An Education (In Nursing)

I decided on nursing after I realized that my first degree would not land me a job that I’d even remotely enjoy. However, I gained invaluable research and analytical skills that have served me well, and continue to do so, in my nursing career. I enrolled in an accelerated nursing program in which I could skip some electives and concentrate on core nursing courses. I bring this up because I recently finished preceptoring a nursing student and it was nothing short of a challenge. His lack of motivation was only matched by his creative excuses to justify his tardiness and absence from shifts. However, what really struck me was his absolute lack of research and math skills. I’m not talking about designing one’s own RCT in the midst of a code or solving a limit of a function as x approaches infinity but basic stuff like being able to look up the pathophysiology of DKA or calculating infusion rates by plugging values into an equation. When I brought up these concerns with him, he said that I was judging him unfairly because I was more educated when I started nursing. I was quite offended because even though I was aware of the economic factors that led to inflation, that knowledge did not really help me in figuring out how to manage someone in septic shock.

He did, however get me thinking about nursing education in general. I have worked with many students from the school that my student was enrolled at and they all mentioned that their school concentrated far too much on nursing theory and not enough on research and data interpretation skills. Based purely on anecdotal data collected during three night shifts, nurses who had another degree in the sciences were much more comfortable with gathering and interpreting data and understanding the biochemistry behind medications and disease processes. Sometimes I think that perhaps there should be a greater barrier to entry in the profession but I realize that the nursing shortage issue would be exacerbated. So nurses discuss – do you think that new grads are adequately prepared to face the job? What do you wish was taught more in school?

Old is Gold

I’ve noticed that my department’s staffing demographics are somewhat unusual because we have a lot of young staff. I’m defining ‘young’ as under 35 with 3-6 years of nursing experience. We also have a few ‘well preserved dinosaurs’ (their term, not mine) who work mostly part-time/casual hours. I have nothing but the best things to say about our dinosaurs because they took me under their considerable wings and set me on the right nursing path. However, when it comes to adopting new technology, some of them are downright useless! Every shift worked with them involves listening to how the order entry system is an abomination upon God’s Good Green Earth and could possibly be an additional horseman of the apocalypse that’s not mentioned in the Bible. Many of them are also viciously opposed to the new defib pads because they feel that the glue is inferior to the previously used brand.

So imagine my luck when I got partnered up with one of the dinosaurs in resus and we got a patient having a big ol’ stemi. We did the usual stuff to stabilize him for a transfer to the cath lab. On the way there the man went into v-fib. We tried to shock him but for some reason the shock wasn’t delivered. Absolutely panicking, I start throwing things out of the emergency transport bag looking for a new set of pads when my partner took the paddles attached to the defibrillator and used those to shock the patient. The baby docling accompanying us was speechless as was I because the monitor showed an organized rhythm and bought us just enough time to get the patient to the cath lab.

In summary – lesson learned. Dinosaurs may be old and roar a whole lot, but their bad-assery is NEVER to be underestimated. Ever.

Its been a long time - I shouldn't have left you...

I can't believe the last time I posted was in May! I've got so many half baked posts on the back burner but I haven't had any time to update. I started doing some agency work to kick start an aggressive project entitled, 'save a down payment or else work shifts with C. diff patients forever'. I was very close to landing a dream condo but got outbidded by a whole lot so it's back to trolling the real estate section of my local papers. In between psychotically obsessing over the real estate market, I've also been traveling which meant limited and/or prohibitively costly wifi access.

In any case, more posts are coming up - I'm here to stay blog world! I'll conclude this brief post by quoting a wise patient of mine who stated his reasons most eloquently for not taking his prescribed meds: 'I can't drink if I take those ma'am'

Let the good times roll!

Words of Wisdom

Yesterday I was taking care of an otherwise healthy 82 year old man with a nasty FOOSH injury when he said that I looked quite sad. I was actually quite happy except for the fact that I was starving and couldn't stop fantasizing about the ginger beef noodles in my lunch bag the entire time I was getting him prepped for the OR. I guess my hungry face is the same as my sad face which makes sense because when I'm hungry, I'm sad. Since this poor guy had been NPO longer than me, I decided it would be a wise idea to keep my yap shut. Before I had a chance to explain myself, he took my hand in his good hand, looked at me straight in the eye and said with the utmost sincerity, 'sweetheart, the world is large and you're insignificant so do whatever the hell ya want because no one will give two hootin' shits about it tomorrow!' Well said sir, well said!

Call me Nurse Muskels

In yet another night, my shoulders were aching from the crushing weight of self-loathing for having picked up an extra shift. I was assigned to the resus room but since my partner and I didn’t have any patients, we were helping out in the rest of the department. Just as I was frantically ripping off my sweat soaked gown from an isolation room, another patient looking worried told me that he saw the guy in the room next to him downing a large bottle of pills. “FML” I thought to myself as I walked away from the piping hot cup of green tea with just the right amount of honey in it and walked over to the room. Sure enough, the guy had downed at least three-quarters of a bottle of gravol. I asked him why he took all that gravol, he said that he was nauseated! “F F F FML” I thought once again as I called the doctor and charge nurse to have him moved into a monitored bed (ie: a resus bed because that’s all that was left). I had finished hooking him up to the cardiac monitor and was drawing up some valium for the seizures I knew he’d have (because such is my luck) when he got all twitchy and said that he had to pee. I gave him a urinal but he said that he also had to do a number 2 and climbed mighty fast out of the stretcher. I wasn’t about to fight with a 270 lb, 6”7’ man so I put on my sweetest voice and told him that me and another nurse would walk with him because his balance seemed to be getting worse. I could feel my heart sinking as I said that because I could feel that this wasn’t going to end well. And it didn’t. Just as he crossed the doorway from the resus room to the hall, he had a massive tonic-clonic seizure. I got to be the unlucky nurse close enough to catch him while avoiding being hit by his behemoth spastic arms. The doc came running and was all frantic when she asked me if he hit his head. I said no because I caught him just in time. “Are you kidding me? You CAUGHT him? He didn’t fall on you? Are you hurt?” Now I’m not exactly petit but I don’t look like I can catch a seizing man that size either. Patients came out of their rooms to see what the commotion was all about and my feat of superhuman strength was verified by them. Eventually six of us managed to lift him into a stretcher and start treating him for anticholinergic poisoning.

Moral of the story:
When nauseated, start by taking one PILL of gravol, not one BOTTLE.
Strength training has benefits beyond being a tool to be really really ridiculously good looking!

Really??

Dude gets dared by his friends to try ketamine for the first time and is brought by them sinking in the k-hole. I ask the friends what he took and they look at me most solemnly and seriously and tell me he must have had a bad cup of coffee several hours prior to his arrival. Really? F%$k you! At least save what little dignity you have and tell me the truth! I kicked them out after that because I was feeling annoyed and chocolate deprived.

Uptown Girl is Admitted to a Downtown World

There I was having just finished transferring some dude on some overdose to the ICU when the charge nurse tells me that she’s bringing in an exquisitely coiffed 71 year old lady with congestive heart failure. Soon enough I hear the crackles of wet lungs being wheeled towards me and I get ready to do my thang. The lady was quite pleasant, if not a bit snooty and started to change out of her very expensive street clothes into her own silk/cashmere robe by none other than Chanel (yes, I think I did quadruple takes at that). I did my assessment, got an ECG, established IV access, got the blood work done, put her on some oxygen, got a chest x-ray ordered for her and told the doc to come in and see her. The poor doc was getting into the stages of being heavily pregnant and was completely overwhelmed by an anxious family of a man with a shoulder dislocation. She gave me some orders to kick start my patient’s care and off I went to deliver some high quality nursing care. I told the patient that the doctor would be a little while but I got some advanced orders so she could be more comfortable. The lady thanked me as I pushed in some IV lasix. Sure enough she had to pee. I didn’t put in a catheter because she was completely ambulatory, the bathroom was beside her bed and she adamantly refused it. But she didn’t like the look of the newly cleaned bathroom so she asked for it to be cleaned again for her own reassurance while she insisted on staying in agony with a full bladder. I kept telling her that the bathroom has been thoroughly cleaned before she came in and if she has to pee that badly she should go for it! Watching her squirm made me want to pee even though I was thoroughly dehydrated. She kept refusing. Fine, whatevs. She kept squirming while the cleaner poured no name brand Lysol into the bucket. Then all of a sudden, she wailed. Then sobbed. Finally, she yelled at me to come to her bed. I dutifully unglued my tired arse from the comfy chair and went to answer her distressed cries which was when she took out $700 from her wallet and shoved it at me to go to her apartment, get her a new gown, underwear and toiletries!! A week later, I’m continuing to kick myself for not having ditched the smelly, snoring drunk in the room next door and grabbing a cab to get her stuff because I still need the money but don’t want to pick up another shift!