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?

I took care of an NP today that I can't even discuss. I wish I could give you guys details, but I am still suffering from PTSD. I mean, I can't believe another nursing professional was OK acting like this. Even the surgeon that worked on her was listening to her as he did his orders and turned around and just shook his head. It was unreal. Give me someone on a vent any day...I usually dream them.

Specializes in Emergency Department, ICU.

I learned that eating lunch before 4pm on day shift is a luxury not often afforded to me even on orientation (ouch). I also learned that when I cannot take this lunch break due to a critically ill patient, I may sound like a total idiot when giving report to the ICU RN because I am too hungry to think. This makes me want to use that "but did they die?" meme, because they didn't die and actually got great care even if I can't always articulate that in a phone report. blah.

I learned that some nurses are wayyyy more concerned with playing doctor than they are with being a nurse. If I informed the doctor and he chose not to address something and left it up to the admitting doc, it irks me to have another nurse tell me what I need to do before I send the patient to her. Again, the patient is fine, in fact much better than when they came in, so if the doc was ok with an O2 sat of 92% on room air, then -you- can put the pt on oxygen when they come up if you and the admitting doc want instead of raking me over the coals for why they aren't on it now.

Some docs like to use toradol for fevers and not everyone knows that this is one of its uses

A young person with no prior medical history can walk in with a complaint of fever and weakness and turn out to have a massive pleural effusion.

Similarly surprising, an adult xray report can contain an interpretation of intussusception.

Nausea and vomiting can be associated with long term cannabis abuse

I am -not- cut out to be a mental health nurse (already knew, but even more confirmed this week).

Specializes in ICU.
I learned that eating lunch before 4pm on day shift is a luxury not often afforded to me even on orientation (ouch). I also learned that when I cannot take this lunch break due to a critically ill patient, I may sound like a total idiot when giving report to the ICU RN because I am too hungry to think. This makes me want to use that "but did they die?" meme, because they didn't die and actually got great care even if I can't always articulate that in a phone report. blah.

You should totally say, "But did they die?" I will say as an ICU RN myself that the anal retentive ones who grill you in report just need to take a pill and shut up. I don't particularly care what report I get - I will figure things out myself. It would be really helpful to know the presenting diagnosis and what kind of access the patient has (I don't care where it is or what gauge, I care about how many there are and whether I should get a central line tray ready or not), and if the family is bat guano crazy, but that's it.

Critical language in healthcare - a phrase that is intended to stop an action without blame.

We use "I have a concern" at my job. I hear it so rarely that it really does stop and make me think.

I learned I apparently suck at being charge. Last night was my first night being charge, which doesn't really mean anything on my unit because we're so independent and have a charge per each section (three charges total per shift, plus a team lead and a unit lead every shift), and the team lead and unit lead are usually the ones who decide what admissions go where anyway. It really is more of an empty title than any actual responsibility. I feel like I sucked, though, because everyone on my unit that didn't have a 1:1 had three patients, and all of us with three patients got out really late. I feel like telling myself, "Congratulations, calivianya, nobody could get their work done with the assignments you made!" :bag:

We are supposed to be out around 0715 and I clocked out the earliest of my group at 0748. Fail. I am going to be charge in my section again tonight. Maybe it will be better and people will actually get out on time?

-This week I learnt my dog can do well in day care. Granted, he was not with the general population because I was scared he would fail his evaluation. But he can do well with strangers (he's always been good with people) and with lots of noise in the background, like barking dogs.

-This week I learnt I can get reimbursed for a gym membership by my health insurance. It makes up for not being able to pay the membership dues with my HSA account. But this is all the more reason to join a gym. I've been good about working out at home, but I want to do more. I'm going to meet a personal trainer today and I hope he's good and the price reasonable.

-This week I learnt anyone who emphasizes cardio over weights for women may be FOS. Unless I use roids, I know I'm not going to look like a she-hulk. I just want to be strong, not an artificially created female Conan the barbarian. But I know it won't be a problem.

-This week I learnt anyone who emphasizes cardio over weights for women may be FOS. Unless I use roids I know I'm not going to look like a she-hulk. I just want to be strong, not an artificially created female Conan the barbarian. But I know it won't be a problem.[/quote']

You have to do a lot of heavy weights and reps to get bulky. I like cardio mostly because I'm trying to slim down in my thighs and abs, but I do weights for toning.

I've learned my house will not clean itself.

Specializes in critical care.
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!

Regarding the member, did anyone demonstrate techniques for getting the member to un-invert for foley insertion/care? There are tricks to this that will be good to learn for future encounters with an inverted member (which you are likely to encounter many times over your career).

If you didn't get to see how you can help this, essentially you can "push" it out. We have a urologist who is mean about this. He'll punch (for lack of a better word) right above the mons pubis and the meatus will pop out just enough for him to do what he needs to. This is essentially the way we'll do things in my description, but we'll be nicer about it. [emoji5]️

If you are doing any procedures, and you are not ambidextrous, you'll need to be mindful of which hand does what. With your non-dominant hand cupped in a C shape, place the tip of your index and second finger immediately above the member and your thumb immediately below. Push "in", placing pressure inward. If my description makes no sense, what I mean is push firmly into what is probably the bladder. Then also press inward below the member. If the firm pressure simultaneously doesn't work, you make need to alternate pressing above and below the member. You should be able to get more than just the glans to come out. When you've pushed out as much as you think you'll get, hold what you are able to grip so that it doesn't invert again.

At this point, you can do any procedures. If what you're doing is a sterile procedure, you really need a second person in the room, bonus points if its a nurse, in case you end up in a precarious position requiring your helper be the one to insert a foley.

As always, professionalism is very important here. Be sure to use slightly less than gentle pressure and avoid non-medical chatting until after you are finished. This will actually increase the psychological/emotional comfort of the patient. The patient needs to feel without a doubt that you are not in any way viewing their member as a sexual organ. They may feel embarrassment over the inversion. ALTHOUGH... I say that but most men I've encountered with an inverted member have had it for a very long time and are well beyond the embarrassment they might have felt in the beginning. I've had a couple of men even joke about it.

You might also be able to find videos on youtube. I'd search and link, but (1) TOS? I'm not sure actually, and (2) I've linked legit videos involving genitalia and legit medical procedures in the past on public websites thinking I was helping, and all the pervs started showing up. Allnurses would rather stay classy, I'm sure. [emoji5]️

Specializes in critical care.
I took care of an NP today that I can't even discuss. I wish I could give you guys details, but I am still suffering from PTSD. I mean, I can't believe another nursing professional was OK acting like this. Even the surgeon that worked on her was listening to her as he did his orders and turned around and just shook his head. It was unreal. Give me someone on a vent any day...I usually dream them.

Are you being literal or figurative about the PTSD?

Specializes in OR, Nursing Professional Development.
I've learned my house will not clean itself.

Shoot, I learned that 8 years ago when I moved out on my own! I just make do. Still wishing for a cleaning fairy though.

Nursing related:

I've learned that it is possible for a patient to say they have no issues urinating but actually turn out to have pretty significant problems. When attempting to place a foley, it would not go in, even the tiniest little pedi catheter we have. When we called in the urologist, he couldn't even get a wire to pass through into the bladder to thread a catheter over. Turned out the guy had some sort of pelvic trauma as a child- he didn't think he had issues because to him he'd never known any different. So, the poor guy ended up with a suprapubic cath and his planned surgery cancelled. Amazing what a long-distant injury can cause.

Shoot, I learned that 8 years ago when I moved out on my own! I just make do. Still wishing for a cleaning fairy though.

Nursing related:

I've learned that it is possible for a patient to say they have no issues urinating but actually turn out to have pretty significant problems. When attempting to place a foley, it would not go in, even the tiniest little pedi catheter we have. When we called in the urologist, he couldn't even get a wire to pass through into the bladder to thread a catheter over. Turned out the guy had some sort of pelvic trauma as a child- he didn't think he had issues because to him he'd never known any different. So, the poor guy ended up with a suprapubic cath and his planned surgery cancelled. Amazing what a long-distant injury can cause.

:wideyed: I can't even imagine waking up to an unplanned suprapubic cath. Talk about a shock.

Specializes in Med nurse in med-surg., float, HH, and PDN.

Reading through this thread, I have learned that I have lost much of my previous knowledge about nursing interventions and lab values: I have to look things up now as mostly it isn't applicable to my work (PD, often with a Sundowning 90+ year old) So, "Use it or lose it" is for real!

I have also learned that, at this stage of my career and at my age, I don't even care anymore.

Specializes in Emergency Department, ICU.
You should totally say, "But did they die?" I will say as an ICU RN myself that the anal retentive ones who grill you in report just need to take a pill and shut up. I don't particularly care what report I get - I will figure things out myself. It would be really helpful to know the presenting diagnosis and what kind of access the patient has (I don't care where it is or what gauge, I care about how many there are and whether I should get a central line tray ready or not), and if the family is bat guano crazy, but that's it.

I think I give a really good report, but it drives me crazy when I get asked for what times I gave or started what meds. It's charted, they can see it. I don't remember all that down to the minute, I just remember what I have given and what drips they are on, and at what rate they are currently running.... lol. I always tell them where their access is, etc. It's funny how everyone has their "thing"...

+ Add a Comment