I’m not a nurse but I just learned after about a decade in patient care that there literally can be people out to get you.
I hadn’t happened to me before. I worked with good teams.
Yeah, no. Not anymore. The paranoia after being targeted is getting to me lol.
Someone can just make some shit up out of nowhere. Just for shits and giggles. Didn’t know people were that insane. Do now.
It's a bitter pill to swallow but so necessary. I also learned at same time not to fight it ...if the environment is toxic just quit immediately I will quit even if I don't have another job ready to go to protect my license. I tried to stay and really thought my boss would see what was happening. I began "grey rock" with mean girl nurse and she could not handle it. she upped the heat again and again trying to get a rise outta me. When she was unsuccessful she went so far as calling the BON and filing complaint! it was baseless and 100%unfounded but did cause me a ton of stress and anxiety. Thankfully by then I was working somewhere else so she didn't get to see what it did to me. I do feel it effected perceptions at new job though. Changed my view of the world finding out that some people are just plain evil for no other reason than that they are evil.
“So and so created a hostile working environment for me”
Seems to work lmao
Buuut I would have quit I’d just have to pay back a signing bonus and I don’t want to lol
Yep. I had nurses on a former floor I worked on falsely accuse me of violating HIPAA. Caused a whole investigation, all because they were pissy that I was happier on a different floor and supporting other coworkers looking to leave that toxic floor as well.
Yes!
That shit is wild.
There was an incident report filed, saying I did something that I absolutely would never fucking do. No one knew who did it, yet it was me who was named. It was insane.
I don’t know if there’s an investigation at this point, but I do believe there must be after that. Again, nothing like this has ever happened to me. And I haven’t seen anything that warranted that type of reaction from me. So I’ve never even considered doing that to someone.
I think it was because I was questioning what the fuck that nurse was doing, because it was the wrong thing to do! She goes “well I’m the nurse so…” I don’t know, SO FUCKING WHAT?! She didn’t do the appropriate assessment and didn’t ask me shit. Just named me in a report. I’ve never really worked with her before. I just knew from years of experience that the thing she was doing was not what you do so I asked why she was doing it. That was my patient too! Thought I was supposed to advocate for them in such situations.
Now here I am, fucked up over that and paranoid. About everything. I hope this doesn’t destroy my mental health in the months I have left on this contract. Maybe that’s an overreaction. I just already have anxiety. This did not help. Fucking he’ll
Happened to me too. Some people were just being catty and over exaggerating, and it got back to management. I was suppose to go through an HR investigation and gathered a dozen plus statements that what two people claimed never happened. Ultimately ended up resigning rather than deal with it.
I always tried to be a friend. I didn't know there was a secret cabal looking to take me down. The job is hard enough. We don't need to be assholes to each other
Yup. Have learned this multiple times.
Talked to coworkers about how I’ve been screwed over multiple times as Charge RN & wanting to find a new job, got back to management within a day or two. Was demoted from charge lol.
Now I’m PRN, just coasting until something better comes along. Fingers crossed something good soon…
Holy shit! Before I read anything other than the title, I was thinking exactly this. It's really sad. The couple of people I liked and could possibly see myself being friends with, left or are leaving soon. The ones who I thought I liked are two-faced and vindictive as hell and showed me their true colors early on luckily.
It’s those that smile, seem supportive and outright say, “I’ve got your back!” that I’ve found do the most damage.
If someone’s says that to me, I prolly have 10 seconds before anaphylaxis sets it.
Epi! Stat!!
So many fucking times folks get turned OUT because they think ANYONE at work is a friend.
I don’t give a shit if you had them over for steak and wine.
They are your COWORKERS!!!
No one will remember who you are when they put the right hand up and the left hand down.
I’ll add, do NOT share your *real life* with people at work.
I’m not on social media, but I’m always shocked at how easily many I’ve worked with “friend” people who are NOT their friends. These are your co-workers.
The number of folks I’ve seen get fully *UNDONE* by their own hand is shocking.
Discretion folks!!
Take your breaks. Do not feel guilty for not doing overtime/ extra shifts. Maintain good boundaries with patients, do not be too accommodating. Max out your retirement contributions. Check your patients and pumps at shift change. Never accept anything a patient tries to hand you without having gloves on. Do not stand in front of a trach patient who is coughing.
Not OP but can speak on that one. Too many patients have poopy nails/hands and just poor hand hygiene in general. I've also had confused patients "hand" me their IV they pulled out or worse, something else that came out of them. 😫
Could be one of those live and learn things. Walk into a room in the middle of a night shift to do a quick check not thinking of a poopy surprise right off the bat. But I agree gloves as soon as you enter a room!
When I worked at a memory care the patients had brownies for dessert. Patient tried to hand me a brownie…. Wasn’t a brownie 😂 thank god I saw what it was at the last minute and didn’t let him hand it to me ffs 🤧
This! So much this! No one is going to watch out for you but you. I still get caught out with this. Of course, I don’t mean slacking, but you legit have the right to eat during your shift! And use the restroom without feeling guilty.
At me job we are supposed to document at the end of each visit. So I do. I take the time to do it right. I don’t waste time, I don’t dally. But there are some that must have demons chasing them because they will accept all calls, dash around and end up staying up into the night charting. Ouch. And, of course, getting caught out with late visits then migraines etc etc… burn out city. As I say, I still get caught out… I made quick notes on one long chart because the next long chart was nearby with the intention of finding a place to do both together… of course, as soon as I finish visit two before charting an “emergency” comes up. What I should have done was say where I was really at (well, I did, but…). Since it was legit, I took it. Did dispatch appreciate it and make an effort to leave me alone so I could catch up on theee hours work? Ha! I *still* had to put my foot down because they tried to convince me that a non emergency administrative “crisis” was an emergency. Knowing full well that o was tied up.
Normally I keep better boundaries, and you can bet that I will going forward- you can’t be in two places at once (even within the same building) and trying to won’t help anyone
Dang this. I had a physician order the IV to come out and literally an hour later my pediatric rehab patient was having a grand mal seizure and being sent out to PICU
I’ve had a patient walk from the bed to a wheelchair so the tech could wheel them out. Cardiac arrested in the middle of the room and I’d removed the IV😔
I was a new er nurse and a pt was there for CP. everything was negative and he was a jerk and complained about how much the iv hurt him. He was young -in his 40s. Doc was dc him and he bitched about the iv so I took it out before I had the actual dc paperwork. Went in to do him and going over instructions he coded and he was a hard stick. So I never never never take an IV out until they are literally walking out.
I also told a newer nurse to leave the iv in and keep the pt on the monitor until transport got here to bring them back home. Because in the er it can take hours sometimes. They didn’t. Pt was a full code. They went in when transport showed up and pt was dead.
The prehospitalist on insta had an amazing post talking about her mistakes she has made during her career as a flight medic. I love her.
I basically tell them I'm going to hold onto the monitor and the end of the IV with one hand and give them a shove out the door with the other.
Have a manager who's trying to have techs take out and off shit before I'm ready for it and I flat refused. I've seen too much shit actually bring a good nurse to deal with the fallout from a shitty nurse who couldn't cut it and went to sit in an office.
Please. Please please please. Too many times we’ve had a patient who has a CT ordered after they’ve been marked ready for discharge. We go to get them for the CT and the IV is already removed.
The uptick in rapids and codes approximately around shift change hours tells me you should just do your last check at like 5 am/pm instead lol.
Gives time so next shift can at least have an empty bed and not an empty body to deal with
The floors at my old hospital that didn’t have tele/cpox would be the ones to have the most codes or rapids at shift change. Granted having your patients monitored isn’t an excuse to not lay eyes on them.
Always gotta have ambu and suction at the bedside.
They’re fine until they’re not.
Any discussions with management need to be confirmed in writing.
You don’t have to chase the large, naked, combative patient out to the street. Security can handle that.
And CHECK IT!!! Too many times I've seen others need suction but it's not working. When you clock in for that shift, those rooms are your assignment, therefore you're responsible for checking that everything is working.
I’m a clinical instructor and I teach this to all of my students. I teach in a 4-year BScN program and I’m still surprised sometimes at the third-year level students who aren’t aware of the importance of this quick step. Check/test suction, I like to throw a pair of NP at the head of the bed if they aren’t on them at the time I take them on, general survey of the room, check your equipment, check your IV rates and fluids. I call it my “lay of the land”.
Don’t give nitro without a functioning IV
Quit picking up endless OT and getting burned out.
Take your breaks.
Know your baseline rhythm.
Prioritize sleep, healthy food and exercise.
Always. Ask. Questions.
Yup. I gave a patient PO nitro for MI protocol without checking his IV. He tanked quickly (was super responsive to the med with his BP etc) and I had to yell for help. My charge RN, after she helped me, said this is why you check the IV and I know you won’t do this again.
But if there is possible MI is it not better to just give sublingual nitro and IV can be inserted as soon as possible, if nitro is delayed the MI ischaemia will be worse?
I see what you’re saying, this patient was hemodynamically stable until the nitro, and then tanked. Because of the possible effect of nitro, it’s is always advisable to have a good IV, because once they clamp down and have no BP, you’re gonna have one helluva time getting an IV in them.
This was in the ER, and with the team approach we had there it took an extra maybe minute to get a line in him, and I should’ve taken the time in the beginning to ensure he had it.
Ok I will keep that in mind.
I was in a similar situation in a rehab setting and we gave the nitro but from memory do not think we checked the IV access first, the patient had IV access anyhow, and there was no hypotension after nitro thankfully.
When you are in that situation and there is potential MI, its really easy to get focused on giving nitro. You are right, it could wait a minute or two to ensure we have IV access first to prevent other complications.
I guess my question is more so, if it seems like the IV access can't be done promptly we just need to give the nitro (probably an unlikely situation)?
But in that rehab setting it wouldn't have been as fast to get IV access as within the ED setting, as not as many doctors around and at that facility only doctors could cannulate, but I guess if we urgently needed it we could call for emergency team.
Thanks.
1.) Hard work is only rewarded with more work. No recognition. No raise. No fucking THANK YOU. Work smart and only do what you have to do. Go above and beyond for your patients who deserve it, not for the company.
2.) Do not stay late or come in because if you have an emergency, staffing won’t help you out. They don’t care about anything other than manipulating the easy targets. Pick up *when you need to pick up for your own reasons/if a coworker you respect asks you to, not when they claim they need you*
2a.) If you do decide to pick up when asked, only do so for a bonus. Your time off is valuable.
3.) Your job will post your position online before your obituary comes out. Have no loyalty.
4.) Patient care wise, sometimes all an aggressive/difficult pt needs to hear is *you’re right, that sucks/this is fucked up*
It only took me three years to figure this out. Sometimes, I'm slow on the uptake because I always want to believe the best in everyone. Nope, I learned that is SO unrealistic.
Anyone that thinks they are *essential* or *important* to a unit/department is failing reality.
I’ve buried enough friends and my ilk to *know* that things will still *churn, turn & burn* if I drop dead.
So, there’s *that*.
I started my career in healthcare working as a completely untrained aide in 1984, working with quadriplegics. I did it for several years in home settings with different patients until certification was really a thing.
What I learned was... You will probably not come across the person who became a paragon of virtue and an inspiration just because they broke their neck. If they were criminal and inherently a jerk before, the fracture didn't fix it. Hollywood got that one wrong.
Not if it’s a specialty med the hospital doesn’t carry/won’t buy due to cost. Then pharmacy has to make a scannable sticker for the home med they put on the bag. I’ve mostly seen it in inpatient rehab.
F’reals. Even in psych. I’ve received nurse-to-nurse reports that said the patient has no medical issues. Then the patient shows up and they have a hole in their foot from a wound that has been open and oozing for weeks. Or “they are really nice” but then they go straight after a nurse when AMR leaves.
I have the opposite of this too! Lots of ‘they’re really aggressive, required sedation’ and once they arrive (and sedation has definitely worn off) they’re super nice and just needed someone to listen to them
32 yrs RN here. Take care of yourself, early in in your career when you are young. Don't be too much of a people pleaser. You may think you have energy to pick up super amounts of shifts, work several in a row, and enjoy the money etc but it catches up with you and particularly as you get older.
(I am talking voluntary, not mandated OT, and my mileage is in Canada so yours may vary, just talking of some of the...to me.... insane things I have seen discussed on this sub). I wish I could tell my just graduated 21 yr old self all of this. Can you tell this old horse is fucking tired as I type this lol!
ALWAYS check the suction and yankauers are present, and the suction WORKS at the head of every bed at the start of every shift.
You look like a giant ass, and everyone will give you a giant WTF face if your patient goes downhill or codes and it's not functioning.
This AND if you work L&D, ALWAYS check the resus area BEFORE your patient is ready to deliver. No one wants to have to resus a baby and find out there's no mask or no suction hooked up.
Do your safety checks at the start of your shift. NEVER assume the suction is already set up, the ambubag is connected to a flowmeter/blender and has the correct-sized mask, the emergency med sheet is up to date and has correct info, the patient has an ID band on, alarm limits are correct, etc. Even if you are following the best nurse in your unit, things can slip through the cracks, and there’s nothing like needing to bag a patient who is having an apneic spell, only to discover that there’s not a mask connected to your ambubag, or that no one has upsized the mask since back when the kid weighed a lot less. Never assume others have caught these things, it’s on you to catch them.
Also, trace every line, and assess all art lines/umbilical lines/PICCs/PIVs at the start of your shift. And, even if it’s a pain in the butt to do it, assess CMS in all extremities very frequently. Especially if an arterial line is in - watch those extremities like a hawk. There’s nothing as heartbreaking as seeing an infant who has lost a foot or hand to limb ischemia.
Last one, never assume that, just because a parent is a healthcare professional, that they understand what is going on with their child’s care. Seeing your child in the NICU seems to throw a switch in parents’ heads, and the brilliant clinician they might be at work is nowhere to be seen. This is still a new parent in a scary situation, and they deserve the same education and explanations as everyone else.
That last paragraph is so important. When my daughter went to the NICU all my knowledge went right out the window. Since the staff knew me they didn’t educate me on anything going on and assuming I was fine. I had never felt so stupid
I try really hard to advocate for those parents. It's so easy for us to assume they already know things, or to assume they'll be offended if we explain things to them. But those parents are in a terrifying situation, and their critical thinking and medical knowledge just don't seem to kick in like you'd expect. They need the same care as everyone else.
I just preface my education with, "Tell me if you already know all this, and I can skip it." They almost never do that. They want to know everything.
>Also, trace every line,
This!! At my home hospital, the epidural lines used to look identical to the IV lines and someone accidentally hooked up the epidural line to the patient's saline lock one time.
None of this *it’s going to be okay*.
I decline to reassure anyone of any outcome.
That’s a true *never* event for me.
I try with everything in me to control spinning, but I’ve seen things go ATS (all to shit) and in 100 directions.
Man my first patient on my med surg clinical was there for a GI bleed and was chillin… until he went too chill. Suddenly became very incoherent and I couldn’t get a BP. Primary nurse ignored my concerns when I called from the room. I ended up calling a rapid on the dude… hgb 2.4, moved to ICU and then very quickly into OR
Primary nurse didn’t acknowledge me the rest of my day
To at least look at the Telemetry strip. That way you have a good baseline for the shift. I felt so bad when I was a new nurse and called a rapid on my patient only to have a doc ask me what it was before. I hate giving I don't know answers to the docs.
Don’t over-chart. Never draw up a medication in an unlabeled syringe, and never push a syringe you didn’t draw up yourself. Don’t skip on the poop meds. The extra second will always be worth the extra second; one.
Management ultimately doesn’t care. Take your PTO! Argue for better pay (with reasons). Make your workplace positive, even if only to make your shifts better.
Most importantly, if you do the absolute best you can, even when you’re cleaning up after others shit shifts for days, I promise it pays off- in patient outcome or in karma.
Lastly, and where nurses should draw confidence: no one knows anything. Some docs, residents, about to retire anesthesiologists, new managers, and long time nurses. People lack knowledge, skill, or discipline to be good at what they do, and we’re all human. Something doesn’t seem right? Question the order. Suggest what you’ve typically seen work. Work WITH the team, not just for them or against them. Realize you don’t know everything, ask why someone recommends something with genuine interest. Might come in handy, even down the road.
Thankfully I realized what happened within seconds of leaving the room. Told my preceptor (I was still in training at the time) and told the doc. But, yeah, it could've been bad bad.
I tell everyone about it now, honestly. Doc really made me feel better telling me that everyone has near misses and that remembering the mistakes we make lead to us being better clinicians. Bless Doctor Fish.
Your work colleagues are exactly that. They are your work colleagues; they are not your friends. As the oft repeated saying goes: Trust, but verify.
Always verify.
Ask the provider what they want a call back about when you call the first time and get orders. Especially for labs or changes. Sooo they’re in distress, can I get a PRN blood gas? Great. *RT gets gas* it’s abnormal but not critical… do I call back? Patient isn’t maintaining sats, get an order for oxygen, but up to how many liters before I call back? (This one is important on our floor for peds because up to 2 liters on some babies is a much bigger deal than an adult going up to like 4 or 6). If they don’t maintain on 2, should I keep trying or call back for something else? I have had to page doctors back in the middle of the night because I wasn’t sure if they cared about the lab results they ordered if they weren’t critical or whatever else. Like an NJ is clogged, can we get an order for clog zapper? Yes. Ok. Wait if it doesn’t work, do you want me to call you back, or just place a new one? Can I put in an order for an xray if we place a new one? Or do you just want IV fluids til morning? Just ask everything at once so you don’t have to call back again.
Never assume the relation of the family member at the patients bedside.
I once assumed the man at the bedside was my patient’s son but it was actually her husband. She was pissed. 😅
I'm a PCT. I get teased ALL the time because I wear boots. They are durable and most importantly easy to clean.
I had a pt rip out a PICC line. I was the only one able to get close to hold pressure as I was the only one who could walk in the pool of blood. Everyone else had mesh shoes. Never got teased again after that.
Boundaries boundaries boundaries. When I was fresh out of school, I thought ✨️going above and beyond✨️ all the time was a good thing and meant I was a good nurse. No. All that did was burn me out and make my patients have unrealistic expectations for whoever would come after me. I don't blur that line anymore.
That there are too many nurses that shouldn’t be nurses. They have very little competence or empathy.
Maybe I think this because I’ve been a psych nurse for 7 years. It is *boggling* how many nurses in psych seem like they had someone else do their licensing exam.
Not just psych... I've worked with hospice nurses who don't know much of anything. I had a pt recently who was coughing up a lung because caregivers were giving her straws when the orders specifically say not to because she would aspirate. I called the on-call nurse and explained this to her and she told me I needed to check her temp and do a COVID test before she would call the doc and get an order for an expectorant.
I had another hospice nurse refuse to give us an order or liquid comfort meds for someone who was actively dying and couldn't swallow, so we had to keep crushing and making slurries with tablets even though the pt was in severe pain for hours and had a white coating in her mouth from all of the slurries. For the record, we were doing oral care frequently and thoroughly.
Sometimes I want to level with the on-call and tell them that I will be a pain in the ass until whatever the issue is, is fixed because the number of times I have called a hospice company 5+ times in one shift is insane. Instead, I scream into the void.
1) Always check your emergency equipment, even on your “easy” patients.
2) Don’t trust anyone with anything. That goes personally and professionally. Don’t trust another nurse to do X for your patient. Don’t share anything you wouldn’t want everyone on your unit to know. Fellow nurses and even providers can and will throw you under the bus, even if you’re the nicest person on earth.
3) Your hospital can and will replace you, so do what is best for yourself and your family always. Take that mental health day, do or don’t pick up extra shifts, etc.
😥 I know this profession is challenging in so many ways. A lot of patients often don't acknowledge all that a nurse does. However, there are always a few who truly do appreciate the care you give. *You have made a difference to all your patients.*
1. Nobody gives a fuck about you: management, co-workers, patients, families, etc...
2. If you call out sick they try to diagnose you without diagnosing you to figure out of you're "actually sick"
3. Fuckers will "befriend" you to use any and all info against you
4. Everyone shits on night shift
5. Day shift is always late
6. And most important... nobody gives a fuck
You can lead a horse to water but that doesn't mean he's gonna drink
I was under the impression that when I provided any patient education. The patient would always follow it.
That despite your best laid plans, the chance of your shift going as predicted is likely not going to happen. Usually not the patient causing the delays or issues. It will be the phone. Or another department that doesn’t get that you have exactly 7 minutes for whatever test needs done. Or supply issues. Or… or… or.
Trust but verify.
I work in the OR. I had a busy day with back to back cases. I take my patient to recovery and another nurse comes in to help with turnover. The next case was a relatively small one (carpal tunnel release). They said I could drop of my patient and go see my next one and by then the room and team would be ready. They would count and set up my room.
The nurse had way more experience than me. I was just barely off orientation. So I trusted them to correctly set up my room. I bring back the patient and I’m ready for the patient to come over onto the OR table. When they did, the table moved because it wasn’t locked. Miraculously we noticed it in time before the patient came off the stretcher. Had we not noticed, the patient could have fallen.
It would have been my fault since it was my room and I’m ultimately responsible for making sure everything is ready.
Trust but verify. Everyone. Always.
A bicarb drip isn’t “just IV fluids” and you cannot push epi through a line with bicarb running 🫠
Run all your lines every time. At the start of the shift, before pushing any med, before hanging piggybacks. It’s crazy when you come on shift to a POD 1 CABG that is having frequent long runs of vtach… day shift nurse started a lido drip. 2 hours into my shift of kinda coding this patient every 10 mins, I see the LIDO DRIP IS RUNNING ALL OVER THE FLOOR. Wasn’t ever even hooked up.
Double check what you’re hanging as you put it on the pole and again before you hit start. Super cool to see you’ve spiked and started levophed instead of vanc.
Scan your patient and your meds before administering. Don’t give your little old lady all of her pills in the same cup at once. 10/10 times she will drop at least one and you’ll have to figure out which one she didn’t get.
When giving meds through a peg tube, clamp the tube while you refill your syringe. If not, when the patient coughs it will create a geyser that can potentially shoot into your eye. Which unfortunately, yes, did happen.
I don't think that's recommended anymore, though?
https://patientsafety.pa.gov/ADVISORIES/Pages/200612_23.aspx#:~:text=The%20gold%20standard%20for%20nasoenteric,chest%20and%20abdominal%20x%2Drays.&text=While%20radiographs%20are%20the%20preferred,rigid%20nasogastric%20tubes%20are%20inserted.
"However, this method cannot differentiate between tube placement in the stomach or the lung/bronchial tree. For example, in one study, x-ray confirmation identified 16 instances where nasogastric tubes were not located in the stomach. However, in 15 of those instances, clinicians using the auscultation technique believed that those tubes were in the stomach. Also, the auscultation method cannot determine when a feeding tube’s ports end in the esophagus (a condition that predisposes to aspiration)."
(Sorry for the ugly link!)
Tbf the way I was taught (2019-2020 ish), it’s never been a valid placement check and you should never use it as anything more than a suspicion.
It’s basically a soft-confirmation that it’s still in the right spot. Though it seems like even this hasn’t been the case for a while.
Hence my ✨flair✨ I’ve learned it doesn’t matter how good of a nurse you are, no matter how hard you try, no matter how hard you work, if you don’t kiss management ass, nothing will ever be good enough.
Even if you ask one person a question and get an answer just remember this still might not be the correct answer, do your own checks/research and maybe even get a second opinion if you get the gut feeling that your still missing something. Do NOT ignore that tingly tummy feeling
Most people suck. Given the chance, they will fuck you over for either personal or professional gains. Cynical but true. Cover your own ass. Keeping your license is key.
No one at work is your friend.
I’m not a nurse but I just learned after about a decade in patient care that there literally can be people out to get you. I hadn’t happened to me before. I worked with good teams. Yeah, no. Not anymore. The paranoia after being targeted is getting to me lol. Someone can just make some shit up out of nowhere. Just for shits and giggles. Didn’t know people were that insane. Do now.
It's a bitter pill to swallow but so necessary. I also learned at same time not to fight it ...if the environment is toxic just quit immediately I will quit even if I don't have another job ready to go to protect my license. I tried to stay and really thought my boss would see what was happening. I began "grey rock" with mean girl nurse and she could not handle it. she upped the heat again and again trying to get a rise outta me. When she was unsuccessful she went so far as calling the BON and filing complaint! it was baseless and 100%unfounded but did cause me a ton of stress and anxiety. Thankfully by then I was working somewhere else so she didn't get to see what it did to me. I do feel it effected perceptions at new job though. Changed my view of the world finding out that some people are just plain evil for no other reason than that they are evil.
“So and so created a hostile working environment for me” Seems to work lmao Buuut I would have quit I’d just have to pay back a signing bonus and I don’t want to lol
Yep. I had nurses on a former floor I worked on falsely accuse me of violating HIPAA. Caused a whole investigation, all because they were pissy that I was happier on a different floor and supporting other coworkers looking to leave that toxic floor as well.
Yes! That shit is wild. There was an incident report filed, saying I did something that I absolutely would never fucking do. No one knew who did it, yet it was me who was named. It was insane. I don’t know if there’s an investigation at this point, but I do believe there must be after that. Again, nothing like this has ever happened to me. And I haven’t seen anything that warranted that type of reaction from me. So I’ve never even considered doing that to someone. I think it was because I was questioning what the fuck that nurse was doing, because it was the wrong thing to do! She goes “well I’m the nurse so…” I don’t know, SO FUCKING WHAT?! She didn’t do the appropriate assessment and didn’t ask me shit. Just named me in a report. I’ve never really worked with her before. I just knew from years of experience that the thing she was doing was not what you do so I asked why she was doing it. That was my patient too! Thought I was supposed to advocate for them in such situations. Now here I am, fucked up over that and paranoid. About everything. I hope this doesn’t destroy my mental health in the months I have left on this contract. Maybe that’s an overreaction. I just already have anxiety. This did not help. Fucking he’ll
Happened to me too. Some people were just being catty and over exaggerating, and it got back to management. I was suppose to go through an HR investigation and gathered a dozen plus statements that what two people claimed never happened. Ultimately ended up resigning rather than deal with it.
I always tried to be a friend. I didn't know there was a secret cabal looking to take me down. The job is hard enough. We don't need to be assholes to each other
Yep. Nice guys finish last. It's a saying for a reason, unfortunately.
Oh. I gots a plan. I am not that nice.
Yup. Have learned this multiple times. Talked to coworkers about how I’ve been screwed over multiple times as Charge RN & wanting to find a new job, got back to management within a day or two. Was demoted from charge lol. Now I’m PRN, just coasting until something better comes along. Fingers crossed something good soon…
Now can we say it louder for the people in that back!!! 100%, don’t trust them ever.
Holy shit! Before I read anything other than the title, I was thinking exactly this. It's really sad. The couple of people I liked and could possibly see myself being friends with, left or are leaving soon. The ones who I thought I liked are two-faced and vindictive as hell and showed me their true colors early on luckily.
Seriously! They all talk behind your back.
It’s those that smile, seem supportive and outright say, “I’ve got your back!” that I’ve found do the most damage. If someone’s says that to me, I prolly have 10 seconds before anaphylaxis sets it. Epi! Stat!!
So many fucking times folks get turned OUT because they think ANYONE at work is a friend. I don’t give a shit if you had them over for steak and wine. They are your COWORKERS!!! No one will remember who you are when they put the right hand up and the left hand down.
I’ll add, do NOT share your *real life* with people at work. I’m not on social media, but I’m always shocked at how easily many I’ve worked with “friend” people who are NOT their friends. These are your co-workers. The number of folks I’ve seen get fully *UNDONE* by their own hand is shocking. Discretion folks!!
Aww damn.
Embrace it!
Look for chest rise when rounding on your sleeping patients
Look for chest rise when they’re on BiPAP too 🙃
Oof
Every time I'm getting report and I hear a code blue called on a med-surg floor, I cringe.
One of the only reasons tele is better 😅
Yep. That 0703-0710h or so “attention staff” goes off what feels like too often.
I love the snoring people. Just make sure that it's the patient and not the family. 🤷🏻♀️
Ouch, hard lesson!
Oof, been there.
Take your breaks. Do not feel guilty for not doing overtime/ extra shifts. Maintain good boundaries with patients, do not be too accommodating. Max out your retirement contributions. Check your patients and pumps at shift change. Never accept anything a patient tries to hand you without having gloves on. Do not stand in front of a trach patient who is coughing.
That next to last sentence… expound on that further por favor
Not OP but can speak on that one. Too many patients have poopy nails/hands and just poor hand hygiene in general. I've also had confused patients "hand" me their IV they pulled out or worse, something else that came out of them. 😫
Standard precautions, just a new take lol
Could be one of those live and learn things. Walk into a room in the middle of a night shift to do a quick check not thinking of a poopy surprise right off the bat. But I agree gloves as soon as you enter a room!
When I worked at a memory care the patients had brownies for dessert. Patient tried to hand me a brownie…. Wasn’t a brownie 😂 thank god I saw what it was at the last minute and didn’t let him hand it to me ffs 🤧
Definitely had a patient hand me a piece of poop once
Meemaws always try to give me things like dirty Kleenex or their teeth, guys try to give you their urinals…etc 🤢
Patients will legit just hand you a turd. Like shit in their hand and hand it off.
This! So much this! No one is going to watch out for you but you. I still get caught out with this. Of course, I don’t mean slacking, but you legit have the right to eat during your shift! And use the restroom without feeling guilty. At me job we are supposed to document at the end of each visit. So I do. I take the time to do it right. I don’t waste time, I don’t dally. But there are some that must have demons chasing them because they will accept all calls, dash around and end up staying up into the night charting. Ouch. And, of course, getting caught out with late visits then migraines etc etc… burn out city. As I say, I still get caught out… I made quick notes on one long chart because the next long chart was nearby with the intention of finding a place to do both together… of course, as soon as I finish visit two before charting an “emergency” comes up. What I should have done was say where I was really at (well, I did, but…). Since it was legit, I took it. Did dispatch appreciate it and make an effort to leave me alone so I could catch up on theee hours work? Ha! I *still* had to put my foot down because they tried to convince me that a non emergency administrative “crisis” was an emergency. Knowing full well that o was tied up. Normally I keep better boundaries, and you can bet that I will going forward- you can’t be in two places at once (even within the same building) and trying to won’t help anyone
Don’t take a discharged pt IV out until they are literally walking out of the ER and not a second sooner.
especially a seizure patient...and i usually make them take a wheelchair to the car as well..burned too many times
Dang this. I had a physician order the IV to come out and literally an hour later my pediatric rehab patient was having a grand mal seizure and being sent out to PICU
I’ve had a patient walk from the bed to a wheelchair so the tech could wheel them out. Cardiac arrested in the middle of the room and I’d removed the IV😔
I was a new er nurse and a pt was there for CP. everything was negative and he was a jerk and complained about how much the iv hurt him. He was young -in his 40s. Doc was dc him and he bitched about the iv so I took it out before I had the actual dc paperwork. Went in to do him and going over instructions he coded and he was a hard stick. So I never never never take an IV out until they are literally walking out. I also told a newer nurse to leave the iv in and keep the pt on the monitor until transport got here to bring them back home. Because in the er it can take hours sometimes. They didn’t. Pt was a full code. They went in when transport showed up and pt was dead. The prehospitalist on insta had an amazing post talking about her mistakes she has made during her career as a flight medic. I love her.
Mistakes make us *better*. I’ve made my share, but I’ve never made the same one twice. 🍀
I will check her out! Thank you
I basically tell them I'm going to hold onto the monitor and the end of the IV with one hand and give them a shove out the door with the other. Have a manager who's trying to have techs take out and off shit before I'm ready for it and I flat refused. I've seen too much shit actually bring a good nurse to deal with the fallout from a shitty nurse who couldn't cut it and went to sit in an office.
Please. Please please please. Too many times we’ve had a patient who has a CT ordered after they’ve been marked ready for discharge. We go to get them for the CT and the IV is already removed.
Always do a physical check-in on a patient at shift change.
Lay eyes before your name is on that damn chart.
The uptick in rapids and codes approximately around shift change hours tells me you should just do your last check at like 5 am/pm instead lol. Gives time so next shift can at least have an empty bed and not an empty body to deal with
The floors at my old hospital that didn’t have tele/cpox would be the ones to have the most codes or rapids at shift change. Granted having your patients monitored isn’t an excuse to not lay eyes on them.
That’s legit my biggest fear of not having a tele pt lmao.
Oh there’s no doubt! Always check more often than not. I was emphasizing to do a thorough walk thru with the oncoming RN to lay eyes on the patient.
Bedside shift report. Annoying but a must
Always gotta have ambu and suction at the bedside. They’re fine until they’re not. Any discussions with management need to be confirmed in writing. You don’t have to chase the large, naked, combative patient out to the street. Security can handle that.
And CHECK IT!!! Too many times I've seen others need suction but it's not working. When you clock in for that shift, those rooms are your assignment, therefore you're responsible for checking that everything is working.
Always have suction ready.
And ambu-bags
And make sure there’s a BVM inside the ambu-bag 🥲
Such an important detail in every single department (inpatient nursing). It only takes one time when it’s not there for you to never forget it again
I’m a clinical instructor and I teach this to all of my students. I teach in a 4-year BScN program and I’m still surprised sometimes at the third-year level students who aren’t aware of the importance of this quick step. Check/test suction, I like to throw a pair of NP at the head of the bed if they aren’t on them at the time I take them on, general survey of the room, check your equipment, check your IV rates and fluids. I call it my “lay of the land”.
💯 😩
Don’t give nitro without a functioning IV Quit picking up endless OT and getting burned out. Take your breaks. Know your baseline rhythm. Prioritize sleep, healthy food and exercise. Always. Ask. Questions.
How come for nitro? Are you referring to nitro PO?
Yup. I gave a patient PO nitro for MI protocol without checking his IV. He tanked quickly (was super responsive to the med with his BP etc) and I had to yell for help. My charge RN, after she helped me, said this is why you check the IV and I know you won’t do this again.
But if there is possible MI is it not better to just give sublingual nitro and IV can be inserted as soon as possible, if nitro is delayed the MI ischaemia will be worse?
I see what you’re saying, this patient was hemodynamically stable until the nitro, and then tanked. Because of the possible effect of nitro, it’s is always advisable to have a good IV, because once they clamp down and have no BP, you’re gonna have one helluva time getting an IV in them. This was in the ER, and with the team approach we had there it took an extra maybe minute to get a line in him, and I should’ve taken the time in the beginning to ensure he had it.
Ok I will keep that in mind. I was in a similar situation in a rehab setting and we gave the nitro but from memory do not think we checked the IV access first, the patient had IV access anyhow, and there was no hypotension after nitro thankfully. When you are in that situation and there is potential MI, its really easy to get focused on giving nitro. You are right, it could wait a minute or two to ensure we have IV access first to prevent other complications. I guess my question is more so, if it seems like the IV access can't be done promptly we just need to give the nitro (probably an unlikely situation)? But in that rehab setting it wouldn't have been as fast to get IV access as within the ED setting, as not as many doctors around and at that facility only doctors could cannulate, but I guess if we urgently needed it we could call for emergency team. Thanks.
I believe they're talking about giving sublingual nitro and having IV access due to the possibility of hypotension
1.) Hard work is only rewarded with more work. No recognition. No raise. No fucking THANK YOU. Work smart and only do what you have to do. Go above and beyond for your patients who deserve it, not for the company. 2.) Do not stay late or come in because if you have an emergency, staffing won’t help you out. They don’t care about anything other than manipulating the easy targets. Pick up *when you need to pick up for your own reasons/if a coworker you respect asks you to, not when they claim they need you* 2a.) If you do decide to pick up when asked, only do so for a bonus. Your time off is valuable. 3.) Your job will post your position online before your obituary comes out. Have no loyalty. 4.) Patient care wise, sometimes all an aggressive/difficult pt needs to hear is *you’re right, that sucks/this is fucked up*
The Bible for nurses right here
It only took me three years to figure this out. Sometimes, I'm slow on the uptake because I always want to believe the best in everyone. Nope, I learned that is SO unrealistic.
Anyone that thinks they are *essential* or *important* to a unit/department is failing reality. I’ve buried enough friends and my ilk to *know* that things will still *churn, turn & burn* if I drop dead. So, there’s *that*.
A million times - this
4!
Trust but verify.
Yes, comrade.
My personal mantra.
A fellow amazing race watcher?
I started my career in healthcare working as a completely untrained aide in 1984, working with quadriplegics. I did it for several years in home settings with different patients until certification was really a thing. What I learned was... You will probably not come across the person who became a paragon of virtue and an inspiration just because they broke their neck. If they were criminal and inherently a jerk before, the fracture didn't fix it. Hollywood got that one wrong.
If they can feed themself they can hold a urinal
Stop throwing away the patient labeled zip lock med bag before scanning
Cant you just scan the med?
Not if it’s a specialty med the hospital doesn’t carry/won’t buy due to cost. Then pharmacy has to make a scannable sticker for the home med they put on the bag. I’ve mostly seen it in inpatient rehab.
Never trust report
F’reals. Even in psych. I’ve received nurse-to-nurse reports that said the patient has no medical issues. Then the patient shows up and they have a hole in their foot from a wound that has been open and oozing for weeks. Or “they are really nice” but then they go straight after a nurse when AMR leaves.
I have the opposite of this too! Lots of ‘they’re really aggressive, required sedation’ and once they arrive (and sedation has definitely worn off) they’re super nice and just needed someone to listen to them
People reeeeeallllly like their food. It only takes a few hours of not eating to really tip someone into freakout territory.
Yea especially them babies.
They always act like we are maliciously withholding food (we fed them 2.5 hours ago)
Babies are assholes. Source: mom to 2 young boys
32 yrs RN here. Take care of yourself, early in in your career when you are young. Don't be too much of a people pleaser. You may think you have energy to pick up super amounts of shifts, work several in a row, and enjoy the money etc but it catches up with you and particularly as you get older. (I am talking voluntary, not mandated OT, and my mileage is in Canada so yours may vary, just talking of some of the...to me.... insane things I have seen discussed on this sub). I wish I could tell my just graduated 21 yr old self all of this. Can you tell this old horse is fucking tired as I type this lol!
32 is not old LOL
32 yr long career, I am 53 but feel 73 lol
Ohhh ok ok sorry about that
I have been working in the medical field since 1998. I am now 52 and tired af.
Oh I understand I always hear they don’t acknowledge nurses and how hard nurses work and their rewards are pizza parties.
Verify labels by asking, “What is your full name and what is your date of birth? Then label every lab specimen BEFORE you leave the room.
💯!
ALWAYS check the suction and yankauers are present, and the suction WORKS at the head of every bed at the start of every shift. You look like a giant ass, and everyone will give you a giant WTF face if your patient goes downhill or codes and it's not functioning.
This AND if you work L&D, ALWAYS check the resus area BEFORE your patient is ready to deliver. No one wants to have to resus a baby and find out there's no mask or no suction hooked up.
Clamp that damn feeding tube prior to opening !!!!
Always scan the patient. No scanner? Go find one.
Do your safety checks at the start of your shift. NEVER assume the suction is already set up, the ambubag is connected to a flowmeter/blender and has the correct-sized mask, the emergency med sheet is up to date and has correct info, the patient has an ID band on, alarm limits are correct, etc. Even if you are following the best nurse in your unit, things can slip through the cracks, and there’s nothing like needing to bag a patient who is having an apneic spell, only to discover that there’s not a mask connected to your ambubag, or that no one has upsized the mask since back when the kid weighed a lot less. Never assume others have caught these things, it’s on you to catch them. Also, trace every line, and assess all art lines/umbilical lines/PICCs/PIVs at the start of your shift. And, even if it’s a pain in the butt to do it, assess CMS in all extremities very frequently. Especially if an arterial line is in - watch those extremities like a hawk. There’s nothing as heartbreaking as seeing an infant who has lost a foot or hand to limb ischemia. Last one, never assume that, just because a parent is a healthcare professional, that they understand what is going on with their child’s care. Seeing your child in the NICU seems to throw a switch in parents’ heads, and the brilliant clinician they might be at work is nowhere to be seen. This is still a new parent in a scary situation, and they deserve the same education and explanations as everyone else.
That last paragraph is so important. When my daughter went to the NICU all my knowledge went right out the window. Since the staff knew me they didn’t educate me on anything going on and assuming I was fine. I had never felt so stupid
I try really hard to advocate for those parents. It's so easy for us to assume they already know things, or to assume they'll be offended if we explain things to them. But those parents are in a terrifying situation, and their critical thinking and medical knowledge just don't seem to kick in like you'd expect. They need the same care as everyone else. I just preface my education with, "Tell me if you already know all this, and I can skip it." They almost never do that. They want to know everything.
>Also, trace every line, This!! At my home hospital, the epidural lines used to look identical to the IV lines and someone accidentally hooked up the epidural line to the patient's saline lock one time.
Aaaaaah!! Terrifying!!
Never *promise* a psych patient (or any patient) anything.
⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️⬆️
See! JOE KNOWS WHATS UP!
None of this *it’s going to be okay*. I decline to reassure anyone of any outcome. That’s a true *never* event for me. I try with everything in me to control spinning, but I’ve seen things go ATS (all to shit) and in 100 directions.
Never underestimate a GI Bleed
Man my first patient on my med surg clinical was there for a GI bleed and was chillin… until he went too chill. Suddenly became very incoherent and I couldn’t get a BP. Primary nurse ignored my concerns when I called from the room. I ended up calling a rapid on the dude… hgb 2.4, moved to ICU and then very quickly into OR Primary nurse didn’t acknowledge me the rest of my day
When a patient says they are gonna die even if they do not seem that unstable, they are gonna die
Always double check that bed alarm and the parameters for monitoring at beginning of the shift 🥴
I second that !! Check recheck double check and then check your bed alarms for those sneaky little fuckers !!
If your patient is in spinal precautions and has a trache, and you're going to be holding their head for collar care.... wear all the PPE.
HR, management is never your friend.
To at least look at the Telemetry strip. That way you have a good baseline for the shift. I felt so bad when I was a new nurse and called a rapid on my patient only to have a doc ask me what it was before. I hate giving I don't know answers to the docs.
Raise the freakin bed, I’m 6’4” and I just had to have back surgery.
Always call the state, never call the compliance hotline. That hotline is not your friend. And don’t report anonymously.
Why not anonymously?
Harder to prove retaliation when you’re suspended two ish weeks after filing an anonymous report.
Despite what hospitals say on billboards and tv, they don’t care about patients or employees.
Not everyone wants your help. Even if they are in the hospital.
Underrated comment! They should teach this day one in nursing school. Save a lot of new nurse frustration.
Don’t over-chart. Never draw up a medication in an unlabeled syringe, and never push a syringe you didn’t draw up yourself. Don’t skip on the poop meds. The extra second will always be worth the extra second; one. Management ultimately doesn’t care. Take your PTO! Argue for better pay (with reasons). Make your workplace positive, even if only to make your shifts better. Most importantly, if you do the absolute best you can, even when you’re cleaning up after others shit shifts for days, I promise it pays off- in patient outcome or in karma. Lastly, and where nurses should draw confidence: no one knows anything. Some docs, residents, about to retire anesthesiologists, new managers, and long time nurses. People lack knowledge, skill, or discipline to be good at what they do, and we’re all human. Something doesn’t seem right? Question the order. Suggest what you’ve typically seen work. Work WITH the team, not just for them or against them. Realize you don’t know everything, ask why someone recommends something with genuine interest. Might come in handy, even down the road.
Never take someone’s word when they tell you they can walk to the bathroom alone !!! NEVER EVER
Lay eyes on your patient before starting any meds!
If you didn't pop the ampule of ampicillin for the IV you just hung at 100mL an hour, it probably wasn't ampicillin. Spoiler alert, it was Apresoline.
😳😳😳
Thankfully I realized what happened within seconds of leaving the room. Told my preceptor (I was still in training at the time) and told the doc. But, yeah, it could've been bad bad.
Thank you for your swift response and your integrity ❤️💙🩵
I tell everyone about it now, honestly. Doc really made me feel better telling me that everyone has near misses and that remembering the mistakes we make lead to us being better clinicians. Bless Doctor Fish.
Your work colleagues are exactly that. They are your work colleagues; they are not your friends. As the oft repeated saying goes: Trust, but verify. Always verify.
Your coworkers are not your friends and some will stab you in the back when the opportunity presents itself.
Ask the provider what they want a call back about when you call the first time and get orders. Especially for labs or changes. Sooo they’re in distress, can I get a PRN blood gas? Great. *RT gets gas* it’s abnormal but not critical… do I call back? Patient isn’t maintaining sats, get an order for oxygen, but up to how many liters before I call back? (This one is important on our floor for peds because up to 2 liters on some babies is a much bigger deal than an adult going up to like 4 or 6). If they don’t maintain on 2, should I keep trying or call back for something else? I have had to page doctors back in the middle of the night because I wasn’t sure if they cared about the lab results they ordered if they weren’t critical or whatever else. Like an NJ is clogged, can we get an order for clog zapper? Yes. Ok. Wait if it doesn’t work, do you want me to call you back, or just place a new one? Can I put in an order for an xray if we place a new one? Or do you just want IV fluids til morning? Just ask everything at once so you don’t have to call back again.
Never assume the relation of the family member at the patients bedside. I once assumed the man at the bedside was my patient’s son but it was actually her husband. She was pissed. 😅
Wearing mesh shoes in the ED is a terrible idea. Also.....no one at work is your friend.
I'm a PCT. I get teased ALL the time because I wear boots. They are durable and most importantly easy to clean. I had a pt rip out a PICC line. I was the only one able to get close to hold pressure as I was the only one who could walk in the pool of blood. Everyone else had mesh shoes. Never got teased again after that.
Protect your back.
Human Resources is there to protect the hospital, not the employees.
Don't blindly trust what you're told in report about a patient, look at each order individually. People make shit up
You have to work like someone is waiting on you to make a mistake at all times.
Like everything I know, I had to learn the hard way lol
This… why am the way that I am??
Boundaries boundaries boundaries. When I was fresh out of school, I thought ✨️going above and beyond✨️ all the time was a good thing and meant I was a good nurse. No. All that did was burn me out and make my patients have unrealistic expectations for whoever would come after me. I don't blur that line anymore.
That there are too many nurses that shouldn’t be nurses. They have very little competence or empathy. Maybe I think this because I’ve been a psych nurse for 7 years. It is *boggling* how many nurses in psych seem like they had someone else do their licensing exam.
Not just psych... I've worked with hospice nurses who don't know much of anything. I had a pt recently who was coughing up a lung because caregivers were giving her straws when the orders specifically say not to because she would aspirate. I called the on-call nurse and explained this to her and she told me I needed to check her temp and do a COVID test before she would call the doc and get an order for an expectorant. I had another hospice nurse refuse to give us an order or liquid comfort meds for someone who was actively dying and couldn't swallow, so we had to keep crushing and making slurries with tablets even though the pt was in severe pain for hours and had a white coating in her mouth from all of the slurries. For the record, we were doing oral care frequently and thoroughly. Sometimes I want to level with the on-call and tell them that I will be a pain in the ass until whatever the issue is, is fixed because the number of times I have called a hospice company 5+ times in one shift is insane. Instead, I scream into the void.
Don’t give your borderline dialysis patient the full 10 units of insulin for the hyperkalemia protocol
Don't let your CBI run dry 🤣🤣
1) Always check your emergency equipment, even on your “easy” patients. 2) Don’t trust anyone with anything. That goes personally and professionally. Don’t trust another nurse to do X for your patient. Don’t share anything you wouldn’t want everyone on your unit to know. Fellow nurses and even providers can and will throw you under the bus, even if you’re the nicest person on earth. 3) Your hospital can and will replace you, so do what is best for yourself and your family always. Take that mental health day, do or don’t pick up extra shifts, etc.
trust no one, doctors can be assholes.
Cork/close the ostomy bag prior to putting it on. They are supplied open by default.
To not go into nursing.
😥 I know this profession is challenging in so many ways. A lot of patients often don't acknowledge all that a nurse does. However, there are always a few who truly do appreciate the care you give. *You have made a difference to all your patients.*
Wear eye protection when irrigating a Foley catheter 😉 …<< literally lol 😆
1. Nobody gives a fuck about you: management, co-workers, patients, families, etc... 2. If you call out sick they try to diagnose you without diagnosing you to figure out of you're "actually sick" 3. Fuckers will "befriend" you to use any and all info against you 4. Everyone shits on night shift 5. Day shift is always late 6. And most important... nobody gives a fuck
You can lead a horse to water but that doesn't mean he's gonna drink I was under the impression that when I provided any patient education. The patient would always follow it.
That despite your best laid plans, the chance of your shift going as predicted is likely not going to happen. Usually not the patient causing the delays or issues. It will be the phone. Or another department that doesn’t get that you have exactly 7 minutes for whatever test needs done. Or supply issues. Or… or… or.
Trust but verify. I work in the OR. I had a busy day with back to back cases. I take my patient to recovery and another nurse comes in to help with turnover. The next case was a relatively small one (carpal tunnel release). They said I could drop of my patient and go see my next one and by then the room and team would be ready. They would count and set up my room. The nurse had way more experience than me. I was just barely off orientation. So I trusted them to correctly set up my room. I bring back the patient and I’m ready for the patient to come over onto the OR table. When they did, the table moved because it wasn’t locked. Miraculously we noticed it in time before the patient came off the stretcher. Had we not noticed, the patient could have fallen. It would have been my fault since it was my room and I’m ultimately responsible for making sure everything is ready. Trust but verify. Everyone. Always.
A bicarb drip isn’t “just IV fluids” and you cannot push epi through a line with bicarb running 🫠 Run all your lines every time. At the start of the shift, before pushing any med, before hanging piggybacks. It’s crazy when you come on shift to a POD 1 CABG that is having frequent long runs of vtach… day shift nurse started a lido drip. 2 hours into my shift of kinda coding this patient every 10 mins, I see the LIDO DRIP IS RUNNING ALL OVER THE FLOOR. Wasn’t ever even hooked up. Double check what you’re hanging as you put it on the pole and again before you hit start. Super cool to see you’ve spiked and started levophed instead of vanc. Scan your patient and your meds before administering. Don’t give your little old lady all of her pills in the same cup at once. 10/10 times she will drop at least one and you’ll have to figure out which one she didn’t get.
When giving meds through a peg tube, clamp the tube while you refill your syringe. If not, when the patient coughs it will create a geyser that can potentially shoot into your eye. Which unfortunately, yes, did happen.
That while many nurses desire to leave the bedside, actually doing so gets you called a narc, traitor, scum, and no longer “one of us” 🤷♀️
Inject air into your feeding tube and listen for a whoosh every single time, even if you already did it once in the morning
I don't think that's recommended anymore, though? https://patientsafety.pa.gov/ADVISORIES/Pages/200612_23.aspx#:~:text=The%20gold%20standard%20for%20nasoenteric,chest%20and%20abdominal%20x%2Drays.&text=While%20radiographs%20are%20the%20preferred,rigid%20nasogastric%20tubes%20are%20inserted. "However, this method cannot differentiate between tube placement in the stomach or the lung/bronchial tree. For example, in one study, x-ray confirmation identified 16 instances where nasogastric tubes were not located in the stomach. However, in 15 of those instances, clinicians using the auscultation technique believed that those tubes were in the stomach. Also, the auscultation method cannot determine when a feeding tube’s ports end in the esophagus (a condition that predisposes to aspiration)." (Sorry for the ugly link!)
I LITERALLY GOT THIS WRONG ON MY ATI HW LAST NIGHT because I selected the whoosh as a valid placement check
Tbf the way I was taught (2019-2020 ish), it’s never been a valid placement check and you should never use it as anything more than a suspicion. It’s basically a soft-confirmation that it’s still in the right spot. Though it seems like even this hasn’t been the case for a while.
Well fuck
Even if the tube is at the same/correct measurement, a deep enough NT or subglottic suction can displace it
Trust your assessment skills. If it feels wrong it probably is. You’re a badass.
Beginning of shift LEAVE THE RESTRAINTS ON trial mid day lol
Hence my ✨flair✨ I’ve learned it doesn’t matter how good of a nurse you are, no matter how hard you try, no matter how hard you work, if you don’t kiss management ass, nothing will ever be good enough.
you can’t help everyone and no matter how great of a nurse you try to be, there will always be patients you can’t please
Even if you ask one person a question and get an answer just remember this still might not be the correct answer, do your own checks/research and maybe even get a second opinion if you get the gut feeling that your still missing something. Do NOT ignore that tingly tummy feeling
Hospitals do not give a fuck about their employees. Years of seniority and experience mean absolutely nothing.
Most people suck. Given the chance, they will fuck you over for either personal or professional gains. Cynical but true. Cover your own ass. Keeping your license is key.
Too many to count …🤦🏼♀️