#New Grad Nurse

[varikascanvas]

I don’t understand people who want to become a Nurse Practitioner and have NO nursing experience and turn their nose at bedside nursing. Then these classmates want to ask me why I’m not doing the DNP. Smh. It makes no sense.

Some of my classmates have an ego problem thinking that it’s beneath them to work as an RN.

I was seen as strange for wanting to work as an RN first before jumping into a doctoral program. And there’s honestly no guarantee that I’ll even get a nursing doctorate degree because it’s too expensive and I’m tired of the stresses of school. I had people peer pressuring me constantly in my school to pursue an NP program.

These people think they have one over on me.

Can I at least have a few nursing friends that are not toxic please?

[newgradnurseblues]

Where Do I Go From Here?

If you would've told me 10 years ago that I would be a Registered Nurse working during one of the worst nursing shortages in years/during a pandemic, I would've looked at you like you had lobsters crawling out of your ears. This was never my original plan, but I'm starting to learn that, as is the case with a lot of people working in healthcare, nursing is something that you're drawn to. Everyone has their own "why" as to what made them decide to go into the healthcare field. That same "why" being the reason why we didn't give up after failing a dosage calc exam or not being able to perform a skill correctly during a simulation lab. If not for our reasons why, we wouldn't have been able to make it through the many crying sessions while studying, the early morning clinicals, or the ATI/HESI exams. I don't want to speak for everyone, but for me taking care of others made me feel like I had a purpose in life at a time when I didn't see the point of life. That's not to say that those feelings have completely gone away, but knowing that there are people that need me in order to feel comforted gives me a sense of happiness. Most of the time I feel numb. When I'm at work listening to patients talk about their families and lives it inspires me. It's amazing to hear where people have come from, in a way we're all walking stories. I've grown used to helping others and while it does bring me joy I need to learn to help myself. You see for such a long time my only goals were to get through nursing school and pass my NCLEX. Once I completed those goals, the only goals I had for the past 5 years, I was left with the question "Now what?". There are so many things that I can do with my life and in my career, but I have no idea where to begin. I'm hoping that I can use this blog as a way to help me process some of the things in my life that I have been blocking out for years. Nursing school is tough and sometimes you have to push the bad things that happened to you to the back of your brain in order to memorize EKG Rhythms or Signs and Symptoms of Sepsis. Maybe somewhere between reflecting on my past and trying to focus on my present experience as a registered nurse I might figure out what it is I want to do in the future. Yes I'm a nurse, but now what?

[sweetdreamspootypie]

On a road of discovery....

I.e. Understanding why half the senior staff quit last year

Too tired for this

I hope at least there's less screaming today

And at least I won't have to work the particular lady who fired me asher nurse for.. *checks notes*.. Bringing 6oclock meds at 6 o'clock

[xiaojuun]

🎓💖💫

[bisexualalienss]

yeah and i’m one of them

[renee-mariposa]

Nothing in my day-to-day job shows me the limits of modern medicine like vancomycin does. And it makes me insane.

(extremely long, somewhat incoherent nerd rant below the cut)

See, vanc is really good at, like, three things: treating MRSA (when given IV), treating ampicillin-resistant enterococcus (when given IV), and treating c diff (when administered orally ONLY). Most every use outside of that, like when it’s used to treat methicillin-susceptible staph aureus for “penicillin allergic patients” (don’t get me started on PCN allergies), actually has data that it increases risk of morbidity and mortality (i.e. harm and DEATH).

Unfortunately, due to the prevalence of multi-drug resistant organisms, vancomycin is empiric therapy for a lot of presumed infections. And it's a lot more difficult to actually tell if someone has an infection than you'd think. A lot of medical conditions imitate each other and when time is of the essence to identify what's going on, the most ethical thing is to start an antibiotic and rule out infection as the hospitalization continues. Lab techniques have gotten a lot quicker: I can remember 8 years ago, it would take 3 days just to identify what microbe the patient had in their presumed infection. These days, anno domini 2023, PCR comes back in a matter of hours, identifying gram positive/gram negative staph/strep/bacilli/etc, and it's the sensitivities that take 2-3 days. (Don't get me started on contaminated cultures.) But even with improvements in lab technique, we might not culture any microbe at all or the provider might keep vancomycin on "just in case" because we don't know IF the patient is infected, WHAT they're infected with, or if the infection will get better with a different drug.

And vancomycin is terrible on kidneys. Extremely nephrotoxic. It isn’t as bad as the 80s when the drug first came out and was called Mississippi Mud colloquially, but it will fuck the patient up if not monitored closely.

But finding the correct dose for each patient in a timely manner is nigh impossible. This is because vancomycin is renally eliminated. We have to mathematically estimate how well the kidneys are working. Unfortunately, our mathematic equation is next to useless if you are:

-Less than 50 kg

-Shorter than 5 foot tall

-Have a BMI of more than 40

-Are an adult younger than 45 (twenty-year-olds get astronomical doses that would be destructive in an older patient)

-Are older than 65 (the official definition of 'geriatric', i'm relatively sure)

-Are female (this is really only applicable if the patient is less than 50 kg or older than 65 - think: little old frail lady - we have absolutely no fucking idea how their kidneys are doing until we order the serum drug level. It is next to impossible to accurately dose vancomycin in little old ladies on the first try.)

-Are missing limbs (lots of leg amputations in the older and impoverished diabetic population!!)

-Have a lot of muscle mass (think bodybuilder or really tall guys)

Fun fact: we estimate renal function by looking at height, weight, age, birth gender (few, if any, studies on trans patients taking HRT), and a lab value called serum creatinine. Creatinine is a byproduct of muscle metabolism, I don't know the fine details, but we can generally estimate how well kidneys are working by seeing how much creatinine is in the blood: low creatinine usually means kidneys are excreting it as they 'should' be. High creatinine means there's something wrong, the kidneys aren't able to excrete it as efficiently as they 'should' be. But the effect of low muscle mass and high muscle mass haven't been studied enough to be able to adjust our mathematical equation to compensate for them. And with high BMI: we often overestimate their renal function because we don't know how to estimate their muscle mass vs their body fat.

(I work out in the boonies. ~70% of our patients have diabetes. ~80% of our patients have a BMI of greater than 35. So what I'm trying to say here is: we are shooting in the fucking dark when we're estimating the renal function of the vast majority of our patients.)

Complicating this: vancomycin is useless until it reaches steady-state concentration in therapeutic range. On one side of this problem: a lot, if not most, medical providers assume that vancomycin starts working its magic from the first dose. So we sometimes get orders for "vancomycin 1 gram now and see how the patient is doing in the morning". That isn't going to solve jack shit! That's just going to increase the incidence of microbial resistance!!

OR, like in the multiple situations I dealt with this afternoon, you make an educated guess on what regimen is going to work for the patient. You get a level 48 hours after the dose starts. And you find out that you fucking guessed wrong and the patient is subtherapeutic. It has been two fucking days and the patient hasn't started being treated for their (presumed) infection yet!! And we've increased the possibility of microbial resistance! *muffled screaming in frustration*

So what I'm trying to say here is: on almost every presumed infection that comes into the hospital (which we're guessing like 30%? 50%? of the time), we're starting an extremely toxic drug, oftentimes 100% guessing what regimen will be therapeutic, only finding out in 2 days that it is not therapeutic, and it can sometimes take days and days to titrate the dose sufficiently to find a therapeutic regimen. And sometimes we're really fucking unlucky and we destroy the patient's kidneys temporarily (or permanently! but kidneys can be very resilient so that's thankfully rare) because we guessed a regimen that's too high!! This is a fucking nightmare!!!!!!!!

And if all of this wasn't bad enough, we don't really have any drugs that do what vancomycin does therapeutically. We have things that can be used to cover some of what vancomycin does, but nothing that's equivalent AND less toxic.

Like, to fix this situation, we need:

-Better education to providers on what drugs are appropriate empiric therapy for different presumed infections (we're working on it, we are working on it)

-Better ways to estimate kidney function (there needs to be more research on kidney function in patients with BMI greater than 35!! And little old ladies!! And patients with low body weight and high body weight and amputations and...)

-Better prognostic tools to tell 1. when the patient is infected (looking at you, sepsis!!!) 2. what they're infected with

-Less-toxic antibiotics AND/OR better ways to treat infection (this would be the evolution of medicine as we know it)

And I want to be clear: vancomycin isn't bad. It's an extremely effective tool when used correctly but we often either don't have enough data to use it correctly or the provider doesn't understand that this tool is fucking useless for the job they're trying to perform.

[bo0zey]

when gerard way said “when i grow up i want to be nothing at all” i felt those words in my gdamn soul bro

[paisholotus]

ok, but what's wrong with nurses wanting to be a nurse for the money?

When you are a nurse, you have to have compassion when it comes to people. When you strictly want to be a nurse only for the money, you are in the wrong job profession.

The multiple times that I went to the hospital and had nurses with bad attitudes, who would straight up ignore me like I wasn't even there, is ridiculous.

The mistreatment that my grandmother has faced with nurses, it either happens when I'm there and when I'm not. We always somehow get a nurse who doesn't need to be in the public helping people.

I understand nurses go through hell and back and should get compensated, but to be strictly there for the money, and you can tell which ones are, nursing is not the job you should be in.

Because the moment you finished the schooling/training, the moment you walked into a hospital, the moment you stick a needle into someone, you vowed to do right and to care for a patient.

You have to have compassion and the comprehension of trying to understand what a patient needs. If they are sick, hurting, dying,....just be a fucking human being man. That's all I'm saying. You just being there for the money, not going to cut it.

[bookishfeylin]

Not ignoring the anons just exhausted. I promise I’ll answer tomorrow!

[slightlybasicbiscuit]

A few weeks ago we had a cardiac arrest come in and it was successful they got him back. A new grad I work with was so stoked to see him up and walking and talking a week later. Three weeks after that he went into cardiac arrest again and we didn’t get him back. We collectively agreed to not tell him that he died later. Let him believe that he’s alive and doing well

[will-come-a-poet]

So I just finished The Magnus Archives and I just want to say that I think Healthcare Workers would actually fare pretty well during the eyepocalypse. Like, being trapped in a hellscape full of your worst fears? Sounds like an average Tuesday but okay.

[straightfromthetorturedpoetsdept]

i legitimately hate when people are like "how I became a new grad travel nurse with no prior experience" and then you watch the video and it's like "so i was an emt for 5 years" bitch get the fuck out of my face

[xiaojuun]

but actually every time i remember i'm turning 30 at the end of this year i'm like this is a sick joke i'm 12

[sweetdreamspootypie]

Plagueblogging / covid nursing 2023

[bisexualalienss]

mayo clinic threatening to leave minnesota if the legislature passes a nurse staffing bill. absolute clowns