AliceTrout

Best advice I have to offer in nursing - or anything is one from my mom. "First things first, second things never". You can't get bogged down in unimportant things if you remember to always keep your first priorities first. Granted, knowing what is your first priority can be it's own challenge!

I was a non-trad in my nursing program, but the youngest one (I jumped degrees back to back). I will tell you at my school there was a pretty strong anti-nontrad sentiment, and for a somewhat good reason. The non-trads typically liked to voice their experiences and background knowledge every chance they got. Over classmates. Over the instructors. All the time. Sometimes they had great input, but over time this becomes horribly grating, disruptive, and just downright condescending. Nursing students are paying to learn from nursing instructors who are selected for the job. Try not to use class time to expound on your personal experiences, that precious time is for the instructors to talk, not you. Adding in your two cents here and there might seem like a good idea, but if you are giving "real world" examples to students who have to take boards using the "crystal palace" standard of NCLEX, you are hurting your classmates, not helping them. In my class we had two competing non-trad "know it alls" who seemed to thrive pointing out the instructors mistakes, book errors, power point typos etc. That behavior alienates you from your peers if you can't reign it in for those special times it is truly warranted (for example a student making a mistake that puts someone in harms way). Doing that too often is like the boy who cried wolf. Eventually people stop listening to you, and frankly just try to avoid you. Non-trads have a lot to offer younger classmates, just recognize that you have to give and take, look for non-verbal cues to see if you are overstepping your bounds. Also. Wheelie bags. Don't get one.

I don't know if anyone said this yet, but my idea was maybe to contact your local state board and ask them. They are the ones that make decisions about the consequences of licensed nurses who are determined to be abusing drugs and/or alcohol. Maybe they can help you get through some sort of rehab or remediation that would grant you entry into a new nursing program?

Before I was a nurse, I was a domestic violence advocate for the county. I would get a page from the PD whenever they were on scene, and I would provide assistance and outreach to the victim. I had received substantial training and certification for this volunteer position, and I felt comfortable that I could recognize a person in distress fairly well. When I went to nursing school, I remember learning all the different ways we can screen for DV, and being a perhaps a little too complacent (smug?) thinking I already knew this stuff. I had accurately identified DV in patients before, and been able to find them assistance. But a few weeks ago I let one slip by and I can't stop thinking about it. She was admitted for suspected intentional OD. History of drug and alcohol abuse. Lots of run ins with the law, failed attempts at rehab, problems with social services etc. My other patient that night was a very precociously ill patient that was pretty 'busy'. My admit, let's call her Sheila* for the sake of simplicity, was lethargic but pleasant and cooperative. She looked like far older than her true age. I brought her husband back to help me with some basic admission information, and when I was done I gave him a card with the ICU visiting hours and offered to show him the family room. He freaked. Stated he had never spent a night away from her, and could I please make an exception. Before I could say anything more, my charge interrupts to tell me that a consult hadn't been made to nephrology yet and that I should page them. At this point, the man sees all the wounds I had listed on the communication board for Sheila, looks back at me and the charge nurse, and back to the board again...freaks out again. "You have to call someone about all that"? He said panicky, pointing at the board Again, before I could answer, the ventilator starts alarming in my other patients room and the monitor starts blaring...I dash in there to fix the problem. Afterwards I go back to Sheila's room, where the husband is now in bed with her, whispering into her ear, holding her hand. It seemed sweet if not annoying. I told him I needed him to collect her items and go home and get some rest. Again he gets anxious, begging to stay. I remove her jewelry and ask him to take it with him. He keeps telling me how he just bought her this ring, it was expensive, he just got it for her - "right baby"..on and on. Finally....I chase him off. He asked me to come and get him from the family room the moment he could come back again. I tell him I can't promise as I basically shove him out the unit doors. Meanwhile Sheila has a good night. She becomes more alert, and comes across as a very kind, sensitive, polite, but meek woman. I like Sheila. So, in an effort to please her, I ask her if she would like me to get her husband now that it is visiting hours again. She says no. Well, she had told me she has 7 boys at home, so I chalk it up to her enjoying the relative respite the ICU might be offering her in comparison to a house full of boys. I give report. I go home. I sit down for dinner. And BAM I realize it. So many red flags. He won't leave her side. His paranoia we were going to call someone. Not wanting him to visit her. Her wounds. The gifts of jewelry. Countless other obvious red flags I completely missed. A wave of utter shame/disgust/horror washed over me as I grabbed the phone to call the unit. It was too late. She was discharged home AMA...the husband had made a big scene and taken responsibility for her ingestion so they decided they couldn't keep her on a suicide hold. She was after all "just another junky". Sorry Sheila. I really am. I failed you and I am so sorry. *It goes without saying her name is NOT actually Sheila

I think nurses who make snarky comments like these instead of seeing that they are in a teaching opportunity are more of a disgrace on the profession than someone who is still learning. Maybe this young nurse did have attitude, maybe she didn't. I don't really think the author comes across as a reliable historian. Either way, the bigger person in my book would have seen this moment as a chance to KINDLY explain why she was upset instead of just going supernova over coband and bandage scissors. It's also a lot easier to drive from the back seat.

Thank you for this story, it helped illuminate some of the emotions I have picked up on emanating from family members when we bring up the idea of hospice to our ICU family's. I struggled to understand why some people seemed to prefer having their loved one die in the cold, harsh, and impersonal ICU as opposed to the more home-like comfort of our hospice unit. I guess I never looked at it as "giving up" but always simply as making someone (and their family) more comfortable when viable life-saving options cease to exist. I thank you for giving me some insight into my patient's families mind-sets when conversations turn to hospice.

I have found that the hospitality industry is very often where future nurses start their careers. I know I did, and so did an overwhelming number of my former hospitality working cohorts. The fact is there are interesting and subtle similarities between the jobs when it comes to who succeeds. Both jobs require high energy people who know how to please/calm/placate people. Both require people who can prioritize and re-prioritize tasks quickly and accurately. Both benefit from employees with dogged work ethics and a touch of perfectionism. Frankly, I am more offended by OPs snobbish attitude toward hospitality workers than I am at the fact the company recognizes what kind of people have the work-based traits they are seeking. Sure, a busser doesn't go to work to save lives (although they do. I have seen several situations where a hospitality worker performed Heimlich and CPR). That doesn't make them a lower class of employee worthy of the shame OP evidently felt when compared to them.

I like to give report somewhere quiet without interruption (no family or patient trying to play HouseMD and misinterpret or get nervous from things in our report, no oncoming nurse looking around the room while I talk and missing important information). Once that is done, go to room and look at everything together. Easy.

You kinda sealed your fate by letting this get to the point you blew up. You should have asked for a different preceptor before you blew up, or found some other way to manage the bad friction between you two. This is in no way a defense of her behavior, she sounds really unprofessional herself. I can relate. I had a similar preceptor as a new grad, brilliant medical mind, zero social skills, worst 'teacher' on earth. I thought about asking for a new preceptor, but realized if I could just bite my tongue she had a lot to teach me if I looked in the right places. (They usually were not the things she thought I needed to learn lol). All in all I think it made me a better nurse, even if it did take the "core group" a few weeks to realize I wasn't the idiot she painted me out to be. 2 years later, I get along with everyone fantastically, and I even still ask my annoying preceptors advice on things. I think you, like me, probably hate having someone younger with less life experience than you treating you like an idiot. Kicks ya in the pride. I get it. But you will have to get over it, because age being what it is, you're still a new grad. And chances are the 20something has a lot to teach you.

HA. Well it turns out he did have a peritoneum to house those bleeding guts. I am guessing the fake IV had something to do with the profoundly low H&H and furious blood bank who called them 99 times to say blood was ready. (Blood bank told me they kept delaying because they didn't have IV access. AH HA!). I guess they had to make it look like they tried? But if you're going to pretend IV start for a blood transfusion, wouldn't you at least tape an 18 g on that sucker? Why the 22? Some mysteries will never be solved. Also the leg stumps didn't appear very swollen, so I guess the dependent edema was in the amputated portion of the lower extremities? Those didn't come up with the patient (shocking lol), so I was never able to verify the veracity of that statement.

This reminded me of one of the best/worst/best again reports I ever got from the ER. Stated that the patient was a "bilateral AKA with dependent edema in the lower extremities" being admitted for upper and lower GI bleed, but that he had "no peritoneum". This left me with more questions than answers. The kicker was that she brought me the patient with a 22 gauge IV tegadermed to the ac, with no break in the skin and the insertion lancet still sitting inside. Was there a medical episode of Punk'd nobody told me about?

I read through all the (somewhat catty?!) replies just to see if anyone else thought this very thing! It was all that went through my mind when I read what happened - how did the massive quantity of this medication not just scream WRONG at this woman who was allegedly used to giving it? I mean even from sheer muscle memory, not even higher level thinking, should have made this error seem obvious to such an experienced nurse, no? What a sobering reminder of how a brief moment of inattention on our part can have such a ripple effect on patients, families, friends, coworkers, and communities. Remain vigilant friends! :)

I didn't read every reply, so forgive me if this has already been said; but to me not having some anxiety as a new grad sounds suspicious and dangerous. On one hand as a new grad you shouldn't have so much anxiety you are paralyzed and ineffective. But on the other, I strongly feel you damn well better be at least slightly apprehensive or anxious before a shift as a new grad, because that anxiety isn't weakness - it's awareness of your inexperience, respect for your patient's well-being, and reasonable caution as a professional! What scares me about someone who isn't anxious as a new grad is that they might be that same someone who doesn't ask questions, isn't afraid to admit they don't know,or is reluctant to ask for help - and therefore is the most likely culprit in a dangerous mistake. I myself have only been a nurse for 2 years. To this day (and I hope every day of my career) I realize a certain amount of anxiety (or what I would define as eustress) is a good thing in what I do, because the day I start becoming complacent and overconfident is the day I start making stupid and scary mistakes. I know this because as an ICU nurse I have observed that many of the rapid responses and codes I respond to have a complacent or overconfident nurse at the root of the problem. We are responsible for taking care of and advocating for human lives for a living. If that doesn't inspire some amount of stress, anxiety, and yes - the occasional tear - you should probably reevaluate your position as a bedside nurse.

Skeptical is my middle name, but surely I am not the only one who thinks this deal sounds to good to be true...am I?

Yeah well lots of nurses say lots of snotty, inaccurate things about other nurses/units/domains of the profession. Doesn't make those things true. A nurse is a nurse and one of the best things about nursing is the fact is that there is a million and one flavors of nursing...arguably one of the most diverse professions on the planet.

People who hit the call light and than use the call light to bang on the bed rail until you come answer it. This is 95% of the time done for some petty reason like "I forgot how to turn the TV off" or "I hear a machine beeping" (in the ICU!? Really? Call me if you don't hear one and we'll talk).

I love how my rooms looks after I organize it at the start of my shift (and how I keep it crisis permitting). IV Lines all orderly, labeled, untangled, neatly strung from bag to pump to patient. All the other various tubes and lines (OG/ETT/Chest/tele etc) neat, orderly, and tucked from view as much as reasonable. No clutter anywhere. Patient assessed and pulled up and looking as cozy as possible in a shoddy ICU bed. I literally can't even bear to sit and chart until my room and patient look anything short of that! I always tell new coworkers that I picture how the patient's mother would want them to look in that bed. If they don't look good enough for momma, they don't look good enough for me! I also really, really love dressing changes. The look of a clean and perfect new dressing makes me giddy.

I know exactly how you feel, I had a mother that who was so preoccupied with advancing her own interests, it sometimes shot me in the foot. First thing you do is recognize the situation and move on. You know she won't hand you a damn thing so stop waiting for her to do so. Take responsibility for yourself, stop comparing yourself to your peers and their family situations. It might take you longer to accomplish your goals independently, but take it from someone who did just that, it will feel awesome when you do! Emancipate yourself from her in every way possible including legally and financially. You can find a job somehow, there really isn't a valid excuse. I grew up in the middle of the mountains with no car or public transit so I paid coworkers for rides until I saved enough for a POS car myself. I had my friends mother take me to the DMV because my mom refused. I moved out on my own when I was 17 into the crappiest apartment ever, but it was all mine (and much closer to work!). I paid my way through school with 0 financial support from my mother, and so can you. If you want it bad enough. It will mean working your butt off when it seems like your friends are getting everything handed to them on a plate. Oh well. You don't know their struggles, they don't know yours. Get over it. Making excuses on your mother's back only hurts you. You don't choose your parents, but you do choose your own path in this life. If you fail to accomplish your goal of becoming a nurse, it is nobodies fault but your own.

I am comfortable in the assumptions I am making because I know the people I am talking about, and what hospital I am talking about, and what policies and amenities this hospital has. Knowing all of that, I am utterly confident in my claim that that 1 or 2 bad apple is doing exactly what I claim. I see from your response that your facility must be a little different. For example, all our ER patients once they go back get their blessed tv and real bed. They are comfortable. And as 7/10 times I am admitting a ventilated patient, that means that per our policy, that patient is the ER nurses ONLY patient. Trust me, the bad apples do NOT want to give that gig up. His or her ER COWORKERS probably want them to, but that particular nurse is in vacation station. Which is the final reason I know they do it. THEIR FELLOW ER NURSES TELL ME. Usually in anger vented over a beer. Cause that's a dirty way to do your buddies in the trenches. Again, I mean no disrespect whatsoever to the great ER nurses I know out there. Let's just acknowledge that every floor/unit has some crappy coworkers. ER included. No need to blindly defend every nurse nationwide that works a particular unit.

E'rry day I plunger it. I saw a coworker try the coke thing and it backfired terribly. I haven't tried it since as I won't do anything I don't want to explain to a doc. (Yeah so the PEG wasn't flushing and so, ignoring our policy, I dumped a coke down it, and lo and behold that sucker mineralized before my very eyes! My bad!)

I moved to this armpit I live in because 1. nursing education was good, had small class sizes, and was affordable - but more so because 2. They hire new grads galore. I knew I could get a good education, hop into the unit and facility of my choice, stick around to get some real experience....and one day move elsewhere. The facility I started at had a great new grad orientation for ICU that was so amazing I am sure they could have sold it to me rather than paid me to go through it. I have plenty of coworkers that have come here from out of state for the same reason. I hate where I live with a passion, but the education, opportunity, and experience I am building for my career is priceless.

I understand this concept. I know that there are a lot of super awesome nurses in ER who are professional, and this quote applies to them. I also know that some ER nurses (like any floor) are not awesome. And I know they are holding a patient until shift change because I know my charge told me (s)he gave the bed away hours ago, and when I finally do get that report called (from the elevator) during shift change, I can see that they had been in the ED for 8+ hours and that they had a status of "admit" for as many hours as it has been since I was told the bed had been given away. This is usually the same nurse or two that do this it regularly. It is obviously on purpose. I know not all ER nurses do it, but let's not be so huffy in defense that we deny that some ER nurses absolutely do it.

Oops duplicate post

Of course not. It varies by hospital. Our hospital has one of the best ratios of this. They only call report at shift change for that reason 50% of the time.

As an ICU nurse, I like this - and not in a condescending way. I realize I am required to know more about my TWO patients than a floor or ER nurse, that is partly why I only have two. In our world, I get dirty looks from docs and peers if I can't rattle off vent settings or important labs from memory. I would never expect anyone besides an ICU nurse do have that kind of memory of their patient. However, I do find it disconcerting when a nurse from ER or the floor can't answer SOME things from memory. It makes me think you never laid eyes on them. I mean, you have in theory assessed and than charted an assessment on them. Surely from that you can remember major lines and drains coming out of their body? (foley, HD cath, central line, PICC, trach etc) So you can't recall what gauge their PIV is? FINE. I get that. But when you tell me in report they have a PIV to the AC and they roll in with an HD cath and a PICC line I get scared for you. Some things you should know about your patient without having to look it up. And if it is too much trouble for you to just spit it out in a brief conversation I think maybe you're missing the big picture. If I have to spend time looking up information you can't be bothered (or expected) to know but that I need to know for this patient's care...that is time I am not spending with a very sick patient.