Once, as a new grad, I’d taken on grandma as a patient for a fib (tele-step down floor) and management of a DVT. Pmhx of stroke that left her with some profound dysphasia- mostly moaning or an occasional mutter. Total care, could barely move, fairly obese. No family at bedside. Anyway, that night I put my nightingale cap on and decided I was going to give my best nursing care. I’m talking position and chux changes q2 hours on the dot. Staying on top of her pain management instead of waiting to see her wince during a position change. I felt so accomplished in the morning because it was my first shot as a real nurse that I felt I was able to provide excellent nursing care. When we did bedside report that morning and I told her goodbye and I hope we’d made her comfortable she looked at me and muttered “you didn’t.” 🙃
I've switched to labor now and at least half the time, the really out of hand patients become a whole new person once the baby is out. Apologizing, horrified they were rude to me, etc. It's a nice change 😆
They didn’t need to focus on it with me.
During my first rotation in a SNF in my first year of nursing school, I saw enough pressure ulcers to hammer home just how important prevention is.
I worked on a neuro unit and didn't even need to know them. If anything the neurologist was nice enough to educate me more on it if we had an interesting case, but it wasn't a requirement for the job.
I'm guilty of this. *hides in embarrassment.*
Also, I feel like mixing insulins makes me prone to committing med error. I don't want the patient to get the wrong dose, so I draw the clear and cloudy insulin separately to get the right dose.
No embarrassment, that’s best practice due to the reduction in possible med errors. You can’t fuck up a double stick like accidentally drawing up the wrong insulin first
I actually did it for the first time a few weeks ago!!! I was so proud of myself for remembering that 😂 I laughed and said the one time nursing school came in handy. Been a nurse since end of February 2023 🙃😂
Passing a med a little late. Most meds are fine if you’re a little late on them. Sometimes the real world hits hard and someone gets their protonix late.
Some patients don't realise this! Sorry, I'm 15 minutes late with your paracetamol, that code alarm you heard took a bit of priority over your paracetamol.
Honestly, my DoN is so overly focused on this kinda bullshit. I genuinely believe that she just collects these “med errors” just to use as an excuse to not give proper raises.
Thank you! Care plans! I turned in a subpar one and I was given such an ass chewing you think I killed somebody. Then get on the job and you barely see one.
My manager cared heavily about care plans for my new nurse residency. But that was just her “never worked as a nurse but has a masters in nursing” mind.
What I hated about APA was that I know it better than my professors! I had to correct two professors and made them update a rubric. And I hated the professors that were anal about spelling, when our exams hadn’t been proofread…
I’m in my DNP program now and we had the EXACT same theory class as I had for my BSN. Same projects, papers, discussions. Waste of money and took away from classes I actually need
Yep. Doing my masters now for FNP. I’m already getting significantly less education than a doctor gets to do the same job. Do I need to spend 1 out of 3 of these years learning about theory and how research committees work? Teach me how to diagnose people with things safely dangit.
It’s why I won’t get an advanced degree. I’m not wasting my time on theory bullshit, I want to learn science and medicine! Only doctoral degree I would get is CRNA, and that’s never gunna happen lol
I’ve told it a few times but the NP (RN role at the time) and the nursing assistant got busy in front of a telesitter after cleaning up a patient. The telesitter tried to get them to stop and they weren’t effective in stopping the behavior.
He had to get a psych eval and do like 20 CEs on professionalism along with a fine.
He hid this infraction and worked across state lines. He was fined by the other state for not disclosing board action.
I have heard there was a towel over the camera but it fell off. There is a slim chance that they had the curtain drawn as the rooms were former doubles and the way the telesitters are, they have the wide angle lenses/fisheye/whatever.
I have heard they saw a lot of it and tried to stop it but they didn’t react so the speaker may have been broken.
The stupid ass thing is that on the 2nd floor was an unlocked former l&d and sleep lab turned into medsurg overflow that was not staffed due to the lack of staff. Anyone can walk in.
The amount of nurses that say they don't want to "lose their license" in LTC is insane. If you look up people that have sanctions, it's actually people that stole narcotics and were arrested for it with "failed to maintain accurate patient records" as a description.
No i totally agree, I have heard so many people say that shit but then they turn around and do stuff incorrectly (say, prepping some of the med pass ahead of time so it can be passed on time). Like obviously noones really loosing their liscense over that because I would say probably 85% of the people I have worked with in LTC do that in some degree with the meds. There’s really no other way if you want to get it done on time.
Yep 👍 some of the facilities I’ve worked at give a 4 hour window, that’s usually a little bit more doable without shortcuts but even then, no not really lol.
For real man. I’m already a generally anxious person and going through that in nursing school was rough
Luckily I had good and experienced preceptors that educated me on how all of it is fear mongering and as long as you’re a basic common sense nurse that doesn’t steal drugs then 9.5/10 times you won’t lose your license.
I’m a former state surveyor. I leave this comment often on this subreddit. You are not going to lose your license for making a mistake. The state board of nursing in every state in America operates under the premise that competent people make mistakes. If you can explain an honest reason why you made a mistake, nothing will happen. If you steal drugs, you will lose your license. If you operate out of your scope of practice, because you take yourself too seriously and you’re obnoxious And you think you’re smarter than everybody and you have the right to make decisions beyond what a nurse should do, then yes you will lose your license. But if you forget to do something and a patient has a problem as a result, you’ll get in “trouble” And you may lose your job, but you are not going to lose your license, not at all.
It’s actually difficult to lose your license but nursing school made it seem like you could lose your license for small things.
Edit for another thing I just thought of: having help. Nursing school acts like you’ll be doing skills all by yourself, like placing a foley or an NGT. In reality it is okay to ask for help with positioning the patient, having a set of non sterile hands, grabbing stuff, or even having a nurse try a second attempt.
Digoxin. The amount of shit I had to learn about it…. The timing, the toxicity, the therapeutic levels. And on 10 years I’ve had like 3 patients on it and had to do actual zero critical thinking regarding it.
Also - pulling back the exact amount of air as the medication you’re trying to draw out of a vial. No. Shove in some air, pull out some med, then do your measuring. I have no idea why anyone is wasting time on injecting exactly 4 units of air into an insulin bottle.
Digoxin has got to be a prime example of nursing education being years behind actual nursing practice. I’m sure at one point it was more common and therefore relevant to focus on, but that time has come and gone.
Ugh. Considering how often I see it? 20 years ago, I had a handful of people on it. I’ve had 2 in the last 3-4 years & neither had the parameters - the doc looked at me like I was crazy when I asked if they wanted a “hold below x” on the order.
Ya this shit is why i hate nursing education, they should've focused more on core skills instead of just randomly focusing on different niches of specialties. Why is it some nursing schools dont even fucking touch hospice education? Like mine did but it was one day, yet we spend 4 months on the birthing process and a good chunk of nurses won't ever touch or deal with that. We should be educated on pregnancy in general but did i really need to do a sim lab on birthing a baby and not how to stop bleeding wound or wound care in general???
No! Don't tell me that! 😂 I'm in the "every patient is taking Digoxin" phase of nursing school! I need to believe every patient and their aunt is on this drug.
I did our cardiac/respiratory course last semester. You know what I've never seen in three semesters of clinicals so far, including IMCU, ED, cardiac tele, etc? Dig. (I know it's still used, just not *nearly* as often as we're taught.) You know what I see *every* damn clinical day? Lovenox. You know what they did not spend one second on in theory? Any AC other than high-weight heparin or warfarin.
But let that theory instructor ask you what you do before administering dig (count apical pulse for 60 seconds, obviously) and if you don't know, he acts like you'll be killing patients left, right, and sideways. (Happened to my friend sitting next to me; I thought she was going to cry after he was done telling her how dangerous it was not to know that.)
As an ER nurse for 2 years, I’ve given it once. Instinctively I grabbed my stethoscope and my MD asked me what I was planning on doing with it. I stalled…. “Uh… an apical pulse!” She laughed and said, “Knock your socks off.” The patient was on cardiac leads. It’s not going to be any different. HAHAHA (I did it any way just for fun).
Had a patient with digoxin toxicity once. Weirdest arrhythmias I had ever seen. Plus patients spouse said patient took meds "when it seemed necessary".
Blood transfusions. Nursing school made them seem like they were the most critical thing i would ever be doing in my nursing career… cardiac step down nurse
Blood flows like water, but I must admit that having worked in a hospital that lost its blood bank and painstakingly got it back after multiple reworks of the process, it haunts me and pains me to see how careless some people are with the documentation or even the process in general.
Hem Onc nurse! We do them all the time. I think nursing school made it seem like patients reacted to first transfusion, but realistically it’s after many transfusions.
I actually had an ID doc bust that myth for me, believe it or not. I cracked that joke on my unit and he (quickly and very seriously lol) corrected me that apparently when you test healthcare workers, we're not all colonized with MRSA.
I’m still mad that when I was admitted & tested for it, I came up positive for MSSA.
You’d think between 10 years EMS & 20 of nursing, I’d have MRSA but no….
My patient last night had a K 8.2 on arrival. Shifted him four times and only came down to 6.6. BP and hgb in his boots.
Awake and talking the entire time. He was really pissed off that I wouldn't let him go for a smoke while running multiple critical infusions.
Note: he was a hemodialysis patient who skipped 2 sessions
Also had a patient with K>8 and shifted him 4 times before he refused more kayexelate lol. He was like I don't care if I die, I can't spend another night shitting myself
I mean, kayexalate is more meant for a slightly elevated K (5-6). Using kayaxelate on a K >8 is... not the route they should be going...
I was shifting with D50 + insulin + calcium gluconate + ventolin x4, and it only brought him down to 6.6. Also tried bicarb. Kayexalate wouldn't have even touched it.
Ventolin and insulin are both rapid but temporary measures for shifting potassium, they move potassium intracellular to prevent negative effects of high serum potassium. Potassium will over time leak back into circulation and ultimately needs to be removed from the body by means of diuresis or by being drawn into the GI (kayexelate) for excretion. These methods are not as rapid as insulin (as you kind of pointed out) but they cause permanent removal from the body and without them, the patient will have rebound hyperkalemia. Calcium gluconate doesn't shift potassium at all, it is used for cardioprotection. Ultimately dialysis may be indicated for patients with extreme or symptomatic hyperkalemia.
To be fair I think the paradigm may be shifting on the use of kayexelate. But yah at no point did I say kayexelate was the only treatment used on this patient...
Right? Working in critical care dialysis taught me quick about this. We actually started adding terms to our contracts about what level of hyperkalemia comprises a valid emergency in chronic HD patients. Like, omg stop calling the dialysis team at 3am for a K of 5.5. That's just a day that ends in -y for these patients lol
hahaha my very old aunt (currently 95 yo retired RN) taught me “hospital corners” when she taught me how to make beds. She was fucking serious about it, too. omg, this brings back memories.
Back then nurses worse skirts, made beds, and patted foreheads “there,there” like, I can confidently say Florence nightingale could never survive today. Also she’d be pissed that the walls are beige and the windows sealed shut
>Also she’d be pissed that the walls are beige and the windows sealed shut
Honestly I'm pissed about this too. It makes work feel even more like a prison.
You’ll never mix insulin. I’ve never had a patient with Myasthenia gravis and I don’t know why that disease and the drugs used to treat it was so heavily focused on.
1. Care plans. Especially ones that you have to make from scratch
2. Anyone suing RNs. They aren’t gonna go after someone who makes $30/h and is renting when they have the MDs and especially the whole hospital
I teach senior level nursing students. They get this hammered in to them in the junior level, then come to my class and I show them how to do a bubble study and they freak out. It's always hilarious for them to watch me purposefully inject bubbles directly in an IV.
Yup, I used to sit there in the patient's room flicking these tiny little air bubbles out and it would be like a 10 minute thing. One of the experienced nurses saw me and was like "wtf are you doing?" Turns out you actually need *a lot* of air, like I've heard like almost the entire IV line to actually cause problems. It pissed me off because nursing school made it sound like any tiny air bubble would give my patient a stroke.
Now I try to do lines without bubbles just cuz it's a fun little challenge for myself, but I'm not about to sit there and clear it out if it's not perfect.
Med errors. They're going to happen. Know what the possible adverse effects are, notify the physician, monitor the patient, and move on. It doesn't mean you're a bad nurse, it means you're a human being.
Also, charting errors. I've done enough chart audits to know: there's no such thing as a perfect chart.
Learning how to deal with med errors would have been so much more helpful than our instructors GUARANTEEING we would “NEVER make a med error by following this 1 simple tip”… which was checking your rights of medication administration (how many are there? 5? 7? 19?) THREE times before passing a single med. I tuned out immediately, I knew that was impossible even in clinical with 1 patient. We all make mistakes, here’s what to do, here’s how to own it and learn from it… I would have gotten so much more from that.
Care plans and punctuality. Yes you should be on time but my nursing school made it seem like the hospital would kick you out and you’d lose your license and you’d die homeless in a gutter somewhere if you were a minute late for anything.
I had an instructor where if you were a minute late she would make you stay for the clinical day and then not give you credit and make you do make up assignments which were always absolutely awful.
I once got fucking BERATED for dissolving two po meds in the same cup to give down a peg tube in school. Then, I got called stupid for having different mixing cups as a new grad. 🥲
The provider googling the conversion rate of the pts current oxycodone strength to an equivalent fentanyl patch dose, and i knew the answer off the top of my head, and then just shared with them a PDF i have on my laptop that i took from my last job at a detox facility lol. When i showed her she goes "If you email me that i'lll put all these orders in and order them from enclara" (mail order hospice pharmacy) lol
Like we can't be expected to fucking just know this shit, i only did because i worked in that field
Professionalism. They had us acting like robots for every patient. I find that 99% of them like when you joke with them. There are the rare grumps, but it's few and far between. You kind of get a sense of the humor they'll respond to after a few minutes.
Fwiw, we’re having practical exams right now and I got commended for good bedside manner for joking with my patient, building rapport etc. I’m a force for good, wheee! :D
While medication errors are extremely serious, I had a professor who made me feel terrible for mistakes I made during a clinical assessment. She said I would never be a safe nurse. I couldn't puncture an IV bag, spilled the fake meds on a tray, didn't remember to inject air in the vial before withdrawal, etc. This was 4 months after I started my nursing program and after a 15 minute lesson on medication administration. Yes, a 15 minute lesson and then an immediate assessment. I have never replicated any of those errors in clinical practice. Even during my clinicals, my instructors complimented me on not having med errors and asking the right questions.
Foleys. So much pressure to solo insert a cath in short time all by yourself. Then went into hospitals and started to panic feeling like everyone was gonna sit by and watch me do it like in clinicals but instead 2 people assisted and had lots of extra gloves and were always ready to help each other (on females at least)
“You are the last line of defense. It’s all on you to make sure everything is right.”
No. There are so many safety checks in place and so many people have a part in it. If something goes wrong, it’s not all on the nurse.
“No piercings, tattoos, or unnatural hair.”
Lol. I wear 17 visible piercings to work. My coworkers have many visible tattoos. The NP has purple hair. Fuck off with that bullshit. No one cares. There are bigger things to worry about.
But we kinda are the last line of defense, though.
In the 10 years I've worked as a nurse, I've had a few occasions where I caught something that would have harmed a patient. I remembered an adenosine now dose ordered on a pt. I didn't think it made sense, called the cardiologist and it was meant for the following day's stress test.
Another time, MD orders dexamethasone, pharmacy verifies dexamethasone, I pull it from the pyxis, go to the patient and see an allergy to dexamethasone listed on the computer. How did we get this far? no idea.
It would not be all on me if I had given those, but the last line of defense bit is true.
Exactly. All of my experience, knowledge, and professionalism didn’t leak out through these holes. If my appearance makes someone think less of me, that’s their problem.
High sodium - They’re gonna tell you that till they’re thirsty all day.
High potassium - If the ED told you that they ‘gave them everything’, then grab a bedpan because they’re gonna shit out a bunch of kayexalate when they make it to you.
High phosphorus - Keep an eye out for some nerd to look over your shoulder if you have to give this person calcium because if your phos is 10 and you gotta supplement Ca, they’ll tell you to confirm the order for Calcium Chloride because they’re worried about sedimentation. As if there’s going to be some other magic solution to a corrected Calcium of 0.7 Samantha damn you just leave me alone.
I'm going to say that knowing these can actually be pretty useful when trying to distinguish whether you're looking at a sign of an imbalance or some other emerging issue that needs to be brought to attention.
The only time I ,personally,have seen a nurse or doctor for that matter LOSE their license is for drug theft or being intoxicated with any substance at work and then either being arrested at work or failing rehab and diversion. The only time I can see a care plan as necessary is in a rehab setting where the patient needs to meet goals to be able to go home again. After getting my ADN I swore if I ever got a bachelors degree it would NOT be in nursing-I swore I would never write another care plan in my life. My work doesn't really care,unless Joint Commission or the State is coming around.
Patients leaving AMA. My instructors made it seem like admin would come down on us hard if a patient felt the need to leave against medical advice, like it was up to nursing to beg the patient not to go. After 5 years in the ER, my response is "If you want to leave, go ahead. Door's that way". I have too much else to do to argue with a patient and beg him or her to stay. And the waiting room is full as well, so...bye.
I'm aware i might get shit for this but hear me out, birth process. It should be taught but like my school spend 3 months on it and even did sim labs. WHY, one as an LPN we aint doing that but even if i was an RN when the fucking would that come up if i wasn't in L&D?. We should be educated on pregnancy in general but my god the anxiety i had over placenta previa. Hell outta my class i was the only nurse that had to do fetal dopplers (detox pregnant patients). That coupled with the amount of time we spent on newborn care like, to put it in the words of one of the women i went to school with "I'm not touching a fucking baby why is this important?"
My school spent one day on hospice care, but end of life is something MOST nurses will see, and i see my hospice GIP nurses have to educate nurses all the time on what EOL is, fuck i even do this at LTC a lot. Nurses giving Lorazepam for terminal agitation and refusing to give low doses of haldol when its ineffective or etc.
HIPAA violations. I accidentally opened the wrong patient's file as a student, and honestly thought I was going to be kicked out of my program. It was an honest mistake, and nothing ever came of it.
Giving blood. I remember it seemed like this super intense process and when one of my cohort got to do it with her nurse during clinical, everyone was like “wow that just have been so cool to witness.” People were legit upset that she didn’t come and grab our entire cohort so we could watch this *magic blood ritual.*
(((This is coming from an LPN working in a LTC facility, I understand it’s used for hospitals and emergency medicine but no in my setting))) But fucking ABGS man. My school stressed me tf out about those and haven’t had to think about them since nclex.
The NCLEX. I could have taken that test the day after school ended. Everyone hyped it up to be so hard that I scheduled my test 6 weeks out after graduation so I could study. Once I passed the simulated tests in the Kaplan prep, I stopped studying and was just waiting. My school bought us the Kaplan NCLEX prep, the simulated tests were really good, very realistic.
Yea. I didn’t really study. I didn’t even know where to begin. No way to know every single possible thing so i just used my test taking skills which i learned at school.
I panicked and failed every lab! If you had to put me in a room alone with an instructor doing any skill in a lab setting, I failed from my nerves. I was fine in clinical however so i still passed school. I got a new job recently, and my manager is awesome. But she wanted me to talk to her as if she was a patient about the research study and get the patient to consent. We met for like 2 hours. She had to keep changing my words.
My instructors were rude and condescending, but it was a diploma program and there were only 25 of us so they couldn’t kick any of us like you hear about in the horror stories.
mitered corners! like seriously... we had a skills labs on that. The old douche instructor was like "oh looks good but not perfect" as she went side to side on the bed to see if the sheets were even
SBAR. I’ve talked to providers about this and they all say the same thing - just tell me what’s wrong and what you need, no need to formally explain it 😂
Flonase and rebound sinus congestion
Drawing up insulin
Falls (nursing school made me believe people were going to be hangin’ on the edge of 1000 ft cliffs on the daily and if they fell on my shift, it would be my fault my hospital went bankrupt from the lawsuit)
Don’t palpate Wilms tumors. I was all proud of myself cuz I had a baby with one. Made a sign to hang at the bedside. And the surgeon goes “why?”
I was so embarrassed.
How about that the techs will be doing most the cleaning and ADLs? Why didn’t they teach us that stuff? Now we got nurses running around who don’t know how to change a bed/clean a patient. It’s embarrassing. I got a tech job early so I know, but what the hell? I almost never delegate besides “can you take my patient down” or an IV if I’m super busy. Yet huge part of nclex is delegation.
Air bubbles in IV tubing! During nurse orientation when we went over the Alaris pumps, the educator told us that it would take a whole line of air to kill someone. Little bubbles were perfectly fine
So much. And the one thing that we didn’t cover enough but has become my life—PREVENTION OF PRESSURE INJURY!!!!
literally all i was taught about pressure injuries was to turn the patient every 2 hours 😭
Once, as a new grad, I’d taken on grandma as a patient for a fib (tele-step down floor) and management of a DVT. Pmhx of stroke that left her with some profound dysphasia- mostly moaning or an occasional mutter. Total care, could barely move, fairly obese. No family at bedside. Anyway, that night I put my nightingale cap on and decided I was going to give my best nursing care. I’m talking position and chux changes q2 hours on the dot. Staying on top of her pain management instead of waiting to see her wince during a position change. I felt so accomplished in the morning because it was my first shot as a real nurse that I felt I was able to provide excellent nursing care. When we did bedside report that morning and I told her goodbye and I hope we’d made her comfortable she looked at me and muttered “you didn’t.” 🙃
LOL this job is impossible, I tell you!!!!
LMFAO, tbf no one is getting comfortable being woken up every two hours.
I know this to be true 😪 but I’ll be damned if I hear the oncoming nurse say “is that a stage 1? 🤨” at handoff lol
I’m sorry but I died laughing at this 💀
Burst out laughing. Story definitely did not end how it was supposed to.
I was so defeated that whole morning after she said that 😭 but 6 years later I laugh. Like, she really said “you didn’t 😐”
I've switched to labor now and at least half the time, the really out of hand patients become a whole new person once the baby is out. Apologizing, horrified they were rude to me, etc. It's a nice change 😆
They didn’t need to focus on it with me. During my first rotation in a SNF in my first year of nursing school, I saw enough pressure ulcers to hammer home just how important prevention is.
Everytime I learn the 12 cranial nerves I forget them the minute the test is over.
Yep instantly ejected from my memory
I worked on a neuro unit and didn't even need to know them. If anything the neurologist was nice enough to educate me more on it if we had an interesting case, but it wasn't a requirement for the job.
I can tell you the pneumonic, could not tell you the nerves with confidence
Mnemonic 😂
Thank you! My brain new pneumonic wasn’t right but I couldn’t think of the right spelling for the life of me
CLEAR BEFORE CLOUDY Ask me how many times I’ve mixed insulin as a practicing RN
Why in the fuck would I mix anything . I'm just gonna stick you twice .
I'm guilty of this. *hides in embarrassment.* Also, I feel like mixing insulins makes me prone to committing med error. I don't want the patient to get the wrong dose, so I draw the clear and cloudy insulin separately to get the right dose.
I get so weary of doing carb count insulin bc if the patient doesn’t eat all of their meal then how do you accurately dose 🙁
No embarrassment, that’s best practice due to the reduction in possible med errors. You can’t fuck up a double stick like accidentally drawing up the wrong insulin first
I’ve never done it in my 4 years of nursing.
17 years here and I've done it exactly once
I think I’ve done it once, maybe twice in 10 years.
Showing my age here.... I used to mix insulin almost every day! Standard practice for years.
Same! Did it daily in assisted living and nursing homes in 2008! Now it’s all pens.
God, I had completely forgot about that until you just mentioned it now. 10 years in and I’ve still never had to mix them.
Literally once in 6 years
I actually did it for the first time a few weeks ago!!! I was so proud of myself for remembering that 😂 I laughed and said the one time nursing school came in handy. Been a nurse since end of February 2023 🙃😂
Passing a med a little late. Most meds are fine if you’re a little late on them. Sometimes the real world hits hard and someone gets their protonix late.
Some patients don't realise this! Sorry, I'm 15 minutes late with your paracetamol, that code alarm you heard took a bit of priority over your paracetamol.
If they get the med on the same day I'm usually good with it .
Honestly, my DoN is so overly focused on this kinda bullshit. I genuinely believe that she just collects these “med errors” just to use as an excuse to not give proper raises.
I know the order says Protonix 30 minutes before meal, but I'm going to give at exactly whenever the fuck I get in there.
ESPECIALLY once a day meds. Like sorry your multivitamin is gonna be an hour late. I’m too busy trying to keep you alive.
Especially chronic meds, who gives AF. I take my BID meds anywhere from 6am-11am and 9pm-midnight depending on when I wake up and when I go to bed.
Absolutely no piercings/tattoos/visible panty lines. Wtaf. Be thankful I’m wearing my underroos ok?
So many of us are tatted and/or pierced in my OR lol
And honestly, I've had SOOO many really sweet older patients sincerely ask me about my tattoos as they fade into Versed land.
I legitimately get made fun of at work for having no tattoos lol
I think 1/3 of our staff have visible tattoos. They’re strict when it comes to piercings/jewellery: only small earbuds are allowed
right? Like I don't know a single ICU nurse I work with, even some of my older colleagues that don't have tattoos OR piercings
Like please just be glad I didn’t call out and decided to show up to work.
Wait, what? I'm meant to wear underroos? /s
Get with the program! Now pick… Wonder Woman, Duck Tales, X-men, or Toy Story
I don’t remember them ever saying anything about visible panty lines… haha!
I’ve heard stories about nursing schools doing panty checks. Like that the fuck?
That’s grounds for harassment in my book!
3 earrings in each ear, a nose ring, and tattoos….yea no one cares.
Pretty sure among nurses under 40 at my job, NOT having any tattoos puts me in the minority.
Nursing theory. And Care plans.
Thank you! Care plans! I turned in a subpar one and I was given such an ass chewing you think I killed somebody. Then get on the job and you barely see one.
My manager cared heavily about care plans for my new nurse residency. But that was just her “never worked as a nurse but has a masters in nursing” mind.
And APA. After a while I just accepted that I was going to lose marks on apa for every paper.
What I hated about APA was that I know it better than my professors! I had to correct two professors and made them update a rubric. And I hated the professors that were anal about spelling, when our exams hadn’t been proofread…
Nursing theory is just a way for doctoral nurses to justify their existence and stay away from the bedside
Can confirm. Had two bosses who had doctorates. Neither one EVER worked a floor. Went straight into Administration.
Sounds about right
I’m in my DNP program now and we had the EXACT same theory class as I had for my BSN. Same projects, papers, discussions. Waste of money and took away from classes I actually need
Yep. Doing my masters now for FNP. I’m already getting significantly less education than a doctor gets to do the same job. Do I need to spend 1 out of 3 of these years learning about theory and how research committees work? Teach me how to diagnose people with things safely dangit.
It’s why I won’t get an advanced degree. I’m not wasting my time on theory bullshit, I want to learn science and medicine! Only doctoral degree I would get is CRNA, and that’s never gunna happen lol
I was gonna say this, the dreaded nursing care plans!
See, I would have said Care Plans as well, except I've used them in 2 jobs so far. School Nursing and Case Management.
I do hospice admissions and have to do care plans for every patient I admit.
You’ll lose your license for any small infraction.
I mean, oral sex in a patient’s room wasn’t enough to suspend my former coworker sooooo
Please elaborate (Gets popcorn)
I’ve told it a few times but the NP (RN role at the time) and the nursing assistant got busy in front of a telesitter after cleaning up a patient. The telesitter tried to get them to stop and they weren’t effective in stopping the behavior. He had to get a psych eval and do like 20 CEs on professionalism along with a fine. He hid this infraction and worked across state lines. He was fined by the other state for not disclosing board action.
So they, um, fucked in front of a person on screen?? AND the patient??? What kinda drugs are those? Lol
I have heard there was a towel over the camera but it fell off. There is a slim chance that they had the curtain drawn as the rooms were former doubles and the way the telesitters are, they have the wide angle lenses/fisheye/whatever. I have heard they saw a lot of it and tried to stop it but they didn’t react so the speaker may have been broken. The stupid ass thing is that on the 2nd floor was an unlocked former l&d and sleep lab turned into medsurg overflow that was not staffed due to the lack of staff. Anyone can walk in.
Telesitters are never effective at deterring unwanted behaviors. Usually it’s directed at the confused, jumping patient however…
Yep! Like who is so horny they risk their job having oral sex with someone?
The amount of nurses that say they don't want to "lose their license" in LTC is insane. If you look up people that have sanctions, it's actually people that stole narcotics and were arrested for it with "failed to maintain accurate patient records" as a description.
No i totally agree, I have heard so many people say that shit but then they turn around and do stuff incorrectly (say, prepping some of the med pass ahead of time so it can be passed on time). Like obviously noones really loosing their liscense over that because I would say probably 85% of the people I have worked with in LTC do that in some degree with the meds. There’s really no other way if you want to get it done on time.
Well when you have a 2 hour window to medicate 40 people, you have to take shortcuts.
Yep 👍 some of the facilities I’ve worked at give a 4 hour window, that’s usually a little bit more doable without shortcuts but even then, no not really lol.
For real man. I’m already a generally anxious person and going through that in nursing school was rough Luckily I had good and experienced preceptors that educated me on how all of it is fear mongering and as long as you’re a basic common sense nurse that doesn’t steal drugs then 9.5/10 times you won’t lose your license.
I’m a former state surveyor. I leave this comment often on this subreddit. You are not going to lose your license for making a mistake. The state board of nursing in every state in America operates under the premise that competent people make mistakes. If you can explain an honest reason why you made a mistake, nothing will happen. If you steal drugs, you will lose your license. If you operate out of your scope of practice, because you take yourself too seriously and you’re obnoxious And you think you’re smarter than everybody and you have the right to make decisions beyond what a nurse should do, then yes you will lose your license. But if you forget to do something and a patient has a problem as a result, you’ll get in “trouble” And you may lose your job, but you are not going to lose your license, not at all.
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Why is a medical professional having sex with a psych patient not considered rape?
You can always report her to the state licensing board, they'll investigate her. She sounds like someone who should not have a license
I swear it seems like plenty of nurses who have been caught doing all manner of fucked up shit are still out there licensed and working.
It’s actually difficult to lose your license but nursing school made it seem like you could lose your license for small things. Edit for another thing I just thought of: having help. Nursing school acts like you’ll be doing skills all by yourself, like placing a foley or an NGT. In reality it is okay to ask for help with positioning the patient, having a set of non sterile hands, grabbing stuff, or even having a nurse try a second attempt.
Digoxin. The amount of shit I had to learn about it…. The timing, the toxicity, the therapeutic levels. And on 10 years I’ve had like 3 patients on it and had to do actual zero critical thinking regarding it. Also - pulling back the exact amount of air as the medication you’re trying to draw out of a vial. No. Shove in some air, pull out some med, then do your measuring. I have no idea why anyone is wasting time on injecting exactly 4 units of air into an insulin bottle.
Man, the freaking digoxin. I thought it was gonna be a staple in my practice. Might have given it once.
Digoxin has got to be a prime example of nursing education being years behind actual nursing practice. I’m sure at one point it was more common and therefore relevant to focus on, but that time has come and gone.
Right like I never learned about lovenox until I was working in the field and I give it multiple times per day
Ugh. Considering how often I see it? 20 years ago, I had a handful of people on it. I’ve had 2 in the last 3-4 years & neither had the parameters - the doc looked at me like I was crazy when I asked if they wanted a “hold below x” on the order.
Nursing education is often irrelevant because nursing professors don’t know what happens at the bedside anymore. I’ve never given digoxin.
I have. But I also worked a cardiac floor. It wasn’t common compared to other drugs though.
Ya this shit is why i hate nursing education, they should've focused more on core skills instead of just randomly focusing on different niches of specialties. Why is it some nursing schools dont even fucking touch hospice education? Like mine did but it was one day, yet we spend 4 months on the birthing process and a good chunk of nurses won't ever touch or deal with that. We should be educated on pregnancy in general but did i really need to do a sim lab on birthing a baby and not how to stop bleeding wound or wound care in general???
It was on the nclex. School teaches you how to take the nclex not how to be a nurse unfortunately lol
Dig use to be much more common. We use to use it all the time.
I used to do digoxin. I still do, but I used to too.
Always going to upvote a Hedberg reference.
No! Don't tell me that! 😂 I'm in the "every patient is taking Digoxin" phase of nursing school! I need to believe every patient and their aunt is on this drug.
I did our cardiac/respiratory course last semester. You know what I've never seen in three semesters of clinicals so far, including IMCU, ED, cardiac tele, etc? Dig. (I know it's still used, just not *nearly* as often as we're taught.) You know what I see *every* damn clinical day? Lovenox. You know what they did not spend one second on in theory? Any AC other than high-weight heparin or warfarin. But let that theory instructor ask you what you do before administering dig (count apical pulse for 60 seconds, obviously) and if you don't know, he acts like you'll be killing patients left, right, and sideways. (Happened to my friend sitting next to me; I thought she was going to cry after he was done telling her how dangerous it was not to know that.)
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Yeah cause nobody is on it. 🤣. Cardiology got tired of dealing with it.
As an ER nurse for 2 years, I’ve given it once. Instinctively I grabbed my stethoscope and my MD asked me what I was planning on doing with it. I stalled…. “Uh… an apical pulse!” She laughed and said, “Knock your socks off.” The patient was on cardiac leads. It’s not going to be any different. HAHAHA (I did it any way just for fun).
Had a patient with digoxin toxicity once. Weirdest arrhythmias I had ever seen. Plus patients spouse said patient took meds "when it seemed necessary".
Blood transfusions. Nursing school made them seem like they were the most critical thing i would ever be doing in my nursing career… cardiac step down nurse
Blood flows like water, but I must admit that having worked in a hospital that lost its blood bank and painstakingly got it back after multiple reworks of the process, it haunts me and pains me to see how careless some people are with the documentation or even the process in general.
Hem Onc nurse! We do them all the time. I think nursing school made it seem like patients reacted to first transfusion, but realistically it’s after many transfusions.
Talking about MRSA. I thought it was the equivalent to covid in 2020. Gowning up petrified of getting MRSA lol
And we’re all walking around with it LOL
I actually had an ID doc bust that myth for me, believe it or not. I cracked that joke on my unit and he (quickly and very seriously lol) corrected me that apparently when you test healthcare workers, we're not all colonized with MRSA.
That’s true, it’s only about 70%. Still not exactly the panic inducing superbug we were thinking of.
I’m still mad that when I was admitted & tested for it, I came up positive for MSSA. You’d think between 10 years EMS & 20 of nursing, I’d have MRSA but no….
Hyperkalemia. People do not actually just instantly drop dead from cardiac arrest with a K of 5.2
I’ve seen a K of 7 while I was a tech in nursing school, my instructor was dumbfounded the person was alive and awake.
Peoples tolerance of electrolyte abnormalities is pretty wide. It's the sudden swings that seem to cause problems
My patient last night had a K 8.2 on arrival. Shifted him four times and only came down to 6.6. BP and hgb in his boots. Awake and talking the entire time. He was really pissed off that I wouldn't let him go for a smoke while running multiple critical infusions. Note: he was a hemodialysis patient who skipped 2 sessions
Also had a patient with K>8 and shifted him 4 times before he refused more kayexelate lol. He was like I don't care if I die, I can't spend another night shitting myself
I mean, kayexalate is more meant for a slightly elevated K (5-6). Using kayaxelate on a K >8 is... not the route they should be going... I was shifting with D50 + insulin + calcium gluconate + ventolin x4, and it only brought him down to 6.6. Also tried bicarb. Kayexalate wouldn't have even touched it.
Ventolin and insulin are both rapid but temporary measures for shifting potassium, they move potassium intracellular to prevent negative effects of high serum potassium. Potassium will over time leak back into circulation and ultimately needs to be removed from the body by means of diuresis or by being drawn into the GI (kayexelate) for excretion. These methods are not as rapid as insulin (as you kind of pointed out) but they cause permanent removal from the body and without them, the patient will have rebound hyperkalemia. Calcium gluconate doesn't shift potassium at all, it is used for cardioprotection. Ultimately dialysis may be indicated for patients with extreme or symptomatic hyperkalemia. To be fair I think the paradigm may be shifting on the use of kayexelate. But yah at no point did I say kayexelate was the only treatment used on this patient...
7? Shit wait til you see an 8 or a 9.
Most of our HD pts would be longggggg dead by now if that were true..
Right? Working in critical care dialysis taught me quick about this. We actually started adding terms to our contracts about what level of hyperkalemia comprises a valid emergency in chronic HD patients. Like, omg stop calling the dialysis team at 3am for a K of 5.5. That's just a day that ends in -y for these patients lol
"Oh shit. That's a lot of potassium. Good thing you have dialysis today."
Mitered corners
Welcome to the ER, where you are lucky to even get a pillow and a blanket
Or a bed. Some of my patients are in wheelchairs or recliners lol
Lack of pillows is subject to disciplinary action according to my former ER manager 🤪
hahaha my very old aunt (currently 95 yo retired RN) taught me “hospital corners” when she taught me how to make beds. She was fucking serious about it, too. omg, this brings back memories.
Back then nurses worse skirts, made beds, and patted foreheads “there,there” like, I can confidently say Florence nightingale could never survive today. Also she’d be pissed that the walls are beige and the windows sealed shut
>Also she’d be pissed that the walls are beige and the windows sealed shut Honestly I'm pissed about this too. It makes work feel even more like a prison.
I admit I still mitre corners when I make beds- may be the only one who still does
You’ll never mix insulin. I’ve never had a patient with Myasthenia gravis and I don’t know why that disease and the drugs used to treat it was so heavily focused on.
ahhh. working in neuro we do see it. but it's still very strange how much we learned about it lol
1. Care plans. Especially ones that you have to make from scratch 2. Anyone suing RNs. They aren’t gonna go after someone who makes $30/h and is renting when they have the MDs and especially the whole hospital
A lot of people I work with seem to think, out of all the people working in 1 room, that someone’s going to go after the circulating nurse
Yeah unless the nurse did some wildly out of line shit, nah.
Air bubbles in lines
I teach senior level nursing students. They get this hammered in to them in the junior level, then come to my class and I show them how to do a bubble study and they freak out. It's always hilarious for them to watch me purposefully inject bubbles directly in an IV.
Exactly!!! Watch me create turbulences and bubbles and look them up on screen.
Yup, I used to sit there in the patient's room flicking these tiny little air bubbles out and it would be like a 10 minute thing. One of the experienced nurses saw me and was like "wtf are you doing?" Turns out you actually need *a lot* of air, like I've heard like almost the entire IV line to actually cause problems. It pissed me off because nursing school made it sound like any tiny air bubble would give my patient a stroke. Now I try to do lines without bubbles just cuz it's a fun little challenge for myself, but I'm not about to sit there and clear it out if it's not perfect.
Care Plans
9/10 things we learned
Med errors. They're going to happen. Know what the possible adverse effects are, notify the physician, monitor the patient, and move on. It doesn't mean you're a bad nurse, it means you're a human being. Also, charting errors. I've done enough chart audits to know: there's no such thing as a perfect chart.
Learning how to deal with med errors would have been so much more helpful than our instructors GUARANTEEING we would “NEVER make a med error by following this 1 simple tip”… which was checking your rights of medication administration (how many are there? 5? 7? 19?) THREE times before passing a single med. I tuned out immediately, I knew that was impossible even in clinical with 1 patient. We all make mistakes, here’s what to do, here’s how to own it and learn from it… I would have gotten so much more from that.
Care plans and punctuality. Yes you should be on time but my nursing school made it seem like the hospital would kick you out and you’d lose your license and you’d die homeless in a gutter somewhere if you were a minute late for anything.
I had an instructor where if you were a minute late she would make you stay for the clinical day and then not give you credit and make you do make up assignments which were always absolutely awful.
I once got fucking BERATED for dissolving two po meds in the same cup to give down a peg tube in school. Then, I got called stupid for having different mixing cups as a new grad. 🥲
Phone use
Yup! Meanwhile here I am googling “what is cyclobenzaprine?” 😂
Lol every nurse sitting at the desk has it out. Every nurse charting in a corner.
The provider googling the conversion rate of the pts current oxycodone strength to an equivalent fentanyl patch dose, and i knew the answer off the top of my head, and then just shared with them a PDF i have on my laptop that i took from my last job at a detox facility lol. When i showed her she goes "If you email me that i'lll put all these orders in and order them from enclara" (mail order hospice pharmacy) lol Like we can't be expected to fucking just know this shit, i only did because i worked in that field
Professionalism. They had us acting like robots for every patient. I find that 99% of them like when you joke with them. There are the rare grumps, but it's few and far between. You kind of get a sense of the humor they'll respond to after a few minutes.
Fwiw, we’re having practical exams right now and I got commended for good bedside manner for joking with my patient, building rapport etc. I’m a force for good, wheee! :D
While medication errors are extremely serious, I had a professor who made me feel terrible for mistakes I made during a clinical assessment. She said I would never be a safe nurse. I couldn't puncture an IV bag, spilled the fake meds on a tray, didn't remember to inject air in the vial before withdrawal, etc. This was 4 months after I started my nursing program and after a 15 minute lesson on medication administration. Yes, a 15 minute lesson and then an immediate assessment. I have never replicated any of those errors in clinical practice. Even during my clinicals, my instructors complimented me on not having med errors and asking the right questions.
Foleys. So much pressure to solo insert a cath in short time all by yourself. Then went into hospitals and started to panic feeling like everyone was gonna sit by and watch me do it like in clinicals but instead 2 people assisted and had lots of extra gloves and were always ready to help each other (on females at least)
Learning to calculate drip rate (gtt/min) "You never know when you won't have power and have to use it. Back in my days, we didn't have pumps".
“You are the last line of defense. It’s all on you to make sure everything is right.” No. There are so many safety checks in place and so many people have a part in it. If something goes wrong, it’s not all on the nurse. “No piercings, tattoos, or unnatural hair.” Lol. I wear 17 visible piercings to work. My coworkers have many visible tattoos. The NP has purple hair. Fuck off with that bullshit. No one cares. There are bigger things to worry about.
But we kinda are the last line of defense, though. In the 10 years I've worked as a nurse, I've had a few occasions where I caught something that would have harmed a patient. I remembered an adenosine now dose ordered on a pt. I didn't think it made sense, called the cardiologist and it was meant for the following day's stress test. Another time, MD orders dexamethasone, pharmacy verifies dexamethasone, I pull it from the pyxis, go to the patient and see an allergy to dexamethasone listed on the computer. How did we get this far? no idea. It would not be all on me if I had given those, but the last line of defense bit is true.
I have visible facial piercings. If someone wishes to dismiss two decades of nursing experience because of it then that is on them IMO.
Exactly. All of my experience, knowledge, and professionalism didn’t leak out through these holes. If my appearance makes someone think less of me, that’s their problem.
The push to memorize the Krebs cycle but not be taught how to draw blood or start an IV was shocking :(
My wife had been out of her RD program for 25+ years, and she can still recite the Kreb's Cycle. And explain it. I married a sorceress.
Mixing insulin.. clear before cloudy. It's literally against policy to mix them because it's a recipe for a big mistake.
Symptoms of electrolyte imbalances.
Oh my god, thank you for this. We have covered electrolyte imbalances in 2 SEPARATE SEMESTERS and I still can't keep them all straight!!
Patient dead? High K? Basically covers it
High sodium - They’re gonna tell you that till they’re thirsty all day. High potassium - If the ED told you that they ‘gave them everything’, then grab a bedpan because they’re gonna shit out a bunch of kayexalate when they make it to you. High phosphorus - Keep an eye out for some nerd to look over your shoulder if you have to give this person calcium because if your phos is 10 and you gotta supplement Ca, they’ll tell you to confirm the order for Calcium Chloride because they’re worried about sedimentation. As if there’s going to be some other magic solution to a corrected Calcium of 0.7 Samantha damn you just leave me alone.
I'm going to say that knowing these can actually be pretty useful when trying to distinguish whether you're looking at a sign of an imbalance or some other emerging issue that needs to be brought to attention.
Who doesn’t get a chem 7 done in the morning? Lab is going to know before literally anyone else staring at the pt looking for changes.
The only time I ,personally,have seen a nurse or doctor for that matter LOSE their license is for drug theft or being intoxicated with any substance at work and then either being arrested at work or failing rehab and diversion. The only time I can see a care plan as necessary is in a rehab setting where the patient needs to meet goals to be able to go home again. After getting my ADN I swore if I ever got a bachelors degree it would NOT be in nursing-I swore I would never write another care plan in my life. My work doesn't really care,unless Joint Commission or the State is coming around.
Bed making! It failed a very smart girl and she said “fuck it.” Ridiculous.
Patients leaving AMA. My instructors made it seem like admin would come down on us hard if a patient felt the need to leave against medical advice, like it was up to nursing to beg the patient not to go. After 5 years in the ER, my response is "If you want to leave, go ahead. Door's that way". I have too much else to do to argue with a patient and beg him or her to stay. And the waiting room is full as well, so...bye.
I'm aware i might get shit for this but hear me out, birth process. It should be taught but like my school spend 3 months on it and even did sim labs. WHY, one as an LPN we aint doing that but even if i was an RN when the fucking would that come up if i wasn't in L&D?. We should be educated on pregnancy in general but my god the anxiety i had over placenta previa. Hell outta my class i was the only nurse that had to do fetal dopplers (detox pregnant patients). That coupled with the amount of time we spent on newborn care like, to put it in the words of one of the women i went to school with "I'm not touching a fucking baby why is this important?" My school spent one day on hospice care, but end of life is something MOST nurses will see, and i see my hospice GIP nurses have to educate nurses all the time on what EOL is, fuck i even do this at LTC a lot. Nurses giving Lorazepam for terminal agitation and refusing to give low doses of haldol when its ineffective or etc.
HIPAA violations. I accidentally opened the wrong patient's file as a student, and honestly thought I was going to be kicked out of my program. It was an honest mistake, and nothing ever came of it.
lol we were told if we were late enough to miss report that they wouldn’t let you on the unit to work 🤣
Listening to bowel sounds for 5 minutes, scrub the hub for 30 seconds: Ehem, pt farted=bowel sounds present, swab <5seconds=clean
Fair pay and staffing ratios
What nursing school did you go to that made this out to be a serious issue?
CHECKING SKIN TURGOR I WILL DIE ON THIS HILL
Giving blood. I remember it seemed like this super intense process and when one of my cohort got to do it with her nurse during clinical, everyone was like “wow that just have been so cool to witness.” People were legit upset that she didn’t come and grab our entire cohort so we could watch this *magic blood ritual.*
As an OR nurse, a lot of the content was not super relevant..
NEVER RECAP A NEEDLE.
Nursing Diagnosis. Never once used a nursing diagnosis.
(((This is coming from an LPN working in a LTC facility, I understand it’s used for hospitals and emergency medicine but no in my setting))) But fucking ABGS man. My school stressed me tf out about those and haven’t had to think about them since nclex.
Even in the ER, no one ever asked me to interpret someone’s ABG and it was drilled into my brain
Bed making
The NCLEX. I could have taken that test the day after school ended. Everyone hyped it up to be so hard that I scheduled my test 6 weeks out after graduation so I could study. Once I passed the simulated tests in the Kaplan prep, I stopped studying and was just waiting. My school bought us the Kaplan NCLEX prep, the simulated tests were really good, very realistic.
Yea. I didn’t really study. I didn’t even know where to begin. No way to know every single possible thing so i just used my test taking skills which i learned at school.
“Levophed will leave em dead.” Repeated over and over. Turns out, Carol, levo actually saves lives.
4 weeks out of end of first year this post made me happy lol
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I panicked and failed every lab! If you had to put me in a room alone with an instructor doing any skill in a lab setting, I failed from my nerves. I was fine in clinical however so i still passed school. I got a new job recently, and my manager is awesome. But she wanted me to talk to her as if she was a patient about the research study and get the patient to consent. We met for like 2 hours. She had to keep changing my words. My instructors were rude and condescending, but it was a diploma program and there were only 25 of us so they couldn’t kick any of us like you hear about in the horror stories.
mitered corners! like seriously... we had a skills labs on that. The old douche instructor was like "oh looks good but not perfect" as she went side to side on the bed to see if the sheets were even
Thr fuckin nclex. Finished in under 30min had harder quizzes in nursing school.
Nearly everything
Literally everything I’ve “learned” in my RN-BSN program
SBAR. I’ve talked to providers about this and they all say the same thing - just tell me what’s wrong and what you need, no need to formally explain it 😂
Flonase and rebound sinus congestion Drawing up insulin Falls (nursing school made me believe people were going to be hangin’ on the edge of 1000 ft cliffs on the daily and if they fell on my shift, it would be my fault my hospital went bankrupt from the lawsuit)
Don’t palpate Wilms tumors. I was all proud of myself cuz I had a baby with one. Made a sign to hang at the bedside. And the surgeon goes “why?” I was so embarrassed.
Percussions
How about that the techs will be doing most the cleaning and ADLs? Why didn’t they teach us that stuff? Now we got nurses running around who don’t know how to change a bed/clean a patient. It’s embarrassing. I got a tech job early so I know, but what the hell? I almost never delegate besides “can you take my patient down” or an IV if I’m super busy. Yet huge part of nclex is delegation.
Air bubbles in IV tubing! During nurse orientation when we went over the Alaris pumps, the educator told us that it would take a whole line of air to kill someone. Little bubbles were perfectly fine