tigerlogic, BSN, RN 5,636 Views
Joined: Apr 13, '12;
Posts: 236 (43% Liked)
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Thank you for your thread, I'm also interested in the question you pose.
I'm nearly 4 years into nursing, first CICU now splitting time between ED and Neuro Trauma ICU. First degree in Biochemistry, later and AcBac BSN. I have a bigger and bigger interest in CRNA but Flight nursing is probably my next move.
The biggest complaints I've heard from other boards is that CRNA wages are pretty stagnant (like all of nursing?) and/or not as much money as people thought.
I worry about being able to sit still and, frankly, too many days being boring-- especially as I'd guess that jobs straight out of school are more likely to be with lower acuity surgeries.
The intellectual depth and problem solving very much appeals, as does not dodging punches. The autonomy and constantly evolving practice and science sounds awesome to my geeky side. The ability to do actually meaningful shorter term (i.e. less than a year) volunteer work with MSF and other international groups, is also a big draw for me.
Here are a few other suggestions:
Being transgender or genderqueer isn't a choice or preference, so instead of "what are your preferred pronouns?" Better: "What pronouns should I use?" "What name can I use for you?"
If someone says their pronouns are "they, them and theirs" get over it and use them. Your discomfort with grammar you don't like is minor compared to the struggles your patient feels throughout their life.
There are no 'boy parts and girl parts.' If it's appropriate to ask "do you have a uterus?," ask. Do not ask, "were you born a girl?"
"What is your relationship to each other? Who is this person to you?"
My (suburban, liberal city) ER had an older hetero white couple be offended that someone referred to their spouse as a 'partner' or 'friend.' So, if I haven't been able to established what terms to patient uses for their visitor, I'll generically call them "your support person" or "your support people." Though, tone and report is everything for this working well or not.
Hormones and surgery are better referred to as "gender confirming" not "sex change"
For families that include trans* parents, "pregnant person" is better than "pregnant woman." Some people dislike/don't connect to the words "mother/mom/father/dad." "Parent" is a safe bet. Or ask, "Is 'parent' the best word to describe you? What would be better?"
"Hormone levels change people's risks to blood clots and other things. Are you taking anything that might change your hormones?"
I've seen people take birth control pills inappropriately (ridiculous amounts) or herbs I've never studied that neither person would have called 'hormones.'
Trans* people have much higher risk of suicide and abuse, one trans* friend said that said she'd never go to the ER if she was feeling suicidal because far too many interactions reminded her of "the unfortunate legal truth" (her words) of who she really wasn't. She found the misgendering (being referred to as the wrong gender) not only as disrespectful, but really traumatic. This relationship to health care makes her more likely to die both from a mental health crisis or appendicitis or other treatable medical problems.
It's not just about being respectful or polite-- it's about creating an environment that people feel welcome in so that they come to us when they are sick. It's about preventing unnecessary deaths.
Here's more reading. I make an effort to read more and learn more; I believe it is worth your time too.
Is Your Trans Allyship Half-Baked? Here Are 6 Mistakes That Trans Allies Are Still Making - Everyday Feminism
If you are curious to who I am (not a green parrot), I identify in no particular order as: cis, white, woman, bisexual in a hetero open marriage
Death is sometimes like a tidal wave that you can see coming but you can't stop. Death is also sometimes surprising and random.
Be an organ donor. Enjoy every bite of dessert. Love your people deeply and fiercely.
Also, the pleasantly confused old lady who thinks you look like an angel during the day will be the confused one trying to scratch your eyes out after dark. Be loving and compassionate to both.
Your attitude toward problem solving is fantastic. I wish there were more nurses like you.
I apologize, I'm not familiar with the term TCU. I'm assuming some sort of transitional care unit where you are either taking care of people waiting for placement or are helping them with some type of rehab? My background is ICU and ED-- restraints and heavy medications tend to be in our tool boxes for combative patients but those aren't necessarily good for lower acuity situations. Arguably, they aren't good for most situations based on the papers coming out on PTSD post ICU. Below are some other things to consider.
Is the person incontinent? Could changing him prior to this time of day help?
Is he watching TV? Is something triggering? Is he used to getting a different channel/show?
Are there smells that happen at that time of day from the kitchen? The cleaners?
How is the light in the room? Could he be in a different position or location so that the light wouldn't bother him.
Noises certainly can be triggering, can you limit them or teach him what they are so they aren't so disturbing?
Can he hear someone else in distress and be responding to that?
Are his clothes, shoes, socks too tight because his legs have been in a dependent position?
Is he overhearing staff that are speaking about topics or in a language that he finds triggering?
Is a therapy pet visit an option?
Would changing his bathing routine be possible?
Is he having an allergic reaction to something that could be prevented or treated with benadryl? (Benadryl and Atarax are great drugs)
Is he hungry? Are his blood sugars Ok?
Any suspicion for a UTI?
I prefer to deescalate situations rather than press assault charges. (Not all of my coworkers agree)
I believe that deescalation is a skill worth developing. Personally, I've benefits from classes based on CPI. Check out what's in your area.
Crisis Prevention Institute (CPI Training) | CPI
I also carry license insurance through NSO (though I've never needed to make a claim, so can't vouch for them one way or the other). Things can go wrong even if you have done everything right. www.nso.com
Also, some people who have been a nurse 20 years will have 20 years of nursing experience. Some will have one year of experience repeated 20 times.
Be the first one. Keep reading, studying, learning, improving your practice. It doesn't end with orientation. Be a learner and a self improver for good.
-ICU/ED/former teacher/future flight nurse.
Put a brief over the bedpan before putting it under your patient. Softer, no splashing, easier clean up. Less risk for skin breakdown on the little ones that take forever to go. (If you don't need to get a sample or accurate I/Os)
The bead around gloves can be torn off and used as a hair tie or to bundle supplies together.
Colace works well to get ear wax out. Skip trying to squeeze it out of the pills and just get the liquid (i.e. ask the doc if you can put in the order for him/her to get it right the first time)
If you are using dark iodine to swab before inserting a foley, sometimes leaving the last swab in place before going for the urethra helps avoid missing and accidentally cathing the vag.
Drunks tend to tolerate a pulse ox on their toe much easier than on their hands. Same for teenagers who can't stop texting for 15 sec.
Depending on how loose your department is with their supplies, if you have cuts on your hands from the rest of your life or paper cuts, wrap a tegaderm around it. It'll stay clean for dozens of alcohol hand washes. Naturally, if this would be considered stealing in your department, don't do it! (It's fine where I work, but locations vary)
Nasal cannulas hooked up to NS makes for a good continuous eye wash. However, be sure to account for the mess you are about to make.
Mesh panties with the middle cut out sometimes make for a good way to hold an ABD on a large leg or a normal sized abdomen.
Maxi pads are great for wounds in and out of the hospital. They are often cheap enough patients can afford them on their own.
It is often better to acknowledge people's pain even if you aren't going to give them meds. "There's nothing wrong with you" is rarely a satisfying answer.
"Your scans and blood tests are normal. We tested x/y/z. I'm sorry that you are still in pain but we don't see any reason to keep you in the hospital or send you to surgery. Nearly 100 people a day die because of opioid overdoses so we think it's safest for you to take care of yourself at home with heat/ice tylenol/ibuprofen and follow up with a specialist/primary care. I'm glad we didn't find something so serious that you needed surgery today and I hope you feel better."
Understanding the Epidemic | Drug Overdose | CDC Injury Center
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