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]

[cracklingkraken, ASN, RN]

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.

How long did it take for someone to notice then?

[ixchel]

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.

Holy crap!!!

This is why I always try to "forget" to get the tele off when patients go comfort or hospice. I want to know when it actually happens!

[ixchel]

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

What's crazy to me about this is if you are a really crappy fighter who actually makes yourself more vulnerable by trying, you've just put yourself in way more danger. This was bad advice!

[cracklingkraken, ASN, RN]

What's crazy to me about this is if you are a really crappy fighter who actually makes yourself more vulnerable by trying, you've just put yourself in way more danger. This was bad advice!

Well, the logic was, if there is a mass shooting, they're most likely going to shoot you anyways, so might as well try to incapacitate or disarm them. Hopefully, I will never have to make a choice like that, but who knows. A Martin's near me had a gunman not too long ago.

[kalycat, BSN, RN]

Holy crap!!!

This is why I always try to "forget" to get the tele off when patients go comfort or hospice. I want to know when it actually happens!

My unit has actively done this several times - and have argued that it is a minimally invasive way to monitor progression so that family can be alerted, etc (if they're not holding vigil). We have a fair number of VADs who come in to have their VAD turned off due to complications or who have outlived their destination therapy and we usually have palliative come and assist us. If the VAD and/or aicd are left on during end of life things can get somewhat tricky. Usually we try for a bit more concrete plan!

Overall I much prefer watching the monitor at the desk while the family is at the bedside with their loved one - they have privacy yet I'm only steps away. It helps assuage some of the last minute panic some families feel too when we can explain what's happening and what we are seeing - it's something tangible.

I was an active hospice volunteer for many years and it's certainly not as good as hospice, but for an in hospital death we try to meet all the needs we can, even if we do it unconventionally.

[ixchel]

My unit has actively done this several times - and have argued that it is a minimally invasive way to monitor progression so that family can be alerted, etc (if they're not holding vigil). We have a fair number of VADs who come in to have their VAD turned off due to complications or who have outlived their destination therapy and we usually have palliative come and assist us. If the VAD and/or aicd are left on during end of life things can get somewhat tricky. Usually we try for a bit more concrete plan!

Overall I much prefer watching the monitor at the desk while the family is at the bedside with their loved one - they have privacy yet I'm only steps away. It helps assuage some of the last minute panic some families feel too when we can explain what's happening and what we are seeing - it's something tangible.

I was an active hospice volunteer for many years and it's certainly not as good as hospice, but for an in hospital death we try to meet all the needs we can, even if we do it unconventionally.

AGREED! I had a delay in palliative and GIP orders once when a bipap dependent, one foot on each side of the grave, who had a DNR/I order but still had an AICD turned on. Honestly... How close can you actually be to fully coding a person unintentionally when they have a DNR? Yet another ethical/legal conflict.

[kalycat, BSN, RN]

AGREED! I had a delay in palliative and GIP orders once when a bipap dependent, one foot on each side of the grave, who had a DNR/I order but still had an AICD turned on. Honestly... How close can you actually be to fully coding a person unintentionally when they have a DNR? Yet another ethical/legal conflict.

We just had one of these in the last couple months. Poor patient was being shocked 8-10 times per day by the aicd (end of life, dnr/I) before we got clear cut orders to turn the damn thing off. Patient told me that being shocked that many times was like repeatedly being kicked by a ticked off mule.

Talk about dying by inches. :bag;

[calivianya, BSN, RN]

What's crazy to me about this is if you are a really crappy fighter who actually makes yourself more vulnerable by trying, you've just put yourself in way more danger. This was bad advice!

I have seen that particular training, and I've got to disagree. It's about the type of active shooters who kill everyone - the type of people who look under desks and search rooms to make sure every single person they can find gets shot and dies. There is no making yourself more vulnerable in that situation - if you're in the shooter's line of sight, you are getting shot. The only choice once the shooter has the gun pointed at you is whether or not to make a kill shot easy for them by being still, or giving yourself a chance to possibly knock them out and get away by attacking.

It's actually a decent video. I've seen it at a couple different jobs. If you can have a "favorite" one of something like this, the Run, Hide, Fight one is my favorite.

I learned that one of my single coworker guys and I are alike in three new ways tonight. I already knew we were alike in several other ways. Sometimes I think it's a shame I'm dating someone already, but I guess the grass always looks greener from a distance, at least.

[cracklingkraken, ASN, RN]

I had a nightmare last night. I enrolled into a government statistics class in the middle of the semester, and my first class had a quiz.

I had no graphing calculator, it was my first statistics class in 7 years, and there were non-statistics questions on it, too (e.g. what is the Earth's radius?). I normally like statistics, but this dream might have ruined it for me.

[ixchel]

I have seen that particular training, and I've got to disagree. It's about the type of active shooters who kill everyone - the type of people who look under desks and search rooms to make sure every single person they can find gets shot and dies. There is no making yourself more vulnerable in that situation - if you're in the shooter's line of sight, you are getting shot. The only choice once the shooter has the gun pointed at you is whether or not to make a kill shot easy for them by being still, or giving yourself a chance to possibly knock them out and get away by attacking.

It's actually a decent video. I've seen it at a couple different jobs. If you can have a "favorite" one of something like this, the Run, Hide, Fight one is my favorite.

I learned that one of my single coworker guys and I are alike in three new ways tonight. I already knew we were alike in several other ways. Sometimes I think it's a shame I'm dating someone already, but I guess the grass always looks greener from a distance, at least.

That's true. I hadn't considered the shooter that LOOKS for victims. I was thinking of the one who has a more specific target in mind. In our active shooter ed, they said the target is usually healthcare workers and we were instructed to close all patient doors and hide. Unfortunately, Greys Anatomy reinforces that. [emoji23]

[Vana21, ADN, BSN, RN]

I hear you on the TB.

I admitted a patient, up and close to his face checking pupils and all that good stuff.

Maybe 2 hours later the dr decides to put him on TB precautions

I was fortunate his results came back negative, but I think about it everytime now.

[OrganizedChaos, LVN]

I learned there is NO WAY I can work nights any more. After two days of it my body gave up & I had a seizure after many years of being seizure free. It sucks because I found the case & gave days to the other nurse. So I effectively screwed myself.

But for now the mom of the patient is letting me work 3:30-11:30p so there is that. PDN is so fickle that I have been applying to other jobs like crazy in hopes to find something more stable.