyone you are about to work with on the floor knows up front that you will suck. Be okay with you knowing you will suck. Try the best you can, and know you will make mistakes. YOU WILL. And everyone else knows it to. They expect it. You know why? Because they sucked. They made mistakes. Everyone starts where you are now.

    2. If anyone treats you like dung because of the mistakes and the sucking, let it roll off your back. DO NOT TAKE IT PERSONALLY. Maybe they're just A holes. Maybe you created more work for them, or disrupted their day. Or, maybe they REALLY are just A holes. You can't change them. You can, however, change you. Whatever was messed up, LEARN from it. This is how you improve, and this is how you turn the A holes into nice people.

    3. Always remember that learning is YOUR responsibility. Yes, there is someone teaching you. They may be held responsible for your progress by management, BUT, as a person holding a professional license now, what you don't learn will be your responsibility. Sounds scary, right? It's not, I promise. You have people surrounding you every minute of every shift. You have access to written policies and protocols. You have access to lab, respiratory, pharmacy, doctors. They are always available to you. Use these resources. If it's something easy, like changing an IV site, you can ask a nurse to help walk you through it. (Although, I recommend grabbing supplies and walking yourself through it sans patient before trying it yourself because nothing says, "I'm too new for this!" more than leaving a catheter open and bleeding all over the place, etc. lol)

    4. That said, if you need information, not skills, instead of asking, "what is the policy for xyz?", ask, "Where can I find policies and procedures so I don't keep bugging you for info I can find myself?" This wins bonus points from those around you.

    5. If it turns out your preceptor is not well matched to you, you can still learn from this person. Try hard to get all you can from him or her. Give it time. If you have reason to feel you are severely lacking due to your preceptor, ask the unit manager if you can talk for a few minutes. Don't put the blame on your preceptor, because it might be you. Just ask - "am I progressing at the pace you would expect for a new grad?" It is very possible you are expecting more from yourself than you should be. I actually had this conversation when I was 2 months in. My boss wrote on a sticky note, "I have only been an RN for two months," and told me to put it somewhere where I'd read it when I needed to. If your preceptor is the problem, chances are that has already been noticed, and you may be reassigned. Just keep an open, willing mind.

    6. This first year is brutal. Nursing students are used to hitting the ground running. Nurses do not run in the first year. It's horribly frustrating. You'll get there. It just takes time. Set your expectations at "learn" only during this beginning part. Employ "observe, do, teach," and know you can repeat steps as needed.

    7. Even the best nursing schools turn out nurses who feel they didn't learn enough. I say this from first-hand experience. You didn't learn enough because teaching more is silly when you figure hospitals pick up where school leaves off. That, and people go into specialties. If all you ever dreamed of is public health nursing, how often are you going to be placing foleys? Your education was what it needed to be. It gave you an introduction. You are doing your real learning now.

    8. Enjoy the COBs on your unit. You might hate them at first, but once you get over this Bambi stuff, they'll be your favorite people. They'll be the first to come running when you shout "help" out of a patient's door. They'll be the first to find humor in the dark and twisty that could overwhelm you otherwise. They'll be the first to give you doses of reality without sugar coating. Again, it is not meant personally. It might save your patient's life.

    9. Communication in fast-moving situations is short and sounds very rude to the casual observer. It has to be. You will get comfortable with communicating in the same way over time. You'll hear and use it most in codes. There just wont be time for please and thank you.

    10. I don't know why I've typed all this out because I'm sure you already know it. You're already awesome!
    Absolutely the VERY BEST guide for a first day nurse that I have read in over 30 years of nursing! Where were you when I hit the floors running back in the early 80s??????? Please share that in the article section or on the student nurse boards or somewhere. It is too good and well balanced and honest to be just in the one thread.


    p.s. Hitting the LIKE button once does not do this justice.

  • Jul 21

    Quote from ixchel
    Who wants to host the next WILTW thread?
    I can-I had such an eventful week!

    If you want me to...

  • Jul 21

    In light of the "Overcharting" thread which reminded me of this one, I thought I'd resurrect it to have fun.


    O/T:
    1931: Report received, care of patient assumed. Color of hospital gown is teal blue.

  • Jul 18

    Quote from ixchel
    The variety. It's a small hospital, so we get every type of organ dysfunction.

    The chaos, though many days I'd prefer a little less. You have stable patients, you have unstable patients.

    Night shifts. Because they taught me how to KNOW stable from unstable. It's not like we have a half dozen doctors readily available to come to my floor to determine that for me.

    Also, relating to night shifts, even those with the least cohesive personalities become a team in a code. Or, heck, an almost code. The almost codes are some of the more triumphant times because when it's your patient, you take the lead. You learn to delegate. You learn when the code is needed, and when it's not. Your team will see it if you don't. It's the almost code (even the one that becomes an actual code) when you learn you've become strong.

    PCU is land of almost codes in my hospital. Day shift you call the code more readily because a ton of staff is available for it. Night shift, we don't have abundant resources. That's not to say we'd skip calling it any time it is needed. We just have only one MD on the floors, total. So, if it is something nursing can think through and get a quick order or two for, we take care of it. You'll hear codes on the other floors, for which we'll shuffle patients to make space for the code on our floor since we are the non-ICU highest level of care (unless the code is ICU-worthy, which is rare on the other floors). Us? We try our best to not sent patients to ICU. We see problems before they happen. We try to prevent them from getting worse.

    NOW BEFORE THE OTHER SPECIALTIES JUMP ME

    That's not to say that other floors lack this focus. They definitely don't. The difference is that we get the actively unstable ones. The difference is that in my hospital (and I emphasize that it is my hospital only, in my own experience) I have seen codes called on other floors for the strangest things, sometimes filling a PCU bed that was needed for something actually PCU-necessary. We are the last gate before the ICU doors, and so our beds need to be counted carefully.

    You said you'd like to only stay 6 months. Please consider a year. In six months, for me personally, I was still learning how to be a nurse. I was nervous. I was unsure of everything. I didn't know what was okay, yet. I was still having many moments of victory during which I learned some new nurse insight that was VITAL to my professional growth. You've only begun to taste nursing at 6 months, and you've learned so little that if you are put on a "fast track" orientation for experienced nurses wherever you transfer, you will struggle. Eventually, yes, you'll get it and be just fine. But when you're still afraid you'll mess up on your own, and when you're still overwhelmed by how much you don't know, it's a terrible time to transfer.

    PCU is a hard floor. Our PCU has terrible turnover and what I have heard is that is typical at other facilities. But if you can do it, I really do believe you can do anything. If you're one for a challenge, you are about to meet your match and I think you should go for it. For me, I am beyond grateful for my first years as a nurse being on PCU. I've lately given thought to moving on to another area - ED or ICU maybe. But I will never regret my experience thus far, and only want a change because I feel I'm ready to learn and grow more, not because of dislike for PCU in general.

    I hope this helps!
    Wow, thank you so much for that! I have been having a lot of second thoughts and worries about PCU and reading that was really, really reassuring. I think I was/am just getting cold feet. I will definitely take your advice and stay, preferably for the duration of my contract (2 years) so I can leave on good terms.

    I have some questions, if you don't mind answering. I tried searching online but nothing came up, and my unit gave me a tour but the topic of patient care didn't come up a whole lot and I forgot to ask (super nervous lol). Can you tell me about the kind of total body care that you do as a PCU nurse? Like assisting with eating, bathing, toileting, bed sheets, etc? The floor has techs but at the end of the day, I know it is my responsibility to make sure certain things are done and I just want to be prepared to know what the level of abilities the patients usually are. Do the patients get out of bed and ambulate to the bathroom alone? I apologize if this is a dumb question, I honestly just don't know what to expect. I don't mind if there is a lot/little, I'm mostly curious to how it compares to med-surg and ICU (which is where I did clinical at). I'm only 4'9" and not the strongest person, so I found I struggled with moving even small adult patients. Obviously I should ask for help with that stuff, but I know sometimes it is busy and you don't always get all the help you want/need. I'll also be on night shift.

    My orientation is going really fantastic, we are doing classroom training for 6 weeks including ACLS and some really amazing simulation stuff (haven't gotten to that yet). I'm learning so much already.

  • Jul 16

    What I learned this week: I'm officially an RN!!

  • Jul 16

    I have good news too-my reprimand is GONE!
    I am teaching next week my educational piece to the newbies, and it's on display in the unit for the not so new newbies.

    My new boss is reaching out to get some of the former staff and have great plans for the unit; I'm glad that I can be a part of the solution; she respects my role as part of our bargaining unit and that reassures me that the targeting will lessen-but will still be about my business (paper trails attached to her as a precautionary measure)

    More people are leaving, but are either going to be per diem or part time; but still will be part of the team, so I'll chalk that up as a silver lining.

    Still hoping I can go per diem in an adult ED...will work in a non-trauma one before I work in a trauma one; baby steps!!

    I'm also looking into the TNCC to help as well in October-still lots to learn!

  • Jul 7

    I am honored to be filling in for our beloved ixchel's WILTW thread once again.

    As I continue adjusting to my new job as well as reaching the halfway point in my assessment class for my MS PMHNP progeam, I am glad to have this opportunity to reflect on what I have learned. I also really enjoy seeing what we can learn from each other and how our varying nursing roles result in varying weekly lessons.

    Brain Development

    I attended the third of my sexual reproductive health trainings this week, and learned a lot of new information about adolescent brain development and the translation of said development in various activities and education needs. I found it really interesting to learn a possible cause for the impulsivity, thrill seeking, and at times promiscuous behavior of many of the teens with whom I have contact.

    The brain goes through a period of development during the adolescent period (ages 12-26) after which both the limbic system and prefrontal cortex ate completely developed. However, these two systems do not develop at the same rate. The prefrontal cortex develops more slowly than the limbic system. As the limbic system seeks pleadure, risks and reward and the prefrontal cortex is involved in logic and decision making, it would make sense that during adolescence teens seek thrills and rewards at a rate at which the prefrontal cortex cannot keep up.

    Standardized Patients

    As a student in a MS PMHNP program, I had a midterm in a OSCE environment and was required to conduct an H&P on a standardized patient. As I had used standardized patients in my RN to BS P
    program I thought I knew what to expect. The experience was good overall.

    However, I am short, barely over 5 feet. The standardized patient was 6'8". I had difficulty with the HEENT component if the exam because I could not reach the SP's face. This struggle got me thinking about how I would address this in an actual clinic. I had never encountered this issue (possibly because of the do I if setup). Any ideas?

    Female Condoms

    This week I found out that female condoms are still in use and provided to our clinic. We found this interesting because none of the nurses, PNPs or MDs have been using them in practice. When we got a new drluberyofcondoms from our DOH, there they were. We all has to figure out how to use them because we have not seen them or used them in quite some time.

    What did YOU learn this week?

  • Jun 24

    OP, it sounds like everyone is having a good time except for you.

  • Jun 24

    No probs! I really like the WILTW threads btw

  • Jun 23

    Hi Ixchel, there's a few questions there, they might require quite a lengthy reply!

    In my experience, in the NHS (non-private) hospitals, patients don't often refuse to leave hospital but it can happen. It isn't that comfy in our hospitals, there are no fitted sheets or comfy blankets- everything is clean but minimal. There is often a lot of noise at night and during the day with new admissions or transfers taking place at any time in the med/surg equivalent. Patients are mostly in shared rooms, there can be 8, 10, 12, maybe more in a large area called a "bay". Bathrooms are often 1 per unit. TV is very expensive. Food is often not to people's tastes and there aren't always cold or hot drinks offered between meals, depending on staffing. Snacks are in theory always available 24/7 but not always offered. Water in jugs on bedside tables gets warmer throughout the day and isn't automatically topped up, again it is dependent on staffing and there often isn't ice. There are usually very strict visiting times. Our top priority as RNs is the patient's clinical/medical health and safety. There are rarely resources for more than this.

    However! Sometimes patients prefer hospital with regular meals and cheerful nurses for company to home. The nurses and Dr's explain to them that it is medically time for them to go. That they are better at home and there is a greater risk of infection in the hospital. They explain the bed is needed for another person who is unwell as they were. That they cannot justify the use of national resources when there is no medical indication. More and more senior staff are brought in to explain this and talk through the patient's worries until the patient agrees it is time to go. Security can be called if needed but senior staff have excellent communication skills rendering this unnecessary- I haven't seen this used.

    Sometimes "bed-blocking" occurs where it isn't possible to discharge someone as there is no appropriate place to discharge them. For example, a patient might require a nursing home after hospital and cannot safely return to their usual house. Relatives have been known to drag out the process of choosing a nursing home so the patient will stay in hospital for many months. Social workers are involved and many meetings are held to try to fix this situation.

    Sometimes people are discharged too early and return to hospital unwell. The incidence of this is monitored in an attempt to keep "unsafe discharges" to a minimum. If an RN feels the patients needs to stay for medical reasons but the MD says the patients needs to leave, the RN needs to produce valid concerns and a meeting can be held for a discussion. Ultimately, the Consultant decides and is responsible for an adverse incident that might occur after discharge if it could have been predicted to happen. The RN's role is to flag up any concerns and advocate for the patient. Physio's and OT's also play a very important role, they can assess and assist in planning as safe a discharge as possible.

    If your British friend were in the UK and had strong concerns about being discharged too early after surgery, they would be encouraged to voice their specific concerns. If for example the concern was pain management, their meds would be reviewed, they might be reviewed by the pain management team, expectations would be checked, the wound site would be inspected, an x-ray or scan might be called for if the pain was disproportionate to that expected, we'd work with the patient to see what helped or hindered etc. If something could and should be changed, it would be. If the pain was as normal for that stage of recovery, after advice was given we'd reassure the patient that was normal for many patients. That's just one concern, but it would work the same for anything.

    We don't discharge until the patient is clinically well enough (i.e. staying in hospital won't make them any better than being at home) and until they will in all likelihood be safe at home. If you considered a patient not ready for discharge in your opinion as an RN, we wouldn't either, for the same reasons as you.

    Edit: Just realised I had said nothing about medical bills. We do have some hospitals for privately insured patients in the UK and we have a very few patients in the NHS who pay privately- I don't know how payment works at all, I'm sorry. Who pays the bill for those in the NHS who stay over what is medically advised? The same people who pay for ALL the treatment and hospital stays; the tax payers.


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