Friday, September 23, 2005

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.


shrimplate said...

Shot at or followed home? Were you, like, Russell Crowe's bodyguard or something?

There are a lot of practical reasons to run K+ as a secondary besides not killing the patient, although oftentimes that suffices as a clinical rationale. (See? I can be subtle.)

For example: a lot of patients say it burns like hell, even running abysmally slow. So sometimes I'll hold it and run a little of the primary fluid for a few minutes. Then run the K+ even a little slower. Whatever.

If I ever caught a nursing instructor hanging K+ as a primary or on just gravity, I would cap their knees.

Question: qu'est-ce que c'est House? and how do you out it? Is a stinky pun somehow involved?

Jo said...

Shrimpy, I worked at an abortion clinic. Also, out-Housing House means to be even snarkier than the title character in the wildly popular medical TV drama (mad props to Hugh Laurie).

"House" is the only reason I grieve my dead TV.

HypnoKitten said...

House rocks! Watch it if you get a chance, shrimp - with your sense of humor, I bet you'll love it. Snarky is a great description of him. ;) heh

Judy said...

I had some excellent nursing instructors and my sister, currently enrolled, says that 3 out of 4 of hers are excellent.

That means that, in her case, one sucks. Not good odds. She's in a really good program too. At least this particular instructor doesn't have tenure. She's already checked. I was relieved. I'm an alumna of that program.

While we're dissing nursing instructors (and admitting that really bad ones are in the minority), there are 2 I'd like to discuss:

1. I was in labor, first baby. The 2 students I permitted in the room were WONDERFUL - clearly in spite of the instructor. My husband warned the instructor repeatedly that I didn't want to be touched. Did she listen? Nope. I screamed once. Did she listen? Nope. I couldn't talk, I'd been panting for over an hour by the time she entered the scene. She started patting my leg during a contraction. My husband warned her again. She backed away briefly, then started patting again. I have a very clear memory of my foot on her chest pushing her across the room -- entirely beyond my control. As this was happening, the thought popped into my head: "this must be transition!"

My husband looked at her and said, "I told you she didn't want to be touched."

2. I never met this instructor. She sent a student in to d/c my husband's IV. NO instruction. No supervision. His nurse was in the room, so she gets included in this. Hubby's arm is rather hairy. I showed the 2 of them how to properly remove an IV catheter and tape from a hairy arm. His nurse asked why they couldn't just have shaved his arm prior to starting the IV. I guess more than one of her instructors sucked.

Lioness said...


I think I'd really like you IRL.

Anonymous said...

Do you work at a correctional facility that administers lethal injections? One of the first things we learned in our fluid and electrolytes unit is that that is the ONLY situation potassium would ever be administered by bolus. Maybe the instructor thought she was at ft Leavenworth. You might have encouraged her to admit herself to the unit, as she is clearly not A&O