From loony tunes, to total inadequacies, this week was ... unusual. Certainly plenty to learn. I actually had a much bigger list and realized I was a bit *too* specific with some details. Don't want to anger the HIPAA gods!
That aside, I got my fair share of unstable people and psych consult-worthy (and maybe law enforcement worthy) people. Good times....
Flipping back to days this coming week, and only this week. I hate days. Expect Grumpy ixchel for the next several days. You've been warned! [emoji5]ï¸
This past week, I have learned:
Biopsy was negative! And I'm surprised, because two different providers told me to expect something abnormal. Trust me - it's a happy surprise!
Esme is back!
Being on dayshift this week makes me want to cry. Also, there is no night shift jetlag/hangover when you stay up all night every night. Apparently I do better without all the sunshine.
Using a little creativity to bring a patient a small bit of joy after a week in the hospital from sepsis can really fill the heart. All it took was brewing some fresh iced tea.
"Roadkill", in rural poor slang, means cigarettes in public ashtrays that have enough left you can pull them out and finish smoking the rest.
I have met the creepiest man on the planet. I swear to God he killed his mom the night before he was admitted, and I'm pretty sure every single morning he dosed himself with different meds to have different legit symptoms to keep him in the hospital. By the way, being hospitalized is probably a great alibi.
There is a certain look that a terminally ill total dependent care patient gets on their face when you can tell they're only full code because their family insists. I wish I never noticed that exists. When you get them care that clearly makes them uncomfortable they get that look and all I want to do is apologize and promise I'll never cause them pain or discomfort again.
Expecting short term rehab because your driveway is snowed in is totes legit, yo.
If you are wondering why a medication that you get has increased in price, perhaps it's because their promotional brochure has started to include videos that can be played in English and in Spanish and is in full-color stuck in the middle of an actual pamphlet. God bless the pharmaceutical industry. (As much as I hate to link Vanity Fair, some of this is alarming. Deadly Medicine | Vanity Fair)
Lantus still smells as bad as it did the last time I broke a bottle of it.
If you feel your heart heavy after a shift because a patient situation was handled so horribly wrong, your hospital's patient advocate will enjoy hearing from you. You will also be able to go home and sleep knowing its in the hands of the person who is paid to solely make things better for the patient. If, as an RN, I opt for a 9-5, that's a job I could absolutely love.
I have once again witnessed how hard a body will fight to live. I'm sad for the circumstances with everything that went wrong, but honestly remain enamored by how impressive bodies really are. Newbies, remember this - the body wants to live. Let that truth steady your hand.
I actually found myself incredibly angry at EMTALA. It had good intentions, but now it can justify the non-emergent people pulling vitally needed staff away from the critically ill, leading to malpractice and negligence from severe lack of resources to handle the sudden influx of overflow.
Not school nurse related, but when I worked ER there was this one nurse who insisted on examining all her coworkers' ears during whatever downtime we had and cleaning them thoroughly. She also loved popping pimples, extracting fluid/gunk from abscesses, and watching cyst removals. I found it a little disturbing ...
I just read the staff meeting summary email, and I learned we have seven new grads coming in over the next couple of months. Seven. With our acuity level! And they have been shortening orientations to push people out faster!
And, of course, we have zero experienced nurses coming in. As usual.
Sigh.
I just really hope nobody asks me to precept. I don't want to. I intentionally didn't sign up for a preceptor class. Plenty of people did, and plenty of people want that $1.00/hr diff, so maybe I won't have to. I have too much on my plate to precept right now - I need my free time at work to study, not explain things to a new person who may or may not have gone to a decent school, and may or may not have had a preceptorship while in school.
I just read the staff meeting summary email, and I learned we have seven new grads coming in over the next couple of months. Seven. With our acuity level! And they have been shortening orientations to push people out faster!
And, of course, we have zero experienced nurses coming in. As usual.
Sigh.
Yikes, I'll be that new grad in several months. Don't eat me! I kid. This is why I'll be asking the experienced nurses to new nurses ratio on the floor.
Yikes, I'll be that new grad in several months. Don't eat me! I kid. This is why I'll be asking the experienced nurses to new nurses ratio on the floor.
Crackle, you've been around us long enough to know what to expect. No worries about you.
Today I learned people actually think I know what I am talking about when I burst out with little things like this.
See all those cells in layers that is stratified squamous epithelial see that thin layer of cells that is pseudo stratified. Or crap like Microvilli increase volume surface area by acting like a peninsula to increase surface area contact in the lumen without increasing volume, which would decrease absorption rate. I feel like a talking head
I learned I have a lot to learn, and you can't please everyone.
Yikes, I'll be that new grad in several months. Don't eat me! I kid. This is why I'll be asking the experienced nurses to new nurses ratio on the floor.
I wouldn't even eat a preceptee if I got one... unless they were exceptionally stupid.
We have one of those on our floor right now. I'm most afraid that if I am assigned a preceptee, it will be like her. Walked into her room while her preceptor was in the bathroom to see just why her patient's BP was hanging out at 60s/30s.
"Hey you. How are you doing?"
"Good!"
"I see your patient's on Levophed. What's your max?"
"30 mcgs, it's only running at 12mcgs now. Do you think I should turn it up?"
"I think that's a good idea."
"How much should I turn it up by?"
*facepalm*
She's off orientation this week. Management has thus far been resistant to offer her additional orientation because we're so short staffed. She's had four months already but it's clearly not enough. She even already has had extra weeks with some known hard preceptors to see if they could straighten her out, but everyone has failed so far. I wonder how long it's going to be before she kills somebody.
I wouldn't even eat a preceptee if I got one... unless they were exceptionally stupid.
We have one of those on our floor right now. I'm most afraid that if I am assigned a preceptee, it will be like her. Walked into her room while her preceptor was in the bathroom to see just why her patient's BP was hanging out at 60s/30s.
"Hey you. How are you doing?"
"Good!"
"I see your patient's on Levophed. What's your max?"
"30 mcgs, it's only running at 12mcgs now. Do you think I should turn it up?"
"I think that's a good idea."
"How much should I turn it up by?"
*facepalm*
She's off orientation this week. Management has thus far been resistant to offer her additional orientation because we're so short staffed. She's had four months already but it's clearly not enough. She even already has had extra weeks with some known hard preceptors to see if they could straighten her out, but everyone has failed so far. I wonder how long it's going to be before she kills somebody.
I wouldn't even eat a preceptee if I got one... unless they were exceptionally stupid.
We have one of those on our floor right now. I'm most afraid that if I am assigned a preceptee, it will be like her. Walked into her room while her preceptor was in the bathroom to see just why her patient's BP was hanging out at 60s/30s.
"Hey you. How are you doing?"
"Good!"
"I see your patient's on Levophed. What's your max?"
"30 mcgs, it's only running at 12mcgs now. Do you think I should turn it up?"
"I think that's a good idea."
"How much should I turn it up by?"
*facepalm*
Uh, not good! "Only" 12 mics?!? I'd be calling for a secondary pressor! And a side of celery to go with the ranch dipping sauce ...
Uh, not good! "Only" 12 mics?!? I'd be calling for a secondary pressor! And a side of celery to go with the ranch dipping sauce ...
Patient was already maxed on neo and dopamine - I didn't bother to ask about those because I saw what the pumps were running at. The patient was very sick, but still - if I walk into a room and see a 60s/30s, I'm expecting to also see the RN on the phone with the physician asking for another drip because the drips are maxed, not taking her time propping the patient's arms on pillows and smoothing some wrinkles out of the top sheet while casually asking if I think she should go up on a pressor.
She has zero sense of urgency. It's frightening to watch.
Patient was already maxed on neo and dopamine - I didn't bother to ask about those because I saw what the pumps were running at. The patient was very sick, but still - if I walk into a room and see a 60s/30s, I'm expecting to also see the RN on the phone with the physician asking for another drip because the drips are maxed, not taking her time propping the patient's arms on pillows and smoothing some wrinkles out of the top sheet while casually asking if I think she should go up on a pressor.
She has zero sense of urgency. It's frightening to watch.
We have several nurses like this in my unit and it is terrifying to watch and to precept (absolutely horrible to precept because if you try to convey the urgency, your orientee looks at you like you have three heads). Not that I want new nurses to run around panicking, but some sense of urgency to fix critical vitals needs to be there. I've seen nurses do (unnecessary) bed changes with their patient's sats in the teens and heart rates in the 30s.
We have several nurses like this in my unit and it is terrifying to watch and to precept (absolutely horrible to precept because if you try to convey the urgency, your orientee looks at you like you have three heads). Not that I want new nurses to run around panicking, but some sense of urgency to fix critical vitals needs to be there. I've seen nurses do (unnecessary) bed changes with their patient's sats in the teens and heart rates in the 30s.
Oh yeah, we have one (experienced) nurse who is absolutely hell-bent on getting the patient bathed and clean on admission. I'm all for bathing someone on admission, but last month I had to literally grab her arm and stop her from rolling a patient. I suggested in a lighthearted tone, "How about turn the pressors up, wait until the next BP cycles, and see what it is?"
Patient was gray; BP was in the 40s systolic.
She is a great nurse the rest of the time, but she will bathe anybody right at that moment, regardless of the BP reading. I love working with her, though. She has a wonderful sense of humor and is a whiz with IVs. Just don't let her bathe your patient.
I kid. This is why I'll be asking the experienced nurses to new nurses ratio on the floor.
Farawyn
12,646 Posts
I thought we were friends!