Latest Likes For bebbercorn

Latest Likes For bebbercorn

bebbercorn, BSN 6,808 Views

"Raise your words, not voice. It is rain that grows flowers, not thunder." ― Rumi

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  • Apr 27

    Quote from IsabelK
    I precept. I don't like to precept first semester clinical students because they don't have enough internal medicine knowledge to make the leap to geriatrics. What I find is that I get NP students coming through who have the book knowledge the school gives them about prescribing, labs, etc, but that previous preceptors many times don't let them practice working with any of it. Physical exam skills tend to be good, but the actual "exam, then do" is lacking. When my students are there I make them sit with labs and med lists and diagnoses and tell them to "figure it out". Generally that starts with them talking through it with me and as the rotation goes on it's them coming to me with assessments and plans, including meds, future labs, and reasons why. I won't take "it's the guideline". Ok, nice, but why??? I also let them practice writing prescriptions for everything from PT/OT (I work in LTC) to actually writing the controlled substance scripts. Since the facility still uses paper, they have to think and can't rely on an EMR to populate meds. This means they have to know how to look up dosing guidelines. This is from a school that does weed out people (I've had students set up to come to clinical and then be told they're not coming because they failed a mock physical exam with SOAP note, failed a written exam, etc).
    You sound like an amazing preceptor!

  • Apr 26

    I like KRVRNs perspective as a parent with autism because I was thinking along similar lines when I saw OP's post... If parent stated "You can do the test but can't hold my child down" I would ask why first... Maybe child has autism, abuse hx. If no factors existed that made a hold out of bounds, I would explain to the parents that your child will not like this, it is not painful but most cry from restricted movement, it will take 3 seconds, when they cry, I get the test and they are immediately released.

    At 5-6 years old they can understand a bit of what's going on. Be aware of methods to help by age groups... this group might respond by knowing that you are going to "see if there's a germ and catch it with this swab." I wouldn't go overboard by saying 'this doesn't hurt' but I might give them a swab so they can figure it out by themself. I avoid bribery at all costs, even if parents do it. And I don't give the choice, I say "We are going to do XYZ." If a 'prize' was offered, I would say "We are going to do XYZ. Then you will get the sticker." Works for adults, too.

    In OP's defense, sometimes parents can take it waaaaay out of bounds. I once had to do a conscious sedation for a very simple procedure in a 10 year old (no needles, no autism, perfectly healthy kid), 100% related to the permissive nature of the parents. No judgement... well, maybe a little...

  • Apr 26

    Don't know you, doc, but I love ya.

  • Apr 26

    Don't know you, doc, but I love ya.

  • Apr 25

    Don't know you, doc, but I love ya.

  • Apr 25
  • Apr 24
  • Apr 24

    I think I would really enjoy it! My husband is more against it than I am, but as a PP said, ER is no less dangerous. Everyone has a right to decent health care, whether they've been caught for an offense or not. As long as I felt secure, I don't see why not. I think people make a lot of assumptions of what type of nursing we can do based on the population... e.g., people look at me when I say I do ED/Trauma and say "I could NEVER do that," when most of my patients are not bleeding from 5 places, really... That being said, I could never do OR and NICU because of my own experiences and preferences, although I do know some rockin nurses that work those units, it's just not for me.

  • Apr 20

    I'm in one of those where you have to find one of your own preceptors. We are accredited and one of the highest ranked in the nation. I happen to live in a very saturated area where there are other well known universities. Many sites said that they would only take students from local universities.

    I am currently sitting out a semester because my preceptors practice (MD side) all of a sudden decided they would not take NP students. My institution is trying as much as they can to help, but it may mean going out of state. (!) I do not think it's horrible having to find your own, as long as you are given some resources, which I was (past preceptors, emergency contacts)...

    A huge issue is NPs not wanting to take students. I agree with other posters that if they're not getting paid to, why should they? Those offices I call that do have student friendly NPs seem inundated with requests, and I kind of get that "Siiiiiiigh, I would like to help you, but I've had students with me for a year and I really need a break." We are only allowed to do a certain number of hours with specialty/MD and I was hoping to save these in case I had a specialty NP that I could follow for a bit. Also, some are in positions where NPs state "we only get the walk-ins, and the MDs aren't NP student friendly." Frustrating.

    I'm all for having it set up for me, as then I wouldn't be twiddling my thumbs while all my classmates spring ahead. Unfortunately, even brick and mortar schools are starting to follow this standard. A friend at a very well known NP program has been working on her degree for 4 years because of schedule changes, school being unable to set up a reliable preceptor, etc. I believe it is the new norm...

    I think the answer lies more in a nationwide requirement for an established NP residency than putting all the burden on the school. Some programs I know of blend some of the MD components with NP components (didactic and clinical). I would have loved to do a program like that!

  • Apr 14

    Don't forget the anxiety component. Here are some things I check as an ER nurse...

    1- is the room spinning? Are your ears ringing? Did your hearing change (check with a whisper test, for example). This could be vertigo or inner ear problem, menieres...

    2) do you feel like you may pass out - r/o cardiovascular cause... orthostatic VS, heart sounds even, regular, peripheral pulses strong/weak, cap refill...

    3) Disequilibrium - tripping over feet, problems "turning on a dime" etc to check for gait abnormalities or peripheral probe (unlikely in healthy teens, more with things like Parkinsons or peripheral neuropathy

    4- "Lightheadedness" or vague complaints can be psych related.

    Check for euro hx - migraines, etc. Do they take meds? Pregnant? A million causes for "dizziness," if nervous, get them to a doc! Good luck!

  • Apr 14

    I am so sorry for your rough day!!! From ED perspective (and I don't think this is necessarily right), generally the admitting MD orders it, and it is started on an inpatient basis. Unless, the admitting MD asks the ED to start it, or the patient holds in the ED. Then we can access inpatient orders.

    You had a day from hell and made it. You would have well been within your rights to give some of that attitude right back for calling you at 11 pm! Years in, I still make mistakes. Of course, I internally beat myself up, but externally, thank God, I have reached the point where I can just say "Yes, you're right. I should have done XYZ. Good catch. So, how's the gardening going?"

  • Apr 6
  • Apr 6

    I'm an A-.

  • Apr 6

    We have intubated our fair share of drunks who "couldn't maintain their airway." (They usually start pulling at the ET tube as you're starting the propofol) My new ED typically does not do that, it's been culture specific for me.

  • Apr 6

    When I first started wearing hijab, I was reported to infectious disease because it was "An infection control issue." Their response? So is everything else everyone wears in here: ties, lab coats, jackets, shirts under scrubs... I was glad to have that support.


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