12/5: What I've learned this week - No, I don't have "just a second" to help you

[ixchel]

If I make it out of this weekend without losing my mind completely, it will be an absolute miracle. The last few months seem to be trying their best to do me in completely. I could really use a vacation. Just me, the kids, and sunshine. I'd be a happy girl.

So, some lessons from this week:

Someone posted something on Craigslist that was offensive.

It's surprising how surprising hallucinations AREN'T to some people. (Although on the flip side, it's kind of amusing seeing people get confused when I describe my own olfactory hallucinations.)

We have a tech who is a nursing student. He just finished his first semester. Of all of our techs, he's the most bold (abrasively?) in his approach to patient care and has been the only I've worked with who has made decisions "above his pay grade". I hoped with all my heart that some nursing school would add caution to his approach and performance. I've learned tonight that it hasn't. I genuinely like this person, but am afraid for him (and, unfortunately, patients).

Fitbit needs a NOC mode. Or... Is there a way to change its time zone maybe?

It's weird showing up to work with 6k steps already in for the day.

I'm apparently allergic to something I've put on my face in the last 12-18 hours. Love going to work looking like I have two swollen, black eyes.

Insecurity can turn people into monsters. I already knew this. What I didn't know was how much better it feels to ignore it, rather than engage it. (This is not patient-related.)

We have a tech who would rather cause an injury to a patient (pretending she didn't hear what you said), than increase her workload (by taking a BP cuff off, walking around the bed, and reattaching it to the other arm).

If a coworker is charting in a darker, quieter space, YES, they are are hiding. Go away.

If a coworker calls you and says, "I'm in desperate need of uninterrupted time so I can chart. I'll be (insert place here). Please don't tell anyone where I am - I just want to make sure you know where I am if I'm needed", this does NOT EVEN A LITTLE BIT mean it would be a good time to go chart and chat WITH them.

"Really quickly": adj., meaning to occupy a very short span of time

Ex., "Because literally every single person and patient has needed me to help them with something 'really quickly', I have literally not even begun to do MY OWN JOB yet, and it's 0200 now." You keep using that phrase, and yet your definition of "really quickly" has become my definition of "I am now going to be here over an hour late while you and everyone else I helped get to leave on time." AND I CAN'T EVEN HIDE!

I am so overfilled with my quota of rude people that I just clocked out knowing I'll have some notes to finish when I go back. I may be royally p'ed off at my job right now, but I like being employed.

The charge nurse who told me I am inconsiderate of others' time (by taking too long to give report - apparently I'm not supposed to answer peoples' questions?) spends over an hour and a half receiving and giving report from the off-going and on-coming CNs. (Even when she and the other CN are both mid-way through a 3-day stretch together - so mostly updates only.)

Regarding report, when you interrupt report that you are receiving to ask questions, you're probably asking something they were going to tell you anyway. This will cause you to get an unorganized report. This will also cause report to take longer. Rather than interrupt, you could be a polite person and wait until the nurse is finished giving you reports. If you still have a question at that time, then by all means ask.

And...

Please...

For the love of God...

Don't do your assessments while you are receiving report! That is so rude that I have no words for it! The person giving you report has been there for over 12 hours and may have to be back in less than 12. This is not what bedside report is for!

What do I need to learn...?

When there is literally no one and nothing in the caregiver's "face to face world" to actually give that caregiver care, help and respite, how does the caregiver go about finding those things?

Sorry, guys. Majorly cranky OP this week!

Did you learn anything good?

[Flying4th]

You are right staffing makes all the difference! One extra nurse to offload the patient ratio or an extra aid to help with lights can mean so much!

[sjalv]

I've learned that having a patient who sundowns makes a very, very long shift. An added bonus is when you work in the CVICU and they rip their radial arterial line out on a whim and you are frantically trying to achieve hemostasis on a patient who is trying to get dressed and walk off the unit, hoping that the IV he ripped out that was running cardene is no longer needed since you no longer have a constant blood pressure reading and he won't sit still long enough for a cuff to cycle.

Yes, I just had a horrible shift.

[Farawyn]

I've learned that this is the one job I take with me all the time. The SN job, not the HH job.

I'm having a very hard time with separating, since these kids I work with are my kids in my town. I've never had this before. I've always been able to do my job and let it go. Oh sure, there are patients/situations you remember and recall and grow from, but this job is weighing on my heart.

Ow.

[whichone'spink, BSN, RN]

This week I learnt, or rather it was reinforced, that anesthesia decides if a surgery is a go or no-go. The surgeon's main job is to cut open the affected area and complete their work, but the whole surgical experience is managed by the anesthesiologists and CRNAs. So if a patient has not been cleared cardiac wise or otherwise, then the anesthesiologist is within his or her right to cancel the case. Some do better than others

[mrsjonesRN]

I learned this week that restraints are a nurses friend.

When I float to pcu from ICU, never believe that particular nurse giving me report.. she is useless.

Doctors are overpaid divas.

I also discovered 5 hour energy will help me get through a 12 hour shift.

[Fancypants09]

I've discovered that Subq ports hurt. Pt required hydromorphone SC injections every so often for moderate-severe pain, subq port was installed, more pain just giving the injection thru port. And the tubing on the port is quite lengthy albeit very small diameter, I started wondering if my pt is even getting the full dose of what is being injected?? Can someone share their thoughts on this? I'm a new grad, still so much to learn.

[ohthatswhatthatdoes]

I learned that paradoxical bradycardia when you give too little atropine is a very real thing.

[TriciaJ, RN]

I've discovered that Subq ports hurt. Pt required hydromorphone SC injections every so often for moderate-severe pain, subq port was installed, more pain just giving the injection thru port. And the tubing on the port is quite lengthy albeit very small diameter, I started wondering if my pt is even getting the full dose of what is being injected?? Can someone share their thoughts on this? I'm a new grad, still so much to learn.

I've never done SC ports, but are you flushing fore and aft with saline like you do an IV port? I've seen nurses skip this step; it causes more pain for the patient and no, they're not getting the full dose. Also raises the risk of incompatible meds mixing, although that seems unlikely in your case.

[NICUNurseEliz]

That my black cloud at work is never ever leaving ever.

That even though there are signs everywhere saying "Please do not visit the NICU when sick!", people will still bring their sneezing and coughing children and get super defensive when you tell them to leave. (I knew this already, but this was a new reminder now that we are squarely in cold and RSV season)

That essential oils taste nasty!

[Alisonisayoshi, LVN]

So what I learned was basic and silly, and I really should have known, but I got all the way through nursing school, NCLEX-PN, and my first 6 months as a nurse without knowing so here it is:

It is not advisable to put an IM injection into an atrophied muscle. Even if that arm is probably the place I'm least likely to get hit if I attempt the injection.

I felt very very stupid.

[annabanana2]

I've never done SC ports, but are you flushing fore and aft with saline like you do an IV port? I've seen nurses skip this step; it causes more pain for the patient and no, they're not getting the full dose. Also raises the risk of incompatible meds mixing, although that seems unlikely in your case.

Dumb question, but what does "SC port" mean for you guys (I'm not in the US)? These are the ones we use:

We do not flush before and after with saline, it's not necessary and given that the max volume that can be given SC at one time is about 2 mL it takes up space that could be used for medication. Obviously we just use one med per site. We add the priming volume with the first dose, so if the usual dose is 1 mL, the first time we'd use 1.26 mL (which is the priming volume of the tubing plus the positive-pressure cap we use). Some meds hurt more than others to push this way - the opioids I've found are often culprits. I make sure to push slowly and rub just above the insertion site to sort of provide some "distraction" to the nerves if that makes sense.

I work in home hospice in Canada if that provides any useful context.

[secondlifenurse, MSN, RN]

This week I learned management can make or break the unit. Some management goes off the rails as they try to fix what they broke: first dropping it on the floor and watching it shatter when it was only previously cracked. . . and then hammering and smashing it to bits, and then beating it with a rolling pin until it's powder. Seriously and sadly, management can suck the life out of a place that was lively, fun, and a good place to be just six months ago.