I'm writing for ixchel this week-I enthusiastically volunteered, and I wanted to keep with the continuity; sometimes I become a creature of habit with routine and habits, and I surely didn't want to disappoint members.
I actually am off this week from work, but not without interesting WILTW tidbits, even on my days off; I am currently waiting to send a co-worker, who is a NP off in fashion; she's leaving to go to Texas, where she is going to have a blast-I'm going to miss her, but we will be in touch; she is a great clinician , and a wonderful person who helps my personal procrastination-such as my wedding plans-move forward.
So, without any more introduction:
I learned that negotiating the balance beam between union activities and engaging in management is very interesting to say the least; management has become more transparent since a prior WILTW experience-the sweaty flu-riddled meeting where I enthusiastically volunteered to help with morale to end the meeting and teleport to my bed-and although they are trying to "get things done", the union is making in roads for a process, whether they like it or not.
Soft skills can work...I have learned to talk down very challenging parents, more often because even though volume has been down, the acuity of pts are still there-parents want to be reassured, whether they desire to curse someone out or question what we do at every turn, especially when said parents had a very unpleasant experience with said hospital; at least turning around impressions goes a long way with good holistic psychosocial nursing care-at least this time.
Having three traumas with spinal precautions makes for an interesting night:
L5 injuries can produce back pain and nerve injuries, especially to the sciatic nerve, even if there is no spinal cord damage.
C7 injuries can produce referred shoulder pain, even though there is no spinal cord damage.
Spinal shock can still occur, where it's important for pts to follow-up after discharge.
Miami J collars are my favorite collars-they are more comfortable for the pt-ahh memories working at an acute rehab hospital...
Being a go to person of advocacy for seasoned peers and newbies is a great feeling; I'm never the person who is a "cheerleader" type, but more of an "activist cheerleader" is something I can be comfortable with-being positive, realistic, and being empowered as a nurse can be interesting to say the least.
Sorry, nothing great from the clinical aspect here. Reduced work of late means less variety in the experience.
WILTW is that lots of people are obsessed with their BMs. Our patients are often older and postop. It's common practice for there to be a scheduled stool softener plus an order set of osmotic laxative if constipated, stimulant laxative if no results day after osmotic, stimulant suppository if no results day after stimulant. If pts haven't had a BM in a few days I'll offer the Miralax and explain that it is gentle and takes time to work from the top down. The last few shifts I've had several people announce same-day that the Miralax didn't work and they want the stimulant Right Now. In one case the family got ...assertively... involved. 15 minutes before shift change.
I learned where well-oiled hair comes from.
I learned (in a moment of curiosity after noticing that an entire thread had been deleted, despite the posts that I had seen never going beyond slightly tart) that a concerned lady has been posting anti-vax stuff all. over. the. internet.
I learned that we have a hospitalist who will gladly share knowledge with nurses who have questions (a coworker asked why we don't treat abnormal chloride levels). He gave a great explanation of the rationale and the physiology underlying it... but at 7:45 am we don't have the luxury of spending 15 minutes chatting about cations. I wish I had a job that had more opportunity for learning; most of the time we have to just put our heads down and plow forward or we get behind.
* The irony of absolutely dreading having to go into my PRN job at the hospital, only to break my ankle on the way to the car, and ending up at said hospital anyway.
* Having your husband call in for you while you are SCREAMING in the back ground apparently isn't enough. I called them later and told them my ankle was broken and I got, "Oh, well I guess I'll put down that you for sure aren't coming in." Yeah, good idea.
* The staff and kiddos at my school really do appreciate me, even though it sometimes feels like they don't. School Nurses Day was amazing and I've never felt so loved at a job.
* My little brother got very upset when he found out I would not be going on a field trip (mucho walking) with him. "Sissy, just take crutches!"
* I learned from this thread the reasoning behind the nursing pin--never knew that--but I feel like it's something they should definitely teach.
* The fact that parents think they can just drop off medication and expect me to give it to their kid with no authorization still baffles me. It shouldn't. But it does.
* Some people don't like when the doctor tells them they only have 6 months to live (they feel like the only option left is to give up), and some people prefer to know (to weigh out options, prepare family, etc.) I see both sides, and I've been on both sides as the family of the person that is dying. But it's still hard from the nurse side. My husbands grandfather has stage 3-4 lung cancer with mets. They don't want to know a prognosis-but I also feel like they are in denial--understandably so--and it hurts my heart.
Last night I was driving on the section of Interstate 5 that is known as the Grapevine. It is winding with elevations of 4100+ feet at the highest point. The anxiety kicked in while I was driving, but the alternating tension and relaxation helped me get through it.
Ah . . . the Grapevine. Know it well.
Let's see . . . #1 is I learned that a young man I met here on AN a long time ago is a good friend who talked to me for 2 hours last night and kept me laughing and that was just the medicine I needed.
#2 - Researching MD Anderson in Houston makes me think my son is in very good hands regarding his Multiple Myeloma diagnosis.
#3 - I'm at a loss to think of anything more because my brain is on over-time.
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
I learned that you absolutely need to listen to that little voice in your head. And if they won't listen to you, yell! Don't stop yelling until they listen.
I also learned that you can have a pretty severe asthma attack and have no wheezing. And that getting a tentative dx of secondary PAH really ramps up the anxiety, which just makes the asthma worse.
I also learned that Ativan is from the devil, and hedgehogs, while cute, are actually scary when they crawl out of the potato you holding or are jumping around in the bag of cracker jack you are trying to eat
Oh and prednisone makes you hungry.
Being a nurse on the other side isn't always easy!
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
Ah . . . the Grapevine. Know it well.
Let's see . . . #1 is I learned that a young man I met here on AN a long time ago is a good friend who talked to me for 2 hours last night and kept me laughing and that was just the medicine I needed.
#2 - Researching MD Anderson in Houston makes me think my son is in very good hands regarding his Multiple Myeloma diagnosis.
#3 - I'm at a loss to think of anything more because my brain is on over-time.
I'm sorry to hear about your sons multiple myeloma dx. MD Anderson is very VERY good. We have sent patients there (as a last ditch effort) and they are doing well 2 years later. I wish you all the best of luck
L5 injuries can produce back pain and nerve injuries, especially to the sciatic nerve, even if there is no spinal cord damage.
C7 injuries can produce referred shoulder pain, even though there is no spinal cord damage.
Ahhhh, yes. L5 and C7. My L5 was graciously half removed 4+ weeks ago. I've never been so glad to announce something so gruesome. Injury or irritation at L5 can cause pain through the legs into the feet, loss of feeling, tingling, loss of movement completely, loss of bowel &/or bladder control and pain, pain, pain. Always with the pain.
C7 and I became besties awhile back when the muscle spasm surrounding my L5 injury traveled up my back and into my neck. My arms were in terrible pain. It was horrible. Got and XRay that looked scary, then got an MRI that was after the spasm was relieved and it was totally normal. It was at that time I realized I'll be using muscle relaxers probably forever.
I can talk spinal injuries all day long. I wish that were bragging. It's a terrible club to be in. It's a club that even after surgery, most people never leave. I'm crossing everything that I'm one of the lucky ones.
Ahhhh, yes. L5 and C7. My L5 was graciously half removed 4+ weeks ago. I've never been so glad to announce something so gruesome. Injury or irritation at L5 can cause pain through the legs into the feet, loss of feeling, tingling, loss of movement completely, loss of bowel &/or bladder control and pain, pain, pain. Always with the pain.
C7 and I became besties awhile back when the muscle spasm surrounding my L5 injury traveled up my back and into my neck. My arms were in terrible pain. It was horrible. Got and XRay that looked scary, then got an MRI that was after the spasm was relieved and it was totally normal. It was at that time I realized I'll be using muscle relaxers probably forever.
I can talk spinal injuries all day long. I wish that were bragging. It's a terrible club to be in. It's a club that even after surgery, most people never leave. I'm crossing everything that I'm one of the lucky ones.
Ooh. Spinal injuries suck. My dad is one of the unlucky ones. I've lost count of his surgeries. I hope you are one of the lucky ones that magically do everything right after surgery and that you heal well.
My Dad is stupid and lifts things when he is supposed to be on restrictions, so he kinda caused his own problems, but it is still heartwrenching to watch him. This is a guy who was relentlessly physical his entire life, who is now reduced to walking around the house. He can wash dishes, but no vacuuming. Definitely no lifting anything over 10 lbs. It's very depressing for him, especially when he wants to play with his grandchildren.
Make sure you protect your back at all times. Everyone I know who has done that has turned out well.
I love to teach. Love it, love it, love. it. Really love it.
Except, the thought of being at a desk in the front of a room facing a sea of blank, vapid faces gives me stomach cramps and the jeebies.
* I love to teach when I'm sitting at a table with a flock of second semester nursing students who have heard of Hospice, but are just a little bit afraid of it. Giving them a short background on Hospice history and concept and then asking them their opinions makes for a very lively and informative 30 minutes. When they tell me they hope they're as passionate about nursing as I am when they're my age, I just smile graciously and say thank you.
* I love to teach at the nurses station when one of the facility NPs asks me how I deal with family members who don't want to talk about end of life care because they don't want to "jinx" things, but the time is coming closer for them to make some decisions. And when she actually listens, absorbs what I say to her about this phenomenon we see all the time, and then thanks me (!!) for taking the time to talk, it's a very good feeling.
* I love teaching patients and families about the whole "Hospice thing" and reaching that moment when they trust the team to respect their choices, and that I really am ok when they tell me mom has just the tiniest bit more energy so they're going out for a bit of a drive and could I possibly reschedule for another day.
* I love getting a PM from a member here thanking me for some information read in a post, and that it was helpful in solidifying a decision about working Hospice.
P. S. Sully, your little brother sounds like a sweetheart. You do realize he's going to be by your side when you're old and frail, right??
I learned this week why nurses get pinned. I never knew! Florence Nightingale was given a pin by Queen Victoria and then Florence went and made pins for those nurses working for her and the tradition continues.
Ohhhh! And btw!!!! Thank you so very much for starting this week's thread!!!!
WILTW:
I make a lot less money than I thought I do. Short term disability is based off base pay, which makes this horrible. I work a lot of weekend nights. I didn't realize.
HR is STILL blowing me off on stuff they should be doing, no questions required. I request things multiple times, over weeks, and still receive non-committal responses. Pretty sure I'm just waiting for the chopping block. Any of you hiring?
Clonidine overdose can be treated in part with narcan. This came from this thread:
What I learned this week, a Narcan drip works for a Clonidine overdose. Who knew?
I thought the poster was just kidding (like a patient lied and said it was clonidine) but its supported by research noted on medscape.
Ohhhh! And btw!!!! Thank you so very much for starting this week's thread!!!!
WILTW:
I make a lot less money than I thought I do. Short term disability is based off base pay, which makes this horrible. I work a lot of weekend nights. I didn't realize.
HR is STILL blowing me off on stuff they should be doing, no questions required. I request things multiple times, over weeks, and still receive non-committal responses. Pretty sure I'm just waiting for the chopping block. Any of you hiring?
We are! I think I may be on the opposite coast, however.
I learned that I didn't get the opportunity I was in the running for. Kinda bummed but also realize that the timing may just not be right. There will be other opportunities.
I'm planning to try to transition to full time critical care by the end of the year. Hoping for the best with that. Right now I'm just cross trained and pick up in cvicu - mainly transplants and VADs since I'm trained and they've been really short. I still haven't decided if I want to try the ICU or the ED. The pace of the ED really appeals to me. But other things about it do not....specifically, the frustrating non-emergent stuff. Wondering if the trade off would be worth it.
I feel like I'm still trying to figure out who I am as nurse and where I can excel. I like the super high acuity stuff. I love challenging myself to learn new things and push my comfort zone. Just trying to keep my mind open to what comes my way. Our hospital is doing a pretty huge intake of nurses right now - specifically, experienced nurses. We are trying to keep the experience levels somewhat balanced... But my unit specifically is in a difficult transition period.
I still love working nights and I've actually lost 4 pounds in the last couple of months! Now I just have to figure out how to work in some more exercise...
It's a terrible club to be in. It's a club that even after surgery, most people never leave. I'm crossing everything that I'm one of the lucky ones.
NotAllWhoWandeRN, ASN, RN
791 Posts
WILTW:
Sorry, nothing great from the clinical aspect here. Reduced work of late means less variety in the experience.
WILTW is that lots of people are obsessed with their BMs. Our patients are often older and postop. It's common practice for there to be a scheduled stool softener plus an order set of osmotic laxative if constipated, stimulant laxative if no results day after osmotic, stimulant suppository if no results day after stimulant. If pts haven't had a BM in a few days I'll offer the Miralax and explain that it is gentle and takes time to work from the top down. The last few shifts I've had several people announce same-day that the Miralax didn't work and they want the stimulant Right Now. In one case the family got ...assertively... involved. 15 minutes before shift change.
I learned where well-oiled hair comes from.
I learned (in a moment of curiosity after noticing that an entire thread had been deleted, despite the posts that I had seen never going beyond slightly tart) that a concerned lady has been posting anti-vax stuff all. over. the. internet.
I learned that we have a hospitalist who will gladly share knowledge with nurses who have questions (a coworker asked why we don't treat abnormal chloride levels). He gave a great explanation of the rationale and the physiology underlying it... but at 7:45 am we don't have the luxury of spending 15 minutes chatting about cations. I wish I had a job that had more opportunity for learning; most of the time we have to just put our heads down and plow forward or we get behind.