2/6 What I Learned This Week: If you annoy them, they will order

[ixchel]

Alright, friends. I'm keeping this one short and sweet because my brain is sore and my dog is annoying.

This week, I have learned....

1. There should be a time limit hospitals should have to fix a problem. If things aren't better after, say, 15 days, let someone else try.

2. I'm in the mid Atlantic of the US with spring travel plans to Florida, and I'm actually feeling nervous about Zika. I had a guillian barre syndrome patient in nursing school. On his way driving home from work, his chest felt off, so he course corrected to the ED. When he pulled up and walked to the doors, he struggled with leg weakness. After he was done in triage, he couldn't stand. He was intubated, and completely paralyzed, before he left the ED for ICU.

3. A patient on neuroleptics will still have detectable epileptiform patterns on an EEG.

4. A good neurologist knows no matter how crazy the patient sounds describing symptoms, what they say is legit and will stay the course for diagnosis.

5. My favorite doctors to work with are the ones who will sit and talk patho with a nurse and enjoy that the nurse legitimately loves to learn.

6. Sliding scale coverage alone for inpatient management is not currently supported by research.

7. If working day shift doesn't eventually make me check into a psych ward, nothing will.

8. The GI doc who left me scrambling to save a guy's life (what felt like) single-handedly by doing no intervention before he got dumped on us (actively bleeding out 2 points of hemoglobin over 8 hours and maintaining a BP that won't leave 70s-80s) has suddenly become cautious enough to send a perfectly stable (hemodynamically, symptomatically, and on CBC) rectal bleed to ICU before meeting or scoping her after I've literally done all the work needed on her for the shift. And of course, I was rewarded with an end of the shift admission.

9. The Florida Man Collective has evolved to include its latest - Wrinkles the Clown. He is a scary-looking clown who is for hire to scare anyone you want, for any reason.

10. The more you annoy the doctor about the same thing, over and over and over, the more likely it is they will listen and maybe put in an order.

I have nothing else right now. My broken brain is feeble!

More effed up clowns:

5 Real Clown Horror Stories - YouTube

[Farawyn]

Yea, I'm not clicking that link, Wife.

I've learned, over the last 6 months, when ixchel sticks a link in my face I click it at my own risk.

Sometimes it's a beautiful reward, sometimes it's a serious horror show. (Esther)

ETA: I've learned that my "friends" love shoving clowns where I can see them. Jensmom, Davey and now ixchel. *Tch.*

[Penelope_Pitstop, BSN, RN]

The Florida Man Collective has evolved to include its latest - Wrinkles the Clown. He is a scary-looking clown who is for hire to scare anyone you want, for any reason.

A simple Google images search on Wrinkles the Clown works better than any stimulant laxative I've ​tried.

[Jensmom7, BSN, RN]

A simple Google images search on Wrinkles the Clown works better than any stimulant laxative I've ​tried.

Holy. Schnikes

After doing that I may never poop again.

I reserve the right to continue farting, however.

[aeris99]

This week I learned:

You can be deceased and still throw a BP and pulse (very low but there)

The defibrillator has a nifty box for simulations. I used it for almost an hour!

How to splint fractures and pull traction on a femur (in a wilderness setting)

How to rig a litter for transport using a bit of rope and 2 branches

That I am not well suited to being in freezing weather for hours on end.

I know more than I thought I did.

[TheCommuter, BSN, RN]

This is similar to a post I recently made.....

I learned (many moons ago) that some individuals seek out the 'yes'-people, nodders, PollyAnna personalities, cheerleaders, and head-bobbers to tell them exactly what they want to hear.

This situation can be difficult to initially pinpoint because many people act as if they're seeking advice when, in reality, all they wanted was someone to validate a potentially crappy decision they've already made.

I've also learned that I'll never quite understand human nature...

[kalycat, BSN, RN]

$&-@!? Clowns!!!

And I'm feeling gassy.

This week I learned that it takes some finesse (and courage) to call a doc back at midnight who hung up on the preceding shift's nurse. Glad I hung the nitro drip and followed up aggressively, because said patient whose pain "wasn't cardiac" and who needed a "$&?!!! Ativan" ended up having a retro peritoneal bleed after his BP spiked to 215/110. [emoji33]

Having a no-code palliative patient (who had a run of vtach during a palliative procedure and ended up on my cardiac unit) try to punch me in the face and call me every name in the book was frustrating.

Finally getting said patient's pain and agitation under control was rewarding.

Having a day shift nurse decide the patient needed less pain medication ("he/she is sleeping all day") subsequently starting the cycle all over again made me want to scream. Of course he/she is sleeping and refusing oral intake. They're at end of life with brain cancer. Not everybody we see needs to be treated in the cookie cutter cardiac rehab manner.

I may be an acute care nurse but I'm passionate about end of life issues and palliative care. Now I feel the need to educate. :evil: [emoji48]

[LadyFree28, BSN, LPN, RN]

This week I learned:

With other people leaving and have left, that I am slowly becoming one of the senior staff-and I have only been there a year...very scary since I'm still a novice in a specialty.

Even though I'm new, my actions for advocacy has been noticed by senior and new staff in a positive way across the hospital as we are going towards a possible new change that will allow nurses to have a seat at the table.

I also learned I still have powers of being a pregnant whisperer...I suspected that a ROSA was pregnant-and she was; also going through the forensic process during ROSAs of making sure that evidence is preserved, inspection of physical findings, with dignity to the victim helps with the arduous process to healing-even when one finds out that they are pregnant.

[kalycat, BSN, RN]

This is similar to a post I recently made.....

I learned (many moons ago) that some individuals seek out the 'yes'-people, nodders, PollyAnna personalities, cheerleaders, and head-bobbers to tell them exactly what they want to hear.

This situation can be difficult to initially pinpoint because many people act as if they're seeking advice when, in reality, all they wanted was someone to validate a potentially crappy decision they've already made.

I've also learned that I'll never quite understand human nature...

This behavior is very very irritating to me. I get frustrated in a hurry when people ask for advice with no intent of even considering it because I'm not telling them what they want to hear. I've been burned a few times by people like this so perhaps I'm jaded.

My next least favorite behavior is intentional manipulation of sympathies in order to attain some unknown objective. I have gotten to the point where the only response I can muster is a good ol' deadpan stare.

[smf0903]

I learned this week that patients who want

their PRN pain meds--specific pain meds--don't give a rat's patoot if their BP is in the toilet, even when you explain why you can't give those meds and will see if the doc will order something else.

Some patients really apparently think we can't tell that they they have been toking on a cigarette in their bathroom. Spraying a half gallon of perfume in your room just makes your room reek of perfume and cigarettes. You're not fooling anyone

Immediately documenting conversations with the doc can be a life-saver...especially when said doc doesn't put the orders in that you've asked for multiple times over the course of 6 hours--then says you never contacted them about said orders when it's a half an hour before doc is scheduled to leave. Don't call me a liar because you didn't do your job

i learned what bone cancer looks like. I saw a picture a few days ago and now understand why bone cancer is so incredibly painful.

[Farawyn]

This is similar to a post I recently made.....

I learned (many moons ago) that some individuals seek out the 'yes'-people, nodders, PollyAnna personalities, cheerleaders, and head-bobbers to tell them exactly what they want to hear.

This situation can be difficult to initially pinpoint because many people act as if they're seeking advice when, in reality, all they wanted was someone to validate a potentially crappy decision they've already made.

I've also learned that I'll never quite understand human nature...

Worth repeating.

[guest769224]

I learned that I got my dream job in ICU as a new grad. Happy.