After a week of deliberation on the WILTW threads, I can honestly say I'm glad for a new week! I have only worked one day this week so far, so not a very giant list to share.
This week in nursing, I have learned....
There is a very sad line between moral and legal decision-making in healthcare. When a DNR can be revoked by family only to prolong torture and a DNR not granted on an already terminal suicide attempt, we really need to find a way to make moral and legal stop being mutually exclusive.
After a month of horrible patient acuity, I'm realizing that now "normal" days actually feel a bit slow. Amazing how being pushed beyond your limits teaches you to increase those limits.
I've learned what pleurx drains are. Now I want to play with one.
It takes a lot longer to bring up a 2.3 potassium than a 1.1 mag. A lot.
I have a way about me that makes patients confess very, very strange things to me. (Apparently?)
I'm going to learn tomorrow if short hair is easier at work than long in a braid, bun or ponytail. Also, tomorrow I will get to compare my steps at work on my new Fitbit vs. the app in my phone. And..... Tomorrow is my last day in the 18-34 demographic.
I've realized that hospitals would be more mom-nurse-friendly if shifts were 9-9.
Looking at community health job postings has made me realize I have no idea how to figure out government pay scales. I understand the grade, but how does your starting step get determined?
I've included my children in the "daddy's schedule is changing, so mommy's might have to, too," conversation. It was hard to say no when my girl asked if I could "just" not work for awhile.
Crack is a hell of a drug.
Almost 1.5 years since graduation. I think I've decided I know how to nurse now. It's an amazing feeling!
How about you? What have you learned?
The weekly WILTW threads will remain in yellow as long as we remember to keep the majority of posts/comments focused on things nursing related. Students are welcome to share what they learned in their journey to becoming nurses, and of course, CNAs/PCTs/MAs and other unlicensed people who are part of the nursing team are welcome to contribute as well.
As this thread doesn't really have one single topic, it's very nature is to evolve into conversations that are off topic from individual points shared. This is okay, as long as the majority of posts in the conversations remain nursing, nursing school and UAP-related. Questions or comments on this can be shared in the site feedback thread with "WILTW" in its title.
I've learned that watching my facility's cath lab and EP lab folks' sterile technique will have the OR nurse inside me screaming in agony. They wear rings when they scrub (no! just no!), don't tie the bottom strings of their masks (why even wear one when it's hanging that loose?), and just in general aren't up to the aseptic techniques used in the OR. No, we OR folks aren't perfect either, but it's painful to watch bad technique.
But endocarditis!!!!!!
This is where I'd have to drop an anonymous tip to quality or infection control. This is scary!
Ixchel you gotta give that Mg super slow if you want to increase the serum levels.
We actually just gave a 2g piggyback and scheduled qd PO supplements and his mag stayed beautiful for the rest of his admission. His K, on the other hand, despite K riders, piggybacks, and PO, it just kept yoyoing from 2.1-3.0 for a few days. Normal kidney function, no diuretic administrations. Admits regular drinker and occasional crack smoker, but no withdrawal while admitted. He was HAP, after being at acute rehab post pneumo and chest tube in September. The day before discharge, his K finally hit 3.5.
QUOTE=AcuteHD;8755632]Happy birthday, hope it's a good one.
I think ixchel passed her black cloud to me. thanks.
Sorry about that. If it helps you feel slightly vindicated, I've been knocked down by yet another plague that has kept me down for the count. I used to love fall, before it included my darling children getting me sick every other week.
Happy birthday ixchel!! Love you!!
I learned.... I GOT INTO NURSING SCHOOL!!!!
That is all. Bye.
OOOOOOOOOOD! I am so damned proud of you I could just dance! Congratulations, my love! You have earned every bit of pride and joy this has hopefully filled your heart with! I hope you've been able to celebrate!
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
I burned my nursing school whites after I graduated. I now have to wear ceil blue. I feel like a freaking smurf. Better than looking like a marshmallow.
I dislike Ciel blue with a burning passion. My first job as a Rad Tech, I had to wear Ciel and that job was awful.
I had to wear a white dress with a green apron looking thing, white hose and cap, the who shebang in my first attempt at nursing (I failed out, I was young, what can I say). My second go round was a forest green scrub top and white pants. I hate forest green now.
Come to home health! Or hospice, because apparently for you Americans they're two different things. We tend to get Pleurx clients in waves. I had three for a while, discharged one to a residential hospice, one to the great whatever in the sky. And my last one got hers pulled this past Monday! Ill-advisedly, if you ask me.
That's probably a thing I need to keep working on - how do you support folks that are obviously dying but don't want to talk about it/don't realize it? We get lots of folks who are "palliative" but who are not necessarily completely on board with the "palliative" philosophy of care - folks who will sign a DNR in order to access Palliative Benefits (funding from the government for medication/equipment/care etc) but who, deep down, don't really believe they're dying anytime soon. Sometimes I can get around it by talking theoretically ("so IF, for whatever reason, theoretically, this were to happen... would you want to go to the hospital?") about folks' wishes. But sometimes it's a real problem, like when I can clearly see there are safety issues with this person staying at home and am suggesting transfer to a residential hospice, but why would they want to go when they're not dying? "I just need to get a bit of my strength back and I'll be fine, don't you worry." Probably one of the harder parts of my job.
On that note, I hope you all have advance care plans in place and have discussed them with your family. I definitely have, even at the ripe old age of 27.
Lately my struggle has been those who WANT to die, but family won't let it happen. It's been ridiculously heavy in my heart, and I've been having a hard time leaving some of it at the door. Nursing isn't for the weak, that's for sure.
What I think I've realized is that for some people, it's not that they're in denial regarding their prognosis. It's that they don't want to live like they're dying. Hope. Not hope that they'll live against the odds, but hope that their lives won't be defined by their upcoming deaths. I hope that this is what it is. I'll never be the one to ask. People approach death in their own ways. I don't want to be the one to mess with the peace they may be making with it.
Happy Birthday to ixchel and anyone else celebrating this week..
Happy Bday, ixchel!
Happy birthday ixchel!
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Happy birthday ixchel. Also, congrats on the new haircut?
My 8-year old and I both have 12" braids that are awaiting mailing off to wig makers for cancer. We're trying to decide who to send me to at the moment. We both went all-in, though! I was apprehensive about going shorter than ponytail/sloppy bun length because I HATE HATE HATE hair in my face, but so far, it's been okay. Frankly, I don't know how to girl, so I fear if it gets any longer, I may just go grab an electric razor, put it on 6, and just be done with it.
I already knew this from my LPN program but working and going to school full time sucks up all the energy I have. I am beyond exhausted and caffeine does not help at all.
When I reach this point with caffeine, I find a spot in my schedule when I can be tired and get away with it, and I drop or even eliminate caffeine altogether for those few days so that caffeine starts to actually work again. I'm sorry your oriente, school and life and general have been so draining. Sucks when life makes simply waking up a chore.
My 8-year old and I both have 12" braids that are awaiting mailing off to wig makers for cancer. We're trying to decide who to send me to at the moment. We both went all-in, though! I was apprehensive about going shorter than ponytail/sloppy bun length because I HATE HATE HATE hair in my face, but so far, it's been okay. Frankly, I don't know how to girl, so I fear if it gets any longer, I may just go grab an electric razor, put it on 6, and just be done with it.
1. That's awesome. I wonder if you met the person with your own hair would you recognize it? Would you think, "Their hair is just like mine used to be..."
2. Shaving is a commitment, too. You either commit to keeping it short forever or deal with the awkward teenage hair phase (when it flips out for no reason) eventually.
1. That's awesome. I wonder if you met the person with your own hair would you recognize it? Would you think, "Their hair is just like mine used to be..."
2. Shaving is a commitment, too. You either commit to keeping it short forever or deal with the awkward teenage hair phase (when it flips out for no reason) eventually.
[emoji23]
1. Well, my understanding is it takes a good dozen donations to make one wig, so probably not.
2. Bob and pixie cuts have that awkward phase, too, but thankfully hair ties and headbands help with that.
I learned that it is hard to support an octogenatian's independence when they are still very with it but not recognizing their deficits. It is also difficult to connect them with resources that will impose on their lucidity and self-worth. The system is failing this demographic and I feel helpless to intervene other than getting case management involved.
We have a center here that hosts an organization that makes handicapped devices that are custom taylored to the needs of the individual. It's pretty amazing. Funding is probably their biggest challenge, but as long as they have it, they end up having the ability to foster independence for our oldest old.
Your post reminds me of a gentleman who was a frequent flyer with a problem we couldn't find over and over again. We'd look quite thoroughly and turn up empty handed just in time for his primary symptoms to be relieved. On his last admission, we finally found the cause because it had grown big enough to see (a valve replacement had developed infection, which we suspected from day one, but it took almost a year for it to develop vegetation that was visible, and antibiotics couldn't quite get rid of it completely, even though all sis looked like they worked every time he was treated).
His infection led to other strange things, and he already had a history of stroke. His residual from his stroke was unilateral weakness and profound expressive aphasia, a massive source of frustration for him. But then he developed tremors, usually intention. My first shift with him the last admission, he'd been put on clear liquids. Imagine it - intention tremors on a clear liquid diet. As soon as I saw him with his first tray of the day, I immediately put his broth in a cup with a straw, then hunted down his hospitalist. There was no good reason for this man to be on liquids, first of all. It was a move toward conservatively making sure he was able to tolerate a diet at all (he'd reported recent nausea in the ED). The hospitalist he had this day was one of my favorites, one of the more reasonable ones to talk to. I just told him - "look, this guy is struggling immensely with his loss of independence, and now we're giving him a diet he can't even feed himself. Please let me change his diet so something he can feed himself. Let me order him some finger foods on a regular diet. Let's give this man some dignity."
The MD was amenable, and the patient thankful. These adults we are taking care of have pride in their hearts for the lives they've led and all they've accomplished. The one by one, they are robbed of the most basic abilities they (and we) have taken for granted.
I recommend looking online to see if you have senior centers or respite care agencies. Get in touch with them to see if they know of places that make devices to help facilitate independence for the elderly and/or handicapped. These hidden gems are excellent for the patients you describe.
Happy birthday ixchel. Also, congrats on the new haircut?
I learned that my progress notes become really interesting to read when I've been writing them for 12 hours. I really appreciate my preceptor, and she's skilled and wonderful, but just like in nursing school I find that having two people try to do one job together (i.e., being trained) is sometimes much slower. Necessary, but slow. So, I'm dropping one client slot at the end of each day to give me time to catch up on the things I can't do when I'm waiting for my preceptor to come sign off on my treatment plans and prescriptions. Hopefully that means fewer 12-hour days.
I learned that amantadine can be used for a whole lot of things. All off label, of course. Including attenuating the weight gain from antipsychotics.
I learned two of my classmates treat anxiety with alcohol. Also, that two others had never connected the dots, even after watching one of them drink herself sick at a faculty party.
I have two friends battling depression right now. I feel like a jerk, because that's kind of my wheelhouse now (or, becoming my wheelhouse) but I'm working 60+ hours a week, plus homework, and so I'm struggling to keep in touch with them. Ugh.
Damn, it's been a bummer of a week. I'll try to have better updates next week.
That really sounds like a bummer of a week. I hope this week has been a bit better for you.
Sucks when life makes simply waking up a chore.
SWM2009
421 Posts
Thanks.