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

Nurses General Nursing

Published

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?

Specializes in Pediatric Hematology/Oncology.

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

No truer words. :yes:

Specializes in critical care.
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:

If your preceptor sees that you are conscientious, cautiously willing to dive in, and consistently asking questions instead of pretending to know things in an effort to save face, you will not get yelled at or lectured.

Arrogance tends to get the finger wag and terrible conversations/evaluations. Obviously, you don't also want to walk in clueless with no forethought of your own. One of my favorite questions to ask and be asked is, "Can you show me where I can find this information on my own? I'd hate to keep bugging you over the same stuff, but I'm also pretty sure I'll have to walk through this a few times before I really remember it."

Specializes in critical care.
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.

To the first part - how incredible! Do they have any safeguards in place to prevent the kids in the program from feeling stigmatized or embarrassed? I hope very much that this program remains successful and gets some good, far-reaching press. If there isn't enough nutritional knowledge and physical activity in the home, having this gap bridged is just so important.

Better health = higher educational achievement = better/higher paying jobs = better health

That ^^^ feeds itself over time. Start this in childhood! Do it!!!

The second paragraph... I want to respond, but there would just be a giant line of asterisks with intermittent articles and non-profane, polite pronouns regarding you and others who received the same call. I'm really just glad you didn't get hired by a person who is clearly an A hole. I'm sorry. [emoji17]

Specializes in critical care.
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.

This brings me back to school, lecture day two in med/surg. Acute pain travels one pathway in the nervous system, and chronic pain travels another. While acute pain brings on the increased vitals, GI symptoms, and intolerance to it, a person with chronic pain might experience the complete opposite.

On top of that, if you have to tune out pain literally every minute of every day, you do learn to function through it. I say that anecdotally, of course. Historically, my back pain was there always, but ranged from a 2 to a 8 or 9. You wouldn't see a difference in my demeanor if you weren't a trusted guest in the comfort and privacy of my home. Otherwise, if we were to see each other while out, you would just hear an eff ton of profanity. Colorful, emphasis profanity, not angry or bitter profanity.

The single piece of knowledge that kept me thinking this week comes from my graduate studies:

Critical language in healthcare - a phrase that is intended to stop an action without blame. For example if a nurse recognizes that the surgeon is about to perform "wrong site surgery" the nurse would say "Excuse me doctor but I need some clarity regarding the site you are about to perform surgery". The key phrase "I need some clarity" is not blaming but will make everybody stop.

http://www.ihi.org/education/ihiopenschool/Courses/Documents/SummaryDocuments/PS%20103%20SummaryFINAL.pdf

and a video:

Implementation of critical language will increase the culture of safety and overcome barriers to speaking up.

Specializes in critical care.
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

That is a terrible reason to turn blood away!!!! Here we are, desperately needing blood (with a lot of iron, no less!), and we're turning away the best you get because a patient avoids a co-pay.

NOT COOL, ARC!

Specializes in Family Nurse Practitioner.
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 really liked this post :)

Specializes in CMSRN, hospice.
If your preceptor sees that you are conscientious, cautiously willing to dive in, and consistently asking questions instead of pretending to know things in an effort to save face, you will not get yelled at or lectured.

Arrogance tends to get the finger wag and terrible conversations/evaluations. Obviously, you don't also want to walk in clueless with no forethought of your own. One of my favorite questions to ask and be asked is, "Can you show me where I can find this information on my own? I'd hate to keep bugging you over the same stuff, but I'm also pretty sure I'll have to walk through this a few times before I really remember it."

Absolutely! I am not afraid of asking questions and getting help when I truly need it; as much as I dislike bothering my more experienced coworkers (and very few of them act perturbed by it when I do), I would rather do that than harm or neglect a patient. I hold myself back more in assuming additional responsibilities, applying to jobs in other specialties I'm interested in, etc. But, gotta get over it; no sense in living this career in fear.

This brings me back to school, lecture day two in med/surg. Acute pain travels one pathway in the nervous system, and chronic pain travels another. While acute pain brings on the increased vitals, GI symptoms, and intolerance to it, a person with chronic pain might experience the complete opposite.

We get lots of both acute and chronic, with many of our patients post joint replacement or spinal fusion. I think it's probably the more random non-ortho med-surg admissions that get judged harshly, though.

On top of that, if you have to tune out pain literally every minute of every day, you do learn to function through it. I say that anecdotally, of course. Historically, my back pain was there always, but ranged from a 2 to a 8 or 9. You wouldn't see a difference in my demeanor if you weren't a trusted guest in the comfort and privacy of my home. Otherwise, if we were to see each other while out, you would just hear an eff ton of profanity. Colorful, emphasis profanity, not angry or bitter profanity.

Yep. I've been in pain for one reason or another for almost a year now, but except for when it was interfering with my gait (a rather unavoidable display, and when people asked, I would answer honestly), I wasn't about to let on that I was in pain, much less make a show of it.

WILTW:

You can choose not to see posts by specific usernames, which is nice. If a username is doing nothing but marching around from thread to thread wielding their giant pot-stirrer, I'd rather save myself the heartburn.

It is always, always, always better to e-mail something to a manager rather than relay it via voice message. Voicemails get misunderstood or deleted; e-mail is there forever and can be re-skimmed to make sure you have all the information. Nothing big happened, I'm just trying to get my schedule set up around my work restrictions, with a scheduler that is kind of flaky.

Episodes of House, M.D. are even funnier now that I have a medical education. Start the treatment! If I'm right, they'll get better. If I'm wrong, they'll die. Wait, we could have ruled out that diagnosis with results from a CBC/CMP?

I missed last weeks post so WILLW:

A catheterized member can become inverted, due to fluid status and pt weight.

The result is a very perplexed nursing student who's preceptor is snorting in an attempt not to laugh at the student.

I'm glad that my last night of clinical had such surprises for me.

WILTW:

Crashing of a laptop due to a virus picked up from a school email is not an acceptable reason to miss an online quiz.

18 days until I graduate. 1 test, 2 presentations and 3 finals are all I have left!

Adding on to my previous list:

Colorectal cancer can start off as a polyp.

Avoid making doctor appts in the summer. I can't see my primary physician until July and my dermatologist until mid-June. I've recently been struggling with acne on my back and chest, along with breakouts on my face and jawline. Hopefully, they can prescribe me something (Abx or OCP) that will help clear some of it.

I would look damn good in a military uniform, according to my sister. All the more reason to join the military.

I registered to vote, so I'll have to do some thorough research for the election. Although I can't vote for the primary, since the date has already passed for my state.

My menstrual cramps are so severe, they're debilitating. At times like these, I wish I either had my tubes tied or was a male.

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