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?

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!

I have learned (not this week, I'll admit) that it's important to ask anyway. If the nurse is kind and helpful, everyone wins, you learn, and the patient benefits. If the nurse is rude but helpful, you still learn, and the patient benefits. If the nurse is rude and unhelpful, you know who not to ask again. Asking is tough, but there will always be something you don't know, and you'll end up a better nurse.

I second the thank you to everyone who is the helpful askee :D

Specializes in retired LTC.
I've had bronchitis this last couple of weeks, with coughing jags that lasted 5 to 10 minutes at a time. This week I learned:

1) Never trust a fart!

2) Don't forget to take your "no-pee" pill (Ditropan).

Ixchel, I'm glad the pain decreased dramatically! May you heal quickly! :)

So true to both. (bolding mine).

And 'get well wishes' to you, ixchel.

to Lauraingalls - kudos to your people and school for addressing a childhood issue. Maybe you guys should alert Michelle Obama who has the similar interest in managing childhood obesity. At minimum, write it up for some publication (local newspaper?) for your novel approach:up:.

Specializes in ICU.
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!

If you never challenge yourself you never learn; if you don't ask when you're struggling you might not figure something out. I always tell people what's going on with my patients and ask about theirs. Even if everything's going very well, it doesn't hurt to pick another set of brains, and someone might catch on to something that you don't.

I know technically that's not HIPAA friendly but I can think of plenty of times off the top of my head that sharing information with my coworkers lead to a new line of thinking I wouldn't have thought of before, or had me contributing something that nurse didn't know. I really believe we're better together than we are separate.

I'm sure there were plenty of moments while I was new that people were rolling their eyes at me, too. I remember very clearly one time my first preceptor actually picked a fight with me in the alert and oriented patient's room over the way I did something. Not in the hallway, in the room. With the patient listening. It was bad.

I'm looking forward to one of those people mentioned above making huge strides. She's a pretty new nurse, about 1 year of experience at this point, and has come a long way already and I love working with her. The other one has been a nurse for 20+ years and I like her as a person - I think she just may be a lost cause and need to be assigned the healthiest patients on the floor. She has taught me that experience doesn't automatically equal being a fantastic nurse; sometimes it just means you scrape through just enough to keep your license for 20+ years.

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.

We have a few nurses who just flat out don't feel comfortable giving larger amounts of pain medication. I've had patients who were open abdominal surgeries who when it was all said and done I ended up giving them, say, 4 mg of dilaudid to to get their pain under control. There's one nurse in particular who when she found out that's how much they got before going to the floor, her words were something along the lines of "I just wouldn't feel comfortable giving that much." It baffles me. If the patient is in pain, the vitals are stable (and clearly support the patients reports of pain), why wouldn't you medicate them if you have orders to do so? I think it comes down to our different backgrounds, but I could be wrong.

Specializes in ICU.
We have a few nurses who just flat out don't feel comfortable giving larger amounts of pain medication. I've had patients who were open abdominal surgeries who when it was all said and done I ended up giving them, say, 4 mg of dilaudid to to get their pain under control. There's one nurse in particular who when she found out that's how much they got before going to the floor, her words were something along the lines of "I just wouldn't feel comfortable giving that much." It baffles me. If the patient is in pain, the vitals are stable (and clearly support the patients reports of pain), why wouldn't you medicate them if you have orders to do so? I think it comes down to our different backgrounds, but I could be wrong.

I'm very comfortable giving large doses of pain medications when I'm not the first one to do it. If I am the first person to medicate the patient, you better believe I am paranoid if it's a large dose. I will still give it, but I will watch the patient very closely the first time.

You never do know how somebody's going to react to a dose of medication until it's been given. Had a LOL once who had all this Norco, Neurontin, Flexeril, etc. on her home med list, and the MD ordered 4mg IV morphine. It knocked out her entire respiratory drive and I had to sternal rub her to get her to breathe until someone could get the Narcan out of the pyxis. Her next BP cycled so low I had someone grab the code cart just in case. Family later told me that she had all that stuff prescribed, but she actually took something less than once a week because she didn't like taking pain medication. People will surprise you, and just because something is ordered doesn't necessarily mean it's a safe dose for the patient.

Just felt like playing devil's advocate for a minute. ;)

Specializes in rural, camp, telephone triage, abstraction.
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.

Just had a class on this a couple of months ago, actually! The FDA allows people with hereditary hemochromatosis to donate blood, but the Red Cross currently does not accept those donors. Something about the patient benefiting financially because it saves them from having to pay for a procedure? There may be other organizations that do accept those donations, but I'm guessing they're not as easy to find. It seems silly to waste perfectly good blood when we're always crying for donors...

Donating Blood Questions and Answers

Iron & Blood Donation | American Red Cross

I'm very comfortable giving large doses of pain medications when I'm not the first one to do it. If I am the first person to medicate the patient, you better believe I am paranoid if it's a large dose. I will still give it, but I will watch the patient very closely the first time.

You never do know how somebody's going to react to a dose of medication until it's been given. Had a LOL once who had all this Norco, Neurontin, Flexeril, etc. on her home med list, and the MD ordered 4mg IV morphine. It knocked out her entire respiratory drive and I had to sternal rub her to get her to breathe until someone could get the Narcan out of the pyxis. Her next BP cycled so low I had someone grab the code cart just in case. Family later told me that she had all that stuff prescribed, but she actually took something less than once a week because she didn't like taking pain medication. People will surprise you, and just because something is ordered doesn't necessarily mean it's a safe dose for the patient.

Just felt like playing devil's advocate for a minute. ;)

Completely fair! If I have a patient who has high levels of pain and has been regularly cycling through all their PRNs, and has had no adverse reactions, I'm less concerned about creating a bad situation. Kind of the same philosophy I have with insulin. Do they take this at home? Have they been taking it here? What happened after the doses? If yes, yes, and stable, no reason not to medicate.

Since recess is before lunch the kids have exercises that need to done before they eat.

Overweight kids have their recess taken away and are not allowed to eat until their exercise is done?

I'm very comfortable giving large doses of pain medications when I'm not the first one to do it. If I am the first person to medicate the patient, you better believe I am paranoid if it's a large dose. I will still give it, but I will watch the patient very closely the first time.

You never do know how somebody's going to react to a dose of medication until it's been given. Had a LOL once who had all this Norco, Neurontin, Flexeril, etc. on her home med list, and the MD ordered 4mg IV morphine. It knocked out her entire respiratory drive and I had to sternal rub her to get her to breathe until someone could get the Narcan out of the pyxis. Her next BP cycled so low I had someone grab the code cart just in case. Family later told me that she had all that stuff prescribed, but she actually took something less than once a week because she didn't like taking pain medication. People will surprise you, and just because something is ordered doesn't necessarily mean it's a safe dose for the patient.

Just felt like playing devil's advocate for a minute. ;)

That's fair enough :) I should also probably mention that our dilaudid orders are written so that it's given either 0.2 or 0.4 mg at a time. But you're correct, an order doesn't necessarily make something safe.

Specializes in ICU.

I learned a lot about how an ER runs. I started my first IV and hit it on the first try!! Yay!! I was nervous about that. I also learned that there are many moving parts in a hospital that all combine to help the patient. And that some times the other depts need to realize they play a critical role also. I had a very stupid argument with another dept on my shift the other night about supplies. I needed the supplies for patients and they were mad they had to bring them. It was important and honestly could not wait. I just felt it was silly and I work in a dept where we get critically ill patients at any time. So supplies to take care of those patients are important. We got two new admits shortly after that call.

This week is finals week!! I'm so excited!! I have checked out on school myself. It's been a very long three years.

I'm ready to start my life. Complete new life. New house, new town, new job. In three weeks, I will be there!!!

Specializes in OB.
Overweight kids have their recess taken away and are not allowed to eat until their exercise is done?

Not completely taken away but they have to do certain exercises. And if they flat out refuse, they won't let them go hungry.

Like I said it is only done with kids whose parents approach the school about helping them

Specializes in Pediatric Hematology/Oncology.
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 don't know if this has been mentioned or not already but the Red Cross doesn't accept donations from people with hemochromatosis (very few donation centers actually will) because of the "no compensation" policy. It's apparently considered compensation to the people with the disease since they would otherwise have to pay for their therapeutic "blood letting" so, the Red Cross reasons, taking donations for free from people with hemochromatosis is compensation since it is, in a sense, paying for their therapy (ethics??). Hemochromatosis: American Diabetes Association®

The FDA doesn't care, though, but there is a protocol in place for taking blood from people with the condition. Donating Blood Questions and Answers

And, some places will be happy to allow for this win-win situation to exist: Hereditary Hemochromatosis Donations

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