n00b

So you’re the newest person on the unit. You may not be new to nursing but you are new to this place. Don’t let that freak you out.

As the newbie I was always really quiet and reserved. What I didn’t realize was how off-putting that was to others. It never failed, once I got to know my coworkers they would all say the same thing “I thought you were so mean when I first met you!” For the longest time I didn’t understand why that seemed to be the case. You know me though, if I don’t know then I’m going to ask. That is when I found out that I sort of appeared unapproachable because of how I tended to distance myself from my new coworkers. I changed that once I started the new position I am currently in. This time I made a conscious effort to get to know my coworkers.

Here are a few steps to transition into your new work environment:

  • Introduce yourself to your new coworkers. If you know of a good ice breaker then use it (having the name Shaunelle but being called Fred is one hell of an ice breaker, everyone loves the story of how I got my nickname.)
  • If you are an experienced nurse understand this: your experience is much appreciated but you are the new nurse on the unit. Don’t walk around like you already know everything there is to know. You may know cardiac ICU but you don’t know how they run their cardiac ICU. Have a little humility (ran into this with a new coworker, she didn’t last long).
  • Don’t be afraid to ask questions. It is safer to ask than to assume you know what you are doing and then do it wrong. Your new coworkers will remember that screw up, trust me.
  • If you are a super proactive person, join one of the committees. You are bound to meet your coworkers that way.
  • Become familiar with your physicians and introduce yourself to them. Let them know you are new to the unit, I mean you will be working with them too.
  • Know that not everyone is going to warm up to you immediately and that’s okay. They may still be “feeling you out” so to speak. That is not your problem, that is theirs. They’ll either come around or they won’t. It’s not the end of your world. However, DO NOT allow bullying behavior towards you. You may be the newbie but you deserve respect and if they want it from you then they should earn it. Forget that “nurses eat their young crap”!

Those first few weeks, hell even first few months, are a weird time. You’re trying to adjust to a whole new setting. Things may feel off and that is normal. You may feel a little out of place at first, and that’s normal too. Give yourself time to get acclimated to your new surroundings, you are going to do great!

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ABG’s, what do they mean?

Arterial blood gases… Chances are if you work in a progressive care or intensive care unit you have seen ABG results or you will.

If you’re like me in the beginning, you have no idea how to interpret the results. For the longest time I had no idea what I was looking at. I knew the pH was indicative of acidosis or alkalosis, and that was the end of it. Once I started working in an ICU I wanted to really understand what the results meant. I made one of our respiratory therapist teach me how to understand the results (he was awesome and was happy to help). It turns out ABG results are not too terribly difficult to interpret. You are trying to obtain three key pieces of information:

  • Is the patient acidotic or alkalotic?
  • Is this a respiratory or a metabolic issue?
  • Is the body fully compensating, partially compensating?

While there is plenty of information on the ABG slip (or in the chart if your unit doesn’t have an ABG machine available) you can come up with the answer by looking at three key results: pH, paCO2, HCO3.

One of the ECCO learning modules I did had this handy little chart that made it easier to interpret the results. I thought I would share it with you all in case there is someone out there confused like I was, but may not have a quick resource available.

That’s it. This little handy chart has helped me a lot. It took what was, for me, a larger amount of overwhelming information and broke it down into something I could use. Here’s how to use it:

Look at the pH, is it <7.35 (you’re acidotic) or >7.45 (you’re alkalotic) or is it normal? Circle which side of the chart your value falls in. Then look at the PaCO2. We are looking at carbon dioxide in the blood here. Repeat the previous steps and circle where your value falls. Then look at your bicarb, HCO3. Circle where that value falls.

Remember pH tells you if they are acidotic or alkalotic. Now that you’ve figured that part out, it’s time to figure out if this is respiratory or metabolic. Look at your chart, is the CO2 circled on the same side as the pH? If yes, it’s respiratory. Is the bicarb circled on the same side as the pH? If yes, then it’s metabolic. Now, are we compensating? If you are partially compensating then you will have one value on the other side of the grid. If you are fully compensating then your pH will actually be normal.

I’m a person that needs to see something in action so let’s do a couple of examples:

Note let’s break out the chart:

pH is low so we know the patient is acidotic. The CO2 is on the same side as the pH. The bicarb is on the opposite side of the grid so the body is trying to compensate. We have respiratory acidosis, partially compensated.

Let’s do one more:

Bust out the handy dandy chart!

The pH is high so we know it’s alkalosis. The bicarb is on the same side of the chart as the pH but the CO2 is on the opposite side. Here we have metabolic alkalosis, the respiratory system is partially compensating, that’s why the CO2 is high.

I would like to mention one thing, if all your values are on the same side of the chart then it most likely means the one of the systems of the body aren’t compensating.

Hopefully this post is able to help someone out. If you have any other hints, tips, tricks let me know!

Holier than thou

Hello holier that thou nurse and/or doctor on med Twitter.

We are so glad you came to join us and tell us how wrong we are for sharing our experiences when they aren’t all “rainbow and unicorny”. Let me see if I can explain something to you:

Sometimes it can suck being a nurse. Sometimes it sucks being a doctor. Sometimes it sucks being a CNA. Sometimes, the medical field just sucks.

I know this is shocker for you since your days are only sunshine and blue skies. For the rest of us, however, we deal with patients every day. We see death, abuse, addiction, cancer, and disease progression on a daily basis. We see tears, we get hit, we get verbally abused, we witness (and then somehow get involved in) family drama, we get spit on, we get called racial slurs, we go THOUGH it. Sometimes, we take to “med Twitter” to vent to those that understand us. We don’t do this because we get a kick out of bashing patients. Majority of us in the medical field are in this field because it’s what we love and we couldn’t see ourselves doing anything else. We love what we do but sometimes it’s a bad day and we need to talk about it to other people that have been through what we are going through. We get encouragement. We get advice. We get a picture of a puppy to melt away the stress. It’s our own little online bar where we get to sit and talk to the bartender. We need an outlet.

What we don’t need is your pretend internet holiness and your pretentious “I’m more of a patient advocate than you are” attitude. We would never do or say anything to harm or patients. We are, contrary to your belief, compassionate and caring medical professionals. We use these outlets to keep from losing our minds. So how about you hop on down from atop that high horse, ok?

Vitamin C and sepsis

You may or may not have heard about some new studies coming out that show some positive results adding vitamin C to sepsis treatment.

If you haven’t heard anything about it, don’t worry, you will.

This is what really kind of started it all. It was a retrospective study, not one you could really take back to your ICU and make evidence based changes on, but it provides some interesting factors to think about. This study gives some information about some of the preliminary findings. So far, (cautiously) it looks positive.

However, don’t think doctors around the world are ready to jump on the vitamin C boat just yet. There hasn’t really been a what I would call a “large scale” scientifically sound study completed just yet. It’s safe to say the idea remains controversial. Here is a really good article addressing the controversy surrounding the treatment. I did notice one thing when I read this article: while doctors may not be ready to jump on board do to a lack of evidence, most of them really hope vitamin C treatment does turn out to be beneficial. The health care field as a whole really wants a better treatment for sepsis, especially since what we are doing now is only partially successful.

I am hoping someone decides to do a large scale study and really put vitamin C to the test. I would love to know if this could potentially be an adjunct sepsis treatment or if it is time for medicine to go back to the drawing board. Trying new things is what helped the medical field advance this far, let’s not stop now!

Motivated?

I’m strangely motivated to do a lot of nursing related things that I had no desire to do before. All of a sudden I want to go back to school to get my Master’s. I want to join our shared governance committee. I want to advance on the clinical ladder up to a Clin III. I want to cross train in other parts of our department.

What the hell is happening?

Where did I get all of this motivation from?!

Is… Is this what happens when you’re happy at your job?

I mean, honestly, these are all things I know I can do if I put forth the energy to do it. I’m still (relatively) young, unmarried, no children… I have the time so why not?

I need to sit down and prioritize all of these new goals. Time for me to become Super Nurse!

Wish me luck!

Constantly learning

A little while back, while I was still a STICU nurse, I decided to start a little notebook where I would right down new diseases/diagnoses/medications I came across during my shifts so I could look them up and learn about them. I was afraid when I transitioned into an imaging nurse I was not going to really be “learning” anything new. I’m just going to start IV’s and monitor for contrast reactions.

I was wrong.

People get MRI’s for all kinds of reasons. I have probably come across more diseases that I have never heard of in this position than I had the whole time I was in the ICU.

It’s been a constant learning experience. I start looking up the disease the patient is diagnosed with (which is the reason they are coming to MRI in the first place), and that leads me to another related disease, which leads to a new study, which leads to a med I have never heard of, and so on.

I’d never heard of MGUS, plastic bronchitis, or a syrinx. Came across all of those in MRI. I assumed that I need to be bedside to learn anything new in nursing. That’s not the case at all. As long as you are providing patient care you never really stop learning…

Real nurse?

In a conversation I had someone ask me if I was a “real nurse”.

Yeah, let that sink in for a moment.

Here’s what happened:

I was having a conversation with an individual and they asked me what I do, I told them I’m a nurse. Their response: “so are you a real nurse?”

This was my exact face:

I had to ask what they meant by “real nurse”. Their answer? “You know, a real nurse like ones that work in a hospital and not in a nursing home or doc in the box.”

Of course you know this means war…

I ask why those nurses aren’t real nurses. Apparently (according to this person) those nurses don’t really do anything but take vitals and give meds.

Oh really?

OH REALLY?

To people who think like this I have a question, CAN YOU DO IT? Can you be responsible for the safety and welfare of multiple patients, often at the same damn time? It was a real nurse that took care of you at Patient First when you caught the flu. It was a real nurse that got punched in the face by your demented Nana. It was a real nurse that handled your kid’s GI bug that you brought him to the doc in the box for. It was a real nurse that has been the only person some of these elderly assisted living patients get to talk to since you haven’t visited Grandpa in 3 years.

WE ARE ALL REAL NURSES.

Needless to say, I am an advocate for my nurses.

On my own

This was my last week of orientation in MRI nursing. Starting Monday I’ll be on my own.

I’m nervous.

It’s not that I don’t think I can do the job. Compared to getting my ass handed to me in the STICU, this is going to be somewhat less stressful. It’s the fact that procedural nursing is new for me. I’ve been bedside for 8 years now. I’ve always been in charge of the patient because they were “mine”. Now I’m dealing mostly with outpatients. I also deal with kids. As you all know, I don’t do kids, they make me uncomfortable. I will still have inpatient contact but while I am responsible for their safety while in MRI, they aren’t mine. I have to remember that my contact with them is as a MRI nurse and not as their primary nurse.

That’s a little weird for me.

It’s also kind of nice. Patient being a douche? I can send them on their way. Patient too confused to hold still for the MRI? Back to the unit for you buddy.

Not going to lie, it’s fabulous not going home with back pain everyday.

I think I’m going to like finally being on my own, you know, once I get over the initial shock of it.

“It’s ok, we’ve got it”

I don’t trust this phrase whenever it comes to my patient any other medical professional or anyone for that matter.

Why?

Because I’ve seen it come back to bite people.

The patient needs to go to the bathroom, you go in to help. The family says “it’s ok, we’ve got it”… Annnnnnnnd your patient is on the floor.

They want to place a central line at the bedside so you go in to assist. The fellow tells you “I’ve got my med students so it’s ok we’ve got it” annnnnnnnd then they proceed to place a femoral central line in the right subclavian because the student didn’t know the difference between the kits (this is a true story).

X-ray comes in for the morning film and needs to reposition the patient, you offer to help. They tell you “it’s ok I’ve got it” annnnnnnnd now your IV is ripped out and on the floor.

As far as I’m concerned, you don’t “got it”. Don’t you touch my patient without me being there. I’m going to help whether you like it or not. I do NOT have time to fill out safety events. I’m probably not even done with my regular charting.

It’s ok, I’ve got it.

Log off

Log off of your computer, nurse!

I know you’re just going to go into the room of your patient for a few minutes. I understand that you just need to go to the pyxis and grab one more med. Log off.

You have very personal information about your patient visible for anyone to see. EVS, the random med student, the family member/friend in the room (for those of you with bedside computers), they can all see this very personal information.

How would you feel if one of your friends found out that you tested positive for opioids on admission because your nurse left your labs open on the computer in your room? You’re sedated and intubated so you can’t remind the nurse to protect your personal information.

Doesn’t sound fun does it?

Your patient and their information deserve that same respect.

Even more importantly, it’s law. You have been given the responsibility to maintain patient privacy and you should take it very seriously. You’ve heard of HIPAA. You know just how important it is. Understand just how serious it is to your medical facility. Nurses have been written up, suspended, even fired over HIPAA violations.

Don’t be that nurse.

Get into the habit of logging of when you walk away from your workstation. It may seem tedious but it is your duty to protect that information.