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

Posted
by ixchel ixchel Member Nurse

Specializes in critical care.

You are reading page 2 of 12/5: What I've learned this week - No, I don't have "just a second" to help you. If you want to start from the beginning Go to First Page.

Flying4th

Flying4th

11 Posts

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

sjalv

Specializes in CVICU. Has 1 years experience. 897 Posts

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

Has 25 years experience. 12,646 Posts

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

whichone'spink, BSN, RN

Has 3 years experience. 1,473 Posts

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

mrsjonesRN

175 Posts

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

Fancypants09

117 Posts

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

ohthatswhatthatdoes

Specializes in PACU. Has 1 years experience. 18 Posts

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

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 41 years experience. 4,292 Posts

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

NICUNurseEliz

Specializes in Pediatrics, NICU. Has 5 years experience. 110 Posts

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! :sour:

Alisonisayoshi, LVN

Specializes in LTC. 547 Posts

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

annabanana2

Has 2 years experience. 196 Posts

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:

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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

1 Article; 54 Posts

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.

Edited by secondlifenurse
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