Her: "Boy, you're mean." Me: "Boy, you're perceptive."

The students are back.

It's not the medical students and nursing students that bug me. It's the nursing instructors.

Or, rather, it's the nursing instructors from one particular four-year institution that uses us as a teaching facility. Years ago, the university's nursing program was rated one of the best in the nation; lately, it's kinda fallen off. But those dadratted instructors...oy. They think that once the best, always the best is the rule, and so refuse to listen to reason.

It doesn't help that the woman I'm working with now hasn't practiced in seven years. She's kept her licensure current, and she works as a "nurse expert" in legal cases, but she hasn't laid a hand on a patient in seven years.

That makes it difficult to explain why, if an order is written to run potassium as a piggyback (English: as a secondary IV that feeds into the main IV, thus running very, very slowly), it is not a good idea to run that potassium bolus as a primary IV line. You know, potassium can stop your heart and all. No, really. See? The order is specifically written as a piggyback order, and it gives the rate and everything. Maybe you shouldn't try to run it by gravity, as fast as you can, into this elderly and debilitated patient.

No, you may not take your student in to give medications without me there. I already caught you drawing up one medication into a syringe that should NEVER be given IV; I don't intend to let you poison anybody I'm responsible for.

(And yes, we've already taken this to the DON.)

Anyway, that's one issue. The other is that last-semester four-year nursing students don't know where the pons is. And one of them didn't know the difference between veins and arteries. Like this: "The carotid artery? That's, um, the jugular vein, right?" No, not right. They have different names, like different people have different names. Sam and Bob, artery and vein.

Jesus H. Leapfrogging Christ on a stick.

The Big Issue is this:

You do not get to have an attitude as bad as mine until you pay your dues. I will not eat you for lunch; I will not call you out in front of other people; I will not make you feel small. But if you try for as crappy and cynical an attitude as I have and you're not even out of your externship yet, I will shoot you down. Nicely.

Example: Nursing extern starts discussing the case of a patient who had a pontine mural stroke (English: very, very bad) in front of said patient. Now, this guy is totally mentally there; he just lacks the ability to speak clearly. I took her out of the room before I reminded her, as nicely as I could, that it's considered bad form to talk about a patient in the third person in front of that patient, especially if he or she can contribute to the conversation.

Her response? "Well, the resident was doing it."

Me: "It's still rude."

End of discussion.

I know she's fifteen years older than me. I know she's been a high-powered something-or-other in a law firm for the last ten years. But here, your job means shit unless you can *actively apply the principles you learned* there. And I, frankly, am seeing little active application in terms of tact or motivation.

My last job motivated me to go to nursing school. After all, the prospect of being shot at or followed home by wackos will make you want something less stressful. But I recognized early that the only thing I could take away from the prior job was the ability to tell the wackos from the sane people. I didn't feel I had the privilege of pulling a House until I'd been doing this a while. I got students now who out-House House, and it's getting a little irritating.

Plus, they get all the good comebacks. That's the root of the problem.