10/24: What I learned in nursing this week - moral & legal decisions, patient acuity....

[ixchel]

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.

[AcuteHD]

...I learned.... I GOT INTO NURSING SCHOOL!!!!

That is all. Bye.

Like times a bazillion

(I'm counting this as a nursey comment, but either way I'm still <.500 this week ftr>

[nrsang97, BSN, RN]

I have learned that even medical professionals are gullible and fall for me sharing gomerblog articles. I love it when they ask me if this stuff is true LOL.

[kbrn2002, ADN, RN]

This week is my week off so I learned that time off is very important to my mental health. It's been a busy week around the house, but I still have today and tomorrow off. I find that on Saturday I am actually looking forward to getting back to work Monday morning. I know that by Sunday night I will probably not feel the same about this!

Happy Birthday ixchel!

[Lulu Belle, RN, EMT-B]

I learned (and was tested on) a bunch of basic lab values in my (non-nursing) pathophysiology class this week. Kind of useless knowledge for the next 1.75 years until nursing school, but it still made me happy!

I learned that the most calculating, manipulative, evil, effed up in the head, bat**** crazy person I've ever encountered in my 19 years on this planet (lol) is probably joining my program and following me to nursing school. Her reason? "I think I'm not smart enough for med school so I'll just go to nursing school." Direct quote. Makes my blood boil. The best part is she quite literally thinks she's my best friend.

Eta: happy happy birthday, ixchel 🎈🎂🎁🎊

Eta part II: congrats on nursing school, ood. Can't even imagine how good that must feel

[cracklingkraken, ASN, RN]

I learned (and was tested on) a bunch of basic lab values in my (non-nursing) pathophysiology class this week. Kind of useless knowledge for the next 1.75 years until nursing school, but it still made me happy!

I learned that the most calculating, manipulative, evil, effed up in the head, bat**** crazy person I've ever encountered in my 19 years on this planet (lol) is probably joining my program and following me to nursing school. Her reason? "I think I'm not smart enough for med school so I'll just go to nursing school." Direct quote. Makes my blood boil. The best part is she quite literally thinks she's my best friend.

Eta: happy happy birthday, ixchel 🎈🎂🎁🎊

Eta part II: congrats on nursing school, ood. Can't even imagine how good that must feel

Oh, dear. Bless her heart.

My sympathies.

[Here.I.Stand, BSN, RN]

I learned lots this week!

Fresh ginseng with stem still on, dipped in honey is much less revolting than old roots stored in a jar, soaked in honey.

No matter how much one tells herself that sashimi is just like pickled herring minus the pickle...it's not. (I wish I liked it. I don't. I can't do cold, slippery aquatic muscle. Although I have to admit, nothing from the sea can ever match the revolting nastiness that is Lutefisk.)

I learned I can control my gag at the table better than I thought I could, to be polite.

I learned that walking in mountainous metropolises in heels could probably be an enhanced interrogation technique.

I learned how amazing it feels to have an elderly man -- who you barely know -- happy to see you.

I learned that my phone takes better pictures than my expensive camera. (Good thing I didn't buy it; it was a hand-me-down when my dad upgraded.)

I learned that the addition of cinnamon and an orange slice makes One. Amazing. Mocha. I'll remember that one!

Nothing work related, but I'll be back at work next weekand learning. í ½í²ª

[kbrn2002, ADN, RN]

No matter how much one tells herself that sashimi is just like pickled herring minus the pickle...it's not. (I wish I liked it. I don't. I can't do cold, slippery aquatic muscle. Although I have to admit, nothing from the sea can ever match the revolting nastiness that is Lutefisk.)

Amen to that! Don't care for raw fish myself, but lutefisk? Man, that stuff is a special torture. I live in an area where weekly Lutefisk dinners are a common holiday season church event and many households have the traditional Lutefisk holiday meal.

Now to keep this marginally on topic...I wonder how many cases of food poisoning are reported from improper preparation of what is essentially poisoned fish?

[annabanana2]

I've learned what pleurx drains are. Now I want to play with one.

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.

[joanna73, BSN, RN]

Happy birthday Ixchel! :)

I've learned that I could manage a very busy week at work and still force myself to study stats at night.

[SWM2009]

Happy Birthday to ixchel and anyone else celebrating this week..

I learned that I am getting another raise this year which means that in total my pay will have gone up $3 since January. I'm very pleased and I know I work hard, but the motivation for this seems to be an incentive to make sure I don't leave. A few long termers have left recently and management is concerned. I apparently qualify as a long termer now even though my 2 year anniversary is 3 months away.

I also learned that I have little patience for the new "know it all" orientee I have been working with lately. She already knows everything even as she is grabbing the wrong needle for an IM injection or starting to draw up 40 units of Humalog instead of Lantus. She is extremely defensive when errors are pointed out. She also seems to hate any kind of silence and talks all the time and has an opinion on everything. Yesterday I went into the MDS office to have my lunch because I needed a total break from her before I snapped and said some not so nice things. Anyone have suggestions for how to tell someone to "shut up" nicely?

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.

[WellThatsOod]

I learned (and was tested on) a bunch of basic lab values in my (non-nursing) pathophysiology class this week. Kind of useless knowledge for the next 1.75 years until nursing school, but it still made me happy!

I learned that the most calculating, manipulative, evil, effed up in the head, bat**** crazy person I've ever encountered in my 19 years on this planet (lol) is probably joining my program and following me to nursing school. Her reason? "I think I'm not smart enough for med school so I'll just go to nursing school." Direct quote. Makes my blood boil. The best part is she quite literally thinks she's my best friend.

Eta: happy happy birthday, ixchel ������������������������

Eta part II: congrats on nursing school, ood. Can't even imagine how good that must feel

I want so badly to like like this, but all that about the crazy person has me going eh.....

[margin261]

SWM2009- Re your difficult orientee, I've had some success by casually mentioning that one of the reasons I love nursing is because I have the opportunity to learn things constantly- even having been in the field for 15 years- just to let them know it's ok that they don't know everything.

Then gently remind them orientation is part of their education and they should use it because when it's over, those careless mistakes can be dangerous.

Sometimes that works. But I've had 2 that blamed everyone & everything else for their mistakes and never took personal responsibility for one thing. One didn't make it off orientation because she was dangerous. The other made it about 2 months out but was fired basically for just not being able to handle the job. I wish you good luck!!