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Ruby Vee BSN

CCU, SICU, CVSICU, Precepting & Teaching

Original Member of the Crusty Old Bat Society

Content by Ruby Vee

  1. Ruby Vee

    Night Shift For Newbies

    Most of us don't get much choice over whether or not we work nights, although we might get a choice about when. We also get a choice about how we handle our night rotations. There are pluses and minuses to working eight-hour shifts, to working twelves, to working straight day shift, straight night shift or rotating. That's for you to decide for yourself but here are some tips that have helped me and some of my night shift colleagues survive and thrive on the graveyard shift. Attitude is everythingYou can moan and whine about your lousy fate and getting stuck working graveyard shift, or you can approach it with a positive attitude. Guess which one is more pleasant and might possibly even be more fun? Night shift can be funOften there's some downtime (not as much as some people think) where you can sit and chat with your coworkers and get to know one another. You can pick each other's brains about what to do in case of x or y and learn tips and tricks from the experienced nurses on your shift. I met my husband working night shifts with him, and our first date was an eight am drink after work. Just us and all of the local alcoholics bellied up to the bar. Drinks after night shift got to be a Monday morning tradition and soon the entire shift was congregating for one -- or more -- drinks at the Scarlett letter. Because we got to know and like each other outside of work, we became a cohesive group and we had each other's backs. Years later, I still miss the teamwork and camaraderie. Get your sleepTake your sleep seriously. I've known more than one new nurse who regarded the days before and after her night shifts as days off and spent them cleaning, shopping or having fun. It's tempting, especially when we all know there aren't enough hours in the day but it's a dangerous precedent. Your body cannot function without sleep and sooner or later your brain won't function either. Worse, you may not realize when you're making bad decisions and overlooking the obvious. Install black-out curtains in your bedroom, invest in an industrial strength fan to block out the sounds of barking dogs and lawn mowers and take Ambien or Benadryl or whatever you need to sleep. If you cannot afford blackout curtains, aluminum foil over the windows works, although your neighbors may think you're growing marijuana in your spare time. (but that's another story for another article.) Tell your mother, your sister, your best friend and your boyfriend that 9am to 5pm (or whatever works for you) is your sleep time and you are not to be disturbed unless there is blood (lots of it) or flames. You'll have to tell them more than once and sometimes less than tactfully. Some people won't get it until you call them at 3 am to discuss your life insurance needs or to chat about your cousin Hilda's new man. If you absolutely have to be available for emergencies with children or aging parents, get a beeper or a cheap cellphone and don't give anyone the number except for one person whom you trust to recognize an emergency and not to disturb you unless it truly is one. He might not realize this, but your husband is just as capable of discussion Timmy's misbehavior with his teacher or meeting Ellen at the emergency room. Get some exerciseGo to the gym before work, swim after work or walk on your break. You know you need to do this, and night shift doesn't make it any less necessary. Eat. Eat real mealsDon't make the mistake of thinking that because it's night time you can snack all night without consequences. I have dinner with my husband for breakfast, leftovers for "lunch" at 1 am or thereabouts, and breakfast when I get home before I go to sleep. (if I don't eat, I wake up starving after far too little sleep.) That schedule may not work for you but whatever you do, eat meals and drink water. You need it. Drive home safelyIt can be done, even by those of you who are absolutely certain it cannot be, at least by you. I've driven home with the windows open and the radio going full blast, singing along with the most obnoxious songs on the radio. Getting angry helps me stay awake, hence the radio tuned to right wing talk shows. There are days I've bargained with god -- "just let me stay awake until the next exit and then I'll pull over and nap, god, honest!" sometimes I do pull over and nap -- even five minutes may be enough to get you home in one piece. Some people drink coffee and swear it doesn't keep them from sleeping once they get home, and some people eat breakfast on the way home. Figure out what works for you and do it. Avail yourself of the opportunities for afternoon coffee with your friend the stay-at-home mom on your Wednesday off or breakfast with your sister after your shift and before she goes to work. Meet your family for church at 8 am on Sunday and go to bed afterward. Chat with your friend on the opposite coast in the wee hours if you have time at work, or on your night off. You may not have Saturday night off every weekend, but you can make the most of the time you do have off. Make the most of the opportunities to look up procedures, study the disease process you're most likely to encounter in your patients or make drug cards. There's often time in a night shift to do those things that you can't do during day shift when visitors vie for your attention. Ask your colleagues at work (and on allnurses.com) for strategies that help them survive night shift, and if you have a great tip pass it along. I'd love to hear what works for you. night-shift-for-newbies.pdf
  2. Ruby Vee

    Ask Me If I'm Safe At Home

    My husband and I shared the same PCP. After my first visit to the practice, no one ever asked me again whether I was safe at home. I wasn’t. But no one asked because everyone had met my husband, the handsome, charming life of the party. The guy that everyone liked. They all “knew” I was safe at home because he was “such a nice guy.” They knew him, you see. A nice guy like him couldn’t possibly be an abuser. They only met Dr. Jekyll. I lived with Mr. Hyde. I’ve written numerous articles on the website about domestic violence, about the ex-husband who strangled me into unconsciousness and left me on the highway with the clothes on my back and my dog. I’ve written about the elephant in the room, what leaving feels like, about starting over again and about the bravest thing I’ve ever done. I lived it; I’m resilient. Thirteen years after I left my abuser, I married again. THIS time I married a friend, someone I had known and worked with for nine years, dated for more than five years. THIS time I was sure I was going to be safe at home because he really loved me. THIS time I knew I had the right person. I had known him for years; I knew all there was to know about him. And we were happy, for a time. For years. And then I got sick and I needed him. Suddenly, he was not the center of attention at all times, because I had to focus on my health; on getting better. And my happy marriage and perfect husband were never the same again. I beat breast cancer, and a serious back injury. I had two joint replacements -- he dropped me off at the hospital for the surgery and had to be BEGGED to come and get me when I was discharged. He had a bad cold, you see. It was such an effort to come to the hospital to get me. I had a post op infection and a fever that registered as “HHH” on our cheap electronic thermometer. AT one point, he actually told me, “I know it must seem strange to you, me whining about my bad cold when you have a potentially lethal post op infection . . . But it’s a really. bad. cold.” After 48 hours of me peeing every 15 minutes, he finally deigned to take me to the doctor. After he took a nice, long nap. My best friend asked me if I was safe at home, and I assured her that I was. I had lived with abuse; I had survived it. I knew what it was like and this wasn’t it. My husband, the man I thought loved me more than anyone on earth except his daughter, only talked to me to nitpick. Or criticize. Or scream at me that I was fat and useless. I was pretty useless -- I’d just had a joint replaced, I had a fever and a CAUTI and was exhausted from trying to get down the stairs to the bathroom every fifteen minutes with my cane and my brand new artificial joint. Eventually, I recovered, but rather than stopping, the screaming and the criticism just escalated. Soon he was having tantrums three or four times a day. I was tiptoeing around him, trying to avoid setting him off and trying to please a man who could not BE pleased. He was always right, he was never wrong and if I dared to disagree with him -- or even failed to agree with him quickly enough -- there was punishment. One day he opened the kitchen cupboards and smashed all of my coffee mugs. There were shards of my coffee mug collection on the floor, in the sink and in the dog’s coat. Another time, he swept everything off the dining room table -- almost everything -- and sent it flying into the next room. Just my stuff, it seems. One time I came home from work to find that he had painted the closet doors, and “somehow” got white paint on every one of my jackets. It was an accident, it just happened. He didn’t mean to. But HIS jackets somehow escaped the carnage. That winter I was always cold because I didn’t have a winter coat. HE was warm enough -- and was I harping on THAT again? He SAID he was sorry that my coats “got paint on them.” It was an accident. Why couldn’t I just get over it? My old friend asked me if I was safe at home, and I assured her that I was. I had lived with domestic violence, I knew what REAL abuse was like, and this wasn’t it. There was no perfect Ruby-shaped dent in the drywall, no purple fingerprints on my neck. I was safe. There was a letter from the mortgage company telling us that we were going to have to find another lender as one of the conditions of our loan was keeping homeowner’s insurance. My husband admitted that he had let the homeowner’s insurance lapse because, and this is really special, he was angry at me. Somehow this became my problem and I had to scramble to get the house insured. He had so many single cars or at-fault accidents that the car insurance was cancelled. I got that reinstated as well, at an exorbitant cost. Then we took a 900-mile car trip to see his daughter graduate from college, and I drove because I was frightened of riding with him. I stopped to go to the bathroom and foolishly left the keys in the car -- he was sleeping. When I came back, he was behind the wheel and raging at me because I stopped to go to the bathroom too often. For the next three hours, he wove in and out of traffic, changing lanes and exceeding the speed limit by 30 mph or more, tailgating, cutting people off, screaming at me the whole time for being fat, ugly and useless. In a deluge, with standing water on the roads and people sliding off the road right and left trying to avoid him. I was terrified, clinging to the armrest and promising God that if I lived through this, I would leave him. When we got to our destination, he dropped me off at the hotel and took off in the car to “see friends.” If there had been an available hotel room or rental car, I would have left him that night. There wasn’t, and I didn’t. And then, in a domestic violence thread on AN, one of our members recommended Patrica Evans’ book about the verbally abusive relationship. And I realized that my happy marriage and perfect husband had deteriorated into a verbally abusive relationship. “It’s not that bad,” I told myself. “I’m strong. I can deal with this. It’s not as if he’s VIOLENT. I lived with that, but he isn’t like that. But maybe it’s time he got back on his Prozac.” In an extreme act of courage -- or perhaps idiocy is more the word -- I brought up the Prozac discussion with my husband, whose depression had always manifested as anger. Get the depression under control, and he’s easier to live with. That was the night he had such a tantrum that I left “walk the dog” and was afraid to go back. Instead, I sat on a park bench in the rain and called the National Domestic Violence Hotline. They asked me if I was safe at home. I thought I probably was -- after all, all he did was scream. And throw things. And smash things. And punch things. And drive recklessly and terrify me. “Abuse is about power and control,” they said. “Verbal abuse can escalate to physical abuse. They can kill you.” But we were on vacation on our boat, in a town too small to have a hotel or an Enterprise. I got back on the boat with him, and we cast off to go to the next town. My husband went to his PCP and asked for anti-depressants. He was referred to a psychiatrist. For Prozac? Or Zoloft? I wasn’t sure he needed that. Turns out I was wrong. He came home from the psychiatrist's office, a study in rage. “That guy doesn’t know a thing,” he raged. “I am NOT a narcissist.” He was kicking the punching bag (a safe enough thing for him to kick, I thought) and I went to “walk the dog.” Only I was too afraid to go back, so I sat on the bench cleverly placed at the school bus stop, and cried. A neighbor lady sat down next to me. I had nodded at her at the mailbox but had never talked to her, unlike my husband who frequently stopped to talk to her and her husband when they were outside. “He’s a narcissist,” she said. “Run.” Who was this woman to tell me my husband is a narcissist? She’s the clinical psychiatrist who lived a house over from us, and who could easily hear his rages through her open windows. She started the domestic violence program in our state -- and in another state. She’s an expert. She knows. “Are you REALLY safe at home?” She asked. “Really?” “No,” I had to admit. I wasn’t really safe at home. Just the other day, my new PCP asked me if I am safe at home, and I assured her that I was. I am, you see. I left my husband, the love of my life, with what I could carry and my dog. I rented a car and drove a thousand miles AWAY. I’m safe here. I’m living with a generous friend who lost her husband to cancer. I have my own bed now, and a bed for my dog. I bought a car last year, and this year the divorce is final. I don’t have much, but what I do have is MINE. I don’t have my house, or my lovely dishes or my leather sofa or any of the things that I once thought were so important. But I have me again, me without the soul-crushing load of abuse. I’m getting my sense of humor back. One day it will be my superpower again, but for now, my superpower is resilience. Really. I am finally safe at home. Ask your patient if she is safe at home. Even if her husband is handsome and charming; even if you KNOW him -- he works at your hospital, he's a good guy. Because perhaps you've only met Dr. Jekyll and she lives with Mr. Hyde.
  3. Ruby Vee

    Ask Me If I'm Safe At Home

    Good on you for going no contact! You're mighty!
  4. October is national Breast Cancer Awareness month. It’s also Domestic Violence Awareness month. I wish I wasn’t, but I am very aware of both. Running Away... Two years ago today, I was driving northwest and crying most of the way. I’d want to take the exit ramp -- nearly every exit ramp I passed -- and turn around and go back to my home, back to my husband. But I didn’t. That was unexpectedly strong of me, because going back would have made things far worse for me. It would have signaled to him that I had no boundaries; was willing to put up with whatever he dished out. That wasn’t the sort of message I wanted to send. Running To... If I could have known then how much better my life without him would be, perhaps I wouldn’t have had such difficulty running from him. I could have been running to something instead. I *was* running to something; I just didn’t see it that way at the time. I was running to a more peaceful life without an abuser always nitpicking, criticizing, blame-shifting, gaslighting and having tantrums. Without an abuser who constantly threatened my safety, my very life. Maybe it’s OK that I didn’t know; life requires taking some risks. You don’t always know what will happen when you step off that curb; but you have to step off it anyway or you’ll be frozen in place. Probably as apt an analogy as any. Why? It was difficult to identify what was happening to me. We were happy in the early years of our marriage. I thought so, and he said so. Things changed when I was diagnosed with breast cancer, and not in the way that I would have predicted. My husband -- let’s call him “Mac” -- reacted by going to the Medical Library and looking up “breast cancer,” reading everything he could about diagnosis, treatment, prognosis -- medical stuff. He’s a nurse. I reacted by reading about all the “soft skills” surrounding living with cancer and its treatment -- having your support group, how to secure the drains inside your surgical bra and what questions to ask your doctor. Mac insisted that my treatment be at the large teaching hospital where we both worked as opposed to the smaller community hospital I preferred. (I had a strict policy against being naked where I work.) I went along with him because things would be tougher on him, as the caregiver, then they would be on me. After all, I would be unconscious during the surgery and already had my prescription for Ativan. Mac accompanied me to every appointment -- every lab draw, every MRI or CT, every pre-op visit, post-op visit and of course, the main event. He invited two women who were friends of his to wait with us in pre-op holding for me to go to the OR. I went along with that because this would be tougher on him, with the waiting, than it would be on me. I would be unconscious during the surgery, and I already had a dose of Ativan. It took me a long time to notice that all of this “support” I was getting from him was really his chance to show off to the people we knew at our hospital about what a good husband he was being, a chance for him to get attention and support from his friends and colleagues in radiology, in the outpatient center, in the department of surgery (where he was a nursing supervisor) and all over the house. In fact, he wasn’t so much supporting me as controlling which questions I got a chance to ask -- in fact whether I got to ask questions or whether he took up all of the appointment time showing off and talking a mile a minute. While I was in a room with three-foot thick walls with radiation bombarding my left chest, he was chatting up and flirting with the women in the waiting room, at the reception desk, passing through. I’m slow that way -- I was still operating under the assumption that we had a good marriage. He had always said so; I had always believed so. Narcissistic Abuse If you’ve ever read about narcissism or narcissistic abuse, you’ve read that the cycle consists of love bombing, devaluation and discard. I’d had a really long run of love bombing, where the narcissist convinces you that you are the only person for them, that you’re wonderful, everything about you is perfect and that they are truly, deeply, madly in love with you. The mask dropped the day my oncologist pronounced me a “breast cancer survivor” rather than a “breast cancer patient.” I wanted to go out to dinner to celebrate my good news. He said maybe lunch instead, and then spent the entire meal criticizing my lack of energy for housework and cooking, calling me “lazy” and “useless.” Narcissists will treat you like gold in public; in private things are different. If I expressed concerns about any of his behavior, I was “jealous” or “a shrew” or “crazy.” Overnight, he became cold and uncaring, nitpicking and criticizing me constantly while refusing to be accountable for anything and making wild excuses for horrible behavior. I rationalized all of this by telling myself that caregiving was very stressful, and that he had had it much worse than I had. After all, I slept 20 hours a day. I was in survival mode, and let some of the worst behavior go. One day I was scrolling through my Facebook feed and got announcements that my friend Mac had just friended “Fawn” and “Lola” and “Windy,” with accompanying profile pictures of three women wearing not all that much and posing in very suggestive ways. (Mac said he didn’t know how they got there, and made a big show of unfriending them.) After the breast cancer, there was my mother’s descent into dementia to deal with, and then I had knee surgery and then Mac retired. I was still working, trying to make up for all of the time I had lost to medical leave, all the deposits that hadn’t made it into my 401k. Things got worse at home. Mac had long since moved out of our bedroom, and criticized me constantly. He presented my strengths as weakness and constantly compared me unfavorably to other women. My chest “used to be spectacular,” and he liked me better with long, straight blonde hair -- not the short hair that grew back curly and brown. He spent thousands and thousands of dollars, draining money from his 401k, and I knew nothing about it until the letter from the IRS arrived. “We” had underpaid our taxes by thousands, underreported our income. I had no idea where the money went, and asking Mac triggered the scariest tantrum I have ever seen. When I got the letter from our mortgage lender telling me to find another lender; homeowner’s insurance was a condition of our mortgage, Mac told me he had deliberately let the insurance lapse because he was angry with me. “I asked you for more money,” he said, “But you didn’t give me any.” (What I remember saying is that I didn’t have any money to give him until payday next Friday). He had sabotaged me at work, smeared me to his “friends” and acquaintances at the hospital, convinced everyone that I was crazy, jealous and controlling. I was constantly walking on eggshells at home, trying not to set off another temper tantrum and trying futilely to please a man who refused to be pleased Looking back, Mac’s behavior seems clearly abusive, but I couldn’t see it as such. At least not until he deliberately put me in a life-threatening situation and then sat back smirking when I got injured. And even then, it wasn’t until the SECOND time that the pieces slowly shifted into place and I realized that I had been suffering verbal and emotional abuse for years, and that he had escalated into physical abuse. Making the Right Decision Two years ago today, I left my home, my husband, my marriage with what I could carry, and my dog. I had no job, no home, no family, no car, no church, no community. What I did have was determination, an Enterprise (car rental) account, and a friend living a thousand miles away. My life is much better now. I have an interesting, challenging job in my new city. I’m happy again. I paid off the bills, saved my money, bought a car and filed for divorce. I don’t have much -- the collection of Revereware, the leather sofa, the beautiful home that all seemed so important to me once upon a time are now things of the past. But what I do have is mine, and mine alone. Starting over again in my 60s is so much more difficult than it was thirty years ago when I left the first abuser. I’m older now, but I’m wiser. And I finally have some peace; home is a refuge rather than a battleground. Breast cancer is not the worst thing that ever happened to me. Domestic abuse was.
  5. Ruby Vee

    Your most bonehead moment in nursing. Or 2. Or 3.

    At least it wasn't TPN, which is so sticky there was still a sticky patch on the floor months later, and I overheard a colleague telling the medical student, "Yeah, that's where Ruby had a little accident with TPN . . . and over there, that brown stain -- that's where Ruby started the blood without plugging it into the patient."
  6. Ruby Vee

    Your most bonehead moment in nursing. Or 2. Or 3.

    At my first ICU job, all of the patients got Metamucil down the feeding tube. It was tricky to administer -- you had to mix it with cranberry juice and then give it quickly, before it had a chance to congeal. But very few of our patients had tube-feeding induced liquid stools. In those days, we put blue food coloring in all tube feedings, so the stools would come out looking like little round, rubber bouncy balls. Our unit was 8 beds, fairly close together and surrounded by privacy curtains that ended about a foot from the floor. I'm sure you can guess where this is going. My friend and I were cleaning up a patient, and set the used bedpan at the end of the bed, where the patient promptly (and most likely accidentally) kicked it off the bed. Those little blue turds went bouncing out of the bedpan and under the curtain, where they bounced across that patient's area, surprising a visitor whose shriek caught everyone's attention, then rolled two beds over. The worst part was going from bed to bed, looking for errant bouncing turds. And then there was the time Dr. Worldfamousinfectiousdiseasespecialist came walking into my patient's cubicle for a consult just as I was pushing liquid Tylenol -- that obnoxious red stuff -- into a feeding tube that turned out to be clogged. I sprayed myself, the patient and Dr. Worldfamousinfectiousdiseasespecialist with bright red, sticky liquid Tylenol. The patient was pretty forgiving, his wife thought it was hysterical but Dr. W was decidedly NOT amused.
  7. Ruby Vee

    265 questions is almost guaranteed if your a male.

    Your quote actually stated that the pay gap is not a myth. Which was my point.
  8. Ruby Vee

    265 questions is almost guaranteed if your a male.

    While I have only anecdotal evidence, I'd say it isn't false propaganda. I worked in the same unit with my ex, hired the same day. I had a Master's to his diploma and five additional years of experience. Union hospitals, set pay scale. They still paid him more. And then there was the first nurse I married -- we both had BSNs, but I had significantly more experience -- we worked in the same unit, I had a year of seniority in the facility -- and he made more. I did the taxes; I saw the pay stubs.
  9. Ruby Vee

    265 questions is almost guaranteed if your a male.

    Men still get paid more -- per hour -- at union facilities where pay is based on a set scale. I know because I've been married to two nurses, both with less education and less experience than me in four different union facilities and in each and every instance, the male's hourly rate was higher. I did our taxes; I saw the pay stubs.
  10. Ruby Vee

    Discouraged New Grad

    Thanks!
  11. Ruby Vee

    Bullied nurse. I quit. :(

    Thank you for your input.
  12. Ruby Vee

    Discouraged New Grad

    Thanks for the shout-out, Rose_Queen, but I cannot seem to find that article on the new, improved forum. I know some of my articles didn't make through to the new site, but I don't know which ones. And I cannot remember how to look for my own articles, so when I have more time, I'll try again.
  13. Ruby Vee

    I am not good at nursing

    If you started out your tenure on this floor talking about how you didn't want to be there, that is insulting to the nurses who DO want to be there and who are teaching you to function on that unit. Then you compound it with bragging about how you're going on to be a midwife . . . bad moves. Really bad moves. Managers and preceptors don't like to be told, especially from the get go, that your heart isn't in it, that you don't want to be there. Of course they think they're going to spend the time and effort in training you and you're going to bolt at the first opportunity -- that's what you've TOLD them. You have no business raising the specter of of bullying when you are the one who created the "toxic environment" in the first place. If your workplace relationships are poor, it's because you started out heavily on the wrong foot and then continued to compound your disrespect of your colleagues. Being shy has nothing to do with it. As far as "standing up for yourself," your colleagues probably heard you saying you're better than them. Whether or not that's what you actually meant. Your major problem on this unit isn't that you're a bad nurse or the medication error you related to us; your major problem is that they don't like you. And that, my friend, is entirely on you. Mistakes are forgiven more easily by coworkers and managers who LIKE you; people are more willing to help and teach those they LIKE. On the other hand, if you're viewing someone's work through a lens of DISLIKE, it is easier to find fault, more difficult to overlook mistakes and remediate. Your problem is that your workplace relationships suck and you don't get it. You're going to take that to the next job and the next, complaining of bullying and toxic workplaces unless you own your part in the dynamic and fix it. Please don't make the mistake of dismissing my advice because you don't like it, although I am certain that you won't. I was that employee who created my own toxic environment at work until someone far wiser than me took me aside and talked to me about what I was doing. I was that one employee that people didn't like unless they got to know me, and they weren't going to bother to get to know me because I wasn't likable. I turned it around with the help of a very wise (and brave) orientee. (Thank you from the bottom of my heart, Judi!). You have the power to turn this around, to go to your next job and create positive workplace relationships. You have the power to humble yourself, ask for help and accept negative feedback and turn things around at your present job, although that will be much harder. I did it, you can too.
  14. Ruby Vee

    I am not good at nursing

    I agree that she may be better at teaching than as a bedside nurse, however she lacks experience at the bedside and this would diminish her credibility as a nurse. I'm not even certain she could be hired to teach without a graduate degree.
  15. Ruby Vee

    I am not good at nursing

    I must have missed where the culture was toxic. Perhaps, like all of us, you are viewing the original post through your own lens. Viewing the culture as toxic (not my fault) takes away from the introspection that might lead a new nurse to examine her own contributions toward her workplace relationships, whether they're negative or positive. That would be a mistake. And giving a list of complaints to people at the highest levels of hospital management isn't going to help advance a nursing career. It might even get you blacklisted. That can be a real problem with hospitals buying each other up and health care systems gobbling up all of the facilities in an area. I fail to see "unlimited potential" in this very brief post, and "unlimited zeal" is a major stretch. I fear your advice, as much as anything in the OP's workplace, is toxic.
  16. Ruby Vee

    What was nursing like in the year of 2000?

    I don't remember exactly when we went from paper charting to the electronic medical record -- I suspect it was in the late 90s. I cannot believe how much easier it was! Instead of calculating SVR and PVR by algebra, the flowsheet calculated it for us! It calculated drip rates, totaled I & O and made the medical record visible to a surgeon at a conference in San Francisco as well as to the physician sitting outside another patient's room in another ICU. Before the EMR, we totaled our I & O on a paper towel before entering it on the flowsheet. Everyone carried a calculator in their pocket for calculating drip rates, body surface area, converting pounds to kilograms and back, etc. There was only one flowsheet and often five or six people who wanted access to it at the same time. (My favorite was the doctor who grabbed the flowsheet out of your hands and then quizzed you -- "what time did you turn up the dopamine? What was the K+ at 3am? What was the pCO2 when you made that ventilator change?"). Computerized charting, computerized medication access (rather than carrying the narcotic keys around and hoping fervently NOT to be the one holding them at change of shift when count had to be done) and email were the biggest changes in the past 20 or so years. Email was a big game changer, too. Instead of those paper notices clogging up a tiny physical mailbox on the unit, all of those changes in policy, introductions to the new house staff, cautions about drug shortages and complaints about how someone was rude to the blood bank were in an electronic inbox. You could ditch the ones you didn't need and keep the ones you did, then pull them up when you needed to know the new phone number for the lab or the name of the new chief medical resident. When hospitals started putting their policies and procedures on line, that was fabulous. You used to have the policies in "policy books" which were 20 pound binders. Things weren't always filed as they "should have been" and you might find the policy for patient elopment under "e", under "p" or under "a" for AMA. Or you might find it misfiled under "q" because whoever pulled it out last didn't put it back where it belonged. A searchable online policy and/or procedure manual was a real game changer. I could ditch my thick binder with copied policies or procedures (useful when precepting) and just show my orientee how to look things up on the intranet. Along with tons of other useful stuff, like the formula for calculating Fahrenheit temperatures from Celsius, the policy for incarcerated patients or how to use that shroud that comes in the death kit. (And we didn't need the formulas anymore with the EMR.) What else has changed? Health care has become more of a business, more concerned with the bottom line than ever before. The "customer service" craze happened, and hospitals were sending managers to Orlando to study the Disney model. Seriously. Suddenly, making patients happy became more important than helping them get well, and complaints about not getting the third Dixie cup from a patient hospitalized with DKA and not getting a cheeseburger from an NPO patient were seriously entertained. Visitors became more concerned about their "right" to be in the patient room than with what the patient needed, or about supporting the patient, and their complaints were taken seriously. You can't just eject a disruptive visitor; and if you try, you have to explain it to management. (Even if they're carrying knives and guns, which was rare 20 years ago.) IV pumps became smarter (and more plentiful). We had ventricular assist devices, first to bridge to transplant, and then as destination therapy. Telehealth is a thing now -- it was in its infancy 20 years ago. We have new drugs, insulin pumps, continuous blood gas sampling . . . too many wondrous inventions to name. Devices have become smaller, and things we never dreamed could be computerized have been. Now if you want to know about changes in the past 40 years, I got stories for that.
  17. Ruby Vee

    I don't know if I want to be a nurse anymore :/

    Suck it up and stick it out. There is lots to learn in post partum, and as you learn more, you may like it more. It takes about a year to be confident as a new nurse or in a new specialty, and about two years to become competent. The more competent you become, the more you like your job. Usually. I think you may have even grown to like Med/Surg if you hadn't made up your mind "right off the bat" that you weren't going to.
  18. Ruby Vee

    What one law would most improve nursing?

    How about making it a felony (in ALL states) to assault a health care worker doing her job? Staffing ratios are controversial, but surely it shouldn't be argued that it's a GOOD thing to throw a chair at your nurse because she brought you green jello instead of red, or shoot your physician because you don't like Mom's diagnosis.
  19. Ruby Vee

    I am not good at nursing

    At six months, you're not going to be good at nursing. It takes at least a year -- sometimes two -- to become confident and competent. Being "nurse on the floor smart" is critical thinking, and if you cannot do that graduate school isn't going to help. We don't need book smart CRNAs or NPs who cannot think critically. But I'm not convinced you cannot become "nurse on the floor smart." At six months, it is too soon to tell. What did you learn from your medication error? What have you learned from your other errors? If you are truly smart, you will learn something from each error you make. Keep learning, and you'll become a good nurse. You don't say you've been fired or asked to resign, so I'm hoping you still have a job. Take some time and a hard look at yourself and your practice and decide how you can best learn to improve. And then work on that. I was a horrible nurse for about my first year, but with time and practice, I got better. You will, too.
  20. Ruby Vee

    IS THIS HIPAA ??? Being harassed for reporting ...

    This is several shades of effed up, but I'm not seeing the same problems you are. First, if the photo shows a resident in an institutional setting, it is a HIPAA violation. Unless the resident has signed off on having this photo posted on social media, it's a no-no. In fact, it ought to be a no-no anyway, because everyone who has any sense knows better than to do such a thing. Instead of talking to the CNA, who might possibly be clueless enough to post a photo showing a resident where he works, the nurse copied it off the internet and sent it to the bosses. That's a cruel and selfish action. An honorable nurse would have first talked to the CNA, then if there was no action, TALKED to the bosses instead of just sending them the photo. (And what difference does it make whether the nurse is male or female?). You don't know whether or not there has been any disciplinary action taken against the CNA because disciplinary actions are private. The biggest issue is the CNA's threat against the nurse. That is clearly wrong, but again, the first place to address it is with the boss. Only after addressing it with the boss do you go to HR. Bosses don't like being blindsided like that. As far as suing, sue for what? Because the CNA was foolish about posting on social media? Because you think the bosses ought to have done something different from what you think they did? Because the nurse was stupid enough to send possibly HIPAA-challenging photos around by email? Get yourself a new resume and start shopping it around, because I don't see any good workplace relationships for this nurse.
  21. Ruby Vee

    Confused

    You've been at your current position for under 3/12? Does that mean less than three months? Your post isn't particularly clear, and I would encourage you to do some proof-reading before posting. Your written communication skills aren't super, and this is as good a place to practice them as any. You have not described anything that even resembles bullying -- only some negative feedback in a meeting that you asked for, and with which you do not seem to disagree, and that someone doesn't seem to like you much. There's a big "click" (I think you meant "clique", but I'm just guessing here) that you aren't apart of. Do you mean that you aren't a part of the clique? Or that you are not apart from it? Which would mean, I guess, that you ARE part of the clique. What does that have to do with anything? It certainly has nothing to do with underperforming, which seems to be the issue here. If you like your job and want to stay, then you need to work on your performance issues. The clique has nothing to do with that. Hopefully you and your boss discussed very specific areas in which you are falling short and what you can do to remedy that. You also need to work on developing positive work place relationships. Whenever someone complains that "nobody likes me" I think it is probably, based on my own experiences as a new grad, because they just aren't likable. You aren't a new grad, but you are new the the specialty and you've admitted that your experience isn't all clinical. I was so afraid of messing something up that I double, triple, quadruple and quintuple checked everything, excessively and obsessively rechecking, becoming unnecessarily stickler for the rules, and not taking time out from all of this checking and rechecking to talk to any of my colleagues unless it was to ask them a question I had probably asked a dozen times before. They didn't like me. There was no reason for them to like me. I wasn't likable. As I grew into my job, I was able to relax somewhat, and I began noticing my colleagues. I started saying hello, smiling at them (which I was too anxious and intimidated to do at first) and asking about their weekend or their prize winning roses or their kids. Gradually, they started to act as if they liked me. It wasn't them, it was me. I'm thinking that it's not your colleagues, and it's not bullying. It's probably you. In addition to working on your performance issues, you need to work at being friendlier. Smile at people and say hi first. TALK to them. You don't have to say much -- just ask them about themselves. It only takes a minute or so, and it pays off big. That's not "playing the game." That's just good sense.
  22. Ruby Vee

    Name for New Grad/New Hire Newsletter in ICU

    Why not develop a newsletter for everyone in your ICU? Think team building, positive workplace relationships for everyone and a great, fun way to disperse information about new policies/procedures/equipment/etc. so that everyone is on the same page. Have an "Introduce the New Employee" column, and once in awhile feature the Crusty Old Bats, too. After all, we're people too and I'm sure there are things about us you might find interesting.
  23. Ruby Vee

    Bullied nurse. I quit. :(

    Oh for pity's sake. You drag up an ancient post to espouse a self-serving misogynist viewpoint. There is no more bullying in nursing than there is in the general population, and nurses have no interest in making others feel miserable, fail, or anything else. That you proclaim such a viewpoint says far more about you than it does about all of these other people with whom you apparently are not able to get along. Learn to develop positive workplace relationships. I'm sure you will feel far less miserable, and the issue won't be "tearing your life apart."
  24. Plan to stay in Med/Surg for at least a year; two would be better. It takes at least a year to learn the things you need to learn there. I know you said you were in “post acute care” before your three year hiatus from the bedside. Is that long term care? Rehab? Would Med/Surg be a refresher for you, or are you going to be covering a lot of new ground? Most CRNA programs require at least a whole year of ICU before applying, and many of them won’t consider less than two years. You’ll be gathering recommendations for anesthesia school as you go, but consider that you might actually LIKE Med/Surg or ICU and want to stay.
  25. Ruby Vee

    Wise One Liners

    I forgot this one, which was my signature line for years: ”Half the world’s population has a below average IQ.”
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