Indy

What makes a glove sterile is not how it fits, but how it's sterilized. That lady is handing you some weird BS, in my opinion. My hands are tiny, and maybe some XS non-sterile gloves fit decently, but it would take a size 4 sterile to fit me. I put in foleys and such just fine with whatever comes in the package, and take a size 6 unopened in case I do something dumb just to the gloves. I've seen many folks put foley catheters in with the glove fingers hanging off looking loose, it can be done even if the things don't fit. And patients will not be upset if you have funny-looking hands, they will be impressed that you are able to function and overcome your issues to help people. Honestly I don't know what kind of people they get to teach these days but the Dean needs to have a less discriminatory attitude. The things that will determine how people respond to you are your ability and your confidence. It sounds like the woman is projecting her own problems and needs to hush and let you learn.

You could call them and ask, since they made the job offer, would another unit in the hospital consider hiring you? It's worth a shot.

I'm not too keen on the chloroform, but the rest of it sounds like it would do the trick. I'd wake up three days later, on earth or in heaven, and presto! Cough is gone!

My favorite song to hear on the way to work: "The ****** is Back" by Elton John. And sometimes I mangle a Johnny Cash tune: "golightly on the ledge babe, golightly on the ground... I'm not the one you want babe, mag citrate's where it's found" Last week I had "mister hanky the christmas poo" stuck in my head. All the patients were serial poopers.

Tell your coworkers to mind their own business, wear something that moves with you when you bend, squat, walk etc and does not ride up or fall down, and wear a top that comes down to about the hip line so that it camouflages it a bit. Whatever that winds up being for you, buy it, wear it, and ignore what folks say about your weight; if it were easy to lose weight everyone would be the size they want to be.

Also in the epic category: a 3 way foley to irrigation that just won't run clear, no matter how much you dump in there. It drives the tech crazy to hear "do NOT touch my foley tonight, I don't care what you see. I can't keep up with it if you do." Then trying to convince the day shift that the I's and O's total greater than thirty LITERS is wonderful. They keep looking at you funny.

Hm. A Bard bag with a urometer will hold 4800 cc of urine. Granted, it will be completely round and the urometer will be sticking out and pointing up, but it will hold. Will the hanger-do thing stay on? No. I know this because I helped empty a coworker's patient's bag and was quite impressed. Also not fun is when they call a code while you're emptying, resulting in wet shoes, your head being bonked on the bed, and having to come back a half hour later to mop up the mess on the floor and finish emptying the foley.

Once I was in home depot with my hubby and he said "it sure is quiet in here"... and I chastized him for it. "Shh! don't SAY that! I like it this way and now it won't be!!" He looked at me really funny and said, ok honey but we're in a STORE. I said, yes but now some old dude will wander in with an oxygen tank and fall out right in front of me and I'll be at work again! The word knows I'm trying to enjoy my day off!

I have used Horizon, really old brown Baxters, the colleague- both the triple channel ones and the single channel ones, and now use the sigmas by Baxter. Horizons were ok, except the big "pillow" magnet thing in the middle of its lines would do an annoying air trap during priming that made you need to beat it half to death to get the air to a point where you could aspirate it or re-prime it. The Colleague were very annoying in that they even MADE a single channel pump- I mean why make it weigh 15 pounds and be a foot tall if it could be 3 inches taller and hold 3 lines?! Plus they had recalls for dumping fluid and I did see some that I suspected were doing that during pressor infusions. The sigmas are okay except that sometimes I have to put up a cheat sheet and program it in basic fluid mode to get it to do what I want; levophed and nitro should not have a max dose. The max is either symptom reversal or black hands and feet... and that isn't something the pump can know. I like that they are small, and I like that our facility has poles with the power strip built in that are made to hold 4 pumps. In reality we can put about 6 on one pole but it gets a bit interesting with that much going on. I haven't met a pump yet that doesn't beep and annoy people. But yeah, the sigmas have an upstream occlusion fetish.

Having worked with a number of couples that worked together, I have yet to meet one that was functional. And by working together, I mean same shift, same unit, same days. There is always one that does a larger portion of the workload, it may or may not cause drama depending on how things happen. One factor that is outside the couples' control is how other people react to them. I was my husband's boss when we met and I am glad that I changed jobs shortly afterwards; we thought it was workable but really, we had to change our minds. (It was not nursing. This was prior to nursing school for me.)

Marla, I have faith that you'll get through this okay.

People are afraid to deal with mental issues because they aren't an easy fix, and out of fear, but also from denial. "That is not me, that is not my family, that is dangerous, etc." Then they get upset when it affects them or someone they love and people still have the same responses they once did. People don't change easily. I come from a large family full of mental issues. We have alcoholics, one known suicide, many attempted suicides, at least two schizophrenics, at least two autistics, a whole bunch of drug addicts and some that just haven't been classified but surely need to be. My current adaptive measure is to take care of my daughter, who is autistic, and to ignore the rest of them, because one is about all I have the patience for, realistically. And that includes my nutcase of a mother. I would like to be understanding. Right now, I am supportive of disabilities that include the autism spectrum and mental retardation, and it's lovely to help folks "be all they can be" and see them start to develop a sense of purpose in life. I am regularly in contact with folks who have all the other issues, as they don't have good support systems and self medicate, and wind up in my ICU with problems that ultimately, hark back to mental illness and their inability to deal with it. All I can do is adapt in how I respond to them, attempt to suspend judgement and try for the barest of behavioral contracts with them: I'll be nice if you be nice, and this is what the rules say, etc. I will say that I see parallel, but not the same, types of reactions with regard to other chronic, currently incurable conditions and having been smacked in the last year with RA, I can see why nurses don't routinely share their struggles with other nurses. My patients are more understanding of my issues than my coworkers. I don't talk to all of them, but when I start to preach biofeedback, I reference that I have a reason to be concerned about how I personally take pain meds, and this is how I manage and stay away from a narcotic dependency, at least for this year. Most patients love to see a nurse working who is human, who overcomes adversity to help others. It's inspiring. Only once have I heard of a nurse discussing their own mental struggles with a patient, and it's because that coworker shared with me the gist of their conversation after the patient was, later, successful in her quest to leave this life. I don't think that nurse has really processed how to feel about it, and may come back to it time and time again, but that's just my guess. That is where the parallel breaks down; those with MI feel that maybe no one, patient or coworker and likely not even family, will understand the issues. I certainly don't; the closest I've come is a reaction to prednisone and I knew at the time that the effect would be temporary, although it was really interesting. I'm at risk for any of the things that my family has in their history, maybe not schizophrenia or autism since I'm middle-aged and would have been diagnosed or dysfunctional before now, but certainly addiction, depression, those are still things that could come around and visit. I don't know why I can't understand, except maybe that it requires personal experience to do so. All I can do is try to accept. Those that deal with these things personally, know that I am thankful for your honesty, and I wish the gap could be bridged more successfully.

I am one of the nurses who tells people they are not supposed to be "pain free" at all times. I tell preops they are going to have pain, but we will try for taking the edge off. I tell postops it's supposed to hurt. I tell chronics you aren't supposed to feel "good" after you take pain meds, the best you should hope for is neutral and the ability to function. If you feel really good, you took too much. I preach biofeedback till I am blue in the face, people do not want to listen. I can't make a dent in this problem, but I take my own advice, and I guess that's the best I can do, is to keep working, and to keep talking in case someone accidentally listens.

Tell them a written report will help you get your shift started sooner, and save them from having to interrupt you once you have gotten started?

There have been quite a few that were memorable. My first DIC patient I wound up sharing with another nurse, we did hour on, hour off for him- the hour out of the room we would snack, pee, chart and watch telemetry a bit. The hour in it was drips, give all the blood products, etc. I actually enjoyed that shift because we made a good team and we made progress with the patient, and never before or since have I been 2 nurse to one patient, no matter how sick they were. Then there was the night the 15 year old crackhead tried to kill us all (if you believe what he was screaming) and the floor nurses thought I was doing chest compressions when they answered the code button. We just needed warm bodies before the police could get there, and that was not cpr, it was me trying to hold a dude down. It was one of three nights in my whole life that I had a cigarette when it was done. Supervisor was not helping with other issues and the doc wouldn't sign off on this healthy psycho so he could go to jail; I just called the hospital DON at home, at 6 on a sunday morning, and said oh my god please help me. Help happened. My ICU boss was on vacation far away or she would have been there in a hot minute. Then there was the night on telemetry that everything went wrong. Let's see, the whole floor was full of about 100 plus visitors due to a traumatic, messy death in ICU, oh yes and in the middle of that right before our shift, a non-related lady coded in their waiting room so the tele nurses had to do that code, because she fell out due to the news her husband had died in ICU right along with the other lady. Ok. Before, during and after report every minute someone stopped us to say "how or where is XXXXX?" which was the very traumatic death in ICU. Holy cow. Then one of mine went psycho, thought I was his dog, took two IV's out and kept trying to PET me and take me for a walk. No. We had to call in a nurse just to be his nurse and tie him up good. Blah. A belly doc who had been in ICU walks into one of my pt's rooms with his toupee on sideways and blood all over him, says "ok we ready for surgery tomorrow? great!" and scared the bejeesus out of her. Not to mention all these shenanigans were LOUD. A mean, old, crabby CHF'er was found screaming in her room for folks to be quiet and find her daughter. The supervisor somehow collapsed in a laughing heap, tears running down his face outside her room, so much for help! I got her meds like, around midnight along with foolishly promising her that we would indeed quiet down. As soon as the words left my mouth I hear more screaming down the hall, come out of the room and the fire doors are shut. Hm?? I went and opened one and was yelled at "don't do that the bats will get back in!!" What the heck. The hospital does have a bat problem from time to time, and one got loose and was chasing the nurses up the hall from one end of our floor to the other. Somewhere on the other unit a heart patient was very upset that the nurse flung his door open to run into his room in the middle of the night all out of breath and wide-eyed, then refused to explain and walked back out a minute later. Hm. We all joked that if a baboon came charging up the hall next, it would not be a surprise. That one's probably the best story. I can wait a long while to have a night like that again.

I recommend the Sylvia Rayfield books- one on meds and one on basic nursing. I recommended them several times, to folks who didn't pass NCLEX the first time. They passed using that course. This is only good advice if there is still time to take the test, I don't remember how long they give you.

Fruit of the Loom long sleeved tee shirts are comfy and do help. Also LL bean makes silk undershirts if you have a pricy budget (I don't, well I might could try one but I keep forgetting about them.) Uniform stores sometimes sell jackets out of fleece, I've seen them.

I got influenza A this year from a patient, and gave it to my husband before either of us knew what hit us. Our entire household was vaccinated. It wasn't a good week. I shudder to think how it might have been with no vaccine. My daughter took one look at us and said "oh no" and got out bleach wipes for the bathrooms and the kitchen. Then she promptly stayed away from us. Smart gal.

I've seen patients get 80 mg IV Lasix as an IV push, given over oh, ten minutes or so... Of course for those patients, there was backup potassium ordered. There should have been as well, for your patient on a Lasix drip. It takes a day or two to get over the adrenaline rush (bad rush, it's scary as heck) of a med error but just analyze, remember how you made the mistake and avoid doing that again. You are doing fine. You caught it, figured it out, reported it, fixed it, didn't kill the patient, and the next step is to go back to work and hold your head up, and just work. It'll be all right in the end. I misread a computer printout from a dinosaur system when I was brand new, checked it twice with my preceptor, and gave mag citrate to a dude who was only gonna have an upper GI and only needed to be NPO after midnight. What a fun night. Lesson learned: don't be in too big a hurry to make someone poop all night, make sure they REALLY need it first. I was embarrassed, the patient was 10 lbs lighter in the morning, but it all worked out. Edit to add: they fixed the computer instructions very shortly after that.

And on the practical side of things, don't put solidifier in a full container of nicely acidic bile from the suction thingy on the wall. Seriously. Dump a little down the toilet first, or you'll get chemistry in foamy puddles, then when you're done cleaning it you get to use chemistry to get the stains out of your whites.

I have learned to ask people to differentiate by saying, ok so does it make you itch, get a rash, or does your throat swell up and give you trouble breathing? If yes, allergy and that's that. If the answer is no, say ok what do you not like about this drug? Sometimes they dislike the effect for a good reason, example I dislike taking muscle relaxers with my blood pressure meds because well, they're too strong in combination. Or, they don't seem to work. Sometimes the patient dislikes an effect that turns out to be an atypical adverse reaction, and I put it down as allergy with explanation, because the pharmacy doesn't allow us room in the computer for "atypical adverse reaction," only allergy. I'm sorry the response isn't cut and dried and easy, but people aren't easy, they are pretty complex sometimes. Edit: I have to tell you the funniest allergy I have EVER seen. The allergy tape on the chart read: (long list of drugs, blah blah blah, THE COLOR PURPLE.) We were all like WHAT?! Do they mean purple nitrile gloves?? Then we read the History and Physical, and it's there in print, patient is allergic to blah blah blah and the color purple. We asked the doc in the morning and she was quite annoyed, crossed that out and initialed it, and said some people were talking too loud while she was dictating and no, the patient was not allergic to purple.

I have had a lot of experience with quads, ALS, etc. I dread them, I find out as soon as I can what things they are picky about and how they want "it" done, it meaning everything, and whether or not they have autonomic dysreflexia and how it manifests for them if they do. (That's really important, don't put a dude on pressors or fluid overload if their bp is normally very low.) Then we work hard and try to get things done. What I've discovered is that you can't care for them without listening, comfort is almost more important than health, and scheduling appointments and laundry lists work for most of them. As in, I'm coming back in 1 hour, when I come what do you want me to bring? and write it down. One of my pickiest laundry list patients ever was just a little short, fat, cardiac cripple who the staff always took turns caring for. I wrote the laundry list in my pocket notebook as she said it. Then went to the whiteboard and put "long term issues" up and out of the laundry list, wrote all the things I could not get done in one shift. As consults were ordered or whatnot over the next few days, we checked off items (in that we addressed them, not that they were resolved) and as I did items that shift, I checked them off. The morning came and I showed her I was done with her short list, and we were good. She was so pleased that I had her two more nights. In that time, I had my first dying patient, my first hospice patient, (not the same thing unfortunately for one of them) and a buttload more work than I could reasonably do. The third night this patient and her sister made me sit down, demanded to know what was wrong, and I told them the essence of it without really getting into the details. They told me stories and tried to make me laugh. In the morning, the patient got up, bathed herself, and did her care for the first time in a while. I would not have believed the laundry list would be so powerful a tool as to make people feel you really are trying to help them, when for me it was only a way not to lose my mind. Let's see. Also for the patient who wants you to drop your nursing task mid-stride and fluff the pillow: I tried telling that patient that we get to take turns. If I'm carrying narcotics when I walk in, I get the first turn to do my things then I will do the things you want me to do. If I'm not carrying narcs, you get the first turn. For some folks it works really well. Again, I came up with that idea so I don't put the vial or ampule in my pocket, lose it, or break it while trying to accommodate the patient. Also if it's pain or anxiety med, the nurse and the patient benefit from the med taking effect sooner, especially if dressing changes or moving the patient will occur soon. Another thing I like to do is remember that if it's difficult for me to move the patient one handed, it probably hurts them like dickens, so work with my coworkers to get help for those things, along with trying to get the patient a bed that assists in turns whenever possible. I have all sorts of tricks for these folks and basically it means the staff works themselves to death, and sometimes there is a bond, sometimes not, and it usually feels like a bad marriage when you keep taking the patient back just because you know how to handle them well.

I'm glad I never did that. Of course I have wanted to! The one time I know someone who did, it turned out to be the wrong patient to pull the light out of the wall on; she was a trach patient who proceeded to have respiratory distress and coded. That employee lost his job. I will have the talk with patients about how it's not a telephone, and tell the story of the boy who cried wolf. And sometimes I just go in the room and pick every intervention I can think of, and do them all at once. It's a bit annoying to get a bath, dressing changes, have to brush your teeth, do range of motion and physical therapy, maybe get a little trach care if you have one, fluff the pillow x2, elevate the feet, roll all over the bed multiple times, and be made to snack whether you want one or not, all the while the nurse chatting away about the therapeutic benefits of each thing, if all the patient wanted was to bug the nurse. Occasionally it has made the patient either tired or frustrated and they leave me alone a bit. Plus it gives me a bunch of things to chart when I have to document the things that were done for the patient.

I know many nurses with autoimmune problems, two of whom have lupus. One recently retired; she worked about 30 years or so, with a lot of old icu experience, and in the year or two before she retired, I noticed she had a lot of problems with getting her tasks done. Basically it felt like giving report to a student, and it was just as difficult to follow. I am putting all that down to brain fog because she put 100% of herself into good effort every time she showed up to work, but eventually realized that she needed to do something else. I'm glad she was able to retire, instead of being stuck financially. (And please don't read this wrong; I really like the person, but you may find that some people are great, just not to work with.) One other nurse was an LPN for 20 something years, sometime during that time she was diagnosed, and went on to become an RN. She's one of the smartest, hardest working people I know, and she does not EVER complain. She only ever mentioned her disease once. I have also worked with a wide variety of nurses with rheumatoid arthritis, and a bunch with osteoarthritis. They just work, and the only time disease is mentioned is if there is something new that crops up, or someone apparently is having trouble walking. I really want to know how these courageous women "make friends" with their pain, because it is a skill I apparently lack. I don't know what I have, other than a lot of pain and an upcoming rheumy appointment. I do feel like I can handle nursing with whatever is presented to me, but I may have to adjust and not work all my nights in a row, or not work overtime. I think that if I felt like this when I was thinking of school, I would have tried a different career path altogether. The reason I think it's doable, for me, is that I have experience, a good job, and a sense of how to organize my life to make 12 hour nights something that I enjoy doing. It's really good most of the time, and that means that when it's really bad, I have ways to destress and it kind of averages out. Plus there are all these wonderful people that inspire me to keep on going.

I will say, I don't particularly enjoy my dinner when it's brunswick stew interrupted by poop cleanup on a liver patient, who ate meat and tomatoes and apparently digested none of it due to the lactulose. I also discovered that if I tell said patient "wow you didn't chew your tomatoes" they will present me with some puke that is exactly the same as the poop. It is also considered in bad taste to follow that with singing the doublemint commercial song.