I've been asked to start the WILTW thread, and I'm more than happy to!
This has been an exciting week for me, as it was the last week of my Med/Surg I rotation. I'm trying not to feel too relieved though, because finals are next week. That being said, I will still absolutely squeeze in time to catch up on GOT.
This week I learned:
That my clinical instructor is a big ole softy. I can't believe that I thought she was super scary when the rotation first started.
That having just one year left of nursing school doesn't feel like enough time. Don't get me wrong, I feel like I've learned a ton in the one year of school I've had (and I'm more than ready to graduate so that I can get my social life back), but when I think of just how much I still don't know, I get a little worried.
That I wish I could take some patients home with me. Throughout clinical, I had nice patients, but none that really lingered in my thoughts when I went home for the day. But last week I had a patient who had already been through so much. His whole family had already been through so much. Sometimes it's hard to know just what to say, and I hope I was more helpful than I felt I was.
That I'm probably going to have a lifetime of telling family members, I'm not a doctor. You really need to talk to your doctor about that. I will probably NEVER be able to diagnose you.â€
I've also learned that said family members, when you actually do give them advice (such as dietary advice), will say Oh, you're just regurgitating what you've learned in school,†and will continue to eat everything under the sun while wondering why their blood pressure isn't controlled. Why yes, I am telling you what I've learned in school, but apparently you'd rather hear that steak for every meal paired with a margarita is the best possible chance for survival.
That being said, I do follow the steak and margarita diet. But hey, I'm working on it.
That the best way to get a resident to like you is to empathize. Let them vent. Losing my independence is something I can hardly fathom, and I'm sure I wouldn't handle it with grace. (Like, really I'm very certain that I'll be the LOL trying to escape everyday and falling out of my wheel chair in an attempt to lunge out the door). It's ok to let residents feel angry about it. It's ok let them know that, yes, it does suck, and that you'll be right around the corner when they're ready for help.
But it's not ok if they scratch you. Or bite you. Oh swear at you. We still need some limits.
That I will never ever forget to do an oral assessment on my patients. This is the second time I've shined a penlight in there and found a massive case of oral thrush.
On that note, I'm also very glad I'm not a dentist or dental hygienist. I'll wipe all the butts in the world, but don't bring that mouth any closer to me.
But what's grosser than the grossest mouth? Maggots. I was not pleased to learn that maggots are still being used for wound debridement. That...is my limit.
Having an enthusiastic instructor makes a big difference in students' willingness to learn.
I have my pinning ceremony tomorrow, although I won't feel like I'm officially done until I've completed my Kaplan review next week.
I learned the 6 P's of compartment syndrome: Pain, Pressure, Paresthesia, Pallor, Pulselessness, and Paralysis. Faschiotomy that sucker. Some docs might have you cut a window in the cast.
For those with a strict upbringing: my family decided long ago I was heading for the hot zone. Strangely, (sarcasm) it works for me. I love the family I've built from the friends I cherish and who never let me down.
I've learned I'm a vegetarian with a serious craving for steak and Cadillac margaritas. :peace:
Yes. The hot zone. It isn't as hot as they led me to believe it was [emoji12]
And yes, the friend family, or framily (because I'm cheesy) is where it's at. There are several different religions and non-religion within my framily, and it works beautifully. I feel lucky to have found my people early in life.
Having an enthusiastic instructor makes a big difference in students' willingness to learn.
I have my pinning ceremony tomorrow, although I won't feel like I'm officially done until I've completed my Kaplan review next week.
I learned the 6 P's of compartment syndrome: Pain, Pressure, Paresthesia, Pallor, Pulselessness, and Paralysis. Faschiotomy that sucker. Some docs might have you cut a window in the cast.
There's another P that I just learned about--poikilothermia distal to the affected area.
Oh yeah, I agree. I think we have very approachable docs. I love our docs, and they're even nicer to the patients than they are to us (as in they have great bedside manner even when having a bad day, for the most part); I think sometimes though patients get tunnel vision when talking to the doc. I hate it when a doc will come in without reading my nursing notes first. I think a lot of the perception of docs being less approachable just has to do with the different focus of a doctor-patient relationship, but that's just me.
I'm sure you're right, and I'm sure some patients also get white coat syndrome. Some of our docs are the approachable type, others are not. Some depend on the type of day they've had. We have two people (oh my bearded Riker!!!!! [emoji35]) who have no problem arguing with a patient and/or nurse about what the patient reports. I hope desperately their contracts are NOT renewed!!!
But, I digress... Five minute u-turn docs are frequently the cause of the, "the doctor seemed too busy, so I'm going to ask my nurse," problem in my experience. Anecdote, only. [emoji4] I'm at a rural facility that struggles recruiting talent. I think we're fortunate to find the ones we have.
nope, I didn't. Honestly I think its one of those things where certain docs struggle with the idea of being proactive with airway management in a patient that comes in that can at least kinda talk. My experience has been that its a lot tougher to get some docs to intubate patients that actually have looked into their eyes prior to needing the tube... but maybe that's just my perception. I mentioned several times that I was worried about her tiring out, her airway patency, etc, and kept getting the response of "but she can open her eyes and look at you and can talk (kinda) when spoken to".... uh, yeah, and I'd like her to be able to do that in the future, not just now. lol
We had someone sent us who had been hyperventilating for hours. Came to the floor, no intubation, not one but two doctors didn't question this. No ABGs, no intubation... Real head scratcher. First thing we did was get ABGs. CO2 was 5. Off to the unit he went. Some things just leave you wondering - what the Samwise Gamgee were these people smoking?!
I've learned that I love when cali posts and cops to every single petty 8th grade girl feeling I have.
There's a large portion of me that never grew up and I'm not ashamed to admit it. :)
nope, I didn't. Honestly I think its one of those things where certain docs struggle with the idea of being proactive with airway management in a patient that comes in that can at least kinda talk. My experience has been that its a lot tougher to get some docs to intubate patients that actually have looked into their eyes prior to needing the tube... but maybe that's just my perception. I mentioned several times that I was worried about her tiring out, her airway patency, etc, and kept getting the response of "but she can open her eyes and look at you and can talk (kinda) when spoken to".... uh, yeah, and I'd like her to be able to do that in the future, not just now. lol
I feel like that's every hospitalist ever. My ICU isn't closed, so the hospitalists can admit to us, and I just want to throttle every single one of them. They always just want to sit on the patients before they make any decisions. I had one go unresponsive with an O2 sat in the 70s on 100% BiPAP before one of them agreed to tube my patient. I thought the guy was going to have to arrest to get a tube. If a patient gets admitted to my unit, the attending should be in the INTENSIVIST GROUP! Oh my god. All the rage ever. I feel like good hospitalists are few and far between... it's all the crappy ones that stay on the night shift in my hospital. One is famous for everything being "very dangerous" - "Patient ees very seeck, very septic, room air, BP 120/85, needs ICU bed stat!!!!"
It's like lady, you just took the code bed. What are we supposed to do if somebody actually CODES ON THE FLOOR?! Is one of us supposed to go up to the floor and roll in ten million IV pumps, a ventilator, and an Arctic Sun into one of those miniscule med/surg rooms to take care of the patient???
Oh god. Some of our the hospitalists are okay, but there are some I wouldn't trust to keep a cockroach alive.
Long time lurker, firs time poster :) decided to bite the bullet...
...where I work, I also feel like a patient has to be borderline arresting to receive some tube therapy - like that oxygen saturation of 67% taped to their forehead isn't accurate / ABG pH of 7.04 is all just for show. Yikes!
What I'm continuing to learn is that morale in my unit seems to also be super low with it only going lower. Nursing staff burn out rates on the up. Can be challenging to advocate for the best patient care when the odds are that the covering provider doesn't see it as priority.
I hope everyone is enjoying their margarita & steak diet for cinco de mayo! :)
We had someone sent us who had been hyperventilating for hours. Came to the floor, no intubation, not one but two doctors didn't question this. No ABGs, no intubation... Real head scratcher. First thing we did was get ABGs. CO2 was 5. Off to the unit he went. Some things just leave you wondering - what the Samwise Gamgee were these people smoking?!
Yes! I now have a go to request of an ABG whenever the doc wants to say "let's just see how they tolerate....." ... nah... "how about we check a blood gas doc, and then decide?"
ixchel
4,547 Posts
If I'm "ixchty" (which, lets face it, probably is pronounced "itchy"), does that make you "Farty"? (With a capital F)