BONUS JONAS: Juicy Bits Episode II
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- Juicy. - Hello guys, welcome to Juicy Bits. I'm your host, Lindsey, and I've got my husband with me today. Probably more so a co-host at this point. Like you're not really a guest. - Yeah.

But today I'm going to dive into some Reddit stories I have saved. I personally love Reddit stories. I think they're hilarious. I got into them after listening to the podcast, Too Hot Takes. If you haven't listened to that podcast, it's one of my favorites. But literally, they just read Reddit stories and give their takes. And that's one of my favorite things to do in my pastime. So I found a few that I'm going to give you. I'm going to let you pick which one we read first. Maybe we'll just do one. Maybe we'll do a couple. We'll see how they go because it's kind of our first time doing this. Okay.

So, do you want R slash nursing? Shocked doctor discovers 30-year buildup of smegma under the foreskin of a married man who is suffering agonizing pain in his penis. Or what was your worst ever fuck up? R slash nursing. Let's go worst fuck up. Really? Okay. Yeah. Saving the smegma. I think that's going to be more of a visual thing.

Well, I would have it. I'll have it up on the screen for everyone. There is a visual. Fine. We'll dive into what was your worst ever fuck up?

r slash nursing i'm a brand new nurse and i made a mistake at work today nurses with more experience what was the worst slash most impactful mistake you've ever made in your career i'm really beating myself up over my own mistake i don't know if i'm willing to share what i did here because i know my co-workers lurk this sub and it i think it might help me not feel so alone right now that was our topic in the in uh the episode one um

Let's see. I'll go to the edit after, but let's just start with, do you have your worst ever fuck up that you want to talk about? I'm trying to think of mine. I have fucked. Oh, I don't mind. Yeah. The one that comes to mind, I I've been pretty fortunate. I haven't had any like major, major issues, um,

But there was one when I was early in my nursing career. I'd been a nurse for maybe one or two years. But it was a prescribed medication by cardiology, little old 80-year-old lady, and she was new to a dosage of Carvedilol. And it was a massive dose. And I double-checked it, and I didn't have the confidence yet to be like, this is insane.

Please change this. Confidence comes with time. But even then I knew it felt like a huge dose and, and like I double checked and called them and you know, I got the rude response, like just give the med. And so I gave it and it was right at shift change. Yeah. And so I passed report over and I forgot to mention that I had given that medication. Oh, wait, I remember this. They called you, right? Uh, they didn't call me the next day. Whenever I got there, I worked the next day as well. Whenever I got there, I got,

Yeah.

And so I didn't pass on that that was a new dose. It was a dose that I was uncomfortable with, that I had double checked it all. I just missed all that in report. And so she thinks she's getting like a totally normal, healthy patient. And then out of nowhere, they just bought them out. And so that was my communication screw up. Well, you did communicate though. You just didn't have the confidence to say no. Yeah.

You did communicate. You called the doctor. Yeah. And I did all the checks that I'm supposed to do, but I wasn't confident enough to be like, I'm not giving this. I'm sorry. This is insane. Because I feel like me now as a five-year-old nurse, I'm like, no. I don't care if you yell at me. You want to do it? Like that's how, if they're going to be rude, I'm like, then you do it. You scan your name and you do it. And also like if it's bad enough, obviously we like absolutely not do not do this. You know what I mean? But yeah.

I feel like, I mean, it's also just like a learning experience. Luckily, the patient is fine. I remember this, actually, because we both work ICU. He's a year older than me in nursing. I would say mine... Somebody to choose from. Somebody to choose from. They say common sense, you can't learn, but I did. I learned pretty quickly. What's it called?

RTs are going to come after me. I was a new grad, okay? What's it called when they get the syringe and they clean out their trach while they suction? Sorry, their ET tube. It's called something. Man. I know. Any other time I would know the word and now that I'm on the spot. When they get the little pink syringes or the little pink saline but they're suctioning as they're doing it? Yes. Yeah, I know what you're talking about. I don't remember what that's fucking called. Lavage. Lavage, yes. I was in a room with a sedated patient with the RT.

And she said, do you want to lavage them? I said, sure. And she handed me the pink, the saline. I was like, goes here? She's like, yeah. I said, okay. Didn't bother putting the suction down with the saline going directly into their lungs, drowning them. You drowned them. Yeah. And she immediately came over there and was like suctioning. They're fine, by the way. They're perfectly fine.

But I did get yelled at by that RT. And I think back to that where I'm like, I wasn't confident enough to say, how do I do this? I don't know what I'm doing. I've never seen this actually. That was on me. But this is why I'm telling you guys this. That was probably my worst fuck up because that could have been really bad. Let's say she just gave it to me and left. Right.

And you learn, now that we've been nurses for a few years, it is absolutely a red flag if you have a new grad that isn't asking questions. Yes, it is a red flag. Because you don't know everything and you are missing stuff. I don't care how good you are. Exactly. You are missing stuff if you're not asking questions. And this is where we will come back time and time again and say, stop being mean to new grads. Stop making them feel stupid for asking questions. There was a reason I didn't ask her. It was because of our own unit bully who made me feel inferior. And that's still on me. It's still my responsibility. Yeah.

Um, but that is kind of the explanation as to why I didn't ask questions. I just, I was so nervous. I just lavaged this lady without suctioning. Oh my God. You waterboarded. I waterboarded this poor fucking lady. She's fine once again. Um, but it just, that was a moment for me where I was like, you're done fucked up bitch. Like get the fuck out of here. Ask some questions. Yep. So we're going to dive into the, into the Reddit post now though. Um,

Top comment says, sent a lung specimen in formalin? Formalin? Formalin? What is that? I know the word. Is that like the stuff? Sent a lung specimen in formalin instead of frozen section. I thought the surgeon was going to kill me. He did write me up, but he was surprisingly cool about it. I felt like shit. Ever since, I always double check when I get a cancer specimen, even if we cover it in the timeout. I actually have no clue what this means.

We've never done that. We don't do a lot of biopsies. I'm guessing that's what that was. That does remind me of another screw up. This was probably the most embarrassing one for me where I wanted to just like die. I wanted to hide in a corner. We were going down for some sort of invasive procedure. I don't remember if it was some sort of imaging or something like that. We get all the way down there. I'm fairly new at this time. We're still in Tulsa. So it would have been in my first two years.

We get all the way down there. We're about to scoot the patient over. And the physician of all people, not a nurse, the actual physician doing the procedure was like, all right, let me see the consent. The consent never once crossed my mind. I didn't have it. The patient hadn't signed it. It hadn't been printed. There was no consent. And so I just freeze. And I think I was silent for 10 seconds. And I was like,

I don't have it. I'm going to have to get it. And so they have to tube down a consent form for this patient to sign. And we're all sitting there. And the whole time, the doctor is just ripping my ass. He's saying, I can't believe talking about how we were trained and how it's insane that I don't know about consent and how could I ever miss this?

how I'm wasting his time and this is going to hurt other people, blah, blah, blah, blah. And I just have to sit down there and I'm, I'm like waiting for that sound of the tube station so I can run out and get it. And Oh, it's so embarrassing. This is what I mean though. Like, okay. At the end of the day, the consent not being signed actually doesn't harm anyone. We're going to pause. We're going to grab it. We're going to get it done. Right. So shut up, shut the fuck up. Why are you berating a freaking new grad? Yeah.

Well, you know how those radiology creatures are down there. Oh, I do. The doctor pops in for the procedure and then he's gone and they go to, I don't know, like another realm. I've never seen them. I've never seen them again. Yeah. Okay, I kind of want to bring up one more that I fucked up about that never reminded me. By all means. Oh, God. I've talked about this on my social media before, but I was also new. I believe it was in Tulsa.

I was taking one of my first patients down by myself to the MRI and, you know, empty your pockets when you get down there. I did. Thank you. They're all my shits on the table. As you can see, you know what the hell we go to push my patient into the MRI. We go to scoot her over when all of a sudden we hear a thing.

And I look up and the scissors from my pocket, the scissors, the metal scissors flew out of my pocket into the magnet right by the tech's head. I'm talking like, and he looked at me and he looked at the scissors and back at me. He said, get out. I don't ever want to come back. Literally ran out, bawling my eyes out because I realized I could have hurt him or killed him along with my patient.

He wrote me up. He hated my guts. But that was the... It is fair. It's fair. But that was the last time I ever didn't quadruple check that my pockets were empty. And it's actually the last time I ever carried scissors with me. I don't carry scissors on me anymore. I use the unit scissors. I literally am scared to have them in my pocket because I thought I had everything removed. I don't carry scissors with me.

me anymore. I don't even go into what is it zone four? Yeah, whatever zone it is. The active zone. I don't even go in unless it's absolutely necessary. I actually think a lot of hospitals don't allow us to go in anymore because of people like me. I mean, we don't need to be in there. Yeah, you have us doing a million things upstairs and then you give us scrubs that have like 35 pockets. So, you know, I've got stuff stuffed everywhere. It's hard to remember. Yeah, I am seeing a lot of facilities

they pull on an extra staff and they don't allow nursing in there unless there's an emergency, obviously. As they should. People acting like we're stupid. We're overwhelmed with tasks. That's what it is. We're not stupid. There's so much going on. Yes, we need to slow down, but like, damn, it feels like you can't. It feels like you can't sometimes. Right.

Let's see what the next one is. My old coworker told me a six-month-old nurse was precepting red flag number one and tried to administer NGT Tylenol through an IV push. Preceptee stopped her and told her wrong route. I hear about this a lot. I do too. I've seen this actually, but it was stopped mid-give, which is good.

But I see this a lot and it's because you're pulling it up in a damn syringe. You're going through motions versus thinking you didn't slow down. And man, when you don't slow down,

that is when stuff goes haywire one of my own medication errors was because i didn't slow down it was because i was kind of on my own like i was still with my precept preceptor but she was kind of letting me do things i went and grabbed some meds from the fridge went to go scan them this pop-up came up on epic like why are you giving this i was like because it's their med scanned it again went through this about three or four times and finally just clicked next like

quit let me give this med anyway gave the med came out all happy that i gave all the meds and i was like but there was this weird pop-up that kept coming up on epic and she was like wait what what did it say and i was like i don't know she's like what do you mean where where's the vial show me so we went back through and i showed her and it was popping up telling me this is not the correct medication for this patient this name does not match this patient and i was like it is the correct med the problem was the exact medication they needed wrong name it

had the wrong name label on it. It was for next door. And so luckily it wasn't an actual, it was a medication error because it wasn't the correct name of the patient, but it was the exact dose and same medication they were supposed to give. But it wasn't a learning opportunity. This could have been so much worse. You could have given them a medication that they were not supposed to get. And that was- Close call, right? That's what they call it. Close call. That's what it is. It was very close call. I was like,

Oh, so just slow down. Yeah. Yeah, and back on the route of administration, some hospitals we worked at, they have specific NG programs

down to like five mils and they have a purple plunger. They're a slip tip. They're not a lure lock. And so it's really hard to screw that up. You can't put a slip tip on a... I mean, I guess you could, but it would feel wrong enough that you would probably stop. But most places, they just buy a bunch of lure lock syringes and that's what you use for all your different routes of administration. So yeah, there is some pitfalls in there and in places that it's understandable to screw up. But if you're drawing...

Like a thick syrup out of a cup. Yeah, like anything you're giving in the IV is going to be like ultra packaged. Yeah, and it's like, it's a different color. It's not typically clear. It's typically like orange or red or pink. And it's like, that doesn't go in your vein. Do you know of a medication that's colored that goes in their vein? I don't. I can't think of one off the top of my head. They're typically clear. Iron. Oh, well, iron. Cyprex is like highlighter yellow, isn't it?

I don't know. That's how I am. Yeah, but still it's not thick, syrupy. It's like, oh yeah, that doesn't go there. Let's see. Yeah, at six months, I feel you should know that a thick colored syrupy liquid does not go in the IV. And it's not that they didn't know it. It's probably that they're going too fast. It's just one of those things like, and maybe they didn't know and that's

A bit scary, honestly. But honestly, not everyone has common sense. And that's what you learn when you work with other people in any field. Not everyone's born with common sense. Some people have to learn it. And just having, they said a six-month nurse was precepting?

Yes, that's... I mean, that tells you quite a bit about the state of the hospital. Yes. Yeah, like you're struggling at that point. It's not their fault. At the same time, it's like, why would you have a six-month-old nurse precepting? Why is a two-year-old nurse a charge nurse or less? I've met six-month-old nurses being charge nurses. You're being set up for failure. Yeah, I can't imagine. I...

I took to ICU nursing pretty well. I learned pretty quickly at six months. There's no way I'm teaching somebody else stuff they should be doing. I still don't want to be a charge nurse or a preceptor at five year old nurse. I don't want to because not because of the student or the new grad. It's because I am quite honestly afraid I'm going to teach you the wrong thing. Like I don't want to make you fuck anything up. Um,

There's just so many stories about, like, young nurses, not how old they are, how old of a nurse they are, teaching others. And it's just like...

Like you just don't have the experience. It's not your fault. But like you shouldn't be put in that position in the first place. It's like putting the one year nurse at charge. Right. I mean, that brings up another story. I've talked about this in the past. One of our travel contracts, the worst contract we've ever had, in my opinion, at this trauma center hospital. I, long story short, had a patient coming to me from another unit.

from a med-surg unit to the ICU. She had had a car wreck the night before, had a CT the night before, didn't show anything, but she was coming to me for stroke-like symptoms. She gets to... Recently altered. Recently altered stroke-like symptoms. Comes to me. I'm like, okay, we need to call for a CT. I'm very new here, so I don't exactly know everyone's protocol. I'm like, we need to call for a CT. The NP in charge comes to tell me we don't need a CT. She's already had one. I was like, where? I didn't see the results on Epic. And he's like...

No, they're on there. He kept saying they're on there. I was like, are you talking about the one from last night? He's like, yeah. He said, just go ahead. He had already put in orders for TPN, not TPN, TPA. I was like, wait, that doesn't sound right for TPA. And I was like, I'm not hanging that. She needs a CT scan. Isn't this stroke 101? Like I thought that was stroke 101.

Someone's already grabbed the TPA is stringing it up. I'm like do not hang that and it was under my name. They went to scan it. I literally badged myself out. It was like a little movie scene. I badged myself out. I was like, okay timeout timeout. She needs a CT scan. He keeps telling me the one from last night showed showed nothing.

And I was like, but this is new. This is nursing 101. This is new stroke symptoms. That's why she's coming to the ICU. She needs to have a CT scan. And she wasn't crashing. She was quasi-stable, right? She was quasi-stable. She wasn't crashing. He yells at me, yells at me in the room, give the TPA. And I was like, I'm not giving it. The one-year-old, two-year-old charge nurse comes in.

scans in scans the medication gives the tpa we end up having to rush her out of this hospital to another much better bigger hospital because she had a dissection in her brain so it was hemorrhagic it was hemorrhagic and you gave her tpa what are you doing and that is when i was like

Okay, this unit, this hospital, something's wrong. We literally had to have education come up for the next week. Ask me about other hospitals and how they do things. And I was like, this is a huge red flag for this community. Oh, yeah, because they had no... They were taking stroke patients with no stroke protocols. With no stroke protocols. Yeah. And I was like...

This is absurd and who got the brunt of it the one to two year old charge nurse who ended up scanning her name and That medication and hanging it because I was like you're not hanging that under my name I tried to stop them from hanging it in the first place, but when you're getting yelled at by a toxic masculine dude who thinks that he's a doctor and

It's a chaotic scenario. It really is. Like someone's going to hang that. It wasn't going to be me. And it sucks for that patient because she had a fucking dissection in her brain. But that is one of those times where you're like trying to advocate for your patient. No one's listening. And a young, inexperienced nurse doesn't have, I don't know, doesn't have the common sense, doesn't have the critical thinking, X, Y, Z to say no. And challenge this dude. That's why you have to

nip that behavior from the top. Immediately. When somebody's yelling, especially as a doctor, you're in a place of authority. When you're yelling, nobody's thinking clearly. No. And also when...

Me, though, when I see you yell like that now, I'm like, ew, really? You look like a little kid. Are you okay? Yeah. But anyway, that's kind of my other story of like, it's sad putting these people in a love and putting these young nurses in a position of where they had to make serious decisions. And they haven't even been taught fucking stroke 101. Yeah.

I heard of a similar story from a coworker where they had left the pump and when they got back, the whole bag of heparin was gone. It was programmed correctly prior to them leaving the room and coming back to nurses to verify. They had to have a sentinel meeting where they looked back at the pump programming and saw that multiple soft locks had not

had to be overridden in order to bolus the whole bag. It was determined that the nurse was not responsible for the bag bolus, but someone else. I don't know what, who else came into the room to do this, but all in all, it ended up in a sentinel event, a whole bag of heparin given in what a very short time. Jeez. Yeah. I've, I've heard of, uh,

People will get the units per hour and the milliliters per hour mixed up. I did this recently. And a lot of times it's harmless because the units per hour is so high that you get locked out. Yeah. But there's some situations where you can hit the very max rate that it'll allow you, but it's very wrong dose for the patient. And that's where you get into a lot of trouble. And then your next...

anti-10a comes back sky high right or you do units per kilogram per hour versus units per hour yeah there's standard protocol weight-based protocol weight-based yeah and that's what always fucks me up going to different hospitals is I forget that there's two protocols but I always end up remembering the one I just came from and I'm like

oh, it's weight-based, so it's this. Or, oh, it's not weight-based, so it's this. But it does make it extremely confusing. And you're like, as a traveler, you have to slow down. Because I got in trouble for that. I was like, fuck. Yeah, you lean on your EMR quite a bit to...

Because that has all of their, how they dose that, how they dose their Levo seems to change quite a bit. There's a lot on this thread of like bolusing medications that didn't need to be bolused. A similar thing happened to a coworker, except it was Pitocin on a pregnant patient. Ended in a crash C-section. Honestly, I don't, I honestly don't know how baby did. Wow.

Oh, this person says that might've been me. I was pitting an induction. And at one point the tubing came apart under the bed after hours without any CTX. Uh, I figured it out. I'd been pitting the floor all afternoon. I don't understand that.

Pitting is, I assume, administering Pitocin. Oh, okay. So she'd been administering it in the floor. To the floor. I redid all her lines, labeled them, hooked them up on the pump, and then restarted the pump. She did everything, but it was literally giving it to the damn floor. Oh, yeah. It's feeding the bed. I've done that before. You always trace your lines. Trace your lines. And also clamp your piggybacks before...

How many times have you had an unclamped piggyback and let it run into the floor while you're getting everything? You go to prime it and you're doing other things and then it's like literally your magnesium is gone because it's all on the fucking floor. It's like, cool, cool, cool. That was a lot of money. Great. Yep.

A patient was violent and my supervisor came to the ward to help. She elected not to put the patient in restraints because he agreed to be good. I felt uneasy because I know the patient well. As the charge of the ward, I was responsible for my staff and had authority to restrain the patient, but I didn't. The patient attacked the staff, broke one staff's finger, spit blood into the face of another, and severely injured a third with a bite to the face. I will never again let the safety of my staff lie in someone else's hands and I will never second guess my intuition again.

That sucks. Yeah. Yeah. And I, I know, um, the general public gets a little antsy about, uh, medical staff talking about restraints and things like that. But I, I, I've never in my six years, six and a half years, I've never, uh,

seen them used punitively. No, I haven't either. It's only if they're, because we don't like doing it. It's a bunch of extra charting for us. No one likes to do it. There's a bunch of extra danger. Like we don't like putting people in restraints. And just at the core of it, it's a human. You're literally tying down. No one with no sane person likes doing that. Yeah. And you can pretty much guarantee if you restrain somebody, they're going to be more agitated because

People don't like being tied down. So most nurses avoid it at all costs. So whenever they get slapped on, it's usually the patient's going to hurt themselves or they're going to hurt staff in an acute situation. Yes, and this happens a lot. And like you said, the general public gets really antsy about it. And I understand where it comes from, but you have to understand that...

We are working with people sometimes at their lowest low and sometimes literally mentally unstable that they cannot even recognize that they're harming someone else or themselves. And it's needed sometimes. And it sucks all around. No one likes to do that. No sane person likes to put people in restraints. But this is I had a very similar situation happen when I was working in psych. The patient was like.

The patient was psychotic, agitated, and aggressive. We called the supervisor and security to the unit to help. I asked for a sitter because the patient had been making threats to hurt me and the tech. I did not feel safe, and I told the supervisor this. The supervisor told me that they would not give me a sitter because of staffing.

And because the patient was not actively trying to hurt me, if you could have seen the patient's body language and eyes, they were not joking around. Thankfully, no one got hurt that night, but the patient had hurt staff previously. I submitted my two weeks notice that evening. This is another big, big thing that we see in all units of the hospital. When a patient needs a sitter for their safety or the safety of others, it's not done because we don't have the staff. And it's once again, like I blame hospital systems so much for this.

not coughing up the money to pay for extra staff is so dangerous to patients that it literally, if you know this, you know that hospitals don't give a fuck about you. They care about money over people every single time. Profit over patients. This is literally, this makes me so angry when I see this because like we work in it all the time. Hey, my patient needs a sitter. They keep pulling out lines and life-saving medication. They're trying to punch me. They're trying to do this. They're trying to do that.

oh sorry we don't have the staff yeah you could have the staff if you would cough up the fucking money yeah yeah and we're seeing nurses

I mean, we're in one of the most in-demand careers that exists right now. So a lot of nurses are voting with their feet and they're leaving. And they're going to hospitals that respect their staff more. And I am happy to see it. Me too. I'm going to end on this last one. If you've met a nurse that hasn't made a mistake, they're lying. Yeah, absolutely. 100%. I have met nurses that say they've never made a mistake. And I'm always like, are you okay? It's okay. Yeah.

It's okay to make a mistake. It sucks, especially if you harm the patient. But we are human. Again, at the end of the day, we are humans. We're not robots. Yeah. I mean, there are hundreds of protocols, which means a rule. You're either right or you're wrong. There are hundreds of protocols we follow every day. And...

trying to act like you don't hit one of them on on your 30 40 shifts a month like come on you're telling me the hundreds of micro macro decisions you make every single day you don't mistake one time get real and that's all that's all god all right guys that's all i have for you for this juicy bits but uh let me know what you want to hear from us thanks juicy