2/20: what I learned this week: people do not understand TB

[ixchel]

People......

This week. I got asked by my bosses boss to pick up a shift. I used the weakest excuse there is and I stuck to it: my group was just too much, I haven't gotten sleep, and I desperately need my days off.

So now, I bring to you what I learned while sitting in my home ED triage wearing an N95. Yup. It's been that kinda week.

1. I have yet to meet a grumpy person who didn't perk up after giving them a shift of kindness. It feels like the biggest victory, too.

2. It sucks that being required to report abuse and self harm means destroying the trust you'd achieved before that point.

3. Some patients make me hate nursing homes. I'm so sorry to the NH staff we have on here. I understand you function under terrible limitations. However.... When a nursing home gets a patient they are unequipped to handle, they don't realize how horrible the outcome can be. One such patient made me cry. HARD. I found a dark corner of the hospital and just hid. Some things we'll never let go of.

4. We have a patient with us who has been with us three times over 3 months and was not shown to have TB until last week. For some reason only those of us directly exposed seem to be freaking out at all over this. Sputum results would be nice, please.

5. You can do everything in your power on the planet to fight hard to end abuse and make progress for a patient. And then you can find that it did absolutely nothing. Your time was wasted. THIS is where burnout begins.

6. When you FINALLY feel awake enough to get your URI checked out, and you're honest about your TB exposure, you'll get turned away by everyone but the ED. What a waste. Honestly.

7. I don't want to be a psych nurse. I tip my hat to all of you out there. I don't want to be a psych nurse, but you know what? I'm good at it.

8. I don't know what is going to happen if I'm positive for TB. My kids have fevers this morning. Maybe they'll let us room together. [emoji22]

[ixchel]

I'm so sorry, Ixchel. I hope everything works out. Fingers crossed for you.

This week I learned:

1. I am woefully unprepared when it comes to understanding NP contract language.

2. My acute care/ICU knowledge has really waned since I started focusing on primary care. Looking forward to my ACLS course coming up.

3. Explaining what it will look like as someone begins to die to my sister-in-law and husband was humbling, heartbreaking, and something I never imagined myself ever doing.

4. I'm so glad my other sister-in-law is an ICU nurse.

5. I had the best mother-in-law I could have ever possibly hoped for. She saw me, supported me, and understood me in ways that my own mother never did. And it absolutely F-ing sucks that she only had 50 years on this planet.

6. Cancer is one of the most evilest things in the history of forever. But I guess we all knew that. Still doesn't make it any less sucky.

7. On an unrelated and happier note, throwing yourself a birthday party instead of stewing over how no one remembers your birthday is definitely the way to go. Even if you're in your late 30's.

1. Thank you, so very much. [emoji173]️

2. Is it time to update your screen name? Did you just graduate? If so, big congratulations!

3. Your husband and sister-in-law are so, SO thankful you were there for them, in that capacity. Same with your other sister-in-law. I'm positive she was was thankful to not be the only nurse there. I imagine it would be emotionally draining and utterly heartbreaking to be the only nurse in the film for that, especially when you need your own space to prepare and grieve.

4. I am so, so sorry for your loss!!!

5. ALWAYS celebrate yourself!!!! Happy Birthday!

[ixchel]

Don't trust the med student to accurately report the symptoms of a declining patient to the intern/resident. Someone should teach this particular one the difference between delirium and unresponsive.

HOLY CRAPPPPP!!!!!!

Are you serious?!

[ixchel]

I've learned the business/recruiting end of home health/PDN is very dirty. Some agencies will slander another just to get patients or nurses. Homie don't play that.

What an awful situation. The only people who get hurt in that are the patients. What happens when their agency can't offer what the patient needs? Now the patient has been told these other places are terrible, leaving nowhere else to go.

[ixchel]

Awe, ixchel, I hope it comes back negative.

1. I learned just how invasive your employer can be into your medical history in the premployment physical. I was not comfortable at all with the process of that and honestly wondered where hipaa fell in. But it's all done and I'm good now.

Well, that's a bit...creepy. If you don't mind me asking... How far DID it go?

Annnnd thank you!!!!

[ixchel]

I learned that women who are essentially guilted into breastfeeding when they previously had no desire of their own to do so rarely succeed at sticking at breastfeeding for very long. This week alone, I talked to 4 different moms who quit nursing very early on and admitted that they never wanted to do it but were guilt tripped into starting. Breastfeeding is great but it's a lot of work and if some women really don't want to do it, they won't.

I learned that some anesthesiologists, when desperate for IV access, will run blood products and certain meds together.

I learned that fighting a cold, getting less than 4 hours of sleep, having a horrible coworker be nasty to me, and walking into a chaotic assignment = crying in the bathroom at work for a brief moment. I haven't cried at work about anything non-patient death related in years!

I learned that I'm really done being a pushover. I'm such a conflict avoider and I try to get along with everyone, but that doesn't work with people who feel the need to bully others to get what they want. (I realize that bully is an abused word so I'm not using it lightly) So basically, I need to stand up for myself more and learn to fight back when I need to.

I learned that my hospital's cafeteria makes a delicious grilled cheese sandwich!

First!- Awesome moment in the history of you deciding not to put up with crap anymore! Stick to it! You got this!

About breastfeeding, it doesn't help that these are NICU moms. So many have guilt for so many different reasons. The best thing you can do is VALIDATE their parenting choices, and validate their feelings. It's normal to feel sadness and guilt for not being super mom, or perfect in any way at all.

For the anesthesiologist with the blood and meds, I would have been all drop-jawed and freaked out right there with you if I hadn't seen a patient bleeding out so much faster than we could put anything back in. We literally had 7 open lines on this guy and it still wasn't enough, and due to the speed at which we had to move, there wasn't time to make that central line anything bigger than a regular quad lumen central line. As long as the blood isn't having a transfusion reaction, desperate times.....

And I say that with the immediate follow up - NEVER EVER DO THAT IN ANY OTHER SITUATION unless it's do or actually die.

I had a work-cry as well this week. I'd be glad to share my tissues with you any time. [emoji5]️

[ixchel]

Ive learned...

That I got offered a job with awesome pay in a big hospital in one of the cardiac units and I'm thrilled and scared too!!

Congratulations! You'll be great!

[ixchel]

1. That the hospitals by me ate truly desperate for nurses.

I missed the word "for" the first time around and thought... Someone should probably report that.

[ixchel]

1. That the hospitals by me ate truly desperate for nurses. They literally hold job fairs and start hiring new grads in January-March, BEFORE graduation

Also, around here that's actually pretty normal. The schools host job fairs as well. Many of us and those from other schools were snatched up before graduation. It's very helpful to have that security!

2.that l&d is where I want to be! I impressed my consigned nurse, she said she would hire me!

Congratulations!!!!!!

4. My mother, who is the reason I moved out of her house and into my own apartment last year (family drama) whom I have not spoken with since then, inadvertently moved last week. Right into an apartment complex. That I live in. She didn't know I was there. Time for mending some fences I guess.

doh!!!!!

[ixchel]

I learned:

That according to my peers in my annual review, I am considered an "agent of change"; I've decided that this was a great complement to my work ethic, although I am still a newbie at Emergency Nursing.

There have been another round of people leaving-people who have shaped me with their wisdom in my first year. although I am happy that they have decided to move on, I am nervous that I have been slowly been included in senior staff, when I still need support in transitioning in my new specialty.

I've recently been feeling that feeling of being one of the "experienced" nurses on my unit. It's an odd feeling and I definitely haven't been a nurse long enough for that. But then, one of the newer ones will ask me a question or need advice on a judgment call. I'll walk them through whatever it is. They'll thank me and I'll realize... I feel new, but maybe I'm not!

I guess there'll be a time when the newness fades.

[FurBabyMom, MSN, RN]

Sorry Ixchel, sounds like you had a rough week!

I am not sure it is of some consolation but I have taken care of patients who turned out to be "tb positive" - of course taken care of them without N95 until placed on precaution. My own PPD never turned positive despite ...Hopefully it will be just fine for you!

This. A million times.

I really hope it works out just fine for you (and your family and coworkers). Positive thoughts for you ixchel!

I *will* say - I have also taken care of patients we didn't know were TB positive. In the OR. With 8+ hours of exposure (as in without an N-95 mask). Even if patients are intubated there is a chance for exposure to TB... TB can exist in areas other than the lungs (bone or as an abscess). Unfortunately, this has happened more than once to me - and in my case it just bought me an extra TB skin test.

[FurBabyMom, MSN, RN]

I've recently been feeling that feeling of being one of the "experienced" nurses on my unit. It's an odd feeling and I definitely haven't been a nurse long enough for that. But then, one of the newer ones will ask me a question or need advice on a judgment call. I'll walk them through whatever it is. They'll thank me and I'll realize... I feel new, but maybe I'm not!

I guess there'll be a time when the newness fades.

There is a time when the newness fades. All of a sudden you're the expert on something (or the person your coworkers go to). The OR is a little different for us, but we've had a lot of turnover in the past year to 18 months. All but one of the nurses that were on my team/service line when I was the new kid are gone. Somehow you become the expert in everything. Suddenly you don't feel paranoid about your assignments/what you're being asked to do.

I had one of the most recent OR residency class members ask me how long I've been at work - and the "3.5 years" thing really surprised me. How did that happen? It's crazy how it works. There's days I just want to be like 'but I'm still new, I don't know!' - except it's not true, I'm *not* new, and largely I do know (or I know how to find the answer).

It's pretty amazing isn't it?

[NICUNurseEliz]

First!- Awesome moment in the history of you deciding not to put up with crap anymore! Stick to it! You got this!

About breastfeeding, it doesn't help that these are NICU moms. So many have guilt for so many different reasons. The best thing you can do is VALIDATE their parenting choices, and validate their feelings. It's normal to feel sadness and guilt for not being super mom, or perfect in any way at all.

For the anesthesiologist with the blood and meds, I would have been all drop-jawed and freaked out right there with you if I hadn't seen a patient bleeding out so much faster than we could put anything back in. We literally had 7 open lines on this guy and it still wasn't enough, and due to the speed at which we had to move, there wasn't time to make that central line anything bigger than a regular quad lumen central line. As long as the blood isn't having a transfusion reaction, desperate times.....

And I say that with the immediate follow up - NEVER EVER DO THAT IN ANY OTHER SITUATION unless it's do or actually die.

I had a work-cry as well this week. I'd be glad to share my tissues with you any time. [emoji5]️

With the breastfeeding, it's our doctors who try to guilt moms into doing it and then it's always the nurses who are left to pick up the pieces when the moms can't do it anymore and now feel extremely guilty. So we give the "you tried so hard and you gave your baby some breastmilk and that's awesome..." speech fairly often. It's just frustrating. Unless it's about a true safety issue, let people parent how they want to! So I totally agree with the validation :)

Oh, it definitely was a desperate time when he ran the blood and meds together so I understand. I had just never seen it done before and had no idea you could run certain things together if you were out of access. Another nursing school principle bites the dust.

And thanks! :)