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Sleep medicine,Floor nursing, OR, Trauma

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  1. CheesePotato

    How to be excused from clinicals

    I do declare ya'll are killing me! I just legit laughed out loud and seal clapped flour all over my keyboard! Let's just say the fainting style of the individual in question was a mix of: and Seriously. ~~CP~~
  2. CheesePotato

    Left Speechless

    It is often spoken how nursing impacts individual lives--but in truth, it is a two way mirror. Thank you for eloquently capturing and presenting his reflection. Under your gentle care you gave him the gift of understanding, advocacy, and relief and now through your words you allow for this young man to empower and live on in hundreds if not thousands of readers. Thank you. Sincerest regards, ~~CheesePotato~~
  3. Thank you to all who took the time to read, comment, and/or like. I'm always tickled beyond reason whenever something I've posted gathers even a glimmer of attention. The answer to the real question: the winner of the poll was Snickers Pie and so Snickers Pie was made and consumed. And it was !@#% magic. Should you wish to bask in this delicious delight in your own home, please click to find the recipe and my own rambling additions. ~~CP~~
  4. CheesePotato

    How to be excused from clinicals

    Sick of clinicals? Traveling all over from hospital to hospital in hopes of gleaning knowledge from experienced nurses got you down? Are you tired of all the observing of boring surgeries, pointless procedures, and assessment after assessment? Well, in three simple steps you too can be dismissed from this hassle forever. Step one: Be in a room full of people and ignore the fact that each and every one are trained in medicine in some form--especially pay no attention to the gentleman maintaining the airway or the second gent at the microscope working away in someone's spine. Step two: Pretend to faint. Be sure to gently lower yourself to the ground (wouldn't want to get hurt now, would we?) and a small dramatic limb flap is encouraged. When the nurse performs a quick assessment including holding your "limp" arm over your face and letting go, whatever you do, don't let it hit you in forehead. Only truly unconscious people are that boneless. Be sure not to move even after anesthesia taps you on forehead and tells you to get up. Step three: Cry and lie about it. Repeatedly. Make multiple and various excuses for disturbing surgery and taking eyes and ears, no matter how momentarily, from the patient. When that fails, by all means, resort to anger and indignation. Be sure to really lean into the swears when you utter them. Success! You have been dismissed from the OR observation and clinicals in general! As an aside, I guess this individual was a multi-offender when it came to various antics in the clinical setting. It's a real shame. Personally, I was bewildered by the whole situation. This was hands down one of the strangest and most ridiculous things I have heard of. Students, make wise choices when you are in clinicals in regards to professionalism, behavior, etc. Think of each clinical as your standing resume as the nurses you encounter may be the same nurses on an interview panel when you come back looking for a job. And yes, fainting in the OR does happen on occasion and for various reasons. Should you be observing and feel ill or faint, follow three little cardinal rules to keep everyone, mostly yourself, safe: 1) Step away from the sterile field or down from the lift/step you are on. If you need help, say so. No one will ignore you. (At least not the folks I work with). 2) Tell someone you don't feel well so we can help you. 3) Sit down right where you are if you cannot reach a chair. It's okay. I would rather have a student sitting in my path rather than cracking their skull on the floor. And as Forrest Gump said: That's all I have to say about that. ~~CP~~ P.S. For those of you who chimed in on my most recent thread the top vote was for Snickers Pie--a fine and delicious choice. Join me in celebrating the wonderful world of YUM by finding the recipe here.
  5. Can we please call for a ceasefire on the "real" nursing bull crap? May we all come to an agreement that all nurses are "real" nurses? I just talked to an office nurse about a diagnostic exam result and she seemed pretty damn real to me. (Couldn't have been Siri. She has a restraining order against me.) The LPN that helped me resuscitate that patient in the ED this early morning also seemed pretty real--though I will admit I was tired. Perhaps a figment of my imagination? Can we please, for one moment, acknowledge that each specialty has its unique subset of skills and that it takes nursing knowledge and competency to execute them? That it is all integral and we influence and function as a whole in some way or another? Can we incorporate language such as "acute care", "hospital based", etc into our day to day as opposed to "real"? And for the record, I have yet to encounter a nurse anywhere who "only charts". For once, can we lay to rest the inane phrase, "I could nurse circles around you?' and acknowledge it as the idiocy it is? What, is there Nursing Olympics that I'm not aware of? Are there time trials on setting up and zeroing ART lines or balancing an EVD? From what running start can you start an IV? Instead of curling is there vomit mopping? The C-dif long jump? The rectal thermometer relay? I am calling for an end to the hair pulling, the sand kicking, and downplaying of nursing roles no matter what they may be. I say the only high-velocity urination contest in nursing should involve a cystoscopy or two inebriated male nurses outside a bar writing their names in the snow. Rawr. ~~CP~~ P.S. Forgive my rant, but some days some of the things I stumble across on this site make me want to punch a sea cucumber and its hideous mama right in their smug squelchy faces.
  6. CheesePotato

    A Nurse's Choice

    Thank you all for your very kind well wishes and for taking the time to read and comment. Yes, my neck nugget will be watched very closely. Vianne, Welcome to all Allnurses! I am touched and honored you chose to post on my article as one of your first comments. T.H.R.N, you got me a little misty eyed at your enthusiasm and warm welcome on this and Ruby Vee's thread. Seriously. I cannot thank you all enough for your kindness. ​ Sincerest regards, ~~CP~~
  7. CheesePotato

    ER: A Family's Emotional Well Being

    Oh good lord, my heart! This is what it's all about: Competency, problem solving, and heart. Somewhere in this world there needs to be a poster of you with the slogan beneath it: Nursing--you're doing it right. Just....damn, my friend, yes to everything you do. ~~CP~~
  8. CheesePotato

    Stupid Nurse Tricks (Or How To Look Incredibly Stupid)

    Oh my god, yes please to this thread. Yes. May I? ~~ Call a code and begin CPR on a sleeping patient. Continue with CPR (I'm talking compressions and everything, people) after code team arrives to find you with a very much alive, flailing, swearing patient. Get defensive and state you "thought the patient was seizing" as the reason you didn't stop. Get even more defensive when the code team laughs as the patient explains "That lil' thing just came out of no where and wrestled all up on me." ~~ Offer to draw up a med for an MD waiting to do a local procedure. Violently inject 5ml of air into a 1ml ampule and not understand why the med keeps bubbling out. Lather, rinse, repeat 4x before he tells you to "just stop what you're doing. Bring it here." ~~ Give the grand tour of the OR to a group of newbies. Walk face first slap bang into what is normally a motion triggered door because you were too busy running your mouth to see the two 8 1/2 by 11 bright, flourescent-ass, blazing pink "Out of Order" signs hanging on and near the motion device. End up with a black eye and a bunch of chuckling doctors thinking they're clever by constantly pointing out any and all "Out of Order" signage to you until the day you either die or quit. I can neither confirm nor deny this was me. ~~ When beckoned, draw close to the surgical field to watch a fascinating procedure. When the surgeon points out what he is looking at, casually reach over the sterile field with an un-sterile gloved hand and prod the item of interest while asking, "You mean that right there?" (Not me!) ~~ When your surgeon starts whinging about a boom-light being too far out of his reach, swing/karate chop the stubborn boom joint so the light wildly whips right into the side of his head. Casually ask if he "can reach it now?". (Ugh...me.) ~~ Come sprinting into a bloody level one with a 35ml syringe held aloft over your head like the damn olympic torch as if this, not the many blood products or the pending surgery to repair the bullet damage....no, this one syringe will be what spells the difference between survival and demise for this patient. Slip on blood clot, pitch croc in the process into a bottle of albumin which then explodes on contact with the floor, fall, crack head on base of an IV pole and become unresponsive. Now we have two patients and a hell of a mess to clean up. Thanks for that. This is why we don't run, kiddies. Oh yeah. That felt good. Thanks for another great thread, Ruby Vee. My hero. ~~CheesePotato~~
  9. CheesePotato

    A Nurse's Choice

    ​Life is full of choices both large and small and some have long reaching, unforeseeable impact. Sixteen years ago, a young woman named Nancy decided that nursing was a career with the ability to provide for her growing family. Nine years ago, she chose to leave the bedside in order to have greater control of her hours. Seven years ago, she almost left because healthcare wasn't what it used to be. I remain grateful she decided to stay. The face of healthcare is changing. This is news to no one. Now granted, it's been changing ever since I joined the ranks back in none of your damn business, thank you very much. But now, more than ever, fueled by further healthcare reform and the introduction of "Obamacare", we are being urged to do more with less or, worse yet, leave out certain things altogether. But ultimately, when it comes right down to it, what is being whittled and the manner is which it is done is a choice. No one is forcing us to forgo hand holding or back rubs. We choose to in order to meet the more important and higher ranking, acute needs of our ever growing ranks of patients. I am not one to say whether or not this is right or wrong so much as to say that I see it happening and it is what it is. And as much as we feel this push from our managers, our companies, and our providers to develop and maintain a lean practice at the bedside and across the board, so too are providers feeling the pinch in the form of reimbursement. They, as we, are being told to redefine their practice standards and many are even opting to simply do less. But, as each of my rambling articles inevitably weave their way into, there is a story. I have been sick. Dun dun Duuuuuuuunnnnn!!!! Not like horribly sick....but sick in such in a way and for such a duration that it had become apparent my body needed a nudge to get with the bacteria kickin' and macrophagin'. So after much internal dialogue and a very convincing argument involving cookie dough ice cream as a reward, I crawled out of my toasty hibernation den, bundled up in my sleeping bag-like winter coat (which is lovely because, should I ever fall into a snow bank, I can just sleep where I topple. Very handy, that.) and oozed my way to my doctor's office. Turns out he wasn't available. Decided to go on a last minute cruise to Jamaica. Because you know....that's normal. Some people get up and make the choice to eat a poptart for breakfast and apparently others decide they will be in the tropics by lunch. Digress. But his lovely NP was in and just so happened to be able to see me. I admit I was a little gun shy and hesitant given that I have had bad experiences with NP's before. Something about a speculum and pinching something not meant to be pinched. Ugh! Digress again! So off into the office I go. Nancy (yes, the one from the intro) did her exam and talked to me a bit before, with angels sounding in the background, she handed me a script for something sure to beat the tar out of the devil residing in my sinuses. All is right in the world until, with a narrowed eye and a lightly cocked head, she retracted the script and placed it on the desk. I'm bewildered even as she asked if I "do that often". And by that, she meant clearing my throat. I answered that it was a recent thing but I passed it off as being part of the cold or flu or Ebola that I was suffering with. With a gentle shake of her perfectly coifed head, she asked if I would mind if she examined my neck. If I would mind. The answer was very much no, of course. And this, my friends, is where a series of choices were made with an impact which, to me, will remain absolutely immeasurable. She chose to perform a neck exam when my immediate need and reason for the visit had been resolved. She chose to take the time to perform the exam properly and thoroughly and with hands which were skilled yet careful. She allowed for the words, "I think I feel a mass" to settle and when my hands darted to my own neck, trembling, fretting, wrought with worry and the need to feel, to find, to poke, prod, dig, she chose to guide my fingers to where the small protrusion lie before softly bringing my hand away and back to my lap. She took the time to talk, to answer questions way too advanced for the what the situation merited, before sending me over to diagnostics for an ultrasound. No, it is nothing serious. Yes, it will be watched. In an era when each patient is truly only allotted a set amount of face time with a provider, when more with less is the name of the game, it then falls to each of us to make choices on what is truly important. It gives me hope for the future of healthcare whenever I encounter individuals willing to take back control of their own practice. We, as nurses, of all shapes, sizes, degrees, backgrounds and specialties, remain a powerful force in healthcare. We ought to remain mindful of our influences not only over developing better ways to provide care, but in our impact with each patient we encounter. Yes, times are changing and we are going to be forced to once again adapt. In essence that is what has driven medicine and nursing --adaptation and continued survival-- and often brought into being heralded by one voice. We must be careful not to minimize our own impact --heaven knows its easy to get beat down by the system. One may be the loneliest number, but it remains a force to be reckoned with. Because of Nancy and those like her, I am well on my way to healing. In case you were worried, the kraken residing in my sinuses is withering and my ears have popped--finally!--after three weeks of coping with fish bowl audio effects and the overwhelming, thunderous sound of my own gum chewing. And now that I am hearing the world in ultra high definition, I wish the record to reflect that I had no idea my television was so damn loud as to be heard in the back yard. With the door closed. And because a nurse made a choice to flex her practice outside the confines of an ever tightening system and deliver truly excellent care, I am able to sleep easy. And not watch TV with earth shattering volume at 2 am. And for that, my neighbors thank you, Nancy. ~~CheesePotato~~
  10. CheesePotato

    A Letter to Myself - My First Day on an Oncology Floor

    The moment when the fog of task management breaks and you are able to see the person behind the diagnosis is a potent and powerful experience. I am glad to see you recognized this moment and wished to commemorate it to yourself. Through the years and as your practice grows, it is normal to slip and merely see the multi-trauma, the AAA, etc, as this is a normal sort of defense mechanism which allows you to suspend emotion in the face of much needed clear thinking. It never means you don't care, it just means that on Maslow's hierachry....well, let's just say stopping the bleeding outranks my feelings of empathy to the situation. And how do you come back each day? Because sometimes that is what the job is--providing healing, advocacy, and support one day, one moment at a time. And just as you, in your seven or so hours, can never hope to grasp the broad spectrum of each patient's circumstances and influence, so you can you never grasp how your presence in those seven short hours influenced and impacted the patient. May your faith provide comfort in your tough times throughout your journey. May it give voice to joy and praise in the good. ~~CP~~
  11. CheesePotato

    Metastatic Breast Cancer in Social Media

    I personally believe that we, in modern society, have forgotten how process and accept death and grieving. We lack social constructs and choose to introduce our children to the concept of death via media in which death is temporary, a minor inconvenience, and easily rectified by simply starting over with a click of game controller button. As a whole, we opt to turn a blind eye to the inevitable and even phrase things in a way that makes the concept of death and illness seem...well...fluffy: e.g. You only live once. False. You live every minute, every day. You only die once (resuscitation efforts notwithstanding). There is a difference. We no longer have ritual. At one point in time, life expectancies were much shorter and certain diagnosis meant mere days. For gods-sake, my great-grandmother's handwritten recipe book has a "Wake and Funeral" section of various dishes which were prepared for the family of loved ones or various other members of the community whenever hardship struck. As another point, for many, the concept of grief is foreign and frightening. I have several co-workers who have yet to lose a loved one and are petrified of the day when it happens. Even more of them have absolutely no idea what to say or do whenever news of a death reaches them. I wish I could say many do not offer idle, meaningless chatter to the bereaved, but that would be a lie. I believe society has chosen to squirrel away the concept that life is not always roses and I applaud any who, through their words, bring reality back into focus. It is in your voice we may find strength, hope, and an understanding. Through your writing, we may share the path with you and embrace the journey of a fellow human. It is through your words we may find ourselves. If your words make someone uncomfortable, it means you made an impact. It means what you had to say created emotions which must be confronted, dealt with, and will hopefully create personal growth. So no, my friend, do not stop writing. Refuse to vanish. Keep on keepin' on. "Though wise men at their end know dark is right, Because their words had forked no lightning they Do not go gentle into that good night. ... Do not go gentle into that good night. Rage, rage against the dying of the light." --Dylan Thomas-- Kindest regards, ~~CheesePotato~~
  12. CheesePotato


    Good question. First, a pre-answer disclosure statement: ~~ Please keep in mind that the answer I am giving only speaks to pain management. ~~ Without knowing your individual patients and their circumstances, it is impossible to give a specific answer. ~~ Also, bear in mind that you, as a nurse, are well within your practice/rights to call into question any order which concerns you in the matters of safety/lack of necessity. ~~ Always keep in mind that some doctors do not appreciate a thinking nurse. What I can say? Ya' win some, ya' lose some. ~~ Answers non-refundable. Not responsible for any cake/pastry left out in the rain. Void where prohibited. Now I'm not saying that my answer is perfect, but after years of navigating the wonderful world of Ouch, here is what I can tell you: Acetaminophen in high doses can be toxic. Acetaminophen crosses the blood brain barrier. Acetaminophen has been shown to have very little, if any, effect on inflammation. Does acetaminophen have an antipyretic effect? Yes, of course it does. Is that why you are giving it? Unless your patient has a fever/known infection, 97.31% of the time the answer is very much no. The long and short of it: the actual way in which acetaminophen reduces pain is yet to be fully understood (although recent studies involving mice and hotplates within the last decade have shed some light on the topic). The down and dirty quick answer: acetaminophen reduces neuron excitability in the Central Nervous System and Peripheral Nervous System by influencing the binding of other system made chemicals. Decreased excitability/binding = increased pain threshold = decreased or no opioid use. This effect has lead to breakthroughs in pre-operative administration of IV acetaminophen to control/manage post-operative pain. As a side note, whenever a patient is being given an opioid medication and is continuing to complain of pain, scan the orders for our dear friend acetaminophen. The effects may surprise you. Cheers! ~~CP~~
  13. CheesePotato

    New nurse anxiety

    Welcome to Allnurses, Sarah, First of all congratulations on surviving nursing school and all that other horsehockey. Most good. To begin with, know the feelings you are experiencing are very normal for new grads and even for those experienced nurses that change specialties. However, where feelings of slight anxiety are normal, it should not be impacting your work/life balance outside the facility. I am glad to hear you are taking action to provide care to yourself and I hope Lexapro turns out to be the right tool to help guide your stability. From reading your post, I caught two little niblets that seemed to stand out to me: One, it seems that organization is a skill that has yet to come along (very, very normal for new grads). And two, your anxiety and tension seems to be primarily self fueled. I wish there was a quick fix for number one, but there is not. Time management and organization are skills best learned through real life application. And yet it is important to note there are many things which may be done that can help streamline the process for you. I have enclosed a link to a organization thread here on the forums that features some of Esme12's fine brainsheets. These types of tools are critical for new nurses as they help guide thinking and lay the foundation for organized and efficient thought. Please adapt brainsheets or use them as a building block to make your own. Once you feel a bit less like you're chasing your tail, that nagging "Did I leave the stove on?" feeling should begin to resolve. Remember that each and every day is a learning experience. Even for nurses with oodles of experience, each day brings a new opportunity to do something better, faster, stronger, shinier--wait, what? ::ahem:: For some, cataloging those moments in a journal of sorts helps, for others finding a mentor or a trusted person you can talk to in order to debrief after each day proves reflective and therapeutic. (Remember HIPAA). Now let's pause for a second and talk about anxiety management. On a chemical level, yes, there is a part of this that you cannot necessarily control. This is science. On the other hand, there are things you can do to give yourself a fighting chance of kicking anxiety to the curb. First of all and I cannot bold this enough: Self care. Okay yeah sure, they probably touched on this in nursing school. Well, I'm going to beat the snot out of it now. Be sure you are eating well, making time for yourself and getting adequate sleep. And when I say eating well, I don't mean going off the rails and only eating salad. If you want a donut, you know what? Eat that donut. Enjoy it. Savor it. But pay attention to how certain foods make you feel afterwards. You may be surprised to find things that make you feel low or jittery. Example: Caffeine increases that jittery crawling out of your skin feeling as well as wrecking the hell out of sleep patterns. Make time for yourself. It doesn't take a lot of effort to do so and it can make all the difference in the world. It's not about the grand gestures so much as the little moments. To begin with, Sarah Time begins when your shift ends each day every day. Period. No exceptions. What does that mean? That means work stays at work. It may take time to retrain your brain away from vulture circling the shoulda/woulda/coulda routine of self doubt, but learning to let it go is a huge step to a happier you. Now let's don't get stupid. If you are driving home and realize that you forgot to hang an antibiotic on someone (been there, done that), taking action via phone call is the right thing to do. Just sayin'. But take care of yourself: listen to music you enjoy on the way home, sip a favorite beverage of the non-alcoholic variety while you drive, or sit in silence and just breathe. Find a way to build in time for yourself into your day. Adequate sleep is self explanatory: go to bed at a reasonable time. Aim for eight hours a night. An exhausted brain is like an over-caffeinated hamster on steroids: flighty, temperamental, and a bit prone to biting. You may be amazed at how you feel if you allow yourself to rest. Secondly: Self awareness. Be kind to yourself. The world is full of jerks, don't be one to yourself. Recognize that you do the best you can in the moments are you are in. No one can ask more of you than that. Become aware of times when you need a breath and be sure you indulge them (provided someone isn't coding. In which case I dare say you are not the one in critical need of deep breathing, know what I mean?) Identify your triggers and brainstorm realistic, practical ways of facing down/dealing with them. Last but not least, repeat after me: It gets better. Best wishes to you, ~~CP~~
  14. Although I can see your point, and I agree that self reflection is critical to evolution of self in both a professional and personal context....personally, I like to set the bar...shall we say a bit lower? or, more to the point: In summation: Happy New Year! ~~CP~~
  15. CheesePotato

    If Hospitals Were Run Like Denny's.....

    Honestly, if you think about it, the Denny's model of healthcare could make life so much easier. Seriously. I could stand there with one hand haughtily placed on my cocked hip, smacking my gum behind fuchsia lips while I struggle to see through caked mascara spidered eyelashes sprinkled with powder blue eyeshadow. "What'll it be, hon?" And the wonderful thing? My surgeon could answer me in a series of grunts, points, and hand gestures all aided by pointedly tapping the choices on heavily laminated, picture laden card-stock while making prolonged eye contact. You know....something like this: Which would loosely translate to: My what a splendid evening it is, CheesePotato. This fine young gent has broken his femur and such news is both distressing and makes me get in touch with my inner feelings of sadness, because I am delicate and sensitive like a flower. That being said, I wish to place either a traction pin or external fixator in an effort to provide stabilization and I have taken the liberty of pulling those tray options myself. I do hope you do not mind. What is that? Yes, clever spud, I would absolutely need a c-arm. Oh, and be a lamb and open some dressings for when I'm done. Most good. Most good. Wait.....what the-- Another page?! ::displays a calm and nearly flat affect. Smiles and peacefully heads back to the ED to handle said trauma/crisis:: Order up! ~~CP~~