Ask a nurse anything.

reply to post by justsaying


Hang in there Justsaying, if you are doing it because you care, and want to help you'll make it. That's the biggest factor. That is mostly what it is all about. Weeding out the ones that are just after a bigger paycheck than most associate's, or bachelor's degrees bring home. Yeah the pay is alright, but there will be days that it isn't enough for the crap you deal with to earn it. Then there are other days that you would do it for free. I guess it evens out in the wash.

It is my observation, and opinion that a lot, not all ,but a lot of medical facilities have gotten spoiled to the calibre of the modern nurse. They know that they get a mulligan here, and there because a nurse has their back 24/7. That's why nurses get a bit grumpy, 99% of the time we don't get mulligans. We protect our patients from infection, injury(especially self induced), mistakes, adverse reactions, doctors, pharmacists, and visitors. Then we have to deal with the notion that we are glorified wait staff, or a ground based flight attendant. Old imagery dies hard.

Now don't shoot me down because I mentioned service industries. I used to wait tables, and it's back breaking work, but being slow on an order, or switching an order might get you no tip, and eventually fired if you keep messing up, but in nursing one bad screw up can land you in jail, and your great grand children paying off a tort claim.

The modern nurse has more knowledge, and access to better techniques than a physician had 75 years ago. Of course modern physicians have access to techniques, and equipment that would blow your mind. However the access to knowledge is equal thanks to the digital age. I was studying for the CCRN test, and a doctor friend of mine wanted to help. We were doing a practise test, and he was astounded by the level of difficulty. He said it was a lot higher level than challenging the board to become an MD.

A modern nurse is 1st, and foremost a patient advocate. We make sure that everything that happens is in your best interest, and according to your wishes when applicable. Of course patient best interest trumps wishes. To accomplish this job of advocacy we are scientists in that we apply the nursing model, and use evidence based practise to execute a plan of care. We are teachers so that we can put needed knowledge into the minds of our patients so hopefully they don't end up in the same boat again. Then there is the art of nursing. The ability to wade through blood, guts, and feces in one room, change into greens, then go into another room, and lightheartedly joke with the next patient so that they feel better. Knowing when to be tough, and when to be soft, and when to just be there, and say nothing, just BE there. When to bend the rules, and when to break them. They can't teach that in school. The art comes from experience, and some nurses never do quite get the artful side of things, we usually call them managers, and supervisors.

So your battle with sickness, suffering, and death is actually the easy part of the job. The battle with the little subservient maid mentality, or expectation of some, and the laxness of some of the people who are supposed to be the leaders, and role models is much more difficult.

I agree with Byrd, hang in there you'll make it, and it really is all worth it. You have to be a strong individual to be a nurse. If you need others approval you'll have a hard time. If you are satisfied within yourself with knowing that you did a good job even when no one seemed to notice, you'll be fine. As long as you know you're the best practitioner you can be, and what others think doesn't matter, you'll find happiness knowing you really do make a big difference. If you need other's approval you might be in for some hard times. It doesn't bother me to play the bad guy if it is going to help my patient. I'll stomp on a doctor's toes all day, and get yelled at for being insensitive, or heartless because I won't let a visitor camp out all day with an exhausted patient, or called mean because I make a fresh knee surgery patient walk through the pain to rehabilitate, no problem. As long as at the end of the day I know that what I did helped my patient. I'm here to save people's butts not kiss them.

I'm rooting for you Justsaying!!! We need you!!!

I have RA and a few other autoimmune diseases. I never, ever complain to my doctor. Mostly because thats what every single other RA person does- I hear them. My question is this: How is it that he can tell when I'm feeling really bad. I don't tell him because I hate being a complainer, but he really always knows when I'm in bad shape. He even takes action and will start asking me things specifically to try and uncover whatever I'm leaving out.
It's almost like he can read my mind. It's not only my doctor, his nurse can read me the same. I'm not saying that I lie to them, I just leave out some parts when it comes to how I've been feeling. So....What is it that you guys see in us that we are so unaware of? If you can, and I believe that you can, how is it that you are able to read your patients so well? I hope this isn't a dumb question!

I think this thread is amazing- thank you very much in advance.

reply to post by TabKat


Hi TabKat,

It sounds like you have found an excellent medical care team. Keep them at all reasonable cost. We see diseases and sequela(symptoms) all the time. We can tell by how you walk, how you guard, your vital signs, small changes in tone, and pentameter of voice etc.... Your doc must really know you, and pay attention. Kudos to him, and to you for having found such a good doctor, and nurses. I hope your treatment, and control of RA goes well. It isn't magic it's just paying attention, and knowing what you are doing. Sounds like you are in good hands

reply to post by Binder


[color=C3FDB8] Thanks so much Binder. From what you've told me, I feel extra fortunate to have a good medical team. As for the RA, and other stuff, it is sometimes a difficult battle, but it helps to have friends and family who really understand and care. Whenever I start to feel bad about things, I stop and think about how many other people in the world have it so much worse than I do. That keeps my perspective in order.
I don't know if I can give you a star because I'm new, but I'm going to try. Thank you so much for doing what you do here!

Mine is a simple observation of fact. Most nurses like doctors are uncaring and cold feeling towards those they take care of. It's all about money now and nothing else. The patient is last on the list. It could be from seeing those who are sick every day that they become so distant, uncaring and cold. But that's my experience.

So, tell me, if you are a nurse, do you really care about the patient ? What is your observation of the doctors in the room ?

reply to post by Fromabove


Hi Fromabove,

I'm sorry you've had bad experiences from healthcare visits. The problem is a mixed pot of perspectives, and expectations. On the one hand there are mean, impatient, uncaring healthcare workers. There are those that just do it for the pay check, and it shows. On the other end of the continuum there are nurses who are almost psychotic in there endeavor to "care enough". Problems arise at both ends.

There is a concept called caregiver fatigue. You can only lift so much weight, you can only run so far, you can only stay awake so long etc... It stands to reason you can only care so much. In a lot of cases it is not that the caregiver doesn't want to care any more, they can't. Their givachiter broke. Their are more people who need care than there are caregivers. Because nurses are generally people who tend to have a larger more robust givachiter. They pull double time for years to plug the holes. After a while no matter how large or robust the givachiter is, it must be taken down for maintenance. Most nurses don't do this, and in some cases it breaks permanently, and if they can't change professions you get a nurse, or a doctor with a really broken givachiter. Most people just can't imagine the stress, and emotional toll on some healthcare workers. Most people internalize, and after so many years of build up the mainspring in the givachiter just goes "sproing" and that's it. Bad attitude, minimalist performance, and general overt grumpiness ensue.

I forget the hospital exists while I'm off duty. I ride Harleys, build classic cars, invent wierd gizmos, and pursue a wide variety of other interests. I take all the vacation time I am allotted in a year. I only work overtime when it is REALLY needed. For the most part my patients love me, and it's reciprocal. Which brings me to the other continuum the patient continuum.

On the one end you have the guy who just lost his leg on a dull chainsaw, and stoically refuses to admit he is in pain, ask for anything, or say he needs anything. On the opposite you have the guy who just had his tonsils out, under general anesthesia. Has had 10mg of Morphine, is snoring when you enter the room, but upon waking begins to moan, and groan, and complain of utter, unbearable agony. The ice cream is too cold. The soda is flat. The pillow is hard etc... ad nauseum. Both ends cause problems. The stoic guy is not going to get good care if he does not communicate, and be honest. The Mr. Mcneedy is going to badger everyone until he is ignored. Open, honest, and polite communication is the key for both. There is no need to make a drama scene if you are hurting, and stoicism makes it hard to treat you.

So there are the perspectives, and the expectations are a bit more complex. Your healthcare team is there to do a job, promote healing, and get you back to normal. Some people's expectations of nurses either come from old assumptions, and tradition, or TV. Both are inaccurate. Nurses are not gussied up waitresses, or waiters. We are not personal concierges. We may double into those roles to a limited degree to make you comfortable, and make your stay pleasant, and it is part of the job, but only part. It is secondary, or tertiary when a primary care need overides all the other stuff. Many people become dependent on a nurse for a lot of things during a long stay at the hospital, and think it is mean when we start weaning them off the gravy train. We would be doing a disservice to send you home dependent on a nurse that isn't going home with you. As my favorite nursing saying goes "I'm here to save your butt, not kiss it."

Most conflicts arise from an unmet expectation. Sometime the expectation is valid, and the nurse has a broken givachiter. Sometime the expectation is unrealistic, and sometimes the expectation is realistic, but not a priority at the moment. I don't conflict with my patients very often, but I also work in an environment where it's pretty much my way, no highway option because to come see me you are knocking on heaven's door usually, but as they get better i do my best to make everyone comfortable, and happy. I try to just be human. No I am not going to be as emotionally invested in your grandad's plight as you are. He is YOUR grandad. Mine died 8 years ago, and I can't go through that experience 3 times a week, every week for the rest of my life. It doesn't mean I don't care, it means I have 2 or 3 more grandads I have to go care for too, and I can't spend it all in one place. I love my patients, and I love my job, but I also have to detach, and get away. That is the only way to be a nurse, and stay sane.

For some specialists, and the hospital. It may be all about money, but for the GPs, internalists, hospitalists, and nurses it ain't just money keeping us around. I don't make enough for money alone to justify what I do.

reply to post by Binder


Very nice, well put Binder. Especially the very last part...

For some specialists, and the hospital. It may be all about money, but for the GPs, internalists, hospitalists, and nurses it ain't just money keeping us around. I don't make enough for money alone to justify what I do.

I just love this thread.

Originally posted by Binder
reply to post by SeekerLou

 

Excellent work I have nothing to add except that I am praying for your speedy recovery. Shingles is a miserable condition, and especially at christmas time. Digital hugs my friend.

Hey , still keeping up with your thread. You're a keeper!

Thanks for the prayers . They worked! I may have missed Christmas and got behind on everything but I'm back a kickin' Thanks for the hug! How did you know?

Glad to have helped.

reply to post by Binder


Hi Binder,

Well...you got my U2U and I appreciate that we have both have a positive understanding of the underlying angst. Thank you for being a great human being.

Sorry it's taken me so long to get back to this thread, school is back on and I'm back to being overwhelmed.

Binder and Byrd, thanks so much for the encouragement! I do really appreciate your insights Binder, into the real world of nursing.I can only hope I have the good fortune to work with someone like you when I eventually graduate (this December!) I am scared to death and yet excited that I will have a career that makes a real difference in people's lives. Scared that I will make a mistake and hurt someone, scared that I will never know enough, and yet excited with the knowing that a good caring dedicated nurse can make all the difference in someone's recovery. I know I am ready for this, I've waited my whole life it seems, to get me to this point where I have what it takes to get through this on a mental, emotional and spiritual level. But, I have to get through these last two semesters before I can worry about the real world of nursing! So, I will keep in mind the big picture you wrote about for inspiration, because as you know, there are those moments in school when you just get so overwhelmed you wonder what the hell was I thinking, bagging groceries sounds better right now, lol.

reply to post by justsaying


To be honest there are still shifts that I go home thinking I should have just been a sacker at the grocery store. You will make mistakes that is the only way to learn. Just hang in there when you do. The first 2 or3 years is a bit rough, but then it gets easier. After about 5 or 6 years you can run a code in your sleep and then the real fun begins. You are valuable enough to the facility that they can't get rid of you and you have some street cred so you can fight the system when it is wrong. Good times, good times.

I received my pediatric rotation assignment, and I am doing clinic at a local children's hospital on the floor for cardiac and burns. I am okay with working with the cardiac patients, but after listening to my instructor describe the type and severity of burn patients we will see, I am sick to my stomach in anticipation of what I will encounter. Burns are my worst nightmare, both because of the type of injury and the severity of pain and suffering, adding into the equation that these are babies and young children who are the one's suffering. I only hope I can suck it up and be a nurse when I know inside I will want to cry for them. This is going to be quite a challenge. Any suggestions Binder on how I can prepare emotionally for what I will see?

reply to post by justsaying


First off, don't try to prepare emotionally. #1 you can't, and #2 anticipatory anxiety is worse than the actual anxiety of the moment. Secondly being a "good" or even a "strong" nurse does not mean not crying with, and for your patient. You have to play it by ear. Of course you don't want to be unstable, and an emotional wreck, but don't over do the stoicism either. You're human, and you will have emotion tied to your experiences. Don't hide it, and don't bottle it up. Talk about it. Of course do not break HIPPA privacy rules, but in whatever capacity you can talk about your experiences. This thread would be a great place!

My Pedi rotation was my hardest too. I have never been so pissed off, sad, and otherwise disgusted with the state of the world, but it is necessary, and you will grow, my God you will grow. In my experience taking care of the kids was great. It was the parents that were hard to deal with. I could barely find the time to care for the important priorities for the child for dealing with the "percieved" priorities of the parents to assuage their feelings. You will learn to communicate the difference between a true health priority, and a "feel better" priority. Sometimes you gotta make somebody mad to make their loved one better. It just comes with the territory. You get over it, and the satisfaction of a child healed will make you forget all about their emotionally hindered, unstable, or unattached parents. Not all of it was bad though. I also had some of my best experiences during this rotation, some of the parents were just awesome, but almost all the kids were. It was the best of times, it was the worst of times!

reply to post by Bhadhidar


B12 taken subligualy is as effective as injections.Its probably more of the other B group of vitamins that you find the energy increase in.The main thing to watch out for these days if food without the essential elements in it..They arn't called essential for nothing!.theirs 72 of them.No Boron High arthritis..no iron weak and breathless...no iodine goiter..no Zinc no sex..no selinium cancer etc etc...The ambiotic sac the foetus developed in had all these elements and you need them to keep the body healthy.

reply to post by Binder

Thank you again Binder. Once again you are giving me perspective which instructors tend to leave out preparing us for clinic. I will check in here when I can to share and vent! On an uplifting note, and something to look forward to after my peds rotation is over, will be an all expenses paid scholarship I received from my school to go to Denmark this spring break to study Scandinavian nursing. It will be for a week and I will be both in the classroom and on the Danish hospital floors learning their ropes, so to speak. I will be traveling with a small group of other nursing students from my program that were picked for this international study trip. I can't tell you how proud and excited I am to get this opportunity! Interesting to note is that their way of treating is based on theory as opposed to the evidence based practice we have in this country, coupled with their national health care system... there will be so much to learn in a very short amount of time. We will get to observe in a university hospital and a children's hospital. I really can't wait to observe their population, especially the stats on cardiovascular and endocrine disease like DM, (good lord every patient I get assigned here in Memphis has DM2), and stress related diseases, with their culture so different than ours here in the U.S., they bike everywhere instead of driving cars, college education is free, have much lower levels of stress, cherish closeness with family and friends,I could go on and on but all of this adds up, so it will be awesome to see how the differences in our societies, lifestyle and cultures affect health and the health care systems. I will definitely share what I learn over there on here if thats ok. Now I really need to get off ATS and hit the books, have exam in 2 days and if I don't pass peds I can forget about going!

Binder,

What's your opinion on synthetic vitamins? Which are 99% of the time used in multi vitamins

Here ya go.

Whats your personal opinion on using Electronic Cigarettes?

Whats your professional opinion on using Electronic Cigarettes?

Now answer: Have you studied in depth the chemicals that make up the electronic cigarette juice and their safety for inhalation? - Do they even teach this stuff or encourage you to learn it?

Whats your opinion on people using e-cigs as a method to quit smoking cigarettes?

Whats your opinion on people using e-cigs as an alternative tobacco product? (for continued recreational use)

reply to post by RadioactiveRob


Hey Rob,

What I believe you are asking about is a concept called bioavailability. Synthetically produced vitamins are molecularly identicle to the stuff in food. Sounds great, however, the extreme "purity" of these compunds at times can be their undoing. Because they are such "perfect" little molecules they are highly reactive, and tend to bind to other stuff before they can be used by the body. Rendering them "unavailable" to be used. Calcium tends to be the worst offender. It binds to a lot of stuff, and makes it unbioavailable. So don't take vitamin supplements with milk. The vitamins in nutrient dense foods are bound in such a way as to usually preserve them for use as the body takes them apart from their source.

The absolute best way to get your vitamins, and other important nutrients is to consume them in the food in which they naturally occur. This means a balanced, varied, and complete diet. That means being a vegan is just as bad as being a Meat 'N Taters dude. I know some will disagree, but years of research back me up on that. Don't avoid any particular food, but also do not over indulge either. Most of us eat too much of the wrong thing, and not enough of the good stuff. The good stuff is dark green leafies, bright colored cruciferous veggies, fruit especially berries, and bananas. The best fat source is fish. The best protein source is good old eggs. Back off on the breads, pasta, rice, grains, and limit concentrated sweets to a VERY occasional treat. Cut out empty calories altogether. Soda pop is the worst offender 300 - 400+ calories of absolutely nothing the body can use, but sugar. Plus many of the ingredients in soda pop bind up, and steal a lot of nutrients. That includes energy drinks. If you need caffeine coffee is the least of the evils.

Multi-vitamins are not necessarily bad. They are supposed to be supplemental though, not a substitute for eating well. You can never take enough supplemental vitamins to substitute what you get from a good diet. I do not take supplemental vitamins, and I have a yearly chem panel, and blood count done. My numbers are awesome. I'm healthy as a horse, but hope I smell better.

reply to post by JohnPhoenix


My personal opinion is that they are safer. I will have to withold my professional opinion mostly because I don't really have one. I have not studied the preliminary research on the E-cig juice. I can speak from personal experience however as I have a couple, and have used them off, and on.

First a little disambiguation. I am mostly a pipe, and cigar smoker. Pipe and Cigar tobacco is not a high turn around product like commercial cigarettes. It is just plant matter. There is a varied small amount of nicoteine in your green beans. All plant matter has it, and nicotein is actually a compound vital to life. It is also a deadly poison. The poison is in the dose. Cigarette tobacco is chemically aged because of the high turn around for the product. They cannot wait months for a batch to dry and naturally age to become "smokeable." So they use formaldehyde, and alcohols, and other distillates to artificially age it in a few days. These distillates leave residue behind that is in the smoke. Also the paper that cigs are wrapped in is bleached. Bad stuff comes from burning chloride. The actual tobacco is the least harmful thing in a cigarette.

So there is no logical way vaporized E-cig juice could be more harmful than cigarette smoke. I would even venture a guess that it is even less harmful than pipe, or cigar tobacco smoke. They haven't been around long enough however to state with complete confidence that they are "harmless." I don't think they would work well as a stop smoking aid. You are just trading one method of delivery for another. In fact you can actually get a lot more nicoteine much faster from an E-cig. Remember the poison is in the dose. Which is my only serious concern about E-cigs. 1 small bottle of juice has more than enough nicoteine to be a lethal dose if ingested. That is how hemlock kills, nicoteine overdose, and it's an awful, wretched way to go. (No bright ideas guys. It's also obvious, and easily detected.)

But, given my personal preferences I do not get much enjoyment from them because I am not fond of cigarettes. I have tried the E-cigar, and even an E-pipe, but they do not even come close. The E-cig actually does approximate cigarette flavor fairly well. So as for using it as a "safer" substitute for smoking a traditional cigarette, I think it can't be any more harmful and is much more than likely a lot less harmful.

Originally posted by Binder
I don't think they would work well as a stop smoking aid. You are just trading one method of delivery for another. In fact you can actually get a lot more nicoteine much faster from an E-cig. Remember the poison is in the dose. Which is my only serious concern about E-cigs. 1 small bottle of juice has more than enough nicoteine to be a lethal dose if ingested. That is how hemlock kills, nicoteine overdose, and it's an awful, wretched way to go. (No bright ideas guys. It's also obvious, and easily detected.)

But, given my personal preferences I do not get much enjoyment from them because I am not fond of cigarettes. I have tried the E-cigar, and even an E-pipe, but they do not even come close. The E-cig actually does approximate cigarette flavor fairly well. So as for using it as a "safer" substitute for smoking a traditional cigarette, I think it can't be any more harmful and is much more than likely a lot less harmful.

Thank you for your reply. I re-post the above because i want to mention a few points on it. I found the rest of your reply interesting about the poisons that make up cigarette tobacco. I am sure you noticed my signature. I have been a vaper for a year now. I made a clean switch to e-cigs after smoking cigarettes for 22 years when nothing else would help. I tried the gum, patches, and all the rest. Only e-cigs worked for me to keep me from harmful tobacco smoke.

People who make the complete switch to e-cigs never smoke again. They have effectively quit smoking. I say completely.. studies of long term e-cig users from their world wide appearance in 2003 show that at least 80 % of people who use e-cigs on a regular basis do not go back to cigarette smoking. We simply cannot. Our bodies are healing at a rate consistent with a person who quit cold turkey and we learn again to hate the smell of burning tobacco. Our taste, sense of smell comes back, we don't want to lose that either. We vapers feel that using nicotine is not the same as continuing to smoke. Smoking and vaping is as similar as drinking a glass of hard liquor and drinking a glass of water. Nicotine is a central nervous system stimulant as is caffeine and has other effects similar to caffeine on the body. Doctors and scientists tell us that using nicotine in this form is no more harmful than heavy coffee drinking.

Because of this, many e-cig users choose to not give up using the e-cig for the pleasure of vaping and using nicotine it gives.Nicotine is not the bad guy here.. the smoke is. it is the smoke, and as you point out the poisons in that smoke, that kills.

Actually, people who have made the switch to e-cigs do for the most part find that it was the easiest way to quit smoking tobacco they ever tried. At this point they have a choice, continue to use an e-cig or stop using one. Most people find that they can easily quit using the e-cig unlike cigarettes.- because the nicotine they are addicted to does not have the strong cravings as the nicotine from cigarettes. Remember those chemicals you mentioned? Turns out the tobacco industry has been holding out on us. The Big Lie is that with cigarettes we are not only addicted to nicotine but addicted also to many of those poisons they use to manufacturer cigarettes. Long term vapers simply don't have the same kind of cravings they used to have with cigarettes, and weaning oneself down to zero nicotine with an e-cig becomes a breeze.

As you see, some of these things may seem to go against conventional wisdom. Once you understand there is a big difference in the nicotine coupled with other chemicals in tobacco smoke and nicotine untainted by itself ( only a mildly addictive substance) such as used in e-cigs you can begin to see why e-cigs do work for quitting smoking as well as they do.

For those who choose to continue to use e-cigs in place of cigarettes recreationaly, they like myself often do choose to use a higher nicotine strength. I personally love the stimulant effect nicotine gives. This is the same as drinking a cup of coffee and drinking a double shot of espresso. With an e-cig, one can use a stronger nicotine and not have the hold the cravings had on him when he smoked cigarettes. I can go for hours at a time without using the e-cig and the cravings are so mild they don't drive me crazy like cigarettes did. It is simply amazing. I encourage you to learn more about e-cigs and really study these things. You are in a great position to help save others lives.

BTW, it takes about 40 to 60 mg of pure nicotine to kill an adult. E-cig liquid is Never this high in nicotine content. The bottles are sold pre-mixed with a medium such as propylene glycol or vegetable glycerin and only 10 % nicotine is used by volume. This is then further reduced when mixed with flavorings and extra PG or VG to become the final product. At most this would make someone very sick, but not likely kill them. We are very conscious about the dangers.