4/23 WILTW: It turns out nurses do make the worst patients

Nurses General Nursing

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It's been a busy week for me, even though I feel like I've done very little actively. I've got a little extra bounce in my step (figuratively) since surgery and it has made me decide to get things done that I have been putting off for ages. Along the way, I've gathered some nursey lessons, some non, and I am still getting employer/employee lessons, but that was expected.

This week, I have learned...

(for my own health stuff, good to know for future patient care)

I have gratitude for the donor I received a part from. The feeling is stronger than I expected. I wish I could say thank you to the family of the cadaver I received bone from.

After a lumbar fusion, the anti-inflammatories they pry from your desperate hands (and refuse to give you anymore) will be the best possible reliever of post op pain. The second best will be muscle relaxers (skeletal muscle relaxants, not benzos).

When spinal post op pain finally reduces, it does suddenly and dramatically. What a beautiful event that is!

Due to my post op high fevers, it is really hard to shake the fear of infection. Last cefdinir was yesterday morning. Now I wait.

I wanted to be able to say that nurses DON'T make the worst patients. But, apparently during my first set of vitals on the floor, I told the CNA she was doing it wrong. And then I took everything away from her and did it myself.

It's become harder to remain appreciative and to continue to express appreciation to a person who is hyper and argumentative, and who has been home most of the days between March 6th and today. And who has a very different definition of helping. And who has no knowledge of ability beyond ABLE. Still, "appreciative" is appropriate because, overall, he's been amazing and he drops everything for me at the first hint I might ask for help. That said... I'm so glad he went in to work today! Now I'm on the lookout for "caretaker appreciation" gifts, or acts, that I am capable of right now. He's driving me nuts, but he does deserve actual gratitude.

Counseling is the best thing I've done for myself in ages.

(medical/nursing oriented directly)

A cardiac nurse who just moved floors (probably this week) to post op spines will be so bothered by the amount of pain medication available to a patient that she'll blow the patient off (in the hopes of spreading out doses enough that SHE feels more comfortable giving them). And then the patient will spend hours trying to get it back under control again. In tears. Because pain. Horrible, horrible pain.

Hemochromatosis is a malabsorption disorder in which iron levels become toxic (high, not low, in case that wasn't obvious), resulting in organs being overrun with iron. Other secondary diseases can result, which is how people usually are diagnosed. Hemochromatosis is usually not caught before damage is caused to organs (cirrhosis is typical), which will cause symptoms and lead to testing.

(And now I'm geeking out on this - are there homeostatic processes that become permanently disrupted as a result of the high iron level? Or, if not permanently, for a prolonged period of time after iron level stabilization? Oxygen level, pH regulation, CO2, what drives breathing (O2? CO2?), etc.?)

It sucks being the normal patient sandwiched between the escape artist who goes room to room insulting perfect strangers, and the lady with the curious family member who just stares in the neighboring rooms. Just keep this in mind if the normal patient prefers to keep the door closed.

In the posterior open approach to lumbar interbody fusion, the surgeon really thinks on the fly through a lot of it. They obviously have the basic expectation and steps for the procedure as pretty standard for the technique they use. But some of the details and steps of it can't even be decided on until midway through.

Related to that, I have half of an L5 vertebra. Also, the anticipated net balance of the loss of discs and bone, and the addition of hardware and cadaver bone, is + 3 mm.

(lessons in employment)

If I decide to not go back to my current/not current/current/maybe current/finally actually current job after everything I have gone through (believe me when I say it has been utter hell), *I* will be the one who looks like a jerk. I will never stop being appalled by this whole situation.

Relating to that, there is a cardiothoracic scrub nurse needed locally (not my current employer) for 4-10s per week plus call (frequent) that pays $8-9 more per hour than my current job. Its making me wonder if I really do care how good of a recommendation I keep if I jump ship. Then I remember this is my first nursing job ever and the only person who screwed up in all of this is the manager. Absolutely everyone else has had my back and has treated me well. So, now, I email my friend, my person on the "inside" who got my foot in that door without me realizing it, and tell her gracefully that I can't burn this bridge. But, I think I might when the timing is better.

(totally unrelated)

There is a show called You Live In What, and it's so cool! I'm ready to comb through the countryside for historical landmarks and abandoned warehouses.

My wallet has, in fact, been on vacation in Cape Canaveral, where they generously cut all my cards up including a $50 gas gift card I keep in there in case of emergency. It's home now. Yay. :\

All this and I know I'm forgetting stuff still! Oh, well!

What did you learn this week?

I learned that in the 50s the Trans-Allegheney Lunatic Asylum had ratios of 100 patients to 1 nurse.

I start my gen-ed classes Wed.

Prothrombrin Time

Specializes in PACU, pre/postoperative, ortho.

Ixchel, glad to hear you're recovering well. I always wonder about how my spinal fusion pts do long term because they hurt so horribly post-op. It makes everyone question how good our surgeon is or if it is the norm for that type of procedure.

WILTW...

I narrowly avoided a HUGE write-up thanks to my awesome coworker who helped me remedy a... well, let's say a "clerical" error (unrelated to pt care). I owe her big time. This was one of those "I will NEVER do that again" moments.

Some pts & family are ok with continuing on with plans for elective surgery after a near code pre-op (not to mention the anesthesiologist & surgeon; meanwhile, all nursing staff are like W - T - F😨).

I'm getting an unexpected raise. Sweet!

Did pre-op for a d&c (fetal demise) for the first time. Not as difficult as I was afraid it might be, emotionally, but I keep thinking I could have done better with explaining mom's options.

My least fav CRNA will insist the HOB just needs raised first while the receiving pacu nurse wants to apply the O2 mask on arrival to a pt who presents hypoxic... Seriously, there are multiple people standing by to do everything at once as the pt comes in. If you want the HOB up more, plug in the bed & do it yourself instead of barking orders & standing in the way. This is the same CRNA who doesn't want us to touch the peds pts when she first brings them in. For the love of...

Specializes in ICU.

I learned that sometimes you fight so hard for patients to get them the best possible outcome. In all that fight you grow emotionally invested. When NOTHING goes right for the patient, it hurts you. And it hurts bad. I'm a new grad and never realized caring could suck this much at times.

I also learned the suck can be buffered a little bit when you see positive outcomes in others. TpA can be an amazing drug in stroke patients.

I learned...

Sometimes nurses make the best patients! My sweet retired nurse I had today never touched her call light unless she had to use the restroom. Also it was nice to talk to her in nurse-speak and not have to think of how to put everything in layman's terms.

Sometimes the grumpy, belligerent, foul-mouthed old man in the bed just wants somebody to listen to him.

There are doctors and supervisors who will shoot down your perfectly reasonable request then turn around and do it while taking the credit.

Ixchel, glad to hear you're recovering well. I always wonder about how my spinal fusion pts do long term because they hurt so horribly post-op. It makes everyone question how good our surgeon is or if it is the norm for that type of procedure.

WILTW...

I narrowly avoided a HUGE write-up thanks to my awesome coworker who helped me remedy a... well, let's say a "clerical" error (unrelated to pt care). I owe her big time. This was one of those "I will NEVER do that again" moments.

Some pts & family are ok with continuing on with plans for elective surgery after a near code pre-op (not to mention the anesthesiologist & surgeon; meanwhile, all nursing staff are like W - T - F������).

I'm getting an unexpected raise. Sweet!

Did pre-op for a d&c (fetal demise) for the first time. Not as difficult as I was afraid it might be, emotionally, but I keep thinking I could have done better with explaining mom's options.

My least fav CRNA will insist the HOB just needs raised first while the receiving pacu nurse wants to apply the O2 mask on arrival to a pt who presents hypoxic... Seriously, there are multiple people standing by to do everything at once as the pt comes in. If you want the HOB up more, plug in the bed & do it yourself instead of barking orders & standing in the way. This is the same CRNA who doesn't want us to touch the peds pts when she first brings them in. For the love of...

Dude....I was starting to wonder if we worked at the same place till you said "she" when referring to the CRNA. We have one who is the exact same way and it makes me craaaaaazy!

"A cardiac nurse who just moved floors (probably this week) to post op spines will be so bothered by the amount of pain medication available to a patient that she'll blow the patient off (in the hopes of spreading out doses enough that SHE feels more comfortable giving them). And then the patient will spend hours trying to get it back under control again. In tears.

Because pain. Horrible, horrible pain."

I see this with certain nurses that I work with in PACU. Patients who are in pain not being medicated appropriately because there are certain nurses who I work with who are uncomfortable with giving higher doses of pain medication. It frustrates me, especially if I may be working in post-op that day and I get a patient whose pain has been poorly managed and all I can give them now is PO meds.

Specializes in critical care.
Interesting fact I just learned recently about hemochromatosis: a treatment for it is bloodletting! Usually I think folks would donate that blood assuming they meet the system's criteria.

I forgot to mention that! I do wonder about the donation criteria. My friend is getting one unit out twice per week, and this will last for probably 10-12 weeks, with one week breaks here and there. Each time blood is removed should drop serum ferritin by around 30 points. Normal is 50-200, he had two back to back readings that were ~1160 and ~960. The discrepancy is a mystery.

When fluid volume is approaching low, it is typically replaced mL for mL by NS. It's an awful amount of blood lost so often, I'm sure. He requested the more aggressive schedule because his diagnosis was a total fluke, found by accident, and he is terrified of that potential harm he faces with ferritin overload.

Specializes in Pediatrics, Emergency, Trauma.

Glad you are feeling better ixchel!

More people are leaving...some have to for more flexibility (more sad about that, management's fault) to having enough (again management's fault); the common denominator is that management needs an overhaul, as well as experienced nurses to help stop the non-trauma related bleeding that is going on; also, there needs to be more docs that are willing to work as a team; it seems as though both areas needs to work together in terms of staffing, and communication in order to promote the highest quality of care to the kids and families.

With all that being said-what I learned:

-Even with more people leaving, people have made the assumption that I am leaving; however, when I share the many jobs that have dumped on me in the past, I can steadfastly convince people that I am NOT leaving by uttering the words "Long Term Care."

-Even with my former preceptor and semi mentor leaving I know that I have a contact for a per diem job; in the other spectrum, having reconnected with another mentor from the past may open those doors too; nursing connections are so important for future goals of working per diem while teaching-something I realized that is a goal I should be working on as an eventual progression.

-As discussed in last week's WILT, unit culture, especially a culture of fear is a hard nut to crack; I realize this-it strikes me due to my DV background, habits of fear are hard to break; I feel as though management promoted and may still promote this due to their emotional intellect; however when one is a point of contact in relation of bargaining during a union contract, people are sure excited to know what is going on and will seek you out to be abreast of progress.

-In relation to emotional intelligence; it seems fitting that a negotiator for management has a mini tantrum during bargaining negotiations, well, due to the fact that management acts like that anyway; the best thing about it was they thought that they can get away with just keeping the status quo-now that they realize that we are here to do business, now they are at least doing what they are supposed to do-work towards a goal.

Round 4 is next week.

And one of my patients learn this this week from me:

"If it doesn't fit-you MUST quit!" ;)

Specializes in CMSRN, hospice.
I also wandered over a lot and tried to keep two of them from killing their really sick ones... if I had a dollar for every time I asked, "Have you called a physician about that yet?" I'm pretty sure I'd have at least $15. [...]

I've learned that it's a good emotional/ego boost to be the person people come to in a crisis, but it's also a real pain in the butt to be on top of everyone else's patients on top of taking care of my own. I definitely understand why people can snap at less experienced/less quick on their feet nurses. It was all I could do at one point to avoid saying, "Are you actually TRYING to kill that guy?!"

Oh God oh God oh God oh God. I learned this week that the biggest thing that has held me back from challenging myself in this field is the fear of inspiring feelings and comments like this. :nailbiting::roflmao:

I can imagine the frustration that comes with assuming a co-worker's problems on top of your own work. Thank you, and all nurses like you, for being a trusted resource in the face of that!

Specializes in OB.

I learned this week that my children's school will work with parents who want help with their overweight kids. They set up an exercise program for them. Since recess is before lunch the kids have exercises that need to done before they eat. They also come in early before school to do a personal workout with the PE teacher. It isn't brutal but with the school and parents on board, these kids are losing weight!

A hospital that I was offered an externship in labor and delivery called and took back the offer for labor and delivery. They are looking into other options. I am crushed. Most of my classmates have jobs and I am standing here feeling dazed and confused.

I'm sorry, Half Pint. I can't like that post. *hugs*

"A cardiac nurse who just moved floors (probably this week) to post op spines will be so bothered by the amount of pain medication available to a patient that she'll blow the patient off (in the hopes of spreading out doses enough that SHE feels more comfortable giving them). And then the patient will spend hours trying to get it back under control again. In tears.

Because pain. Horrible, horrible pain."

I see this with certain nurses that I work with in PACU. Patients who are in pain not being medicated appropriately because there are certain nurses who I work with who are uncomfortable with giving higher doses of pain medication. It frustrates me, especially if I may be working in post-op that day and I get a patient whose pain has been poorly managed and all I can give them now is PO meds.

I've heard an alarming number of nurses on my unit doubting patients' pain levels because they're playing on their phone or manage to laugh. When I'm in pain I withdraw, I don't writhe and scream. Fortunately they're not withholding, just doubting.

My philosophy is: if you say you have pain, if you have an order, if it is not contraindicated (high ETCO2, depressed respirs), I will bring you pain medication.

But then there was a surgeon who only wanted to give one Norco q 4 for a post I&D pt who had incisions down to muscle on her chest, was moaning and shaking while I packed the dressing. I advocated for pain meds with dressing changes and he VERY RELUCTANTLY agreed. He had done her first dressing change of the day during AM shift report, so he must have seen how painful it was firsthand. Boggles my mind.

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