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.
I learned a lot of things about the NxStage CRRT machines that I didn't know last night, due to a known black cloud coworker who is not checked off on restringing the machine needing it restrung...
1. Sometimes the cartridge sets come with defects that you're going to find when you prime the system and suddenly there is dialysate EVERYWHERE!
2. It is not a bad idea to look the set over carefully before loading it into the machine, just in case, because it's going to be a hot mess if there is a defect and you don't catch it before priming starts.
3. You can wipe all you want, but you're going to miss a wet spot in the machine.
4. The machine is NOT going to let you know right away if you missed a wet spot. In fact, it will let you go through the whole 20 minute restringing process, and even let you hook the connections up to the patient and start treatment, before it starts loudly alarming BLOOD LEAK HIGH!!!!
5. I learned where the blood leak sensor was. We had to call dialysis at that point to get them to show us what was wet, because there was no way in Hades I was restringing the thing a third time if it was just going to alarm BLOOD LEAK HIGH!!! and not actually run.
6. I learned that restringing the dang machine three times, especially if you can't figure out what's going wrong, can take the better part of an hour and fifteen minutes.
And that, my friends, is the rationale for the low ratios in ICU. If I never have to deal with another CRRT again I will be happy!
My interview was eh. I froze on some clinical questions. When asked about a post-op complication and what you would anticipate the doctor would order, I forget that diagnostic tests, such, as CT scan are also orders. But all I could think of was infusions.
My interview was eh. I froze on some clinical questions. When asked about a post-op complication and what you would anticipate the doctor would order, I forget that diagnostic tests, such, as CT scan are also orders. But all I could think of was infusions.
Specializes in Critical Care; Cardiac; Professional Development.
Sigh. I learned this week that no matter how thoroughly, how WELL you educate your patients....there is always going to be that one who does the exact opposite of what you told them to do and then trying to get in touch with you in the middle of the night to find out if it is okay that they did the exact opposite because now they are having symptoms from doing the exact opposite and they are scared.
Absolution is hard to come by if you have to wake someone up to get it, yo. Head ye to the ER.
I learned today that I will breathe fire if I have to (metaphorically speaking, as I am not a dragon last time I checked.) ESPECIALLY when it comes to prior authorizations for medication that it is OBVIOUS that the patient needs due to certain lab levels (can you tell I'm frustrated?) Insurance prior auths drive me insane (i.e. yes the patient is deathly allergic to peanuts, but we're going to deny her epi-pen, so there!), even more so when the insurance personnel has an attitude of a teenage girl who has to do the dishes. I turned into the "you wanna play this game? Fine, let's play" type of tone. I am this close to calling back and discussing her "professionalism" to management, but I'm half sure that they'll probably have the same attitude.
So I've relearned that I hate insurance companies. Some of them, anyway.
My hubs, bless his heart, is relegated to his side of the bed and we are almost to the point where I am getting a second set of covers for me. He rolls like an alligator, with elbows out. He has a seven foot wingspan. Ouch!!
We have a king size now.
On the advise of friends years ago we did just that. We have a king bed, and two twin comforters with matching duvet. Best.Decision.Ever.
calivianya, BSN, RN
2,418 Posts
I learned a lot of things about the NxStage CRRT machines that I didn't know last night, due to a known black cloud coworker who is not checked off on restringing the machine needing it restrung...
1. Sometimes the cartridge sets come with defects that you're going to find when you prime the system and suddenly there is dialysate EVERYWHERE!
2. It is not a bad idea to look the set over carefully before loading it into the machine, just in case, because it's going to be a hot mess if there is a defect and you don't catch it before priming starts.
3. You can wipe all you want, but you're going to miss a wet spot in the machine.
4. The machine is NOT going to let you know right away if you missed a wet spot. In fact, it will let you go through the whole 20 minute restringing process, and even let you hook the connections up to the patient and start treatment, before it starts loudly alarming BLOOD LEAK HIGH!!!!
5. I learned where the blood leak sensor was. We had to call dialysis at that point to get them to show us what was wet, because there was no way in Hades I was restringing the thing a third time if it was just going to alarm BLOOD LEAK HIGH!!! and not actually run.
6. I learned that restringing the dang machine three times, especially if you can't figure out what's going wrong, can take the better part of an hour and fifteen minutes.
And that, my friends, is the rationale for the low ratios in ICU. If I never have to deal with another CRRT again I will be happy!