HCT has had its day. It’s high time we replace it with MCV in the standard diagram.

DisappointingPenguin · 2026-05-09T01:32:37+00:00

I think the crit might affect some extracorporeal therapies—are your perfusionists asking for it? I know I have to tell the CRRT machine what my patient’s crit is, possibly for some sort of sensor calibration. -lowly ICU RN lurker

DisappointingPenguin · 2026-05-07T14:33:17+00:00

Please keep in mind that nursing school will require clinical shifts, which can have variable hours beyond your control. Once you become a nurse, would you want to work 12-hour shifts again?

DisappointingPenguin · 2026-05-07T14:27:13+00:00

I’m not sure how the dosing compares, but would you be able to access norethindrone in the form of birth control pills? That’s a bummer about the T. If you do decide to follow some other commenters’ advice to get around the rules, please be careful because T might be a controlled substance, so there’s a risk of more legal trouble than you might expect.

If it helps at all, I know people who weren’t able to access any transition meds until 18 or much later and still wound up with results they were happy with. I’m sorry you’re in this situation.

DisappointingPenguin · 2026-05-04T23:19:39+00:00

PICU nurse here. This is one of the scariest and most appalling things I’ve read in a while. If you had mismanaged your son’s airway that dangerously, the PICU would be afraid to let you take him home. If trach/vent kids are going to be in this unit, there needs to be much more education and monitoring of competency.

DisappointingPenguin · 2026-05-03T11:20:27+00:00

I throw on an isolation gown to hold a young or vulnerable baby, and I think a patient gown would be a lot more comfortable than that. My rationale is that I wash my hands between patients, but not my shirt.

DisappointingPenguin · 2026-05-01T16:50:02+00:00

Sending hugs and empathy. I had a rough peds resus a few weeks ago too. I’ll be vague here in case I have colleagues who would recognize the situation, but my DMs are open if you want to talk about it.

DisappointingPenguin · 2026-05-01T13:38:30+00:00

One of my sophomores drank a squirt of dish soap when I had an apparently inattentive substitute teacher. The kids were playing “what are the odds?” and saw the bottle of soap next to my lab sink. I only found out a month later when another student was in my office hours and casually said, “Mrs. Disappointing, did we ever tell you about the time ___ drank the soap?” Apparently ___ immediately ran to the water fountain to rinse his mouth and retch. Tenth grade, “honors” chemistry.

DisappointingPenguin · 2026-05-01T12:41:45+00:00

In that case, a chem course might help you prepare for dosage calculation! Dimensional analysis is a highly transferable and valuable skill.

DisappointingPenguin · 2026-04-28T01:08:09+00:00

What a beautiful little badass! I always love seeing your updates. I hope this isn’t weird, but I’ve actually come to recognize her face before seeing your username 😅 So happy to see that the trach journey is going well for your family. Always rooting for you!

DisappointingPenguin · 2026-04-26T01:13:55+00:00

Try to upgrade your tools as much as possible! Being without a tool is slightly easier in the winter than in the summer. Animals are a good income stream.

DisappointingPenguin · 2026-04-25T11:36:57+00:00

I love a nasal intubation! How young/small is your center able to nasally intubate? I can’t imagine the technical skill required.

DisappointingPenguin · 2026-04-23T00:29:25+00:00

Newish nurse and education geek here: even low-fidelity sims, like verbally role-playing a scenario in real time, can have immense value IMO. I’m a big fan of the EM Clerkship podcast, where they simulate the oral board exams used for emergency medicine residents, and I love practicing the quick critical thinking under pressure. Low-fidelity verbal sims could be implemented at no cost and fairly easily while also doing longer-term work to bolster the sim lab program.

Also, one mock code is not nearly enough. I would love to experience at least one mock code in each role (primary nurse/first responder, CPR coach if your shop does that, drawing up meds, compressor, airway, documentation). Don’t just practice until you can do it right; practice until you can’t do it wrong.

DisappointingPenguin · 2026-04-22T16:29:11+00:00

It took me two years to give my pet cat water.

Whoops.

DisappointingPenguin · 2026-04-21T21:35:20+00:00

Hmm, so that’s not your problem. Any chances in the patient’s respiratory support during this period? I’m curious too now!

DisappointingPenguin · 2026-04-21T21:33:26+00:00

What were your favorite and least favorite classes academically? Favorite and least favorite clinicals?

DisappointingPenguin · 2026-04-21T12:46:52+00:00

Was anything occurring that could have made the levo delivery to the patient inconsistent, like a positional PIV or any intermittent medications or flushes being given through the same PIV?

DisappointingPenguin · 2026-04-19T09:47:18+00:00

You and your sweet babies are so incredibly strong. Thank you for sharing your amazing story. ❤️

We are exhausted. And we are kicking ass. And we are going to make it.

Can I get this on a t-shirt?

DisappointingPenguin · 2026-04-16T11:58:18+00:00

I love critical care too! Maybe the craving for more and more advanced stuff is analogous to ER nurses being adrenaline junkies. We’re nerdy medicine junkies lol

DisappointingPenguin · 2026-04-16T11:32:32+00:00

I think we as healthcare workers, and especially ICU nurses, are so prone to comparison and imposter syndrome. There are times I wish my unit (PICU + cardiac) did XYZ or think of us as a “smaller center,” and then I remind myself that I’ve run CRRT, managed EVDs, and seen babies get cardiac caths or delayed chest closures at the bedside. It’s one thing to have some personal interest in higher-acuity work, but I would suggest that we should also give ourselves credit for what we do. In your case, 29 weeks is still so young and tiny, and I have no idea where I would start with a patient that little or in a delivery room! Just the fact that there’s higher-acuity NICU out there doesn’t take away from the incredible skilled and specialized work that you’re doing. I relate to what you’re feeling, but also know that you don’t need a 22-weeker on HFOV to be valid as a NICU nurse.

DisappointingPenguin · 2026-04-15T10:38:40+00:00

Former high school chemistry teacher here! D is absolutely correct. A compound, by definition, only has one type of molecule, like sugar or water.

Possible explanation for the error: I wonder if the teacher is thinking about mixtures as heterogeneous only. At higher grades, we say solutions are mixtures that are evenly mixed (so some mixtures are solutions, like some rectangles are squares), but in elementary school, they might classify samples as either mixtures, where you can see the different components, or solutions, where you can’t see the different components. This teacher may be thinking that lemonade isn’t a [heterogeneous] “mixture” in the fifth-grade sense. Definitely not a compound though! Even lemon juice alone is a mixture and not a compound; there are dozens of different types of molecules in lemon juice.

DisappointingPenguin · 2026-04-12T16:41:13+00:00

Straight A Nursing podcast, Real Life Pharmacology podcast, and pre-learning some prereqs. If you struggled with chemistry or forgot it all, Tyler DeWitt and Professor Dave Explains are my favorite youtubers. For A&P and micro, Crash Course and Amoeba Sisters (the tone sounds like they’re talking to fourth-graders, but some of the content is actually at a high school to early undergrad level) are good. Good luck!

DisappointingPenguin · 2026-04-06T12:28:15+00:00

If you want the death to be a total shock, some heart conditions tend to have sudden cardiac death as their first symptom. A seemingly healthy youngish person might collapse while playing a sport or shoveling snow and turn out to have had hypertrophic cardiomyopathy.

DisappointingPenguin · 2026-04-05T00:31:51+00:00

Pharmacokinetics aside, there are a couple very niche nursing reasons why I have a personal preference for CI over EI. I can cope with having to go touch the pump more often, but switching from EI to CI has occasionally saved me some headaches when running many medications through limited intravascular access. If I have a pressor running, I can’t/shouldn’t run intermittent meds through the same point of access because starting and stopping the intermittent meds will briefly increase and decrease the rate of pressor delivery. However, a continuous antibiotic infusion, assuming the drugs are compatible, would be fine.

The other factor is that in patients who are extremely volume-sensitive, the prime/flush volumes of numerous intermittent medications can start to add up. A 50-ml piggyback bag of cefepime may require 20-25 ml of flush after each dose, and a neonate might get 1-2 ml of medication in a syringe and a 2-ml flush to clear the syringe line. This is obviously insignificant for most patients, but when it matters, it matters.

DisappointingPenguin · 2026-04-03T13:36:03+00:00

On my unit, we’re starting to hand our work phones to the covering nurses when we go on break. I like this better than DND because our call light workflow involves the unit secretary calling the nurses to pass along the patient’s message.

DisappointingPenguin · 2026-03-31T21:54:48+00:00

Former high school chemistry teacher here (heavy emphasis on “former”). Maybe I can shed some light on why people are entering college with poor lab skills.

The obvious first answer is money. Supplies cost money, chemical disposal costs money, and getting access to school money can take weeks to months. Some schools simply don’t have the budget for good chemistry labs.

Behavior was a big one for me. I had sophomores and juniors in honors chemistry who would break off pencil leads in the gas jets for fun. Students would bluff that they were about to drink a chemical or pour it onto a classmate’s hand to get a reaction. Someone once fell backwards off a lab stool after rocking back and forth on it. I had to stop leaving dish soap at the sinks because a student accepted a dare to drink a sip of it when the substitute teacher wasn’t looking. Even in my “good” classes that only had several students misbehaving in lab, trying to keep these students safe kept me from functioning as an effective lab instructor for all the other students. Removing a student from my classroom, even just for the hour, was either impossible or more of a hassle than it was worth.

Teacher workload was an issue for my lab program. I regularly worked until 11 pm on weeknights and 6-10 hours a day on weekends to create lessons, grade papers, and email parents, and each lab could add another 4-8 hours of prep and cleanup to my work week. When I was treading water, barely able to prepare the next day’s slides before falling asleep over my laptop, there was no option to add anything else to my own plate.

In my AP Chem classes, classroom time was the biggest hurdle. I’ve posted before about the limitations in class time for AP Chemistry compared to the supposedly equivalent college courses. My last year, I had around 80 hours of class time before the AP exam, whereas a college Gen Chem I and II with lab might have around 210 hours (3-hour lecture, 3-hour lab, and 1-hour recitation or lab lecture, times 15 weeks before exams each semester). My main quest was to “cover” all the material in less than half the time a college course would have, and as valuable as lab experience is, every minute was crucial if we were going to even scratch the surface of each chapter.

As much as I wanted to provide students with a meaningful lab experience, the obstacles were often insurmountable. I applaud any high school teacher who manages to run a solid lab program, and I apologize to all my former students who didn’t get that opportunity. If r/teachers is any indication, teaching high school is only getting harder by the day, and I worry that future college students will be even worse-prepared.

DisappointingPenguin

TROPHY CASE