KatieMI, MSN, RN 37,789 Views
Joined: Jan 24, '10;
Posts: 2,275 (77% Liked)
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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.
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.
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!
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.
"Fully" developed but only to the limits of their capacity. Not everyone's capacity is the same.
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.
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.
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.
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.
What is Harrison's? The textbook, or do you mean something else?
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".
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.
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".
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.
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.
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