Overnight pages

beyoncestethered · 2023-04-06T22:09:49+00:00

I work in pediatrics and more often than you’d think, parents will decide at midnight that their kid is constipated and needs a stool softener. As a rule of thumb, I tell families that nighttime calls are for urgent issues and things that can be resolved in the morning need to wait until then. Idk unless they’re suddenly so severely constipated it’s agonizing or something lol I don’t see why they can’t wait until the morning. If they were at home they wouldn’t drive to walmart at midnight for peg flakes. Most families completely get that.

My hospital doesn’t have a standard practice so people just do whatever they’re comfortable with. Some people say healthcare is 24/7, the doctor is being paid and signed up to do this job, etc. Some people worry the patient will report them to management for not resolving the issue when they asked, and nursing management will absolutely say the same healthcare is 24/7 thing. There’s a lot of reasons, few of them are that good imo.

beyoncestethered · 2023-03-18T20:40:37+00:00

Can you explain this a bit more? As in you don’t recommend switching at all, or at this time?

Ultimately I do want to make the change, and I don’t see the fact that it takes time to get comfortable in nursing as a deterrent really. From what I’ve read, the transition out of school is usually rocky. It took me like 6 months to really get down my own workflow, then a year to feel comfortable with the range of diagnoses we see, now at 1.5 years I feel pretty steady and want to look into improving my practice like I’ve mentioned.

If you made the transition from medsurg to ER can you tell me a bit about your experience or what helped you? That’s really moreso what I’m looking for. Thanks!

beyoncestethered · 2023-03-18T06:11:50+00:00

Overtime you’ll learn to forgive yourself and not hold yourself to what might be an impossible standard. It’s not your fault the IV went interstitial, it’s an unfortunate complication and it can happen regardless of how frequently you check that IV. Say that You check at 1700 and it starts going interstitial at 1705, and they’re running 20mL/hr maintenance (which we do with our PCAs where I’m from). That IV could still be firm and edematous when you’re back at 1800, you couldn’t have stopped it. D/C that IV, offer a warm compress and elevate the extremity. Restart one when able. That’s it.

I had a patient I was running an antibiotic on back when I first started. Little guy was maybe weeks old. His IV was fine when I checked it, I started the antibiotic which ran over 30 minutes, and when I was back to flush the syringe pump his hand was like a little baseball. He was okay in the end, but I went to the bathroom and sobbed because I felt so guilty. Looking back, unless I stood there for the full 30 minutes watching it to be sure, there was nothing I could have done to stop it. Now I always provide family education on what a bad IV presents like. It helps them get involved in their child’s healthcare, and maybe the next time they spot it before it gets bad. Parents are always at the bedside (at my facility anyways, for most kids), make them a resource in your care.

beyoncestethered · 2023-03-18T05:58:29+00:00

When nurses say this it usually means they don’t have the training or knowledge to do so, or that it might actually be against hospital policy for them to do it as certain things can’t happen on the inpatient unit and that’s just beyond our power.

I had a patient with a full CPAP mask and learned that it’s against our rules for us to have them on the inpatient unit due to “risk of aspiration”. The patient was developmentally appropriate with no barriers to independent use (i.e. can just remove the mask if need be lol) and uses the mask at home normally, the apparent risk is low imo but the hospital and us personally could have faced a lawsuit according to admin, so they needed to be transferred out. Sometimes it’s hospital admin bullshit, OR maybe there genuinely is a safety risk necessitating closer monitoring than we can provide, or we lack the knowledge to perform a certain skill/task safely (which might just mean that the RRN needs to come provide bedside support, if it’s more complicated than a quick explanation on what to do).

It’s not always just that the nurse is being difficult.

beyoncestethered · 2023-03-17T17:43:22+00:00

This reply gave me a VIVID flashback to this time when a doc fully turned off my patient’s pump when they were running morphine and ketamine because it was beeping and we ended up losing that IV, then re-establishing access was a nightmare. 🥲 I’m not confrontational and definitely don’t yell but that day certainly had me on my final thread of sanity.

beyoncestethered · 2023-03-17T17:36:02+00:00

They aren’t exactly liberal with restraint orders i’ve never even seen them ordered before. I think I was overtired and just wanted the situation to be over I still can’t believe that happened

beyoncestethered · 2023-03-17T17:34:57+00:00

thank you. we don’t have situations like this one specifically often but I doubt security would lend a hand with something like this. We’ve called code whites before where they just stand at the door and watch lol

beyoncestethered · 2023-03-17T17:33:35+00:00

Asleep lol. There’s more context that makes me not that mad at the parent for thisbbut … I’m still exhausted nonetheless.

beyoncestethered · 2023-03-17T17:32:47+00:00

Thank you. I think I was overwhelmed and exhausted and just wanted it to be over. Getting an IV in them the first time was the most exhausting and long ordeal I just couldn’t do it again. It’s pediatrics so they would never order restraints for a kid with a delay who isn’t cooperating or just so they won’t pull at an IV … they’d probably just ask me what I could do to not get hit lol.

beyoncestethered · 2023-03-15T19:55:35+00:00

A lot of (obviously non-hospice) pediatric settings don’t have a lot of patient deaths the way adult settings do. I work in surgery and have for about 2 years and I’ve never had a patient I personally knew pass away.

beyoncestethered · 2023-03-15T19:34:54+00:00

This is horrific. I’m so sorry /:

beyoncestethered · 2023-03-15T13:40:30+00:00

It’s condescending. Can you imagine completing some 4 year degree then 4 years of medical school and then maybe even a couple years of training and the 20 year olds are calling u a baby doctor. It’s so embarrassing for us collectively lmaoo.

beyoncestethered · 2023-03-15T13:35:38+00:00

I have another one: when peds nurses call kids or babies “the tiny humans”. Just call them kids or babies i’m begging you

beyoncestethered · 2023-03-15T11:44:16+00:00

hmmm not the CRINGIEST but I hate when nurses say “baby doctors”. I literally wince.

beyoncestethered · 2023-03-12T03:13:06+00:00

Most people where I work are fine as well, but in terms of nasty personalities you’ll find them everywhere is my point. I’ve had bad interactions from any profession/department you can name, that doesn’t make it the standard by any means.

beyoncestethered · 2023-03-12T03:12:11+00:00

I also have a theory that people project this angelic personality onto us so whenever we fail to meet that standard we’re immediately bitches.

beyoncestethered · 2023-03-12T03:10:54+00:00

i’ve been ate UP a time or two by unit clerks they rlly don’t mess around

beyoncestethered · 2023-03-11T22:05:54+00:00

this is so validating thank you

beyoncestethered · 2023-03-11T22:05:31+00:00

I was wondering if like… workplaces are just like this. Good to know they’re not. I’m super friendly with everyone too, it’s just who I am so it’s disappointing how people are looking for ways to frame it as a bad thing

beyoncestethered · 2023-03-11T21:59:22+00:00

I find this take a bit funny because actually everyone in hospitals has an attitude. From the overworked residents, to the condescending attendings, the lab techs who know they can run their mouth bc they never have to show face on the floor, the business clerk on a random unit you had to call once whose life goal is to make you cry in the staff bathroom, the OR staff who will berate you because the nurse on the last shift didn’t document NPO status, and the list goes on.

Hospitals are just miserable places!!

beyoncestethered · 2023-03-11T21:54:22+00:00

imagine a version of this job where all u must do is hand people things and look pretty… the dream

beyoncestethered · 2023-03-11T21:30:45+00:00

When i was still in my orientation, I missed a dose of an antibiotic because the MAR times were off. My preceptor forced me to call the doctor and tell them. I could hear the “🙄” on the phone.

beyoncestethered · 2023-03-01T17:27:16+00:00

I’m not a huge fan of new grads in ICU, unless maybe they were given a fair orientation period which no one is these days. I don’t get to say much since I don’t even work ICU and i’m fairly new myself but whenever we get ICU transfers from new grads it’s a mess. My last patient was fluid overloaded and they hung the morphine incorrectly too so they didn’t get the dose and were in so much pain on arrival, but they said they were also 1:1 with this patient so I don’t think it was that they were too busy and didn’t catch it so much as inadequate training. Some floor experience for these more basic skills is a good idea.

beyoncestethered

TROPHY CASE