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

Nurses General Nursing

Published

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]

I didn't like floating either, so when my floor combined with another vent floor and I was floating between the 2 anyway, I became a Float Pool RN!

It was the best thing, nursing wise, I could have done. I saw so much and became a sort of jack of all trades. Admin. knew they could plug me in anywhere.

I networked and I got to choose my shifts and days when I went per diem, and also ended up in Employee Health for a spell, the plumbest of all hospital jobs.

Don't be afraid. Go in, look people in the eye, introduce yourself and tell them from whence you came. Tell them right off the bat if you are not up on something, like a wound vac.

Introduce yourself to charge. Be clear with your CNA. Make sure you know who the secretary is.

Tell everyone your name, ad nauseum.

Farawyn, it truly felt like the first day walking onto the floor for me! As soon as I got to the floor I told the day shift nurse who had my patients (who is also a charge nurse) that I haven't had a surgical patient since probably my second semester of school. Bless his heart, he stayed late to help me change a dressing and walked me through the process. I told the RNs on the floor that it was my first time on the floor so I would probably have a LOT of questions LOL! They were super nice, but I still felt like a fish out of water. When I saw the charge who is usually on my floor she asked how the shift went. I told her no one died, no limbs fell off, and no wounds popped open on my shift so all in all I guess that can be considered a success...or at least not a failure ;) I also told her that while I was super uncomfortable in that setting, the only way I was going to GET comfortable was by experiencing it more. When I got home I started reading back up on post-op care and wound dressings so that at least I can pick up some tidbits that I've pushed to some obscure part of my brain LOL Luckily the night I worked there the aide was one we regularly have on our floor, and she's awesome. Eventually I'm sure I won't hyperventilate if I see I'm on another floor...just will take time and experience :) Thank you for your advice and kind words!!

Farawyn, it truly felt like the first day walking onto the floor for me! As soon as I got to the floor I told the day shift nurse who had my patients (who is also a charge nurse) that I haven't had a surgical patient since probably my second semester of school. Bless his heart, he stayed late to help me change a dressing and walked me through the process. I told the RNs on the floor that it was my first time on the floor so I would probably have a LOT of questions LOL! They were super nice, but I still felt like a fish out of water. When I saw the charge who is usually on my floor she asked how the shift went. I told her no one died, no limbs fell off, and no wounds popped open on my shift so all in all I guess that can be considered a success...or at least not a failure ;) I also told her that while I was super uncomfortable in that setting, the only way I was going to GET comfortable was by experiencing it more. When I got home I started reading back up on post-op care and wound dressings so that at least I can pick up some tidbits that I've pushed to some obscure part of my brain LOL Luckily the night I worked there the aide was one we regularly have on our floor, and she's awesome. Eventually I'm sure I won't hyperventilate if I see I'm on another floor...just will take time and experience :) Thank you for your advice and kind words!!

Sounds like you did great. :)

Another thing. If a floor is particularly good to floats, like this one was, I always let Admin. know. Because why not pass on the good stuff?

Specializes in ICU.
You are not fat. I have your pirate pic.:inlove:

Nope, not fat, but I have rolls I don't want and would rather pay people to get them off of me than get them off myself through hard work. I have no time for eating right and exercising right now. ...That might just be a two-bag worthy statement. :bag::bag:

Stats made zero sense to me until I took genetics and we discussed population stats. That was when (2 semesters post-stats class) that it finally all made sense LOL

Genetics is making my brain explode. I'm glad it helped you with your stats. I'm definitely not having that experience.

I learned that nursing schools are REALLY different. My best friend is in nursing school right now, and listening to her talk about her tests and how unorganized her school is made me go :eek:. She had a test that literally covered cardiac,GI, perfusion, mobility, healthcare billing, and grief. A previous test covered respiratory, ostomies, skin integrity, wound care products, strokes, and pharmacology. Really. Those are topics that were covered in four or five different classes for me, let alone different tests. With three different teachers teaching, which is also ridiculous, who all taught differently and came up with their test questions differently. I never had more than one instructor for a class. How do you even study for a class that takes material from all over the place and uses different teachers? I'm understanding why people fail out of nursing school if it's taught like that some places.

Specializes in critical care.

I learned that nursing schools are REALLY different. My best friend is in nursing school right now, and listening to her talk about her tests and how unorganized her school is made me go :eek:. She had a test that literally covered cardiac,GI, perfusion, mobility, healthcare billing, and grief. A previous test covered respiratory, ostomies, skin integrity, wound care products, strokes, and pharmacology. Really. Those are topics that were covered in four or five different classes for me, let alone different tests. With three different teachers teaching, which is also ridiculous, who all taught differently and came up with their test questions differently. I never had more than one instructor for a class. How do you even study for a class that takes material from all over the place and uses different teachers? I'm understanding why people fail out of nursing school if it's taught like that some places.

We had multiple instructors and multiple very different subjects on tests. Exam questions were in depth, which means we had to know each body system dysfunction pretty thoroughly, but had little time to learn it. On top of that, the different professors with the different testing styles.... Yeah, it sucked.

Specializes in critical care.
TB wise, when I was talking to ixchel yesterday I was reminded of how we handled these things when I worked in Employee Health and it was very different.

I also dreamed about giving PPDs and making perfect wheals.

I missed this comment! I'm happy to be inspiring of dreams, dear wifey. [emoji5]️

I learned that a shellfish allergy actually doesn't indicate an iodine allergy, which is actually not an allergy but an inflammatory process, but has something to do with the muscle protein. My mind is still... Blown.

In hemodialysis, you should be able to hear a bruit and palpate a thrill.

Had an active shooter teaching session offered at our campus. Run, hide, or fight.

Cycler peritoneal dialysis has 3 stages: filling time, dwelling time, and draining time. The catheter is called a Tenkhoff.

Specializes in critical care.
why patient react to IV drug ?

kind regards

In a bad way or in a good way? IV medications bypass the digestive system. Otherwise, a person can react with side effects and allergies just as PO meds.

Sorry Ixchiel. When I was hospitalized for my lung abscess initialy they thought it was TB. I am ironically grateful it wasn't, even though having an abscess sucked.

This week I learned self disclosure about your problems is pointless. I wanted people to learn from my struggles and mistakes. It appears I missed the mark. I came off in a way I did not intend.

A friend posted a thread about being openly mocked for an invisible illness on facebook, so I reposted it. No sooner did I do this then I received a worried pm from a friend because of my past issues. Lesson learned disclosure is bad very bad. All it does is cause worry in the people who care, and or stress. Other people will not care/understand, and yet others will attempt to take advantage.

I wanted people to learn from my struggles/issues, but it appears all I did was cause unnecessary stress to my friends who genuinely care. I though I could make a world where no one had to go through what I went through. All I did was cause others to unecesarilly worry.

So from now on I keep my problems to myself.

Don't! Don't keep it to yourself! It sounds like you've had a profound experience previously, and you have it in your heard to create awareness, education, and prevent others from experiencing the same. NEVER back down from that! If your worried others worry, add a note saying something like, "resharing from a friend" at the beginning. But don't ever back down! Your voice is needed!

One month ago today my brain took a little vacation (i.e. I had a stroke). I saw my doctor for follow up Friday & was released to go back to work starting last night. I'm so happy to be back! I was getting very bored at home! You can only count the cracks in the walls so many times before you start naming them! :roflmao:

Poppyyyyyyyyy!!!!!!!!! This is fantastic! Congratulations!

I learned that our crustiest, quietest, most senior intensivist (who I hold in the utmost regard as he is an amazing physician) will literally whistle with carefree delight while making rounds in the PICU when the computers system is down for eight hours and he gets to write orders on paper.

We have a substitute nephrologist/hospitalist who would totally be this way. Every time he's on my floor, I end up putting in his orders. I'm amazed he finds his way through SOAPs. He's totally old school, at least in his 70s. Master of the non-pharmacological intervention. We'll get orders like, "discharge after soaking feet". He misses the world of paper charting.

Uh huh. Yup.

*walks back out*

How could you just leave me standing alone in a world that's so cold?

-This week I learnt patients can take IV dilaudid at home, if they have a port or PICC line. Is it legit, I don't know. I question the practices of the medical practice group that allows non-cancer patients to have permanent access and IV opioids at home, outside a controlled setting. I highly doubt it is legal. This is not the first time I've seen a non-cancer patient seen by this medical practice.

Oncologists take on hematology, as well. In a patient with a blood disorder like sickle cell, which is incredibly painful, would benefit from this POC.

~ Assessments are hard. I know they get better, but right now I'm just, buh?!

~ ixchel is "okay" and I like that.

All you have to know is when something looks/sounds/feels wrong. Health assessment class will expect you to know some names of what things are called, but you'll get those down. For right now, be able to recognize when something isn't right.

Positive TB test will mean you get an X-ray and possibly prophylactic INH x 6 months.

The ED skipped PPD and Quantiferon and just did a CXR. All it had on it was some congestion in the upper lobes. All clear as of now!

Ps, Ixchel, your week sounds scary. I'm glad the cxr looked good.

I had a direct exposure to Klebsiella pneumonia when a patient (cultures pending) coughed bloody sputum in to my face as we were rolling in to the OR. I'm severely asthmatic and ended up with abx. I was a wreck for several days. Can't imagine if it was TB. At least we eventually had culture and sensitivities working in my favor. Many cyber hugs to you from me :)

Ewwweeee that's icky!

Ixchel, sorry for your TB scare/burnout-beginning week. That is rough, when the work we do is so detrimental to our own health.

Yay ixchel! Glad you didn't end up with TB after all.

Ixchel I hope you are in the clear!!! Keeping my fingers crossed.....

For ALL of these well wishes and inquiries, THANK YOU! The bug that led me to get checked out seems to be enjoying lingering. But, it's not TB. That's perspective!

As I followed a RT for several patients, just to get a feel for her job, she said that the #1 advice she gives to new nurses is be friends with RT.

Your shift can be a success or a failure depending on your relationship with RT. We have two RTs who are... difficult, one depending on who you are the other to EVERYONE. The rest are absolutely amazing and trust that we don't bug them over silly stuff. So the one who is difficult depending on who you are responded to a nurse call from a nurse who generally thinks (loudly) that she's the most amazing person on the planet. RT insisted this patient was just having an anxiety attack, said he'd be okay if he had better care from nursing. She was a total jerk to the nurse in front of the patient, only making it worse. Last time I saw the patient, he was tubed getting on an elevator to get choppered to a facility with cardiothoracic surgery. I heard he ended up dying. But the point is, a bad relationship with RT can affect patient care. It really sucks having to be nice to jerks, but it is for the better.

Oh. My. :eek:

Right?!

I didn't like floating either, so when my floor combined with another vent floor and I was floating between the 2 anyway, I became a Float Pool RN!

It was the best thing, nursing wise, I could have done. I saw so much and became a sort of jack of all trades. Admin. knew they could plug me in anywhere.

I have the same approach - floating may get me outside my comfort zone but that's a good thing. Nurse gotta learn, patients gotta live.

Specializes in critical care.
I learned that a shellfish allergy actually doesn't indicate an iodine allergy, which is actually not an allergy but an inflammatory process, but has something to do with the muscle protein. My mind is still... Blown.

In hemodialysis, you should be able to hear a bruit and palpate a thrill.

Had an active shooter teaching session offered at our campus. Run, hide, or fight.

Cycler peritoneal dialysis has 3 stages: filling time, dwelling time, and draining time. The catheter is called a Tenkhoff.

Your school advocated fighting?!

Your school advocated fighting?!

Actually, it was a local LEO who suggested it if you had no alternative. Said it was better than just standing there.

Man I hope you are TB negative. That would really suck. I have 2 young kids and I worry about bringing home something serious. I also worry about getting something like TB and then loosing my job because I now have TB and at the same time loosing my health insurance just when I need it. No doubt my facility would throw me under the bus to save some money.

Specializes in long term care Alzheimers Patients.
One month ago today my brain took a little vacation (i.e. I had a stroke). I saw my doctor for follow up Friday & was released to go back to work starting last night. I'm so happy to be back! I was getting very bored at home! You can only count the cracks in the walls so many times before you start naming them! :roflmao:

Poppycat

I am so glad to you ' re doing better

Specializes in Hospice.

Today I learned that when a facility nurse makes morning rounds, they don't come close enough to the patient to notice that while their chest is going up and down, they are also mottled, grey, unresponsive, and actually dead.

Nurse didn't realize that the patient's BiPap (which should have already been taken off for the day) was giving the illusion of respirations.

The interesting thing is that the patient had actually been transitioning for several days, and the family refused to accept it, and we're making "we want tube feeds so she doesn't starve" noises. I was supposed to discuss with them today how bad an idea that really was.

I always say our patients take matters out of our hands for us.

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