PewpSmith

Saw this article on NPR and it raises some interesting points I hadn't considered about this specialty. I mean.... I tend to think of you guys being responsible for physical health and student well being during school hours. When it comes to mental health- how do you suss out what is really an issue vs what is normal teen behavior in such a small window of time with students? What can you even do about it? If its not an abuse situation you can't really report it.... idk... so many questions School Nurses Can Be Mental Health 'Detectives' But They Need Help : NPR Ed : NPR

2 things- When they take nearly all the charts on the floor and hide with them. When you find them and ask for your chart to do documentation they're like- I'm not done with it yet- then take the chart you wanted that they weren't even using- and open it and just look at stuff so you can't borrow it. And then when they leave all the charts all over the place and your shift turns into an Easter egg hunt . 2. When certain doctors- and every nurse knows which ones as soon as they start working- get super rude and mad that you called them about their patient. I get it if they're calling for dumb crap, but when you're calling because a surgeons patient (who wasn't on hospitalist service- ie, the patient was their responsibility alone) is a 21 year old >24hour open apply who had perfed badly before surgery is suddenly dropping his sats precipitously despite increasing his 02 and had previously been 100% room air who is now 85% on a non rebreather and is feeling "like they're going to die"- yeah, when I keep calling you for orders it's because your last crappy set didn't work and I'm not going to quit calling you when you hang up on Me AGAIN but I WILL cry because I'm scared for the patient and when another Surgeon sees me I will tell him the whole thing and this Surgeon will intervene and call the other guy himself- too bad it was already after a rapid response and the patient was headed to ICU now in a hospital where there aren't intensivists overnights -only on call- and the ER doc downstairs is tied up in 2 codes so the surgeon that saved the day incubated the patient and played intensivist until the real one could get there..... After that, the original surgeon got a bad reputation because even the other surgeons heard all about it and thought he was crap Lmao that was such a specific example.... this happened 7 years ago and I'm still angry about it. As though nurses are idiots and you didn't know you'd have to be called in the night when you went through med school and residency.... Long story short- DON'T ACT LIKE YOU'RE DOING A NURSE A FAVOR WHEN YOU ANSWER THE PHONE

Ok.... so by your own statistics of 2000 nursing being convicted of this WORLDwide.... let's do some statistics..... Many accredited sources report 3.1 million Registered Nurses in the USA alone.... 0.065% of nurses are convicted of this if we just use USA nurse statistics. If you add in all the other nurses in the world (couldn't quickly find a credible source for that) that number would be much much lower.... Also.... all of those "Signs to look for" parallel those of signs to watch for r/t diversion. This article is bunk

I am super guilty of asking people where they are from and/or what their ethnic background is. Sometimes I've even gone so far as to ask, "Were you born in another country?" after they say a local place. Sometimes these questions have led to fantastic discussions about their culture and their background when I am able to tell them that I had visited their country several times (I travel a lot) and ask them about certain places I've visited and some of the regional food they are known for. Sometimes they share the same background as my husband, who is an immigrant- Which leads me to talk to them about my favorite parts of their culture and heritage and usually always leads to good laughs and stories. When they tell me they are an immigrant I will tell them how awesome that is and that I have kids who wouldn't be here if it weren't for immigration. Nearly every time, it has left the patient, in my opinion, with a sense that I have a real bond with them and have built some trust. ...So.... should I not even ask anymore? Its apparent from several of the responses on here that it is downright rude- regardless of intentions due to past bad experiences- to ask people about their background. I'm genuinely wanting to know. Making people i'm caring for uncomfortable is the LAST thing I want to accomplish from this.

Honestly, as crappy as this is, it depends on who it was that violated you. My husband's ex, who is a doctor, looked up my records for AT LEAST my demographic info (SSN, address, phone numbers, emergency contacts, etc etc) and while they couldn't prove that she had looked up more than that, they could definitely see that she had accessed the aforementioned stuff. I am VERY VERY suspicious that she looked into my actual records MORE than that because of very specific threats she made to me and my husband… but because of her position she simply has a permanent mark on her record, for which she wanted me to apologize to her for, because she has to "explain it at every job interview" she has to go to. So… while it is taken EXTREMELY seriously in most/some cases, for others it is swept under the rug.

Can I just give advice about the friend request on Facebook coming from my own personal experience? Don't add this person. Until you have been there a reeeeeaaalllly long time and you actually would call that person a friend for sure. You never know who that person is buddy buddy with and they could just be combing all of your stuff LOOKING for anything possible that they can laugh about and gossip about. Saw something a while back that said "Be careful who you open up to. Only a few people actually care. The rest just want something to gossip about"

Can I just say that I, too, hate when other nurses make the "I got less than 2 weeks orientation so don't complain about your orientation" remarks. Especially in critical care areas or for any new nurse on any type of unit. I'm fairly certain those same nurses were probably struggling due to their too-fast orientation. It sucks that they didn't get an adequate orientation but that doesn't mean everyone else should be short changed on theirs. Honestly it makes 0 sense because when you're an orientee you're usually extra staff and an extra set of hands, especially at the end of orientation AND an adequate orientation ensures that when the newbie is off of orientation they're able to function as a full member of the team and don't require anyone else to pick up their slack while they're drowning. *end rant*

This is disgusting and makes me see red! Ya know, it MUST be nursing's fault and never that there isn't enough staff and resources (sarcasm font needed) I hate this mentality that it's everyone's fault except administrators who don't want to pay for adequate staffing.

So I'm very excited to announce that I took my CEN exam today and passed it with 131/150! I bought several books but found that only a few were actual useful and/or pertained to the exam. The 2 books that I would buy if I was doing this over again are Sheehy's Emergency Manual by the ENA and the bluish/purplish book by the ENA with 5 practice exams/rationales (they give you a code for 2 online ones too). I used the CEN lectures by Mark Boswell on youtube to supplement this and found that it really helped me single out what was really important to learn. I hope this really helps anyone else out there!

Boswell Page: (link removed) Make sure you go back through at least 10 questions bc a couple are softballs And Solheim: (link removed)

Hey you guys-- I'm on Facebook and was wondering if those of you who passed the CEN exam already could look at the questions posed on the Mark Boswell Facebook page and the Jeff Solheim page and tell me if the questions are really comparable to what they have on there recently. Some of those questions are unbelievably specific. When I do the practice exams in the ENA book I do ok-- around 70-80% but when I try their questions on their FB pages I rarely get them right. I wonder why there is that disconnect….

Uuuuuugh I forgot about that crap! That's the thick white cream we slather on high skin risk pts right? I haven't had to deal with that stuff for a while since I moved to ED

Just asked Mr. PewpSmith (GI MD) and he said he couldn't think of a reason

Can I just say HOLY crap for a moment? I nearly called this post "What is your Achilles Heel" ..... And then settled on kryptonite.... And then our shared aversion to dentures??? I also don't bat an eye with maggots in nasty wounds and am an ER nurse..... Are you......... Me?

Reading that in my head made me giggle like the immature 5 year old I really am at heart. Poop (pewp) should totally be an honorary SN

I have been reading quite a few School Nurse threads (you guys are the most involved on allnurses I think) and it has opened my eyes as the parent of a 1st grader who has frequent respiratory issues and is honestly kind of dramatic about everything. It had always been my feeling when I would get called by the school and I declined to pick the kid up (because I think they needed to tough it out and are pretty much being dramatic) that I was going to be perceived as a bad mom. I thought that the nurse filtered out all the bs/dramatic/faking to get out of school complaints and only called parents when they were convinced the kid was the real McCoy. I now see that much of the calling you do is basically because staff/students pesters you to the point that you have to give them SOME intervention lest you appear that you're not doing your job. Next time I get called for a headache after a very vigorous Recess in the cold with normal VS I will be much more confident saying my kid needs to suck it up and leave the nurse alone lol

See, now I've heard of being squeamish with trach/Oral secretions from just about every other nurse I've had this conversation with. I have heard colostomies too, unsurprisingly lol, but never have I heard of Ocular tasks. Pretty unexpected

He wrote Being Mortal, Complications, Better, and The Checklist Manifesto. They are all typically about the healthcare system and the many double edged swords we face when trying to do what is best and ethical. ....I feel like I know what you're referencing about the doctor with cancer writing a book but, like yourself, can't quite recall which book it is.... JUST CAME UP WITH IT:When Breath Becomes Air by Paul Kalanithi

You should check out the book by Atul Gawande called The Checklist Manifesto if you're interested in healthcare reform based on other industries. Its a very interesting read :) Anything by that author is a win really (reply to user @nutella)

You're absolutely right-- it is serious for sure. I guess my intent was to make OP feel less grief about the order in which she chose to do things because it looked to me like her patient was urgent and could receive abx as piggyback with no consequence to her patient as opposed to critical and in need of aggressive fluid resuscitation. Again- agree to disagree but I think the OP can breathe easier knowing that there are 2 ways to skin a cat and 2 nurses can look at the same patient and order their care slightly differently and the outcome for the patient will still be ideal because in this scenario I doubt that the fluids being on hold for the piggy back will cause any harm. (Again can't say for sure because neither of us can see the patient in question).

Agree to disagree? You make a lot of assumptions (their usual bp, beta use, being elderly or not) to say it was incorrect but any sepsis patient can go down the tubes fairly quickly. Also, many/most febrile pts I've had are tachy to a degree regardless of cause. Mainly what I was saying was most of the picture she painted was one of an urgent but not "Intubate and Central Line ASAP" critical.

Hey there, ER nurse with 8 years varied experience here (3 different ERs with very different settings) And unless you're well behind your peers with how many patients you're managing at the same time (for instance, if you only had the 1 septic patient and they are caring for a septic patient and 3 other patients) I don't really see where the rub is with this preceptor and you. Fluids are important- yes- in a septic patient but antibiotics are key also. I can maybe see if abx were initiated before securing your ABCs but the that wasn't the case. And before someone argues that Circulation wasn't secure so fluids were more important- those vital signs provided looked pretty stable to me. Your preceptor seems to suggest that you're treating septic shock and not simple sepsis-- while I can't say at all what the actual presentation of your patient suggested because I have such a small picture, I don't think your patient was critical. Core Measure initiatives place staring abx and fluids both before 3 hours. Also.... I don't give meds without a doctor order. There are standing orders in some facilities I've worked at but those were common sense type things with pretty strict guidelines as to when you could give various things.... But to gather meds you think you might need on all your patients seems like a poor use of time since doctors rarely order exactly what we think they will and you'll end up back at the pyxis to return meds or give more.... That being said-- if you have a patient crashing then YES pull the RSI meds and whatnot. I think that as long as you're on par with quantity of patients you're caring for as compared to your peers then you're fine. I think the quality of your care is fine and will improve with time.

In my experience I've found that how well the nurses are allowed to take care of their own needs (take bathroom breaks, eat, take reasonable amounts of breaks) depends on the 'culture' of the particular floor/hospital you work for. Some places would have outright laughed in my face if I said I was needing to go to lunch and when could I get covered-- but other places, (my favorite place I've ever worked), made it a priority to take care of one another to the point that everyone got lunches (as long as there was not very abnormally high patient flow) and bathroom breaks. The place I'm thinking of specifically was a VERY busy ER in general (the 2nd busiest in that state) so 'being busy' wasn't an excuse. If the culture is there and the atmosphere is there, then it makes it easier. THAT BEING SAID, I think the key to staying healthy, when it comes to diet, is preparation. Few hospitals allow enough time to leave campus for food and few also have good tasting HEALTFUL food available at all times for staff. It's all about meal prep. When I was on the work-out wagon I made sure to have food prepared and in the staff fridge so there wasn't an excuse to make bad food choices. Also, like most things, people tend to find a way to do things that are important to them. If you make your health a priority, I bet you will find a way. Hope this was helpful?

Sometimes, when you have been appropriate and have tried to address things via the proper channels (Asking the aide to speak to the primary nurse, the primary nurse to speak to the charge nurse, etc.) you have little option other than to speak to the manager of the floor. Squeaky wheel gets the grease. And these aren't complaints that warrant staff becoming annoyed- you're actually wanting him to receive good care. It's not as though you're complaining because you've had to wait too long for ice or you're angry because there aren't enough channels on the TV. You're very VERY reasonable by not wanting him to get a UTI from a foley when he's already post-op and compromised. If you're wanting to seek assurance that being "the squeaky wheel" is appropriate here then ABSOLUTELY, yes. I think you're trying your hardest to just be an advocate for your family. If the manager doesn't respond/address your concerns I'd maybe speak to the CNO. If the CNO doesn't respond try to talk to the CEO. Best of luck. You're in a tough place.

Man… that's a lot to handle. Just think, though, how lucky your kid is to have a nurse for a mom who knows how to manage their condition and you obviously already know how to handle it because of your other child with the diagnosis. Best of luck to you. *Sending good Thoughts