10/31 What I learned this week: Walking Dead anatomy lesson, herpes EVERYWHERE

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I'm having my annual struggle to decide what I want to be when I grow up. Thankfully, things are feeling a bit narrowed down this year. At the very least, I think it's time to start the typical core NP classes.

Every level of care provider at my facility is frustrated by our current lack of psychiatric specialty care, psychiatric consulting provider, and poor staffing for acute psychiatric needs, but no one knows what to do about it. Why aren't we diverting some of these patients?

Huh. Perhaps becoming a PMHNP would knock out both those birds with one stone. (Honestly, though, I'd burn out faster than The Donald's political dreams should have. Hey, Dogen, come to the mid Atlantic when you graduate. We have crab cakes and they are amazing.)

A terminal DNR patient will become full code if they are admitted from an incomplete suicide attempt. I have a serious problem with this.

If you only see one piece stitched in on a central line (IJ, SC, or femoral), you should get in touch with the MD to get the second piece stitched in. That is a lot easier than having to pull a line and reinsert a whole new line. If you only see one piece capable of being stitched in, the other piece wasn't put on, and it needs to be. You'll have someone irritatedly inform you that that will require wasting an entire central line kit just for that little thing, but again, this is better than requiring a whole new line insertion. If you notice this is a trend, consider incident reports. Seriously, it's not okay to increase infection risks and invasive procedures to patients just because the ED doc or intensivist just didn't feel like sewing in a couple more stitches. (See picture) [/rant]

The Fitbit charge HR is my favorite toy right now.

Every time I open the AN app on my iPad, I want to get the eye booger off the right eye of the nurse in the front.

Herpes can literally get in and on every part of the body. I'm glad my innocence was already shattered by sidepockets because for real, people. EVERYWHERE.

My fellow Walking Dead community - blood does not pour like that from the second intercostal space lateral to the midclavicular line, and there are no intestines at approximately the fifth or sixth intercostal space, even if that was somewhat midline. I'm just saying.

I hate to admit this (because I'm in love with, and rather loyal to my hospital), but lately, some ED shifts have been a little scary. I really hope they get their act together quickly.

One of my floor's charge nurses has advanced so highly on my "you are an amazing nurse and charge nurse" scale, that I think she broke the meter. During some of the hardest shifts I have ever had, she has put herself right at my side, battling through the thick of it with me. She has truly made me realize the value of a charge nurse you can TRUST.

That does, unfortunately, make it suck to realize how much harder a shift can be with a charge you can't trust. My understanding is that a previous manager made it a habit of promoting the slower, lazier nurses to charge. Look, if you are a manager and you think it's easier to promote them than it is to fire them when it is obvious the bedside isn't a good fit, you're doing it WRONG.

I have heard that in the last two years, my unit has gone from "fend for yourself" to a cooperative team that has each other's back. It's sad to hear that it was that way, but I'm proud to be part of the change.

This makes me laugh every time I see it:

Apparently my screenname is a planet name in A Wrinkle In Time where Aunt Beast lives. How did I not remember this?! Charles Wallace knows!

After the last two fresh off residency new hires we got (who are absolutely terrible to work with), I never expected to feel the massive amount of relief I felt when we just got a new hire who has a decent background and enough experience to realize nurses are a valuable resource, not competitors in an ego pissing match.

What have you learned this week?

As a friendly reminder, it is important to keep our WILTW threads mostly related to nursing. It's okay to throw in personal life observations, as long as the main focus of discussion remains nursing. Be safe on this All Hallows' Eve, my friends. :) And all you ED peeps - I'm hoping for some really good lessons from you on Sunday!

Specializes in critical care.
Yea, I'm trying to forget that, no pun intended. Family member with it at age 70 and it's devastating. Too close for me. :(

Feeling your pain, love. Big hugs. [emoji173]️

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Specializes in critical care.
Today I learned that when I see HUGE ( like my head) blood clots in the diaper of a 70 yo woman and earnestly ask if it is lady partsl or GI bleeding, I will get the crazy side eye from my ex-preceptor.

That was a valid question. Your preceptor is an idiot (and jerk for the passive aggressive response) if she/he feels differently. lady partsl bleeding post menopause is a sign of cancer in the uterus. Intestinal bleeding can drop a hgb/hct critically low. If you aren't in acute care, she needs to go to the hospital.

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Specializes in Hospice.
I want to save ixchel's post forever. You're not taught how to do IV's? That sucks. We're not taught until 3rd semester, but at least we learn.

Think that's bad? One of my patients had s horribly distended bladder (think eggplant size) and needed to be cathed. His nurse, who had been out of school for 3 years, had never put in a Foley. Not even sim lab in school.

As I told her, "Guess what you're going to learn how to do today?"

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Specializes in Med Surg/PCU.

I learned I can handle it when I have to call a rapid response on a patient. After a year, finally had to do it this week. No longer have to fear the unknown! (and my fab charge nurse made all the difference, I'm sure.)

I learned that working an extra hour with just the right combo of coworkers can turn a very professional group of people into a gaggle of giggling girls!

I've learned to never again work both the daylight savings night and the Sunday night following. Last night was brutal.

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I learned I can handle it when I have to call a rapid response on a patient. After a year, finally had to do it this week. No longer have to fear the unknown! (and my fab charge nurse made all the difference, I'm sure.)

I learned that working an extra hour with just the right combo of coworkers can turn a very professional group of people into a gaggle of giggling girls!

I've learned to never again work both the daylight savings night and the Sunday night following. Last night was brutal.

Hahhahahaha. We had the old fashioned "school" clocks on our unit and would actually watch the clock turn itself back.

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Specializes in Hospice.
Hahhahahaha. We had the old fashioned "school" clocks on our unit and would actually watch the clock turn itself back.

Doesn't take much to amuse you, does it? [emoji104] [emoji8]

P.S. I've been known to do the same thing lol.

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ixchel, on your Herpes comment in your OP. It was one of the worst talks I used to have to have at the clinic. The doc would tell the patient the DX, and then I would step in and do teaching, follow up, etc. 16 year old who thought the guy "really" loved her, Yes, this is your life now. The worst was the 50 something woman who had been married for over 30 years. New herpes dx. "But I've been faithful to my husband!" and then waiting while it sunk in that he maybe hadn't been.

I also had one character who had it on her back and her butt crack- and no, it was NOT shingles. She ripped her dress right over her head in the triage office to show me, and she was naked as a jaybird underneath. Good times.

No matter what, we always renewed the antivirals. I had carte blanche on that.

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Specializes in pediatrics; PICU; NICU.
Hahhahahaha. We had the old fashioned "school" clocks on our unit and would actually watch the clock turn itself back.

When I worked in hospitals, it seemed like it took about 48 hours for the clocks to reset themselves in the fall.

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Specializes in LTC.
I've learned that the month of November is National Diabetes Awareness month.

I am nowhere near educated enough to speak on this topic outside of anecdotally. I would love to read up on it. My nephew has diabetes and Chrohns, which makes management tough.

That being said, Ruby's "October" articles on DV were amazing and profoundly impacting to me. I would like to keep the dialogue going on that as well.

/mini vent

It's because November is Bantings birthday month. World Diabetes Day, November 14th, is his birthday. Since he's a major part of why we are all alive, I think it's cool that our awareness month honors him.

This year JDRF has the coolest campaign, T1D Looks Like Me, which I love.

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It's because November is Bantings birthday month. World Diabetes Day, November 14th, is his birthday. Since he's a major part of why we are all alive, I think it's cool that our awareness month honors him.

This year JDRF has the coolest campaign, T1D Looks Like Me, which I love.

Tell me what to put in my signature, and I'll do it.

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One time my husband (who is diabetic) sent me a picture of him eating a 3 scoop ice cream cone. I sent him pictures of diabetic foot ulcers. When he's so far away, pictures speak louder than my nagging. And I can nag pretty loudly.

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My first orientation for nursing school is Friday. We get our schedules, learn the rules, meet the SNA and some instructors, purchase our white clinical shirts, etc. I'm very excited. I sent Far a picture of my fancy official acceptance letter. 😁

They way they do our schedules is weird though. They put them in blocks, give us the blocks so we know what we have to choose from, then we randomly draw numbers to get the order of who gets to choose.

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