Resident-splaining

One thing that absolutely drives me nuts is having a new resident come to the trauma unit, that I have worked on for almost three years, and “resident-splain” something obvious to me!

What is resident-splaining? It’s when a resident condescendingly “explains” something to you that they assume you know nothing about because you’re just a nurse…

I’ve had a resident (not a very good one at that) start to “explain” calcium in the blood to me. Why? Well, we had given quite a lot of blood products and I asked about giving some calcium as the ABG showed the ionized calcium was low. This is common. Massive infusions almost always drop the serum calcium due to the citrate used in the unit of blood (if this is new to you, here is an article that explains it rather well). Like I said, I know this. Trauma nurses are typically very aware of this because, you know, we give a lot of blood. Trauma… Bleeding… But hey, I’m just a nurse.

Now, she’s not giving me the calcium I need. She starts explaining calcium in the blood and why I should go by the ionized calcium instead of the calcium level on his BMP. Remember, I told her the ionized calcium on the ABG was low… Ionized. Calcium. The level she is currently explaining to me. That level. That’s not enough, she’s not even looking at me while she is talking and it’s in a very condescending tone.

Bruh.

I finally stop her with this statement: “I’m well aware of the purpose of an ionized calcium which is why I told you what it was on the ABG that I just ran (can you hear the attitude in my voice?). I don’t need an explanation, I need calcium. Can you order that or did you need me to throw that order in real quick?” Her:

*blank stare* “Oh, yeah I can put that in for you…” *quickly and quietly begins ordering what I need*

I had no more issues with her for the duration of her rotation on our unit.

It’s irritating. So so irritating. I’m far too outspoken to have someone resident-splain things to me. Don’t try me buddy…

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Know your meds

Nursing school will lead you to believe you need to know every medication, ever. You should have your pharmacology book memorized.

That’s a damn lie.

There are new medications being advertised every month. There’s no way you can possibly keep up. There absolutely nothing wrong with that. However, know the medications you are giving to your patient!

Before passing meds take a moment to look and see if you know what medication you are giving and why. If you don’t know a med, look it up. Medscape, Epocrates , even Google are only a few clicks away. Your pharmacy is only a phone call away.

Let’s say you notice that your patient is on midodrine and propranolol. You know the midodrine is to help your patient maintain their blood pressure since they tend to run lower. You’re not familiar with propranolol but you know that suffix. You remember that “olol” was rammed into your head as a beta blocker for hypertension. Wait, what? Why is your patient on meds to raise and lower their blood pressure?! Better hold that propanolol right? This is the perfect moment to stop and look up your meds. A few minutes of research and you learn that propanolol is also used for tremors. Nevermind, guess that med might need to be given.

This is why I keep Medscape on my phone. I take a few moments and look up a med I don’t know just to make sure I know what and why I’m giving something. It doesn’t take much time at all and I feel safer giving my meds. Also, if you have that family member in the room that questions everything, you look like a genius when you can answer each question they throw at you about what you’re giving. They don’t need to know that you just looked all of this up before walking into the room! A few moments of pause can make you much safer.

Helpful hint

So you’ve put in an naso/oro- gastric tube. Great! Did you verify placement? If so, how? Did you immediately get gastric contents back when you aspirated? Did you listen and confirm placement in the stomach? Did you use the CO2 detector that some institutions have?

I ask because I ran into a situation in which an OG tube was placed in the ER before my patient was sent to me. Helpful. Thanks. Except it wasn’t helpful at all. My new admission’s abdomen was quite distended despite the OG tube. I connected the tube to wall suction and got nothing out. I changed the canister and tubing just to make sure it wasn’t something wrong on that end. Nothing. I listened and couldn’t quite say with 100% certainty that I heard it in the stomach. Hmm… Not sure I want to use this…

And then he vomited. A lot. And kept vomiting while I held the yankauer in his mouth to keep him from aspirating.

Nope, that OG wasn’t in.

So, I took it out and decided to try my luck at placing an NG instead of an OG. As soon as the tube hit 60 cm in depth contents start pouring out. No need to auscultate that! Hooked it to suction and in about five minutes I got a full liter of contents out of him. Oh look, his abdomen isn’t as distended now…

I say all of that to say this: verify placement! However you choose to do so, make sure you KNOW that the NG or OG is in the stomach and not curled up in the back of the throat. Have someone verify it behind you if you aren’t sure. If all else fails, take it out. I would rather you send me a patient without a tube than send me a patient with a misplaced tube.

Go pee!

Hey… Hey you, busy nurse, go pee!

I know you have a blood sugar to grab. I know your other patient wants his 250th cup of ice. Yes, someone has labs due as well. Go pee. Seriously. It’s OK. All those things that you need to do will be there when to get back. I’m sure there is someone you can delegate some of your tasks to. You have to take a moment for yourself.

Go pee. Your bladder will thank you.