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.
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.
I'm curious - do they lose the ABC priorities mentality after they graduate nursing school and attain the pinnacle of all nursing wisdom by passing the NCLEX? I think I'm starting to have an anxiety attack just thinking about working with that type of nurse ... gonna breathe into a paper sack for a little bit and hide in a corner. That's scary!
I'm curious - do they lose the ABC priorities mentality after they graduate nursing school and attain the pinnacle of all nursing wisdom by passing the NCLEX? I think I'm starting to have an anxiety attack just thinking about working with that type of nurse ... gonna breathe into a paper sack for a little bit and hide in a corner. That's scary!
I think the farthest their ABC priorities ever extend is to passing test questions, and they are unable to make the jump from paper to real life. Maybe if I asked them whether the ABCs or getting cleaned were more important, they would be able to tell me it's more important to have a blood pressure because I would have asked them a question in words, which is the same way they learned the information in the first place. And maybe not.
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.
I can definitely say that if the BP is running that low, I would be calling Doc.
I'm curious - do they lose the ABC priorities mentality after they graduate nursing school and attain the pinnacle of all nursing wisdom by passing the NCLEX? I think I'm starting to have an anxiety attack just thinking about working with that type of nurse ... gonna breathe into a paper sack for a little bit and hide in a corner. That's scary!
With new grads, I think a lot of the overly task-oriented thinking comes from nursing school, which centers on checking tasks off in clinical, so that's how the new nurse thinks that the day is supposed to go. So if you have a receptive new grad willing to adjust their thinking, many times you can re-direct them to more of a whole-patient focus and prioritized tasks rather than a series of tasks with no cohesive focus.
Some of this behavior isn't just from new grads either though, which is scarier! I think that some people are far too task-oriented (to the point that they are blind to being able to prioritize or eliminate inappropriate tasks) for the ICU. These nurses would probably do better elsewhere since they are good at their tasks, just maybe are in the wrong environment for them.
I have to say, though, my last new grad was absolutely awesome and was great at prioritizing with a little guidance and the one before her really struggled with it (and was resistant to any attempts to guide her) and has been struggling off orientation for a while.
With new grads, I think a lot of the overly task-oriented thinking comes from nursing school, which centers on checking tasks off in clinical, so that's how the new nurse thinks that the day is supposed to go. So if you have a receptive new grad willing to adjust their thinking, many times you can re-direct them to more of a whole-patient focus and prioritized tasks rather than a series of tasks with no cohesive focus.
Some of this behavior isn't just from new grads either though, which is scarier! I think that some people are far too task-oriented (to the point that they are blind to being able to prioritize or eliminate inappropriate tasks) for the ICU. These nurses would probably do better elsewhere since they are good at their tasks, just maybe are in the wrong environment for them.
I have to say, though, my last new grad was absolutely awesome and was great at prioritizing with a little guidance and the one before her really struggled with it (and was resistant to any attempts to guide her) and has been struggling off orientation for a while.
Plus, during clinicals, we only have 1 patient to take care of (and NOW we're moving up to juggling 2 in our final semester). Like that's realistic, unless you're in ICU. We'll graduate and, essentially, not know how to take care of more than 2 patients at a time. I'n a quick learner though, so hopefully that will help.
Plus, during clinicals, we only have 1 patient to take care of (and NOW we're moving up to juggling 2 in our final semester). Like that's realistic, unless you're in ICU. We'll graduate and, essentially, not know how to take care of more than 2 patients at a time. I'n a quick learner though, so hopefully that will help.
You are in your last semester and only taking 2 patients?
Plus, during clinicals, we only have 1 patient to take care of (and NOW we're moving up to juggling 2 in our final semester). Like that's realistic, unless you're in ICU. We'll graduate and, essentially, not know how to take care of more than 2 patients at a time. I'n a quick learner though, so hopefully that will help.
I totally understand. I only took 5 patients for the first time on my preceptorship right before graduating. I was thankful for that because it did save me a bit of culture shock once I graduated and was working on my own.
I totally understand. I only took 5 patients for the first time on my preceptorship right before graduating. I was thankful for that because it did save me a bit of culture shock once I graduated and was working on my own.
It's great that you had the opportunity to dampen that learning curve before graduating.
We don't even do a preceptorship. To say I feel unprepared for the real world is an understatement
I've learned that in a crisis people come to me, as if I know what I'm doing, and I don't.
Then they ask me for advice, and don't listen to it, anyway.
I've learned that The Holocaust Museum in DC is a must see. It's humbling and horrifying and graphic, and the architecture is beautiful. .
indeed it is. It's s important because it teaches you things you didn't know before. For example, I did not know that Hitler ordered handicapped and retarded people to be killed as way of eliminating imperfections from the gene pool. When I learned this I sat down in the floor and sobbed. This made me profoundly sad.
Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
I've learned that in a crisis people come to me, as if I know what I'm doing, and I don't.
Then they ask me for advice, and don't listen to it, anyway.
I've learned that The Holocaust Museum in DC is a must see. It's humbling and horrifying and graphic, and the architecture is beautiful. I've learned that the kids from other countries in my school (like El Salvador and Honduras) are not taught about The Holocaust, and they were so distraught they couldn't even speak and just kept crying. I've learned the teachers I work with are compassionate and comforting to their students....
When I was in eighth grade, we took a two day trip to D.C. We went to the holocaust museum the first afternoon. Immediately afterwards, we had a debriefing session that included a staff member with groups of five students. That was over 15 years ago, and I still have the images in my head. It was pretty awful, but it made a huge impact...
When I was in eighth grade, we took a two day trip to D.C. We went to the holocaust museum the first afternoon. Immediately afterwards, we had a debriefing session that included a staff member with groups of five students. That was over 15 years ago, and I still have the images in my head. It was pretty awful, but it made a huge impact...
The worst thing to me was the lack of response from the rest of the world, initially.
And their refusal of Jewish, Polish, etc. "Refugees"
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CamillusRN, BSN
434 Posts
Eeek.