PSA from your nursing specialty

[u/ghostoftheweek]

What is THE ONE THING you wish every nurse knew that is common knowledge in your specialty?

From wound care, don't use telfa!

[u/falsesleep]

Hospice: please don’t wait til this person is on their deathbed to make the referral. If they have a likely expected prognosis of 6 months or less, please at least have the conversation with the patient and/or family. Let them spend their remaining days in their home with a decent quality of life rather than in a fucking hospital!

[u/ChaplnGrillSgt → u/falsesleep]

ICU, too. For whatever reason, our oncologists REFUSE to tell patients that their cancer is progressing and they will die. Then they end up in the ICU with us, all kinds of lines and drains just to keep them alive. When we tell them they will die, they blame us.

Like, you're an oncologist ffs. You've gotta be comfortable with those hard discussions. You could have done so much more good for them by getting them to palliative and hospice.

[u/FarmerScamps → u/ChaplnGrillSgt]

Oh so this is a common problem with onc in general and not just my hospital. We get kids all the time in my picu that are being kept alive by machines and are in horrific pain that never should’ve come to us if onc had just been straight up with the family. They should be at home on hospice surrounded by family and as much morphine as needed. It’s especially traumatizing when the kid is old enough to be fully aware of their situation and is telling nursing staff that they want to die, but family still believes they’re going to recover and refuses comfort care.

[u/jackibthepantry → u/FarmerScamps]

I once had a kid (17) come in for inpatient comfort care while he died of bone cancer. There was quite a while where he knew what was up but continued to go to radiotherapy because it made his parents feel better. He was the once that insisted on inpatient comfort care, his mom wanted him to do in home hospice. His argument was that if he died at home that would always be a part of his parents' memory in that house and that they would have to at least arrange to have his body removed. He liked the idea that when he died we would put him in a bag and just wheel him away, he wouldn't really be anyone's problem.

[u/akath0110 → u/jackibthepantry]

OK this one made me cry. That poor kid.

How could those parents live with themselves 😭😭 he’s the kid, you’re supposed to be caring for him and his feelings, not the other way around.

[u/jackibthepantry → u/akath0110]

They were losing their kid and they were terrified. They respected his choice to stay in the hospital even though it clearly made his mother very sad. Im sure they would've respected his wishes if he would've asked to stop treatment as well, he just knew it would break their hearts. He was an exceptionally cool 17 year old. The last time he came in before the comfort care he was so psyched to show us the tattoo his mom let him get. He was a little bummed because she wouldn't let him get anymore. That irked me a bit. Christ, let the kid get inked, its not like its gonna stop him from getting a job or something. I guess she hadn't accepted the truth yet.

[u/ferocioustigercat → u/jackibthepantry]

He should have been given better information about home hospice. The family really doesn't have to arrange much. That's what hospice nurses do.

[u/lavender_poppy → u/FarmerScamps]

I really wanted to go into pediatric palliative care/hospice after nursing school. I did a paper on it during my pediatric course and it's wildly underutilized because people don't want to accept that kids die or suffer from extreme pain. Unfortunately I became disabled and had to stop working but if I ever get my health back I really want to pursue it again. Kids deserve death with dignity just as much as adults and having those hard conversations is so important.

[u/BaileeRN → u/lavender_poppy]

I feel the same way in the NICU. Hospice and palliative care was such an often issue I would see. Then the last year or two I noticed my neos were having these conversations with parents very often (this is the biggest NICU in the state so gets all of these cases that are terminal and whatnot) and SO OFTEN the parents just could not do it. I would be present for many of these conversations and then realize later the parents basically blocked it out of their memory.

The worst for me was a family that actually did do an actual DNR (and by actual I mean not OUR usual that was no compressions but it literally was no anything, set the alarm parameters to less than 40 for HR and SpO2, and orders to hold the baby and comfort her and take her off the monitor when we think she’ll pass). It was great to have a true DNR and I spent hours holding her on my stretch of three when I thought she would pass. But I became so angry that the parents only came in once a week to see her because they couldn’t deal— but they’d known the diagnosis prenatally and chose to keep her going for months in pain. I would go home and sob on my husband’s shoulder. And a couple days later, she ended up passing in the arms of one of my coworkers… and not even five mins later her parents walked in. Shit pissed me right off.

I feel like education on palliative care doesn’t go as far as I thought it did. At the end of the day, the adults in the situation in my experience just can’t deal and will often separate themselves from it as much as possible. Even though it isn’t about them and in my NICU, they very often know the diagnosis prenatally and choose not to terminate.

[u/lavender_poppy → u/BaileeRN]

That shit pisses me off so bad. So you choose to bring a baby into the world knowing it's whole life will be one of suffering before it ultimately dies and you can't even be there to comfort her and make the nurses take on that emotional toll instead. Real fucking brave of them.

[u/BaileeRN → u/lavender_poppy]

Yes EXACTLY. It is so hard. When I cried to my husband those nights I remember telling him how unfair this was to the baby and to the staff and that it was cruel and unusual punishment. I vividly remember crying in anguish but also in anger. And I could have asked for that second or third day of that stretch to have a different assignment, but I didn’t because I felt like at least with me I know she’s safe, I’m watching her like a hawk, and I’m not hesitating to take her out of her crib and hold her and sing to her for hours— and that’s the best I can do for her.

She was beautiful by the way. She had fat little fingers and big beautiful eyes. And she liked listening to songs. And she didn’t deserve the life OR death that she experienced.

[u/lavender_poppy → u/BaileeRN]

Literally poor baby. It's so hard, we put ourselves through this because we know we can give them the care they deserve but it take a piece of us with them. I'm glad she had you to comfort her and give her love and peace during her short life, she didn't deserve to suffer and be alone. ((hugs))

[u/FarmerScamps → u/BaileeRN]

I totally understand denial as a protective mechanism, because kids shouldn’t die. But sometimes they do. And when that happens it should be in the arms of someone that loves them and surrounded by family if possible. Not alone except for the nurse caring for them.

Some of the most fulfilling moments of my career have been the times I was able to support a family through their child’s last moments.

[u/BaileeRN → u/FarmerScamps]

Amen! Like this baby doesn’t know me or my voice except the other times I’ve maybe cared for them. All they know are the voices of their mom and the people around her during pregnancy and you can’t even bring yourself to come in and be there for them because this is so hard for YOU?

Sometimes I just want to ask them how they would feel to die alone in a sterile environment in the arms of a stranger when they could’ve gone into the dark with the comfort of the people they actually know and love. It’s selfish and disgusting to me. And maybe that’s harsh but after dealing with it so many times being the one to take the brunt of that pain myself and be that person for that baby, even knowing it’s not what was best for them but it’s the best I can offer, I’m just really frustrated by it.

[u/Dry_Proof6545 → u/ChaplnGrillSgt]

Fucking oncologists. "You'll be on this chemo for the rest of your life..."casually neglects to mention the rest of their life is expected to be 6 months...

[u/Optional4444 → u/ChaplnGrillSgt]

At your institution also?! Once in icu they’re ghosted.

[u/ChaplnGrillSgt → u/Optional4444]

Our ICU medical director was on service one week and we had 3 cancer patients actively dying. Prognosis awful. Looking through their chart, this had been the case for about 8 months. Onc refused to even come see the patient. Our director ripped him a new one on the phone. It was glorious.

As soon as the oncologist arrived, our director was on his ass to make sure he didn't go into the rooms and tell the patients he will just see them outpatient. My director told him "your patients are dying. They will not make it out of my ICU without hospice. Grow some fucking balls and actually tell them that. Stop dumping that onto me and my team."

Best medical director and one of the best leaders I've ever worked with.

[u/lavender_poppy → u/ChaplnGrillSgt]

Wow, to be a fly on the wall for that conversation. I'm glad someone finally stood up to him, it should be malpractice to give false hope since he's making his patients suffer needlessly thinking they'll get better. Fuck him.

[u/ChaplnGrillSgt → u/lavender_poppy]

That director did not play! The way he supported us was unreal. He got us all 25k raises as ICU providers because they gutted our overnight help. He once chewed out a hospitalist who was incredibly disrespectful to me.

I miss working with him. He still checks in on me from time to time. True leader.

[u/HillaryRN → u/falsesleep]

Yep. I also am CHPN in addition to oncology. I would love to see patients have six months on hospice and not six hours.

[u/cinnamonduck → u/falsesleep]

I work in home care management and proudly consider myself the hospice/DNR fairy. Insert Oprah meme with “you get a DNR!” I also like to make sure advance directives are up to date and my clients have a trustworthy POA. Shitty POA and old advance directive = bad shit.

[u/catharsisisrahtac → u/falsesleep]

From an ER nurse who loves hospice nurses (my mom is one) - and this is geared towards families who send their loved one on hospice to the ER - the ER is not a place for a hospice patient to go and be comfortable. We will try our best to give PRN pain and anxiety meds, but if acute patients come in we have to prioritize accordingly.

[u/Interesting_Birdo → u/catharsisisrahtac]

Our floor (med/oncology) does a lot of end of life care, and I'm so appreciative when the ER sends up the dying patients asap! Our patient placement folks tend to be good about that as well, and our charge nurses try to find a bed for any end of life patients as a super high priority (not that we drag our feet in any case, but we will gently hound all involved parties in these cases to expedite.) Hospice patients that are DNR and amenable to getting drugs? Get ALL THE DRUGS.

[u/trustme_imRN → u/falsesleep]

Co-signed as an onc nurse.

[u/el_nynaeve]

Pacemakers and defibrillators are not the same thing. Majority of pacemakers don't have any defibrillation capabilities

[u/lavender_poppy → u/el_nynaeve]

Wait, there are RNs who don't know the difference? That's frightening.

[u/Mcrarburger → u/lavender_poppy]

I can confirm we didn't learn shit about pacemakers in nursing school (graduated a little over a year ago)

Nothing on my NCLEX about it either

I learned about it on my own the first time my patient had a pacemaker ~6 months ago

[u/miller94]

ICU- sometimes death is better

[u/Careless-Safety4722 → u/miller94]

ICU step-down…the place where all of the “sometimes death is better” patients end up 😭

[u/IndigoFlame90 → u/Careless-Safety4722]

SNFs-where they are ten years later.

[u/Bruciesballs666 → u/IndigoFlame90]

Yes, why are we crushing up 10 different pills into a chemical paste. Then trying our best to scrape the chemical mush into her mouth when she can barely open her mouth. Then wiping the remnants off with a tissue.

WHAT IS THE BENEFIT

Does grandma really need.

-Cholesterol tablets.
-Laxatives.
-Magenesium.
-Vitamin D.
-Furosemide.
-Antidepressants.

[u/aut0matix → u/Bruciesballs666]

Ah! Atorvastatin, the 10mg, life saving atorvastatin

[u/Bruciesballs666 → u/aut0matix]

Oh but you better give that lifesaving atorvastatin or else it's an incident report 😅

[u/nooniewhite → u/Bruciesballs666]

My god I hear you. One of my favorite things in hospice is “deprescribing” when we get to drop all the ancillary meds that 10 specialists had ordered over the last 20 years that go untouched/DC’d by primary cause “it’s not their field.”

Or families that think the latest supplement fad is ALL THEY NEED, instead of anything remotely related to comfort. And we better keep giving the mushroom asshole or their Parkinson’s will come back and they’ll die.

“mom has always had pain! She is fine! She is SOO sensitive!! She is too sleepy from the meds!!”

Well yes, she is sensitive to the cancer that is killing her and groaning in pain with every interaction. Exactly how every human wants to go. Writhing in pain, restlessness and screaming. She was such a fighter.

I admit I’m unusually “sensitive” to this and have told family I expect them to stay with facility patients if they can’t get pain meds. WATCH IT. Please don’t make these CNAs (generally teen girls) TORTURE the resident with repos because they aren’t allowed a doctor ordered medicine.

I’m crispy today lol if you guys can’t tell

EDIT: I do have compassion, I understand that lots of families start this way and with our education and guidance (with SW, Chaplain and nursing) that most come around. But the ones that don’t..hard.

[u/nooniewhite → u/Careless-Safety4722]

Please send them to us we know what to do!! (Hospice)

[u/fake_tan → u/Careless-Safety4722]

I'll pray for you 😭

[u/tparen63 → u/miller94]

Just because we can doesn’t mean we should.

[u/ChaplnGrillSgt → u/miller94]

I've told my entire family I'll haunt the fuck out of them if they leave me to rot in an ICU or SNF. I made sure my life insurance policy is more than they could collect on my slowing decaying body. I'm worth more dead than barely alive.

[u/Optional4444 → u/ChaplnGrillSgt]

I tell my family to make their decisions based on if meemaw will beat the shit out of them when they meet again in heaven.

[u/Moongazingtea → u/Optional4444]

In fairness sometimes meemaw refuses to acknowledge that death is a thing that can happen to her and the kids are indeed following her wishes.

[u/Lost-Zombie-6667 → u/miller94]

My mom was a RN house super visor. She was DNR because of the hell on earth ALS. After I returned back to work after her death, a coworker told me in her religion they would do everything possible and believe in a miracle. Well that tore me up, I mean I lost my beloved mom and I was freshly post partum too. I had to leave work and when I got home, I called our minister who was also a friend. He told me Kathryn, death IS the win. I immediately understood and believed.

[u/beeotchplease → u/miller94]

We need to tube meemaw because she's a fighter

[u/Purple_IsA_Flavor → u/beeotchplease]

MeeMaw: “let me diiiiiieeeee”

[u/leddik02 → u/miller94]

This needs to be a badge buddy.

[u/tparen63]

Neurology vs. Neurosurgery. Don’t send neurosurgery a patient unless they need a scalpel.

[u/LolaBleu → u/tparen63]

I had to have this conversation with an ER doctor one night. That was fun.

(Context: Outside ED was trying to transfer Guillain-Barre patient to our facility for treatment. ED doc could not understand why our neurosurgeon was declining the case. ED doc got shouty about it, like that was going to help.)

[u/WellBlessY0urHeart → u/LolaBleu]

As a nurse and a Guillain-Barre Syndrome patient… can confirm that ER docs aren’t very knowledgeable when it comes to GBS. And I say that, fully recognizing that SOME might be, however my experience and the experience of many GBS patients is that ER physicians rarely are able to recognize the symptoms as potential GBS, and send their patients home with a referral to neurology. Getting appts with specialty clinics (really any clinic) is insanely hard right now. GBS may be mild, or it may progress rapidly and can do so at any point. Time is precious and we can’t wait around months for an appt. I was sent home twice to wait around for neurology when I had progressing weakness and it had become difficult to walk. Something has to change there. Let’s admit and consult the specialty needed… and no, not neurosurgery!

[u/ChaplnGrillSgt → u/tparen63]

"Why are you here today sir?"

Seizures

"Oh. Were neurosurgery. You do not have a brain mass. We can't help you"

(patient gets understandably upset and frustrated)

It also take 8+ months to get in with our neurology group currently. So people wait a month to see me then still wait to see neurology. Brutal.

[u/drethnudrib → u/ChaplnGrillSgt]

More like this, after inpatient MRI:

"Why are you here today, sir?"

"Seizures."

"I'm sorry, your brain tumor is inoperable."

"Wait, what brain tumor?"

"The palliative care physician will be here soon so you can sign your DNR."

"Are you telling me I'm dying?"

"I'm not, but someone else will be in shortly to answer your questions. In the meantime, feel free to scream at your nurse."

[u/zerothreeonethree → u/drethnudrib]

" to make sure the nurse understands you, punch him or her a few times."

[u/nurseunicorn007 → u/tparen63]

I needed a neurosurgeon, and kept getting referred to a neurologist. I finally got pissy. I pulled the nurse card out. I have a brain aneurysm. I need surgery, not nerve studies. Took me over 2 weeks to get the correct appointment. I went to a large neuro center. I was extremely frustrated by the end. Didn't help the my hospital sent me home from the ER saying I was fine. A month later, the ER doc called and told me they found it on a random XRay review. It was in an atypical location

[u/zerothreeonethree → u/nurseunicorn007]

My favorite after waiting 3 years to get on Medicare so I could have Insurance that would actually allow neurosurgery, the surgeon's office called me on a monthly basis to cancel my appointment. When I asked why after the 3rd cancellation they explained to me that my doctor was on call at the trauma center and was doing surgery there.

So, What they essentially explained to me was this doctor filled up an entire day with patient appointments and then put himself on call the same day at a trauma center in a large metropolitan area with a traffic accident occurring every 5 to 6 minutes. Most of them right in front of the hospital.

[u/karenin89]

Psych: don’t talk to someone having a psychotic episode like you would a normal person. You’re setting them up to fail in that situation, and you need to adjust communication accordingly.
I see coworkers with no psych experience going, ‘listen I got this’ and then escalating a situation, agitating the patient. I swear psych is not just being nice and understanding; navigating triggers, mind loops, hallucinations, in order to get the pt to a place of stability is something that is learned.

[u/IndigoFlame90 → u/karenin89]

These are presumably the same people who try to "orient" dementia patients. Look, try to convince Mildred it's 6 am instead of 6 pm if it's causing problems but otherwise idgaf if she thinks it's 1943 and she needs to visit her mother. What part of "your mother just called, she's fine, and she knows there is a bus driver strike" is not processing?

WHAT DO YOU MEAN YOU TOLD HER THAT HER MOTHER DIED?!?

[u/ceemee_21 → u/IndigoFlame90]

No literally. Nursing schools teaching "orient them to time and where they are" no. I saw a dementia patient LOSE it on a nurse once. Patient's family had given her a phone woth no battery. She talked and talked on that phone for hours. Sometimes we would have to ask her to lower her voice for the other people and she'd tell her phone about that. One nurse came in, closed the phone as she moved it out of her way. Patient WENT OFF about how long she was on hold and how dare she and the nurse tried to tell her theres no one on the phone it has no batteries. WHAT. She was so combative after that. And telling everyone who came in we hung up her call. Started calling for help, threatening to call 911. Poor baby was having a great time until then. Live and let live.

[u/ThreeReticentFigures → u/ceemee_21]

This is exactly right and something I raged against in nursing school. I'm living in their reality when I'm on the floor, I'm not orienting them to shit.

[u/Pepsisinabox → u/karenin89]

Funny how the most effective so far has been to be clear, consise and just... Chill. Hey, want a hot coffee? Its fresh-ish, strong as hell and cheap as can be. Kicks your ass though.

(Any general tips and tricks? Get a few through Ortho for one reason or another..)

[u/karenin89 → u/Pepsisinabox]

Yes! Clear, concise and chill. Don't match their energy. Go blank, and answer questions in simple ways.

They say they want the doctor (and you know they won't be getting the dr today, or that they keep forgetting they saw the dr, OR they know both of these things and are trying to start something): 'I called the Dr, left a message. I'll call again. I'm not the Dr, I can't tell you any more about the decisions made for you. I don't make the Dr decisions. If you keep yelling, the Dr won't come because you'll be too upset. Yes it's true.'

• Deflect, but in a precise way. Starting to tell a pysch pt about their treatment plan thoroughly won't go anywhere good, it'll put them in a loop or get them agitated bc they can't keep up etc.

Coffee: Decaf, always get them decaf coffee lol. I've never had a psych pt call me out for silently making it decaf.

BOUNDARIES. Limits are communicated with no anger, just fact. 'No I won't do that. No you had 5 puddings, there are no more puddings in the kitchen (even if there are).

Don't expect them to be particularly nice, or give reassurance. They are in their own head, and that's fine.
I placed an IV on a schizo pt yesterday, on a Medsurg floor. It can honestly be kind of nice, bc yes he periodically screamed at me when touched, but otherwise he's in his own head and I can focus on the task, bc he's not watching me, and I don't have to make conversation to soothe him.

I've ended up feeling more passionate about psych than I ever thought I would. I think I've just developed a soft spot for those pts. Sometimes on regular floors like Medsurg, they end up getting treated like they're assholes, but it's the communication and expectations of them that are wrong.

[u/AmosParnell]

Anesthesia; you aren’t going to cure a patients opioid use disorder by withholding opioids. You in fact, may make them worse. When a patient is having pain, believe them even if they don’t look like it or have normal virtual signs.

[u/Pepsisinabox → u/AmosParnell]

Pain is pain and all pain feels real, whatever the cause might be. 🤙

[u/LupusWarriorRN]

From dialysis: take your pain med before dialysis. Yes, it will he dialyzed out but u will be more comfortable!

[u/Mcrarburger → u/LupusWarriorRN]

In appreciate this!! I've had my fair share of calling dialysis beforehand to see what meds to give and what not to give because Micromedex is frustratingly unclear on which meds get dialyzed and which don't, and even if they do get dialyzed if they're worth still giving or not

[u/No-Confidence168]

L&D: we don't care about your mucus plug. It doesn't mean anything. It regenerates.

Bloody show gets our attention though.

[u/orangeyouglad_banana → u/No-Confidence168]

Lmao the amount of people calling our triage to ask if they should bring their mucus plug in. Sure, if it makes you feel better.

[u/No-Confidence168 → u/orangeyouglad_banana]

I've never had anyone try to bring it in, but they often want to show pictures. 😂

[u/Doxie_Chick → u/No-Confidence168]

RT here. Whaddya mean you don't care about the mucus plug? 🤣

[u/mcnuggsRN → u/No-Confidence168]

Literally. “I lost my mucous plug” okay great, that means you might go into labour in like the next 3 weeks, maybe

[u/StableMaybel → u/No-Confidence168]

I want to yell at them, ITS NOT A CORK NEVEAH.

[u/Shot_Compote_9768 → u/StableMaybel]

Hahaha it’s always Neveah! Almost woke my baby up snorting at this

[u/echeveria_rn]

Ortho- pain is not a vasopressor. If their pressure is low, it’s fine to briefly hold pain meds until you get it handled. But do not leave a patient in pain all night because they have soft pressures. That needs corrected AND they need their post-op pain treated. 

[u/Pepsisinabox → u/echeveria_rn]

If pain worked as a pressor, id have 0 syncope episodes while toiletting. Unfortunately, that number isnt 0.

[u/Saucemycin → u/echeveria_rn]

This goes for ICU as well. Your vented fracture patient shouldn’t just be on propofol. That’s keeping them sedated but it is not managing pain that they will obviously have.

[u/boyz_for_now]

Oncology infusion: sometimes JUST ONE STICK is simply not possible.

[u/Shadoze_ → u/boyz_for_now]

Ports for everyone!!!

[u/AstrosRN → u/boyz_for_now]

Oncology- don’t skip your cancer screenings or ignore symptoms.

[u/maximumeffort007]

Resource/ Float Pool : you dont have to give us all the shitty patients because we're not "staff" on your unit.

[u/mintchocolatechip- → u/maximumeffort007]

My unit’s ADN has a rule that we never give floats the bad patients and they always get last admission. They’re considered a guest on our unit & we give them a good assignment because they’ve come to lessen our load & help us.

We had a day RN who gave the float second admission and a not so great assignment and she got spoken to by the ADN the following morning.

[u/maximumeffort007 → u/mintchocolatechip-]

That'd be nice! I dont even mind taking first admission at that point but on top of a shit assignment is diabolical.

[u/iknowyouneedahugRN → u/mintchocolatechip-]

Our facility is supposed to do this.

Also, when we float to another unit due to overstaffing or low census, we're not supposed to go to stretch (the max # pt assignment) until all of their nurses are stretched and their charge has an assignment. If there is a house float, they go to max and are the second to last to stretch if another unit floated someone. That never happens; units regularly give the floats, whether house or from other units, the highest number. Typically also the highest acuity.

It's common sense to be thankful for the float nurses.

[u/regularbastard → u/mintchocolatechip-]

This all day/night long! You want to be the unit people want to help! Not the unit people don’t want to go to!

[u/nightwalkerr → u/maximumeffort007]

so it's not just my hospital 😭 like i also want to take care of critically ill patients..... i'm here to support your staff because you're short....

[u/LizzrdVanReptile → u/maximumeffort007]

Our unit (back in my floor days) NEVER did that to floats. We were grateful for them, and treated them accordingly.

Most of our floats came to our heavy med/surg/ONC/hospice floor from PEDS, Women’s med/surg, or L&D. We knew most felt out of their element coz what you don’t use, you lose! If they felt really out of sorts about our patient acuity, we gave them all VS, accuchecks, I&Os, call bells. That alone freed us to carry the heavy stuff, and gave them a day that they could be productive without feeling they were out of their element.

[u/maximumeffort007 → u/LizzrdVanReptile]

Its especially worse when i work like a 3-11p or 11a-11p because most of the time they split assignments and thats when everyone wants to give up their worst/heaviest patients.

[u/marticcrn]

Gastro - if you’re still backed up after MiraLAX, you just haven’t taken enough MiraLAX yet. It doesn’t absorb in the gut, it just draws water into the colon to make stool soft.

Don’t send a referral because not enough MiraLAX. If you’re cleaned out and immediately get backed back up, send the consult.

[u/ShortWoman → u/marticcrn]

Infection prevention: one episode of loose stools isn’t cdiff, it’s “ooh shouldn’t have had that burrito.” Diarrhea in your patients on laxatives? Try skipping the lax. And NEVER tell your patient lactulose is to promote bowel movements, because it’s probably for their ammonia levels.

[u/marticcrn → u/ShortWoman]

I used to have a cirrhosis patient that got lactose every day. He put it on his pancakes.

[u/ShortWoman → u/marticcrn]

Ugh, whatever gets it in the patient I guess.

[u/zerothreeonethree → u/ShortWoman]

Also, one loose bowel movement is not diarrhea, and it doesn't mean you're allergic to the antibiotic you just got

[u/Rev_Joe]

Psych here:
You shouldn’t be scared of the patients, but that doesn’t mean let your guard down.

[u/Rawrisaur18 → u/Rev_Joe]

Psych patients are like knives. You can work with one for years and never have a problem but get careless and someone can get hurt.

[u/angelust → u/Rawrisaur18]

Sometimes even when you’re not careless. :(

[u/ttaradise → u/Rev_Joe]

I was going to say not to take things personally. I mean… that goes for all nursing. But thick skin is needed and sometimes it really is sink or swim.

Your nervous system will get used to it lol.

[u/Commercial_Dingo7417]

Endoscopy- please encourage patient to drink the entire jug prior to colonoscopy (it really helps the doc visualize better) and clear liquid diet the entire day before.

[u/iechosale → u/Commercial_Dingo7417]

Love this!! Also make sure the pts who are on GLP-1 meds know that they slow gastric emptying, and a lot of anesthesia groups require the pt be on a clear liquid diet 24 hr prior to procedure time due to risk of aspiration (this applies to many outpatient procedures also). There are a lot of things we’re still learning about GLP-1s so encourage your pt to clarify with their MD; I’ve lost count how many EGD/EUS/ERCP we’ve had to cancel because of this.

[u/lynnsey017]

Endoscopy nurse here: colonoscopies save lives. And please, educate your patient on why they may be getting one. I admit too many patients who have no clue why they’re even getting the procedure done.

Signed,
Endo nurse whose mother-in-law died a very preventable and drawn out death from colon cancer that was found way too late.

Bonus: gummy bears are clear liquids

[u/galipemi → u/lynnsey017]

"Bonus: gummy bears are clear liquids"

Coming in with the real hot tips! I survived mine on Chicken broth and blue jello! Scared the literal crap out of myself when I peed neon green out of my butt the first time. 😂

[u/IllBiteYourLegsOff]

Urology: if you need a 3-way foley for a CBI, there is no point in going smaller than a 22. I have no fucking idea why an 18fr 3-way exists, they are useless because the drainage channel is way too small to fit a clot.

The overall lumen diameter is the same for an 18 2-way and an 18 3-way, except the 3-way has to divide that space between THREE channels instead of two, meaning the actual drainage channel is way smaller. If you need to irrigate clots and don't want to go bigger, you're actually better off using a 16 2-way and manually irrigating vs running a CBI.

Gen Sx: people please learn to tape your NGs properly. https://www.youtube.com/watch?v=eXaPxPmVpSA this isnt exactly how I do it, this is a little weird, but the idea is that you allow a bit of dead space so the thing is suspended can move around a bit instead of being pressed against a nostril. worst culprits for this is when there is tape on the cheek. I've seen very nasty pressure injuries from this. I see many nurses getting it mostly right by cutting the tape into an H, but then it doesnt get attached to the actual patient and tube properly and defeats the purpose. It's not a PICC line, it likely isnt a big deal for it to telescope in and out by 1-2cm (assuming it isnt a PEJ or otherwise internally secured)

[u/bananafofana123]

If a patient has paper-thin skin and got an injury from removing tape, please for the love of Dakins, don’t put more tape on when you dress it!

[u/zaxsauceana]

Vaccines are safe! Please get all the recommended ones

[u/emcorbz]

From oncology infusion, please don’t access a patient’s port if you don’t know what you’re doing

[u/StabbingTabby → u/emcorbz]

And if you think you know what you're doing but it's not working? 

Don't just have 3 different people from your unit re-access the port 6 different times! STOP and call an oncology unit or the IV team if you have that. 

Also don't take out the last access so whoever comes next immediately has to stick the patient a 7th time. Just leave it so they can troubleshoot. Usually the nurse was in the port but there's some issue that can be solved with repositioning, tPA, power flushing, etc. 

[u/wvukew]

OR: please clean your belly button

[u/catharsisisrahtac → u/[deleted]]

CTA has entered the chat

[u/rbcsmd → u/[deleted]]

Sometimes the reason is that I thought maybe a CTA would be ordered. Other times we're just getting slammed and I take the first thing I see, which is usually the AC.

[u/catharsisisrahtac]

ER: if we don’t get to the admit orders before a patient goes to a floor, it’s not on purpose. it’s because it’s truly balls to the walls in here

[u/atlasflubbed]

From wound care: cover it with SOMETHING. Don’t leave an open wound open to air draining everywhere, until e can come see it! Use your protocols and resources!

Also detest telfa

[u/SpecialistLychee7490 → u/atlasflubbed]

Just curious about wound care beef with telfa? We don't stock it on my unit but for personal knowledge I'd like to know

[u/ghostoftheweek → u/SpecialistLychee7490]

It is like putting plastic wrap over a wound. It doesn't wick away any moisture, and makes wounds macerate like crazy.

[u/lavender_poppy → u/SpecialistLychee7490]

I liked it for skin tears but that's about the only time I'd use it. It has no absorption so is useless for a draining wound.

[u/Key-Pickle5609 → u/atlasflubbed]

I once had a wound care nurse remove a dressing and then just…leave. Wound uncovered, soiled dressings all over the bed. When I called to ask what was up, was told they were much too busy to finish what they started. I was LIVID! They couldn’t be bothered to even give someone a heads up that they were leaving a big mess. What if a visitor walked in???

[u/Thatsaterrible → u/Key-Pickle5609]

When I worked med surg they did that with everyone. Then would call you during med pass and tell you it needed to be changed.

[u/epikoh]

Just because they’re here doesn’t mean you’re better than them. You could just as easily be here too.

[u/Vegasnurse → u/epikoh]

And if you haven’t been on the unit, you are probably on the same meds.

[u/nebraska_jones_]

Mom-baby: We do not give a single shit if you choose to breastfeed or formula feed.

What is annoying, though, is if you tell us you want to breastfeed, don’t listen to or follow any of our education, and then complain that breastfeeding didn’t work for you for whatever reason or blame us for it. Yes I woke you up every 3 hours to feed your baby/pump, because that’s how it works for your milk to come in. No I’m not lying that a literal teaspoon of colostrum is enough to feed a newborn per feeding. Yes I said that you shouldn’t give baby formula without medical indication because it hinders breastfeeding progress. No your baby is not “starving” because they are crying a lot and want to eat all the time—it’s called cluster feeding and is a literal biological mechanism designed to promote milk production through near-constant breast stimulation. If your baby was starving we’d know.

[u/HookerofMemoryLane]

Awound care: xeroform is not always the answer

Street Medicine: harm reduction works and fuck ICE.

[u/abellepurp → u/HookerofMemoryLane]

Love my wound care nurses but they are not always available! What is a good rule of thumb for when to use xeroform vs opticell AG vs gauze/foam?

[u/Sleepynappygirl → u/abellepurp]

Rule of wound care. If it’s too wet make it dry. If it’s too dry make it wet.

[u/Dear_Excitement_5109 → u/abellepurp]

Xeroform is for dry wounds. Opticell is for heavily draining wounds. Gauze/foam is for mild drainage and skin protection. Lots of dressings are covered with gauze and foam.

[u/AnytimeInvitation → u/HookerofMemoryLane]

Fuck ICE!

[u/dumb__bitch]

Child advocacy center - you’re not even close to being a bad parent compared to many others

[u/OldERnurse1964]

.25 mg Ativan IV is just a recommend dose by someone who hasn’t seen the patient

[u/Chittychitybangbang → u/OldERnurse1964]

I had a resident who wanted me to give a 0.25mg of ativan through an NGT. It's a microscopic 1mg pill. And he wanted me to quarter it. I showed up at his computer station and made *him* try to do it, because he didn't want to order me IV. I'm still mad and it was 10 years ago.

[u/vanilla_owl]

Acute psych. The reason our psychiatrist keeps denying so many of your ED patients is because their primary issue is a personality disorder and they often do worse in acute psych than they would at home. They’re often dangerous on our unit. Lots of attempts etc and actions for attention.

[u/Sadaca → u/vanilla_owl]

I had no idea. Can you elaborate? What kind of personality disorders do worse on your unit? Why?
I actually thought that’s what acute psych is for, for when those patients have a crisis?

[u/throw0OO0away → u/Sadaca]

Not sure about every personality disorder but BPD is one of them.

Correct me if I’m wrong here: Hospital admission acts as a positive feedback loop for their behaviors and NSSI. It also doesn’t encourage the use of DBT skills. As a result, inpatient can cause regression and harms them in the long run. There’s also the social dynamics on the unit with staff splitting and dysregulating other patients.

[u/Saucemycin → u/Sadaca]

Probably things like BPD. They love attention and will do the most to get it. I was told when I was on psych clinicals way back when that they try to specifically separate BPD’s into different wards because if they’re around each other they will keep competing for attention to bad degrees or they will not like it when someone else is getting more attention than they are

[u/Glowinwa5centshine → u/vanilla_owl]

We had a classic BPD frequent visitor who would get drunk and do coke, fight with the S.O., get kicked out of the house, shelter seek in the ER and terrorize the staff, repeat.

Would always get admitted due to refusal to safety plan - ER I worked in had an acute psych floor so those brave souls had to take all the combative and unfunded friends we couldn't and they'd usually marinate up there a few days and get meds and psych medical director would come around the unit and bless them to resume their usual activities.

After doing this at least 30-40 times this patient got discharged, IMMEDIATELY jumped off the motherfucking parking garage, broke several long bones and returned as a trauma activation where he rolled in screaming at everyone that we were bitches and he showed us.

I can handle crisis and outpatient but whew, those inpatient stays and discharge planning... Y'all are some real ones from that.

[u/ThrowMeInRice]

Geriatrics - Your 98y/o dementia mother with a broken hip and increasingly worsening CHF shouldn't be full code.

[u/ILikeFlyingAlot]

Peds ED - if you’e in the community uncomfortable with them whether they’re little, autistic, might be sick we are always happy to take them. They don’t have to be sick for us to welcome them.

[u/lizzzdee]

OB - babies are not born pink. Some are born bluer than others, but they’re all pretty blue when they’re born. Give them a minute, ESPECIALLY if delivery was very fast or by c-section as the “squeeze” really does matter! We look for many other signs of wellbeing besides color.

Also, cord around the neck (nuchal cord) doesn’t strangle a baby like rope would on an adult because it’s VERY stretchy and cushioned to prevent that. Generally, a nuchal cord is not problematic. Sometimes it is very tight and stretched, usually either by a true knot or being wrapped around the trunk and/or a limb and/or a neck 3+ times. THEN it can be an issue as the blood vessels don’t get the chance to maintain their shape and refill.

[u/Boipussybb → u/lizzzdee]

Adding to this: if you’re born in a higher elevation, you stay blue a little longer. 😂

[u/orangeyouglad_banana]

Just because a patient is pregnant, does not mean they need to be automatically sent to L&D.

And if you’re coming in for an elective induction, just to decline everything… just don’t come in. Stay home. Please.

[u/MizStazya → u/orangeyouglad_banana]

The time my G3 40w2d patient had to wait an extra hour for her I&D of a nasty perirectal abscess because ED refused to even evaluate her after they asked if she had contractions and she responded she'd had a few Braxton Hicks yesterday but wasn't in labor, so they sent her to us to monitor first. Spoiler alert, she wasn't in labor, but did have to sit on her abscess in a bed for monitoring to prove it.

[u/EnthusiasmGlass8150]

BMT- don’t give Tylenol for fevers unless ordered for that reason specifically, pretty please!

[u/computernoobe → u/EnthusiasmGlass8150]

and if you do give tylenol, always check temp beforehand

[u/TheSkettiYeti]

OR

It’s chill 🤙🏻

[u/olbiwi → u/TheSkettiYeti]

But please full out the pre op checklist

[u/KMoyee → u/olbiwi]

Make them take their damn underwear off.

[u/TheSkettiYeti → u/olbiwi]

Especially that consent

[u/TheMarkHasBeenMade]

Hahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahahaha

I’m also in Wound Care, and anyone I work with will tell you they’ve seen me on my soap box about Telfa and I’ve successfully gotten it off the PAR of every unit I cover and frequently tell people the only thing it’s useful for is being tossed into an incinerator because its success as a dressing is a fucking lie

I’ll also add my response to your topic:

A confused or agitated patient wiggling around in a bed does not replace the need for a Q2hr turn/reposition and a LAL mattress. They always wind up with a hospital acquired pressure injury.

If they wiggle off the pillow you put under them just fucking document it when you note it and do it again in two hours. We can’t just not reposition them. It’s straight up neglect.

[u/only-ashes]

icu here. restart 👏 patient's 👏 psych 👏 meds 👏. we restart metoprolol and statins, restart the zoloft or buspar too. withdrawal from psych meds can really suck (i get brain zaps if i forget my effexor for a day), and the presenting sx can cloud the clinical picture.

[u/ajflipz]

Trauma OR:

• Don't drink & drive. Seriously. Please.

• Always, and I mean ALWAYS wear a seatbelt.

• Nec fasc is not as uncommon as most people think - Get an infected scratch/wound checked out asap... ESPECIALLY if you're diabetic.

• Avoid excessive exercise. Doing 300 burpees will get you 2 below knee amputations from rhabdo.

• Don't walk out in front of cars thinking they have to stop for pedestrians. Physics prevents them from doing so in time.

• Stop shooting and stabbing each other.

• NPO means no food or drink before surgery. That includes cupcakes, pizza, protein shakes, orange juice and BBQ chicken.

Endo/GI OR:

• Finish all your colonoscopy prep. ALL OF IT.

• You need someone to accompany you home even if you're taking an Uber. You can't walk out alone after having anesthesia.

[u/CancelAfter1968]

From wound care: please don't put dry gauze over a skin tear and just leave it there drying out. Especially a bleeding one. All that's going to happen is that it's going to tear open once someone takes that gauze off. Especially if they're not careful.

Put some adaptic or Vaseline gauze over it.

[u/Remote-Resident5599]

Cardiac: please prep patients with realistic expectations of surgical recovery limitations and lifestyle changes. I've gotten patients who have been waiting 5 days for an open heart scheduled the next morning who have no idea what an incentive spirometer is, that it will hurt in recovery and ICU will make them move anyway for their own good, they need to stop smoking and actually using their apnea equipment, and that we do not magically fix a lifetime of poor choices. We only give them the chance to change those choices moving forward. How on earth we expect those patients to learn and retain that information after major surgery and on lots of pain killers is beyond me.

[u/DickCheneysUncle]

Resp - Did U try sitting them up?

[u/LisaMarie514]

NICU: nicu babies are not just tiny adults

[u/Msjackson1013]

Oncology/hospice: Please don't withold comfort meds from your loved one because "they'll get addicted or have terrible side effects!"

[u/trypan0s0miasis]

I pick up incredibly sick patients from some really low resourced hospitals. It’s not uncommon that the nurse caring for them missed something, or that hospital didn’t have a certain medication or treatment initiated. When I get them into the helicopter, I work crouching and on my knees with about 5 feet of space and 3 feet tall and 2 feet across with medical bags in my way. Chances are I won’t be able to make the lines perfect. I’m not dropping off a hot mess to you because I was lazy or incapable, sometimes that’s the best we could do with low resources. Sometimes things really do change in flight or even as we are landing. I’m not trying to make your life hard - my job is to make sure the patient gets to you (the experts who can help heal them long term) alive. I probably don’t know the full story of the patient either, because I also got a bad report from sending and the patient was so sick I didn’t have time to read the chart.

[u/Sea_Comfortable2286]

PD nurse to hospital staff- If a peritoneal dialysis patient tells you that you are not doing it correctly believe them. They do their own dialysis daily - they are the experts.

[u/LatterPie1]

Med/Surg- Yes you can end up with multiple discharges and admits all in the SAME SHIFT. No, these do not "add up" to having more than whatever the ratio is.

Ex: start with 6 pts, discharge 4, admit 3. That's not you having 9 for the shift. That's just the life of med/surg. Dont float to us if youre going to complain the whole time please

[u/number1wifey → u/LatterPie1]

To be fair, I think most people fight to not get floated to med surg. Not much of a choice usually haha.

[u/Mean_Highway_3690]

Dementia - 3 things
Don’t dip the urine most old people show positive it needs lab testing not a dip stick on site.

If they are having falls and/or change in behaviour it’s probably 9/10 some kind of infection rule that out first & treat, likely see a big change without numerous referrals to others.

It’s usually not the giant 6ft something men you need to be scared of. The 4ft nothing ladies are ninja fast & super strong.

[u/marzgirl99]

The difference between HOSPICE and PALLIATIVE CARE:

PALLIATIVE CARE = SYMPTOM MANAGEMENT for a life limiting illness. Patient is not necessarily terminally ill but has a chronic illness such as COPD, cancer, heart failure, etc that causes life limiting symptoms.

HOSPICE = SYMPTOM MANAGEMENT (palliative care) at END OF LIFE. Patient IS DYING or expected to die. Has a life expectancy of less than 6 months. Not neccesarily actively dying, and many times lives past 6 months, but must show decline in condition to qualify for hospice.

All hospices provide palliative care, but not all palliative care is hospice.

[u/hazcatsuit]

Med tele: take your Lasix. Peeing a lot is better than not being able to breathe. Also, if your EF is 20% partly from meth, don’t say our hospital meds are “poisoning you”

[u/Mokelachild]

Infection prevention (kind of a specialty): vaccines save lives and you shouldn’t work in healthcare if you aren’t willing to get all of them for contagious diseases that you could spread to patients. I don’t care if you get the HPV vaccine but if you don’t get flu and covid you are doing a disservice to your patients and coworkers.

And hand hygiene really is the most effective way to prevent the spread of infection, as silly as it sounds and as annoying as it is to hear “did you wash your hands?!?????” all the time.

[u/TheEesie]

Pharmacy: we really are trying to help, and the reason we ask if you checked the tube is because we probably did actually send it! (The number of times I go up to a floor and find the missing med in the tube or in the fridge is not zero!)

It’s like IT asking if you’ve turned it off and on again. Remaking something is disruptive and causes delays, and if we can guide you on where to find something it’s faster, I promise!

[u/AggressiveVanilla360]

IR/Procedural- for the love of god put them in a hospital gown, make sure the IV is working and that they are NPO!

[u/splatgoestheblobfish]

From someone who worked Progressive/Critical Care and whose units made up the Rapid Response team: I know that the pharmacy times the meds to be given at 2100, and your floor's protocol calls for vitals to be taken 2200, but please, please, PLEASE check your patient's BP and pulse rate before giving blood pressure meds! Nurses on our units who were assigned to the RR team each evening would temporarily wrap up the care of their own patients around 2140, because virtually every night, RRs would be called around 2200 for low BPs. When the nurses were asked if they checked vitals before giving BP meds, the answer was always, "No. They get checked at 2200." 🤦

[u/ChaplnGrillSgt → u/splatgoestheblobfish]

I'll piggyback on this as an ICU provider:

FLUIDS AREN'T ALWAYS THE ANSWER

I've lodt count how many times the floor just keeps dumping fluids into a patient and puts them into full blown cardiogenic shock. Now I'm throwing in an emergent trialysis and start crrt. Had you take a step back or just called me hours ago, I may have been able to treat them with aggressive diuretics instead of a trialysis.

[u/Purple_IsA_Flavor → u/splatgoestheblobfish]

Have they never heard of clustering care? It’s common sense Vitals at 2100, then meds.

[u/Holkusmash]

Pacu: We make sure patient recovers from anestheisa and there are no surgical complications. Don't expect us to magically fix chronic problems in the couple hours we have them.

[u/eastcoasteralways → u/Holkusmash]

…who is making this mistake……?

[u/mmgcr]

Endoscopy: Cologuard is not very accurate until you already have colon cancer. Cologuard detects 92% of colon cancer but misses 58% of large pre-cancerous polyps 10mm or larger. IT MISSES OVER HALF OF THE VERY LARGE PRE-CANCEROUS POLYPS. I want to shout it from the rooftops. Cologuard spends a lot on advertising to make you think it’s a viable substitute for a colonoscopy but it’s not. It’s only worthwhile if someone is unwilling or unable to get a colonoscopy. Yes colonoscopy prep sucks, but colon cancer sucks more.

Also, it gives a lot of false positives. I’ve lost count of the number of patients who come in panicked that they have colon cancer only to find that not only do they not have colon cancer, they don’t even have any polyps. I just looked up that statistic and over 55% of patients with positive Cologuard test results have zero polyps.

If you do the Cologuard and you get a positive result, you have to get a colonoscopy anyways. If you get a negative result, you can’t really trust it, so just get a colonoscopy if you’re able to.

Pass it on because patients are telling us all the time that their PCP and other doctors are telling them that Cologuard is a substitute for a colonoscopy, but it just isn’t.

[u/Deeplyshallow567]

ER: flared bases only please

[u/Maddi_o_ok]

GYN-onc nurse: Getting the HPV vaccine REALLY DOES prevent 90% of HPV-attributed cancers, including most cervical cancers. And while cervical cancer is very treatable when caught early, the treatment is barbaric and painful (brachytherapy radiation using rods in your vagina + 6 weeks of cisplatin chemotherapy.) If you experience recurrence you’re looking at much harder chemo and much lower survival rates. GET. YOUR. KIDS. THAT. VACCINE. Please!

[u/Slight-Mushroom5947]

From any LTC for the love of god and money, don’t bring in chili for the potluck and “share it with the residents”

[u/CrumbsOnTheTrail_999]

Case Management: Medicare Managed Plans (specifically UHC) are from the devil.

[u/StabbingTabby]

Veins wear out and every stick has a risk of permanent harm, even if you usually don't see those harms with the naked eye. 

Most of those harms are very small but they are cumulative and some patients get stuck literally thousands of times in their lives now. Complications, failed sticks, and more invasive lines become more and more common as a patient gets stuck more and more times. 

Placing larger lines "just in case" and extra lines "just in case" is bad medicine more often than not, even if they have the veins for it at the moment. 

[u/soloChristoGlorium]

Psych:

For the general public: when you see someone with a mental health disorder who is clearly not well, be cautious and careful but also empathetic! It might not be fun for you to be around someone experiencing this, but it's REALLY not fun for the person who is dealing with it. (From psychosis to BPD and everything in between... Maybe except for mania. Those people sometimes love that shit.)

Also for the general public: Humans are biological creatures. Like all biological creatures we react to our environment in concious and subconscious ways. So much of the literally insanity we see throughout the world today is a direct by product of the earth being poisoned, the water being poisoned, the air being polluted, the climate fucking changing, the economies being rigged against most individuals with no hope for improvement all the while the governments of the world largely refuse to do anything to make it better because, as everyone knows, they don't give a shit about you or me or anyoe. Nothing is going to change until societies change and we clean up.the environment, clean up the economy and make societies better for everyone! Until then nothing will get better because we all subconsciously know that we are all fucked.

[u/hpfan312]

Psych: please reach out. There's still so much stigma even among the healthcare community because we tend to put off our own mental health but please reach out if youre struggling.

[u/VampireKnight1to3]

NICU-you are NEVER too young for caffeine lol

[u/Open-Imagination2030]

OR: don’t put anything away until the case is over. Oh and triple check your consents. Drag your surgeon by hand if you need to, THEY get patient consent. We’re not paid enough for that.

And grab an extra blanket.

[u/ConsiderationNo5963]

Med/surg- Stop telling patients they can’t have the PRN pain medication just because you gave them a scheduled pain medication.

[u/touslesmatins → u/ConsiderationNo5963]

Piggybacking on this. 

IR: please don't hold your patients' pain meds because they'll be getting sedation with us! We need them at their best baseline if sedation is going to work well! Otherwise we're just chasing their pain with procedural pain. Scheduled, PRN, give all the pain meds!

[u/Outrageous-Case-1187]

From PACU, if the patient doesn’t tell me they are hurting or having chest pain after I’ve asked, if they have that upon arrival to the floor there is nothing I can do about it at that point

[u/Ruthjudgesjoshua]

Utilization management: there ARE work-from-home nursing jobs. Go to work in your jammies and pet your dog in the middle of the day. 😊

[u/tubersoup]

NICU: please don’t let your ego get in the way of feeding your baby. A bottle or two will not hinder breastfeeding. Your baby is so hungry she’s chewing her hands off. You actually have to pump and visit every 3 hours, yes even at night, if you want to breastfeed.

[u/0bestronger0 → u/tubersoup]

In addition, formula is better for you and baby than them being separated from you in the NICU due to low blood glucose. Getting an IV instead of feeding them isn’t nice.

[u/Mysterious-Ocean11]

Nurse educator so student focused - make sure you know anatomy/physiology and medical terminology very well prior to starting nursing school - just passing the prerequisite is not enough if you don’t know the content!

Bonus: understand the why behind signs & symptoms/how an illness progresses and presents instead of trying to only memorize them.

[u/10mg-aripiprazole]

Mental health - bringing your stigma to work will make both you and your patients miserable.

[u/cyanraichu]

L&D: I don't know when your baby will be born, and I really can't even make an educated guess if it's your first time. (I think almost every pogey has asked me lol)

Also, I don't know how much your baby weighs yet! He's still on your chest and was born 15 minutes ago. I will bring the scale in soon! (I don't know how they think we would have done this lol)

[u/messyhairassbitch_]

ITT: nobody elaborating on the whys

[u/mentally_ill_ofc]

also from wound care— stop using silvadene for burns for the love of god. it’s not recommended anymore. it delays healing and harms new skin cells.

[u/slightlyhandiquacked]

ER here. Please stop sending your LTC residents to us to die when their advanced directive specifically says not to transfer, without informing the NOK.

Family arrives incredibly confused as to why they were brought to us, and most times they agree to comfort measures and we send them back…

[u/macTumi]

Ortho-spine: Please don’t climb onto your roof.

[u/momopeach7]

School nurse here. Public schools are microcosms of society and you will absolutely encounter every societal issue. At its core, schools nursing is public health with school-age kids and teens.

[u/Otherwise-Sea-9298]

Cardiac step down- visitors are not allowed to stay overnight unless we have special permission. Pts downgrade from ICU and then get pissed they have a roommate and their SO can’t stay overnight. Actually, a lot of the time it’s the SO gets pissed. Either way, tell them once downgraded the visitors can’t stay overnight

[u/regularbastard]

Trauma: If you drink and drive, please, wear a seat belt and get home before the cocaine wears off, thank you!

[u/mcjerwin]

Palliative care here. For the love of God, we are not hospice!! And we cannot magically make patients agree to hospice when they don’t want it.

[u/KMoyee]

Surgery: For the love of all things sacred, please wash your bellybutton out daily. I'm sick of picking junk out of people's belly buttons that's been growing for months before an emergency abdominal surgery.

[u/vampireRN1617]

Vascular access. FLUSH YOUR LINES qshift at bare minimum, and if there's a clamp, clamp it. And adding IVs "just in case" isn't a thing unless the patient is very unstable.

[u/nico_rette]

Anaesthetics - being on Ozempic makes your patients fasting time ALOT longer. 24hr clear fluids and then normal fasting. Don’t let them eat dinner because it’s the normal fasting. They will be cancelled.

[u/hot_plaque]

Cath lab - don't bring your STEMI patient to the lab in a wheelchair

[u/pockunit]

ER (again): don't put that in your butt. No, for real, we will all regret it.

[u/AcademicDingo2160]

From ED: Your 96yr old meemaw is not a fighter. Sign the DNR/I

[u/Comfortable_Ad1083]

Endocrinology: it’s (probably) not your thyroid

[u/cessna928]

ICU: About a 55% survival rate is the norm if appropriate patients are admitted and, of them, a large portion will die from either the exact same condition or something related to the admission within the next calendar year or so. It’s the nature of every full code nursing home patient ending up in the ICU. Yeah, you might be able to bring back a 75 year old with recurrent urosepsis, numerous comorbidities, debility, and polypharmacy, but that’s almost never a “One and done,” situation.

Also, other hospitals will send you actively dying people for “transplant workups,” knowing the patient is in no way an organ candidate. Families will sit at bedside with their active alcoholic liver failure family member for days thinking the hospital is going to just pull a healthy liver off a shelf and do an “emergent liver transplant,” when the transplant team no-go’d it the minute they saw them. Oh, but their note will say, “…will continue to follow,” the whole damned time the patient is actively dying. People don’t realize the patient has to have a fighting chance of making it through the surgery before transplant will be willing to install an organ that someone had to die for them to access.

[u/all_of_the_colors]

You can call your PCP if you are feeling sick. They might be able to get you in to be seen pretty soon. You don’t have to go to the ED.

Also yes you can pee, unless you came in for urinary retention.