5/29 This week, I have learned... One year later!!!

imbatz, BSN, RN · May 31, 2016

This is a great thread! Congrats on the one year anniversary.

1st week as a new nurse (still on orientation) on an open heart step down unit. WILTW- AHA has changed the names of systolic and diastolic heart failure, use a towel to cover the patient when you pull chest tubes, blood WILL splatter everywhere and have a good hold on those tubes when you pull them, a really really good grip.

I start 2nd week tomorrow....

kalycat, BSN, RN · May 31, 2016

1) I really, really hate poison ivy. Lucky me, I got cellulitis and a fever from it on my arms, that required an urgent care visit. My arms are wrapped up like a mummy's from the weeping sores, I'm on a prednisone taper and cream, NSAIDS/Tylenol, antibiotics, and so many antihistamines I'm dry as a bone. Blergh.
2) I have total sympathy for any patients of mine on prednisone, makes me feel really weird, jittery, and hungry. Also blergh.
3) Apparently, this poison ivy is going to take 1-2 more weeks to clear my system, and I might have permanent scars. SO. AWESOME.

Dude. I can't like this. For the prednisone alone...yikes. I hope you start feeling better stat because that sounds utterly miserable.

Thinking of you!

PS: my military vet husband had the worst response ever to prednisone - like a massive ptsd exacerbation. We had to stop it immediately. A useful drug for what it is, but sometimes the side effects are awful

Long Term Care Columnist / Guide · May 31, 2016

Sheesh, where did that year GO?? I've been reading them all this time, although I don't post often because what little I might have to say has already been said, and better than I might have said it. Anyway, keep up the good work, ixchel, and we'll continue to follow you on your journey that takes us along for a great ride. :)

nutella, MSN, RN · May 31, 2016

This week I have learned that I am not 100% clear on how I want to utilize my MSN once I am done - hopefully next spring. I am not studying the NP curriculum as I do not feel strongly about becoming a NP. I am satisfied in my current position but also want to put the education to work. Perhaps I will be able to find some kind of teaching job on the side.

I would like to continue my education but with one child in college this summer and child 2 entering college in 2 years I have to be mindful of finances. Right now I am doing some research about different programs and the costs.

greenerpastures · May 31, 2016

This week I learned I can be a good patient in the outpatient surgery setting, even when it was delayed multiple times. I learned although I love caring for medical oncology patients, I very much dislike the process of becoming chemotherapy certified. I learned that even though I'm approaching 40, my older brother still feels the need to be my protector when I'm sick, and it made my heart happy.

quiltynurse56, LPN, LVN · May 31, 2016

Happy birthday to WILTW

Me?

Being the wife of a car accident victim is no fun. The darn ER wouldn't let me back there for what seemed like forever. When I got back there, the doctor came in and asked all the orientation questions as the EMTs and nurses thought that his responses were too slow. Doc asked if always replied that way. I told him when he is under stress like that he does. Phew at least the Doc listened to me, but the Doc was the one person who knows I am a nurse. Hubby was checked over and sent home. He is doing fine now, just all the seatbelt type bruises. Now the car on the other hand, I have a new one.

I also learned that I did the right thing by going PRN at the job I held for a year. That place is toxic. The nurse on the shift before me both nights was loopy. Told me I didn't need to know all the ins and outs of the new computer system since I am "only PRN." WTH?

Working shifts through the staffing agency is so much better. Much easier to stay away from the drama and even though I may only be there a shift or two, they make sure I know how to use the computer system if they use one.

Well, I shall be working the next five night shifts. Something I try to avoid, but somehow got myself scheduled that way. Well, the paycheck will be good.

LadyFree28, BSN, LPN, RN · May 31, 2016

1) I really, really hate poison ivy. Lucky me, I got cellulitis and a fever from it on my arms, that required an urgent care visit. My arms are wrapped up like a mummy's from the weeping sores, I'm on a prednisone taper and cream, NSAIDS/Tylenol, antibiotics, and so many antihistamines I'm dry as a bone. Blergh.
2) I have total sympathy for any patients of mine on prednisone, makes me feel really weird, jittery, and hungry. Also blergh.
3) Apparently, this poison ivy is going to take 1-2 more weeks to clear my system, and I might have permanent scars. SO. AWESOME.

I had weeping poison ivy when I was a kid on one of my wrists...I can't remember which one-I think it was my right one due to instinct of always looking and the ringed scar for many years-because it is no longer there; it has been gone since my mid twenties due to my affinity to coco butter, shea butter, and aloe vera. :yes:

smartassmommy · May 31, 2016

Oh I also learned the 7 rights of medication administration

calivianya, BSN, RN · May 31, 2016

I learned that being shocked as all get out over a new job opportunity can give me some sleepless nights!
I'm super excited that I am transitioning to picu. I do love my floor. I do. But the constant turn over is killing morale (and to a certain extent, safety). It's not that we have a particularly bad culture, it's just that everyone is chasing the elusive flight nurse or CRNA opportunity. I even see this happening when I pick up in cvicu.
...
I've learned that rushing leads to mistakes, no matter how minor. That rush of tasks, particularly in the last 3 hours of my shift, is something that plagues me. I can fly - but it might mean that my NS is running at 1.65/HR instead of 65 after I clear the pump.

I feel like I could have written this whole post myself this week. I have an interview Thursday for a critical care transport position (NO PATIENT FAMILIES!!!!!!), and though it wouldn't be quite as flexible as what I've got right now, and the overtime would probably not be there, it might just be worth it for the increased quality of life I would have.

The morale is so bad on my unit everyone is fleeing left and right. I feel bad to potentially be a part of it, but it is what it is. Even work crush told me he has offers elsewhere last week, which made me really sad. I actually like my unit. If I don't get the transport position, I'm not going anywhere. Transport is literally the only thing I'd leave my unit for right now, and a full time nights transport spot just happened to open up.

...Speaking of turnover and the consequences to patient safety, I made a med error this week. I had two pre-existing ICU patients and just admitted a sick as crap third (because, as usual, we were understaffed because everybody's leaving) when lab called me a critical glucose. I was standing in my admission's room and just "uh huh, uh huh, uh huh'ed" my way through taking the critical since I was thinking I was too busy to sit down and document it as I was hearing it - my admission's BP was in the toilet and I was priming a vasopressor at the time.

I just knew the critical was going to be on my diabetic patient. I had already given him D50W once that shift; my brain was primed to give him another dose. He had very high tube feed residuals so he wasn't processing any nutrition, I had just weaned him "off" an insulin drip that in reality had been off for most of the time it was "on" due to repeat hypoglycemia, and I believed I had ordered too much scheduled insulin when I actually got him off the drip just per protocol and I had been anticipating his BG dropping again. I gave him more D50W, went to document it... and it was my NON-diabetic patient who we weren't even checking blood sugars on who was hypoglycemic instead. Oops. I really hate writing incident reports on myself!

So, here's what I learned this week - even if you think you're too busy to be bothered, stop in your tracks and document that critical live in the computer as you're hearing it so you will treat the actual value called to you and not the value you thought you heard. Lab can wait a few minutes for you to stop what you're doing and find a computer to log into. Avoiding a med error is more important than avoiding lab audibly sighing in your ear for taking so long to take a critical.

kalycat, BSN, RN · May 31, 2016

Cali, same thing for me. I was referred to a picu position initially by a former faculty, but didn't get it - they told me to keep applying, though. Then I get a call that another position has opened up! It's a very low turnover unit so it's sort of like finding a unicorn, at least in my area.

I hope the transport position comes through for you - that has been one of my long term goals for as long as I can remember.

Sorry about the med error. As much as we read about multi tasking leading to a higher rate of error, we all have to do it to keep our collective heads above water. I was so busy with catching up Abx, dealing with TPN, the patient's confusion... I just dealt with the fluids on autopilot.

Very good advice about grabbing a computer to take the critical! Xo

Farawyn · May 31, 2016

Thanks! I hope that when I have my license, it'll be a bit easier to secure a job. I'll let you know if I have any lucky with HFH. I found out my friend who has the extra room works at BASF, which is literally down the street.
ETA: Went to Belle Isle today and kayaked for the first time. It was gorgeous outside.

(((((crackle)))))

Love ya! Thinking of you with the NCLEX!

Farawyn · May 31, 2016

Oh I also learned the 7 rights of medication administration

"In my day" there were 5. :rolleyes: