1/23: What I learned this week: Long, long week. But the bagel was tasty.

[ixchel]

This week has felt painfully long. And here it is: the end. Just in time for the new one to begin already. I'm so not ready for a new week to begin, especially if it's going to be more of the same.

In my world, I've learned....

How fast a 31 year old being treated over the last year for skin cancer can go from okay, to gone.

How utterly heartbreaking it is to watch her husband fall to pieces.

How the very first RR code I ever witnessed, EVER, is doing now. It was during my internship in school. After a narcan bolus woke her up, a narcan drip didn't KEEP her awake (or breathing for that matter). It's been years since that day, and I imagine she thinks we're idiots with tiny fish brains. Her "allergy" to narcan with the response "heart stops" really isn't convincing.

On further reflection, if you ever want to stop someone from giving you narcan, tell them it will stop your heart - the one thing worse than the overdose it is supposed to be stopping.

I can't decide which hospitalist is worse: the one who totally ignores nurses (leading to malpractice suit-worthy near misses), or the one who thinks nurses are secretaries and puts pointless testing and orders in, and schedules things at times that make absolutely no sense. This one is a fan of q3h vitals (floor protocol is 4, so we thankfully can override that), q8h orthostatics (usually they're q12h), q4h fingersticks on NPO after midnight NONDIABETIC patients... The list goes on. Both these people need to go. Apparently people can't be terminated for simply sucking at their job.

It is so, so sad to watch a sweet, elderly, a&o, dignified, former doctor become humiliated by his sudden rush of diarrhea, which he did not make it to the toilet to pass. It was kind of beautiful, though, seeing his recognition and deepening respect for all that nurses do. I don't think that he knew. With one doctor ignoring us, one treating us like secretaries, and this guy, I truly wish we could take time with each physician (especially on a hard day) to show them what we do, and share with them what we know, what we see, support and experience in any given shift.

Kidneys suck. Especially when contrast literally kills them.

I strained stone fragments out of urine that looked like poppy seeds and sesame seeds. Totally got an everything bagel on the way home. Toasted. Cream cheese. YUM!!!

Ages ago I started a thread asking for advice regarding good scrubs for a short, tiny person with a big booty. It's probably been a good year since I asked, but I've finally found my answer! Butter Soft Stretch 8-pocket pants (in petite sizes) and 5-pocket v-neck shirt.

I've decided to hop on a project, choosing frequently seen chronic and acute conditions to gather EBP on for the unit committee I'm on. And suddenly, I'm back on the books and research article libraries like they're crack and I'm hooked.

The recent dynamics change that we are experiencing on night shift are so not good. We've had a rather dramatic drop in the last quarter's satisfaction scores, and as we went through respondent comments, it was pretty clear that a core group of night shifters are likely the cause of the drop.

There are some nights when I feel like I'm the only one chasing down the noisy pumps to make them stop beeping and bed alarms when the ninjas come out of the LOLs. They'll all be online, looking up stuff to buy, while I'm all go-go-go all night. Then, shift change comes, and they're all waiting to clock out and leave. I'm still charting and wrapping up my shift.

Caring for a patient with a horrible looking skin wound might make you slightly freaked out when you get a red spot on your nose that begins to breakdown like 3 days later, then takes days to show progress of healing.

I was really hoping I would have learned the result of my biopsy by now. I have kept this mostly to myself, because of the passing of the wife mentioned at the top of this list. It hasn't helped, though, to feel the sadness and horror of her sudden loss of life due to skin cancer. Just please let this be negative.

This week, the drug of choice appears to be heroin. And hookers. And drunken brawls in the ED.

Deciding to always stay up all night was the best decision I could have made. It's amazing how much more productive I am on my days off when I'm not all jacked up trying to sleep.

I have a person in my life who is constantly looking for things to be angry about. Seek and ye shall find. Not only is this utterly exhausting, but it's incredibly frustrating.

So, yeah, long and complicated week. And I'm way behind on this place. Share with me what I should have learned!!! And, of course, I'd love to know - what have you learned this week?

Eta: I didn't add a video!

What the heck ISSSS this?

[calivianya, BSN, RN]

I got a 100 on my first Genetics quiz last week, so I've learned that (so far) it's doable to work a full-time job, a PRN job, take three classes and two labs in person with class five days per week, and still do well at everything. My tolerance for anyone else who complains about a lack of time is at an all-time low. When some of those people whine, I really want to say, "Witch please. I'm not Wonder Woman. If I can keep my head above water with all the balls I'm juggling right now, so can you."

So there. :)

[nutella, MSN, RN]

Ixchel - I hope and wish for good results from your biopsy!

Here is what I learned:

No M'am - just because palliative care is concerned with end of life care in general and sometimes in detail, does not mean that we can change patient's or relatives minds!!! No, we do not have the power to tell a person what kind of treatment or non treatment they want, we can only put out options and have discussions. If you are in your right mind, even with a body full of cancer, and still want to be a full code despite education and discussion - that is what is going to happen.

Also, we can not change a patient's mind when the patient is above 90 and still wants involved surgery and the surgeon wants to go ahead.

Some request for palliative care directly translate into "please come and change a person's wish to continue treatment"... end of life is still such a taboo and clinicians as well as patients and healthy people shy away from any discussion around it until it is unavoidable/crisis.

"Can I be on hospice for a couple of years? - because I like the services and the benefit plus I do not want to worry about insurance?" -- No, Medicare frowns upon such a thing (rightly so), hospice care requires seriously dying - life expectancy six months or less as certified by a doctor. If you get admitted to hospice and your illness does not progress and you are not end the end of life you will graduate from hospice. "What about people who have been on hospice for years and years???" - yeah that is totally WRONG.

I learned that all they say about menopause may be true - you do not take hormone replacement or any other option to help with hot flashes you run around like a volcano with short sleeves and a fan in every bag and on the desk - plus you want a tower high power fan close to your bed. If you do decide to take hormone replacement to turn into a more sane person so you do not feel like burning up and can enjoy a coffee without breaking out in sweats - weight could become an issue - no matter how often you work out. The estrogen patch definitely makes me hungry . I stepped my work out routine up and try to reduce calorie intake - but boy - this seems like "mission impossible"...

Death comes to all of us - sooner or later.

[OrganizedChaos, LVN]

I've learned I missed nursing & this forum. That I need to go back to school & I will figure out a way even if it kills me.

That my mother is turning into my father, my father turned into a nicer version of himself & my brother apparently can't be trusted. So I basically have no family I can trust & I hate my family.

[AJJKRN]

(((Ixchel)))

Negative Negative Negative (Chants, with prayers, with fingers crossed!)

[Jensmom7, BSN, RN]

I've learned that overhearing an Administrative Minion telling someone over the phone "Well, if you're worried about costs, we can look into putting her in Hospice, they cover a lot of stuff so you wouldn't have to pay as much" makes me want to bite. Really, really hard.

That many times facilities want people on Hospice so it doesn't impact THEIR mortality stats.

That wanting someone on Hospice because they have a long psych history, have become floridly psychotic and their screaming is scaring the bejeebies out of everyone is the new craze. Sorry, paranoid schizophrenia isn't a terminal diagnosis, and other than that, the patient is healthy as a horse. Deal with it.

That getting over a URI when you're almost 60 takes longer than when you were 20. And makes your husband nag you to see the doctor. [emoji35]

That said URI uses up all my cares and makes me want to tell an NP "Sorry, you wanting someone on Hospice really, really bad isn't going to make it so. You're the facility NP, and know a lot of stuff. Hospice rules and regulations don't fall under your area of expertise. That's why I'm here". Only reason I didn't say it out loud is because said lack of cares would have made it come out much more snarky and cranky than I would have meant it, and this particular NP and I have a decent working relationship.

That seeing OC back last week gave me a happy and made me smile.

That I am not sure I could be as sanguine as ixchel seems to be about waiting for a biopsy report. ((((((Ixchel))))))

[CBlover, BSN, RN]

I learned-

-That no matter how deep the snow is and how many roads are closed, the bosses could care less. Ya better be here or your job's at stake. By the way, there's a backway. Oh thanks. You mean the one with the mudslide?

-that I've worked on the same unit 5 yrs and that I quit learning anything new 4 and a half years ago. Boring. I'm ready for a change. Going to look for a new job.

[Rose_Queen, BSN, MSN, RN]

That it's possible to get an entire winter's worth of snow in a single weekend.

That when surgeons go on vacation, it's nice to have a lighter schedule but it does get old not having surgeries.

That I do not like being pulled out of my own specialty into specialties I've never circulated before.

[LadyFree28, BSN, LPN, RN]

I've learned:

Ativan is a hell of a drug-especially for a kiddo with fencing posturing, CN VII tremors and change in mental status.

I have been considered a resource person to new hires; considering that it will be a year in two weeks I have worked in the ED, and I still have much to learn. It is quite exciting, but also terrifying.

The "changes" I discussed on the previous WILTW thread have escalated; it will be a step in the right direction for nurses; I'm hoping for a positive outcome that I am excited to be a part of!

[Farawyn]

I've learned I missed nursing & this forum. That I need to go back to school & I will figure out a way even if it kills me.

That my mother is turning into my father, my father turned into a nicer version of himself & my brother apparently can't be trusted. So I basically have no family I can trust & I hate my family.

Liking this because you're back, not because of the content.

I'm sorry, Chaos. Love ya.

[TheCommuter, BSN, RN]

Things I've learned in the past week:

1. I'm lazy and unmotivated...my house is messy, yet I'd rather browse the forums of Allnurses.com than break a sweat to clean up.

2. It is possible to overcome a lackluster training and orientation period to learn one's new job duties via 'baptism by fire.'

3. No matter how much you enjoy your job, one managerial change can throw a wrench in your plans. After all, employees quit managers, not jobs.

[OrganizedChaos, LVN]

Liking this because you're back, not because of the content.

I'm sorry, Chaos. Love ya.

It's ok, it's probably the push I need to go back to work and/or school.

Love ya too!