Latest Comments by KatieMI

KatieMI, MSN, RN 37,789 Views

Joined: Jan 24, '10; Posts: 2,275 (77% Liked) ; Likes: 9,411

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  • 2
    broughden and Kitiger like this.

    Quote from Orion81RN
    I can see myself making that phone call. I would certainly feel dumb afterward bc it is so obvious. It's a duh moment I would just laugh about. It doesn't mean I don't fully understand the pathophysiology, pharmacology and HD process. Now, if concepts are often missed by the nurse and not just a single "duh moment" then there is a problem.
    I would say that where I am (mixed acute med/surg - not ICU and LTC) calls are divided as below:

    - 15 % housekeeping. Travel with/without tele, order continuation, consult opinion, etc. No problems with it.
    - 5% or less true emergencies. No problem with it either.
    - 30% - non- emergencies, at least borderline appropriate. Postoperative patient on high dilaudid is expected to be constipated, and if he is, it is not necessary to call at 11 PM for that. It can wait till tomorrow, I assure you.
    The call about colchicine goes into this category. As well as majority of calls about "something for something" - after all, here everybody is truly powerless otherwise.

    - the rest 50%:

    - patient is on stable coumadin, INR 2.5, calling to let you know it at 3 AM
    - ST elevation (chronic LBBB, no changes otherwise)
    - BP 94/55 at 3 AM., HR was 60. Baseline when awake low 100th/60th, RR called already, bolus is going
    - BP 80/40, patient lies on left side (as he always sleeps), BP was taken on the right hand, in this position. Reasoning: customer service
    - something for cough after chest percussions. Preferably with codeine, please

    I understand. I was there myself. But I would be so immensely happy if there would be less of those 50%.

  • 0

    Quote from Wuzzie
    But how is this the nurse's fault? Or any nurses fault. And how does that automatically make them stupid, overactive and lazy as implied in your first paragraph (that I opted not to copy here). We HAVE been pressed into a narrow box and we are FORCED to stay there. We have no other choice if we want to stay employed. We have our place and the PTB make sure we know it. Step one foot out of it and they will come down on us...hard. Most of us can't take that risk so we dutifully call somebody a few pay grades above us and ask questions that we already know the answers to just to cover our butts. I'm in the middle of a situation like this right now. A couple of rapid response nurses are all butt-hurt about me because by the time they arrived to assist me with a patient in my clinic we had everything done and all they needed to do was transport the patient to the ED. Did I need them really? No. But it's the process I must follow and now I'm in trouble because egos got offended...because I provided excellent, intelligent and timely patient care instead of standing around wringing my hands about what I should do.
    First, I would kindly ask you to please abstain from putting your own words into my mouth. "Not thinking" is not equivalent of "stupid".

    Second, nobody held me and thousands of others into that box. Nobody is holding you, or anybody else. It is entirely up to YOU and your peers. You alone is pretty powerless, that's true, but if the majority of nurses refuse to follow another stupid policy AND find way to cooperate with the Powers, it will go down one day or another. Try it - it works marvels!

    Third, I am sorry for that RR business, but now you know how I was feeling for my entire first year. If the place where you are doesn't value you for what you are, you have a choice to find a better one.

  • 3
    TRN2020, Medic/Nurse, and broughden like this.

    Quote from Wuzzie
    But at least she asked!!! She had a patient on dialysis prescribed a nephro-toxic drug. She called to clarify if this was okay. It is not within our scope to make that determination. Now panicking was over the top of course but she at least had the sense to know about the med she was giving and its risks. And she asked. It's the ones who don't ask who are the problem. The ones forge ahead and do things without thinking or reason or rationale. And these are the ones who are usually the least teachable because they believe they are The Best Nurse Ever!
    IMHO, it was well within the RN/BSN scope of practice to make a conclusion that nephrotoxicity stops being a factor once renal function per se is signed off the board. Even if the nurse is not working in HD, it is just plain logical, at least for me. That's why nurses have to study pharma. That's what that pharm book gathering dust near Pixes is for. It just would take a little time to think. But why do that if there is a convenient way to get someone on the phone and declare that "iamonlydoingmyjob, iamjustconcernedaboutSAFETY!!!!"

    If determining that, for the same HD patient, dosing of vanco q12h would quite possibly be wrong and calling for clarification would be entirely appropriate for an RN, why the exact the same action with opposite outcome (determining that the drug was safe because the patient is now on HD and therefore NOT calling) would be somehow inappropriate? Only because vanco is used all the time and colchicine is not?

    The only one explanation I see is that, despite of doing years of college, hard science and etc., nurses are still not expected to use their knowledge outside of pretty narrow box they are put into by their employers. The box can be more or less narrow, but it is still there, and if a nurse even thinks about looking out of it, he/she is immediately perceived as being "unsafe", "not wishing to learn", "that know it all" and all other mortal sins. The one expected result of it, though, is that nurses who tend to think outside of the box (and therefore can be invaluable asset for their peers) avoid the said peers and bedside nursing altogether. They run - to profile units, to grad schools, to where ever - leaving behind those who are predictable, reliable, rule-obedient and "safe" - till an emergency strucks some very fragile, very sick, very liability-prone patient.

    Unfortunately, here is the fact about modern US nursing: the system is more forgiving to bottom 10% of nurses than it is to top 10%. It presses its own cream out.

  • 0

    Relax. There is no risk of exposure with intact skin:

    ("cut and stick" exposure is just 1.8% anyway)

    HepC RNA test become positive in 1 to 2 weeks postexposure if you really want to get poked and burn some $$$:

    HCV FAQs for Health Professionals | Division of Viral Hepatitis | CDC

    RNA test is NOT screening and you'll have to either find a compliant provider to get referral or face that your insurance won't pay for it. The 3 to 12 weeks and longer is about antibodies. They are looked for in screening tests, which cost much less but take more time to get positive or negative. But counting the circumstances (possible exposure of intact skin) you have risk as close to 0 as it gets. Even CDC which tends to overblow things a bit doesn't recommend screening for such cases.

    If still in doubt, go to your primary care provider.

  • 3
    kalycat, FrenchNurse18, and Kitiger like this.

    Quote from broughden
    "Fully" developed but only to the limits of their capacity. Not everyone's capacity is the same.
    Something tells me that potential capacities of many people around us, including our nursing colleagues, are much higher than we can predict. They just not get used. If a person is able to discuss for hours the minorest things about college football or golf or guns, then there are no problems about intellect or memory.

  • 18
    RobbiRN, inshallamiami, kbrn2002, and 15 others like this.

    One time in LTACH we got a patient from low level group home with mysterious symptoms and wound on his abdomen. The group home had no RN on premices, only one LPN who clearly left school around the time when the last dinosaurs roamed the Earth. She was locally known for very detailed and very unprofessionally expressed documentation.

    That time, the description sounded approximately like this: a hole wide enough to pass two my gloved fingers; upon taking them out, they smelled like Sloppy Joe patient just ate, but a good deal rotten.

    It was gastrocolonic fistula, after all. The food passed directly from stomach to transwerse colon and from there out farther away or on skin. We were thinking long time who else would imagine sticking fingers into that badly looking "hole" and then smelling them, noticing what was eaten an hour before.

  • 3
    kalycat, brownbook, and Oldmahubbard like this.

    Quote from hherrn
    I don't think this is about the nurse who still "aspirates" an IM, or rubs the spot after, or uses Trendelenburg, or does a Valsava vs a Modified valsalva.....

    This is about missing basic concepts, and lacking either the aptitude or ambition to understand them.

    No amount of constructively crafted feedback will create aptitude.

    I am not a good dancer. I lack rhythm. And grace. It does not matter how you speak to me about dancing, I will still not be a good dancer. Ever. I do not have the aptitude. Even if I passed a 2 year dancing course, and somehow passed my national dance exam, I would suck at dancing, and you would wonder how the heck I made it this far.

    Now substitute "nurse" for "dance".

    That is what this vent started as.

    Oh- I forgot to mention- I think I am a great dancer. In school, some of the instructors picked on me, and all 6 choreographers who fired me were ignorant.
    The problem is that sense of rhythm, grace and turnout can be developed only to the point. One has to be born with slight dysplasia of hip joints in order to have good degree of turnout later in life. Some people even seem to crawl gracefully, some are not and there is not much to be done about it.

    Unlike the above, logic, analytical thinking and knowledge base can be totally and fully developed, and in pretty much any age. But people just refuse to do it. They refuse to use their own brains.

    I got a panic call yesterday from a nurse. Patient was started on dialysis recently and was prescribed colchicine (highly nephtotoxic drug). Nurse was wondering if it should be held.
    "Now, just think" - I said - "why should we care about the kidneys now, when the patient already is on HD?"
    It took for the nurse full 30 sec and then some cues to realize what it was about.

    It was, for me, a common logic. Kidneys are already out of the game as far as we are concerned. Even if the drug kills half of the remaining 5% of function, it doesn't matter from now on - HD is on board. And patient had acute gout, which is VERY painful. I did not need renal dose table, HD filtration dosing table or even advanced knowledge of HD to make this decision, which took me a split second. But for the nurse it seemed to be a significant effort to understand this basic connection. Everything the nurse knew was 1) patient is in renal failure, and 2) drug is bad for kidneys. The nurse just couldn't insert one more dot between the two and connect them all with straight line.

    This nurse passed school, NCLEX and everything else and was very successful in a place where I was abused into stress-related cardiomyopathy.

  • 1
    Orion81RN likes this.

    It is not a law of the State of Michigan or State of the USA but some private state which exists exclusively in your NM's head.
    The question is, can anything be done about it.

    P.S. I am in Michigan, worked in many places, everywhere it was ok and expected practice. After discharge, everything was sent to laundry service.

  • 6
    kalycat, Dean Uguan, Kitiger, and 3 others like this.

    Quote from CrunchRN
    I don't know you so I wasn't sure whether this was serious or you were being facetious. Must be just awful to be so much more intelligent than the majority.
    You know, I was darn serious when I wrote it down.
    No bragging, it is really uncomfortable. And you're treated poorly for just being smart unless you chose career like my husband's, where only extremely smart survive.

  • 8

    Quote from Cowboyardee
    What is Harrison's? The textbook, or do you mean something else?
    Harrison's Internal Medicine. Holy Bible of the subject, pretty much the only one book you really need if
    you are internist. It is vehemently hated by quite a few in nursing academia since it has, well, nothing at all to do with anything "nursing".

    It is one of my favorite free time reads. Seriously.

  • 3

    Technically, ectopy. It is not caused by sympathetic INNERVATION (although it is caused by effects directly related to SNS such as neurohumoral) but it is not in table numbers, so it might be wrong.

    SNS also does not increase contractility BY ITSELF. Contractility increases after increase of afterload (your SVR, norm 700 to 1500) by Frank-Starling mechanism and cathecholamines. Your contractility is low (CI below 2.5). So, I think that contractility is the right answer, and ectopy is " fool's catch".

  • 5
    nursej22, mc-escher, Sour Lemon, and 2 others like this.

    Please focus on the most important thing for now, which is your recovery. The rest, including your career, will come in its own good time. You can have many jobs; you can only have one body.
    Big good luck to you!

    P.S. part time is not a career killer.

  • 7

    Quote from Sour Lemon
    Something similar happened to me in English Composition. My research paper was well supported and well written, but I didn't come to the "expected" conclusion, so I was docked a letter grade. It would have been much easier to write out the typical paper, but I get in creative moods once in a while. She couldn't tell me a single thing that was "wrong" with the paper, just that it gave her a "huge headache".
    Heh, remembering couple of undergrad and grad clinical papers when professors clearly had no idea what I was writing/talking about. In my head, patho, biochem and pharma represent a single continuum of a kind, so it took me some time to try to explain, in one case, that pH changes are part of inflammatory process... and she asked me in astonished voice "but what these letters mean - P and H?" She later claimed that she did not understand my accent to save her face

    Granted, it was in undergrad. In grad, most professors looked conveniently other way when we cited Harrison's and other untouchables of Holy Nursing.

  • 1
    brownbook likes this.

    I'd seen that and was there couple of times. Anaphylaxis, very low BP and someone started compressions while I was still quite there.

    It is good real 10/10. But it is just the case when pain is, actually, good for you.

  • 13
    kalycat, CardiacKitty, mzinfinit, and 10 others like this.

    Honestly, I still wonder how did I make it through undergrad accounting for vicious antiintellectualism of some of my classmates, professors and colleagues.

    Being smarter than the majority of people around you sucks, plain and simple. It doesn't make life and job any easier, and there's pretty much nothing to be done with it.