Rlien

A few things. 1. Wound care is a specialty. You either love it or hate it. In the nursing field expect to change some dressings and do some wound care, but the wound you saw wasn't routine. Wound vacs can be tricky; you need to know how they work, how to fix them, how to change them etc. But the area you vaguely described is far from your average wound vac dressing. 2. The nurse screwed up and/or the patient refuses pain medication. ALWAYS TRY TO PREMEDICATE PATIENTS PRIOR TO CHANGING DRESSINGS!!!! Having spent time in wound care, if it's moderately involved try to pre medicate and take steps to lessen the pain. Now, that doesn't mean the patient is going to be pain free or noiseless and stoic, but if a patient is screaming then you need to stop and medicate or stop and notify MD. You may need to get pain management on board. There may be other issues that need to be addressed (infection, handling, positioning, disease process worsening, etc.) but no patient should be screaming in pain. They might need a local or regional block. There are a variety of options. Bottom line... Somebody above you needs to make the decision on how to handle the uncontrolled pain and what if anything else to do.

I graduated idk 3 years ago. I'd give you this advice. Hold onto those feeling of inadequacy but kick the anxiety to the curb. Knowing you need to be smarter, better, faster, etc. helps you keep the edge to be smarter, better, faster, etc. You are anxious about it for a reason, use it. To give an example, I had a patient that was "blowing up" (facial edma, arms and legs weeping). Everyone was looking at electrolytes and I/O, but it wasn't getting solved who ended up getting diagnosed with myxedema. I was furious that I didn't think to sit and analyze to ask for TSH (this was in my first two months of nursing btw). 8 months later I was working an extra shift on 3rd and saw a patient with similar symptoms (recurrent edema issues, facial edema, etc.) who looked puffier when I was ending the shift than when I started despite sleeping most the night and having minimal fluids. I called and got an order for TSH in addition to CMP and a few other things the doctor wanted. Turned out the patient was getting less than half the synthroid needed. Knowing you need more will help you; when you're inadequate, improve yourself. Don't know enough, learn. Not fast enough, analyze how you use your time. Not synthesizing information, stop to look for patterns. You'll never be perfect but you can be better; work to make yourself better. Regarding emergencies and codes. Just stop. I don't mean stop having codes or stop going to codes. I mean take 10-15 seconds and ask yourself what the problem is and what it is that you need to fix the problem. It's sounds dumb. Pt with no pulse and no breathing; I need the crash cart for a mask, I need the pet to get cpr, I need more hands to help and document, etc. PT zonked out, low respirations, low vitals, etc. I need the MAR to see if narcan/romazicon, rebreather/intubate, blood sugar level, etc. "Doing something" isn't always effective; doing the right thing is effective. Stop to take a second to figure out what the right thing is. As far as confidence goes, pretend. You will get there if you work at it in time. Until then, fake it. But like Castiela said, celebrate your wins. Even the little things; especially the little things. Learn from your losses, but celebrate your wins.

Essential tremors (mostly hands/fingers) run in my family. It was a running joke at the poker table that if my hands were shaking, then I was betting; I was almost always betting. But I've never really had an issue with IVs except with overweight dark completed patients where I struggle to visualize the vein. First thing I did, was study vein/artery charts; no body is the same but it makes it far easier to find what you're looking for if you know where you can look. I don't know what will work for you as it seems to be a different underlying cause, but I'll tell you what I do. I take as much time as I need. I get comfortable with which vein looks the most promising; I spend time to find out how it will move. I always have a second set available and second site chosen already. If I'm struggling between site choices I get a second opinion. I wait until I'm ready and then I go for it. Working in LTC I don't have time to waste, but for something tricky it's worth spending the extra time to get things done right the first time. If you can, practice on other people; not those runner types with bulging veins on skinny bodies. But on moderately difficult sticks. Usually, the cephalic vein is the easiest for me because it's easy for me to find where it hitches over the radius. Idk why my hands steady down after that. Maybe I fake it and don't realize I'm shaking still. Just keep on trying. You can do it steady hands or not.

Just me, but I've found I got sick more often when depressed or stressed. Maybe could look at that? Idk, but I wish you the best of luck with expanding your family and staying healthy however things work out.

Good news. I've been a bit busy. Had two facilities contact me almost the same day (morning after?) that I posted this and kinda forgot about this. I actually started training Tuesday. It felt like a perfect fit which is why it all moved so fast. My "work wife" (nurse friend who I worked with where I was fired from) had switched there and put in a good word. Had a nice long interview explaining what they were looking for and how I could fit in, etc. it really kinda restored my faith that there are still people who care more about good service than the bottom line. The administrator even seemed like this great down to earth guy instead of a greaser. I don't know much about hospitals except from reviews I've seen left on them. But my experience in LTC (being familiar with almost all of them in my area) is that the ones that don't care and are not "picky" about staff are the ones you don't want to work for (or go to). @LilNel and Pixie: I really appreciate the support. It really made me smile when I saw the update email and looked back here.

I got fired from my last job. I worked there (in LTC/short term rehab) for a year and a half. I told them I'd work on my off day so long as it wasn't on a specific cart; they put me on that cart. I had texts saying I wouldn't work if it was on that cart. I had conversations four days in a row about how I wouldn't work that cart. I notified them that I wasn't going to work it (after making sure every other cart was covered by nurses on their regular carts) and left. I didn't clock in, I didn't accept report, nothing. They fired me for bull **** reasons. Where I worked the MDs relied on me, trusted my opinions, and used me as a resource (because I caught numerous potential problems and got their oks on fixes prior to it being a problem). I got things done and made sure things were all above board. Still fired. Now 6 months later, no one will hire me. Hospitals won't hire me because I don't have a BSN despite having my a Bachelors in Biology. Interviews go well, then I never hear back. A little over a week ago I was sent for a drug screen (the best sign I've had yet) and haven't heard back or been able to reach the interviewer; left two messages and still haven't heard back. I'd been saving prior to being fired and I've cut as many extraneous expenses as I could. My nest egg is now gone. Unemployment was denied (yay "right to work" state). I've applied in Town, out of town, in state, out of state, everywhere. It doesn't matter. I've applied to places where former coworkers put in a word for me. I've applied to random places. I've applied online. I've gone to places to apply in person. I've applied to hospitals (urban and rural), LTC, dialysis, physicians offices, dialysis. I've applied everywhere that's even slightly responsible. I've done everything I can think of. I don't know what to do. I don't even want to get out of bed anymore except to take a shower and eat once a day. I can't handle this anymore. I don't know what to do and I don't even know what I can do. I don't want to do things with friends because I don't want to ask them to pay and I don't want to hear them ask if I've found anything. Hell, going to a friend's wedding this past weekend I couldn't handle going to the reception just because everyone would ask me where I'm working and how it's going. I just can't.

I've spent the last 6 months in an odd position. I'm a big guy ~280lb with a bit of a beer gut. I'm 6' and a 'shower'. The problem I'm having is that scrub bottoms are either too short, too tight/showy in the groin, or extra baggy. Any scrub brands that work around the boys well?

I have a pt who's been in LTC for years. He thinks he knows everything. I'm a newer nurse (6 months post graduation) and I'll admit to not being the most knowledgeable about everything, but at least half of what he "knows" is wrong. He refuses to stay in bed, but then he gets mad when I can't come running to spend 30+ minutes to re-dress the wound vac when it's fallen off his peri-anal and scrotal abscesses. He wants everything done ASAP. He's refusing to take ABT because it's a capsule and not a tablet. An hour of my day is eaten up with him. He's just an obstinant jerk. Is there any way you have learned to get it through to these type of patients? How do you deal with them? I'm pretty sure it isn't me because 18 of my 19 other patients adore me and complain when it's my weekend off. It also doesn't help that my work is begging me to work 13/14 days.