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Cowboyardee

Cowboyardee

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Cowboyardee's Latest Activity

  1. Cowboyardee

    Case Study(CSI): Stomach flu? Anxiety? What’s Going on Here?

    There are some conditions that can at times cause significant st elevation thats neither an mi nor benign early repolarization. I do agree that whether or not an mi is actually the most likely diagnosis, most symptomatic patients with significant precordial st elevation would wind up in the Cath lab. How do you post an answer in the admin help desk? Just make a new topic and then it disappears or something?
  2. Cowboyardee

    Gossiping Nurses

    I'll attempt to rephrase: your coworkers will at some point discuss your job performance, good or bad, amongst themselves. This is neither avoidable or necessarily a bad thing, as it's human nature and serves an important function in helping the nurses in your unit situate themselves, know the lay of the land, understand how to make assignments or which patients to watch out for, etc. On the other hand, it is very reasonable to be concerned that this kind of talk can turn malicious, and to want to avoid that. How to avoid that depends on the situation. Sometimes the best way is to be assertive and stand up for yourself. Other times, the best way might be to drop the large and obvious chip you might or might not have on your shoulder. My advice to the OP is not to take every single whisper as an act of war and to actively seek out help and advice rather than to hope against hope that no one will ever notice or speak of his/her mistakes.
  3. Cowboyardee

    Gossiping Nurses

    I keep an eye out, catch mistakes, offer help, and coach struggling nurses through difficult situations rather than ignoring them to their own devices and letting them and their patients suffer.
  4. Cowboyardee

    Gossiping Nurses

    If I have to look over a new coworker's shoulder to make sure they're not killing anyone, I prefer to have advance warning. Of course, there are ways of talking about other people's job performance that are mean-spirited or motivated by an impulse to haze or gossip or make the gossiper look better by comparison. But don't go filing all discussion of our coworkers' job performance together under gossip. There are more important principles in our field than each minding our own business, and more at stake than your feelings.
  5. Cowboyardee

    Considering ICU.... among several other options

    My guess would be that you are reasonably competent at your retail job. Your coworkers might take a while to get to know you, but as long as you're pleasant and do the job well, they don't worry about you. Imagine, if you will, an introverted retail employee, quietly hanging shirts upside down and inside out on the rack. A fellow employee wanders over to inform them that's not quite the preferred way of doing it, and the introverted employee smiles politely and thanks them before hanging yet another shirt inside out and upside down, placing a clearance sign on the wrong rack, and wandering away or offering no meaningful feedback whenever someone tries to approach them about their job performance. Being introverted is only really a problem when you don't know what you're doing, refuse to ask for help or advice, and no one can effectively talk to you about it or figure out what you're thinking.
  6. Cowboyardee

    Considering ICU.... among several other options

    Don't get me wrong, btw - I'm not trying to make you feel bad. It's just that we all come out of nursing school as pretty weak and unskilled nurses, but you specifically seem to have some defense mechamisms in place that keep you from honestly confronting your mistakes and learning from them. You sound like you'd like to be a nurse for a long time to come, and in that case you'll be much better off in the long run if you do the temporarily painful work of acknowledging to yourself that you have some serious deficits in your job performance. That means dropping some thoughts that might be comforting right now. No, you dont have excellent critical thinking either on paper or in real life - which means you have to work harder to assess patients well. No, being quiet doesn't mean that your coworkers misunderstand you - they correctly see a nurse who lacks skills and knowledge and refuses to ask questions to help compensate for that and practice safely. I'm afraid you'll just have to speak up more even if it's uncomfortable. You can do this, but it will be hard and require you to be brutally honest with yourself, making hard changes as necessary. Best wishes in improving your career, your life, and the lives of your patients.
  7. Cowboyardee

    Considering ICU.... among several other options

    One thread running through several of your issues is either dismissing concerns/abnormal findings/symptoms/etc sight unseen (whether that's merely a verbal dismissal or actually failing to investigate), or else offloading the responsibility for assessing abnormal findings onto another health care worker (e.g. the doctor you called with lab results before evaluating the patient in question). Ultimately, evaluating the patient and ensuring that they receive appropriate care and interventions is the single most important part of your job. Seemingly too often, you fail to do this and then excuse yourself for it afterwards. Don't be that easy on yourself. You're inexperienced - it's fine to admit this and not to know everything and not to have the ultimate say in exactly what might be happening with your patients. But you have to make a good faith effort to find out.
  8. Cowboyardee

    Case Study(CSI): Stomach flu? Anxiety? What’s Going on Here?

    Agree with a previous request for an echo. Where I work, a patient with pain/symptoms that are plausibly cardiac in nature and substantial st elevations on 12 lead ecg would likely be whisked away to the cath lab, even if the overall picture suggests... something else. Where is that echo tech anyway?
  9. Its not clear from your post - do you have a preceptor? It would be pretty worisome not to have at least that much. Anyway, if you have a preceptor, bring your concerns to her and develop a plan to get you where you need to be in 8 weeks. Feeling overwhelmed at this point is normal and you can get past it with training and a good plan. If you don't have a preceptor and they expect you to go from new grad to independent ICU nurse in 3 months just by wandering around and doing errands for whoever is there, you need to have a very serious talk with whoever hired you and get your resume back into circulation.
  10. Cowboyardee

    Millennial Nurses Have Issues

    Millenials are individuals like everyone else. Generalizations about millions of people based on a 15 year birth window will invariably wind up being so inaccurate as to be completely pointless. Sure, if you work at the fed and are trying to set monetary policy for millions of people based on macro-economic trends, generalize away. But if you're a nurse or manager and trying to figure out how to increase hiring or interact with Mike, Viv, and Malik who just hired on, maybe drop the silly generalizions and go do the harder work of researching your local job market and/or actually getting to know Mike, Viv, and Malik.
  11. Cowboyardee

    Am I too stupid to be a nurse?

    I think anxiety is more likely your problem than intelligence. A panicky mental state is not at all conducive to clear thinking, focus, and organization. For whatever it's worth, the mental demands get easier with practice. For everyone, most definitely including those who think it never will. Your brain just eventually reorganizes itself to do what it needs to do - I was super slow, forgetful, and foggy when I started, and now I can remember full panels of lab results on patients I had last month but still need to check my phone to remember my mom's phone number. Still, the problem you describe has nothing much to do with intelligence or memory, and everything to do with anxiety and frame of mind. Please talk about it with your provider to see what your options are.
  12. Cowboyardee

    stethoscope recommendations?

    Thanks, and very true. I just wanted to add that youtube is a great resource for this kind of thing because you can get decent recorded examples of different adventitious sounds along with discussion of said sounds, patho, etc. Tons of free educational videos, many geared toward med students. Wish I had it back when I started.
  13. Cowboyardee

    I feel like I’m not taken seriously?

    Right now you are inexperienced in critical care. April 2019 wasnt long ago, and it takes, realistically 1-3 years just to be competent in an ICU. That's a bigger issue than being young looking. Visitors might focus on your apparent age now - that won't happen so much once you really know what you're doing and have the confidence and authority that comes with that. Give it time. Fwiw, I looked like a teenager for the first 5 years of my career.
  14. Cowboyardee

    stethoscope recommendations?

    Got the littman cardiology (4 I think) as a present, and I like it a lot. Even the cheaper littmans arent bad either. I haven't seen too many double-tubes stethoscope that are awful regardless of brand, though I certainly havent tried them all. Frankly though, more RNs fail in their skills, knowledge, diligence, and interpretation than in their equipment when it comes to auscultation. The best tool is often just solid clinical education amd experience.
  15. Cowboyardee

    Preceptor is SO BAD!

    Part of the problem for this kind of topic is that it really lends itself to projection. People who've had genuinely useless or malicious preceptors can easily imagine the OP as themselves and cast the nightmare preceptor from their own past as the OP's foil. Meanwhile all of us who've had the displeasure of precepting a new grad who has no idea how little she actually knows but nonetheless runs to administration every time she sees anything different than what she learned in school and cries about being bullied anytime someone tells her she's wrong... well, we can easily imagine the OP to be that particular new grad. The truth is probably that neither one quite fits, but ALSO that two shifts is definitely too early to tell. All I can say with any certainly at this point are the following 3 bits of advice: - Be patient. 2 or 3 shifts is too soon to know the lay of the land. - OP does need an attitude adjustment. Not because the preceptor is necessarily in the right but because the OP's attitude surely isn't helping things in either case. - The OP should quietly and carefully cover her own butt.
  16. Cowboyardee

    Preceptor is SO BAD!

    Her preceptor has been there for 7 years. If her unit manager doesn't already have a pretty good idea of how she practices and her M.O. as a preceptor (and she isn't brand new to the unit herself), the unit must have bigger problems. If, on the other hand, the manager is new to the unit and legitimately doesn't know these things, the OP would be wise to exercise caution before inserting herself further into unit politics than she needs to be at this point. She has no allies yet and any manager happy to use a new grad as ammo against established staff isn't necessarily looking out for the long-term interests of the new grad anyway. Even if the OP ultimately asks for a new preceptor, she really shouldn't blindly launch a crusade against established staff.
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