Neuro--tell me why you do/don't like it!!

Beentheredonethat · Aug 16, 2008

Great thread. I started in 1974 so I guess I know a few dinasaurs by now. Did ER, Surg, Tele, Step down, CVICU, MSICU, MICU, and Neruo twice. Neuro seems to be home for the last 10 years. My thoughts.

At first it scared me more than a fresh heart crashing. A lot more. Then I realized it was because I didn't work at learning enough to know what was going on. Having taught neruo for the last 5 years that seems to be the route cause of everyone's fear.

First, find a good teacher and read read read. Ask every MD to explain. When you get conflicting answers just keep asking and reading. And realize that in neuro you can have more than one answer. Neuro is like doing cross word puzzles. At first you don't do well. Over time you begin to see the patterns. Then you begin to see the cleaver little twists to try and throw you off. I made it a game between myself and the docs to see who could figure it out.

Then I allowed myself to be wrong and not beat myself up but just go back more determined. Sometimes what you are seeing is an early stage so it is not clear what is happening. In those cases it is a matter of what is most likely and working from there. Learning to do a good neuro exam is KEY. Practice it until it is fluid.

I was lucky. I had a position that was like working with House MD. Only four of them. Each was recognized as being top for the state. I can't tell you how hard it was to see them take one look and diagnose from across the room and I was having to stand there and say " I don't know." My job was to triage all neuro cases coming into the hospital. Every single day I went home and read... determined to match them. Can't say I could match them in everything but I got damn good at strokes and stroke mimics. Knew I arrived when I could disagree with them and show them why they were wrong.

Now why do I like it after all that. After all the other fields it was a challenge. It made me think about brain function in different ways. I learned that the brain is magical and yet deals with the world on a yes/no basis. Something either works or it doesn't. And, there is that range in between were it is like a reostat for a light. On a lot or on a little. Off a lot or off a little. Still just an extention of the on/off but just to degrees.

I think I like being able to figure it out and know that my patients need someone who will stay there and figure it out. I feel that I can understand their thoughts even when they can't communicate. I try to put my mind in thier body and "see" what is wrong. I try to feel their energy and read their needs.

May sound a little strange but it is like taking care of your child. After a while you learn what they are feeling, you can hear them suddenly scream outside and know if it is play or something is wrong. That scream has a nuance that defines it. So does neuro. And neuro is energy. Little elec charges used for one cell to talk to it's neighbors and sometimes they chat in groups, wrap it all up and it is called function.

I teach students to focus on observation. Take time to watch every pt and after a while you will see that nuance before it becomes a crisis. I like turning the mystery into simple functions that either work correctly or don't.

Regardless of the dicipline you will see tragedy. In those cases it is what you do to ease the burden or transition. Love em like they are your kids and you will love neurology. Like your kids sometimes they aren't all that loveable but you still do.

Oh yes, neuro surgeons can be the biggest Ass. It ain't easy for them either, especially when they can't count on you telling them what is going on. You are their eyes and ears and they are dead tired and cranky. Got to love them too and then love yourself for doing it. You are special, it ain't easy reading minds but you can do it.

K8TLittleone · Aug 30, 2008

I am a new grad (May 2008) and kind of fell in to neuro at a large Level 1 trauma center/teaching hospital two months ago. It wasn't my first choice, but I think the Lord works in mysterious ways because it's a perfect fit for me! It is very challenging, and forces you to hone your assessment skills right quick because in neuro, assessment is everything! Then, depending on what part of the brain is involved, other systems become involved that you are now taking care of in addition to the brain injury. In my short time there, I have learned ALOT about a myriad of conditions! It is sad sometimes, because your patient may never fully recover (or recover at all), but so is the case with many areas of nursing. What is really rewarding is when someone you have been taking care of for awhile that is non-verbal says "Goodmorning!" to you for the first time. It's when the coma patient suddenly opens his eyes for the first time in months while you are doing your daily assessment. Its so many of the "little victories" that make such a huge difference in a patient's life. Think about what the difference would be for you between being fed or being able to feed yourself? Sometimes it's frustrating. Sometimes it's emotionally wrenching. Often times it's incredibly rewarding! I guess all I can say is give it a try, and be open to learning. If you don't like it, you can always transfer to another area. Just want to add this: it's interesting to note that our neuroscience unit has the highest nurse retention rate in the entire hospital!

neurorn6 · Aug 30, 2008

I miss it to tell you the truth. I worked a 30 bed neuro unit in South Jersey and then moved out of state where they transported just about everything. When I first started, I was scared to death but I was fortunate enough to work with a gal who had tons of experience and she taught me so much. Also had 5 different neuro surgeons who were willing to teach. I love the diveristy and the challenge that neuro brings (see my handle). Currently working in Cardiac, love it not so much. Neuro more of a challenge. Getting ready to do ER again so we will see.

Beentheredonethat · Aug 30, 2008

Why do I Love Neuro? Boy, that is kinda like asking why you love your kids. I think it has to do with knowing that so few can help your pt but you can. It is seeing recovery from disaster. It is reaching into the dark and shinning a light. It is realizing how much you saved vs what you lost. I have been showing a GREAT video at our hospital to help generate interest and explain what the fight is all about.

The video is about a Harvard neuro anatomist who happened to have a

stroke. (bleed) She relates how she thought "how cool is this, I can study my own brain while I am having a stroke." Her story is told from the perspective of the inside of the brain while areas are being shut down, and finding out what works and doesn't work. How she didn't know she couldn't speak or understand language until she tried to talk. "Oh, my God. They sound like a golden retriever. I sound like a golden retriever. woo woo woo woh"

She relates how she went from being a left brain to a right brain. How those two sides differed in how they saw the world. Her 'Stroke of Insight' tells us what is happening on the inside while it is happening.

It is insightfull and beautiful at the same time. The first minute is background info and then the ride begins.

Goto TED.COM

You can search via title, speaker, or gategory.

My Stroke of Insight

Jill Bolte Taylor

Science and technology

Oprah found this so intriging she did an entire series on re-training your brain.

It is only 17 minutes in length. Enjoy

MDJRN · Nov 24, 2008

This thread is interesting. I have worked Medicine stepdown and ICU for 6 years so far and in January, I am moving to a Neuro ICU with some trepidation. All my career I have avoided Neuro patients, mainly because the surgeons don't have the best attitude and take a long time to answer their pages. Anyway, if there is any advice for a MICU nurse on transitioning to Neuro, please let it be known! Any bit helps.

Beentheredonethat · Nov 25, 2008

Give your self time to learn and don't beat yourself up if you don't know something and someone thinks you should. It is easier to learn the numbers associated with invasive lines etc than it is to learn the nuances of a changed behavior or response to a neuro exam. You will spend a lot of time "just observing." In neuro observation is a science into itself. At first just focus on "the change" then work in the reasons behind the change and then what to do about it. Be quick to ask for another's opinion. The pts life is worth more than your pride. You will do just fine.