1. RN Rule # 62: Whenever there is a stinky, dirty, disgusting, puky, gross, obscene, unruly patient, RT must be somehow involved in the care of that patient. Tell me you don't know what I'm talking about
2. Empathy: The ability to relate to the feelings of others.
3. Commode: Portable toilet seat so patients don't have to roam far from bed to poop and produce that putrid smell nurses have a high tolerance for.
4. Urinal: A small, portable chamberpot for men to pee in without having to get out of bed.
5. Bed pan: A small pot that sits under your rump so you can poop without getting out of bed. The reason RTs went to RT school and not nursing school
6. Sign: Things you observe, such as temperature, labored breathing, color, blood pressure, winded, pulse oximetry, heart rate, respiratory rate, labored breathing, cyanosis, breathing easy, etc. See objective
7. Symptom: Things only the patient can tell you; subjective. Examples include: Short of breath, dyspnea, hot, cold, pain, heart palpitations, etc.
8. Subjective: See symptoms. Something you cannot observe, and can only know by the patient speaking. Examples are
9. Objective: See sign. Something you observe; something you know about a patient independent of the patient speaking his thoughts.
10. Cyanosis: Blue discoloration of the skin due to lack of oxygen to that area.
11. Central cyanosis: The patient's core (chest, neck, face) is blue or purplish in color. This is a sign major organs are not being oxygenated. It's a serious, life threatening sign.
12. Peripheral cyanosis: Cyanosis of the fingers and toes, ears, nose, lips, etc. It's cyanosis that occurs because blood is shunted from digits to important organs of the body. It can be a sign of chronic airway disease, and is not life threatening.
13. Nauseous: The patient makes you feel pukey. Often used in the wrong context to mean nauseated.
14. Nauseated: You feel pukey; your patient feels pukey.
15. Malaise: A general feeling of discomfort, pain, or nausea.
16. Waitress/ Waiter: One of the many tasks of nurses is to provide food and drink services to their patients.
17. Patient load: The number of patients a nurse cares for on a given shift. Generally the load tends to be higher, and yet nurses are still expected to (and usually do) continue to provide excellent patient care.
18. Puke: The stuff expectorated from stomachs that nurses have to clean up. This is one of the many reasons RTs become RTs.
19. Poop: The stuff expectorated from but holes that nurses have to clean up. This is yet another reason RTs become RTs.
20. IVs: One of the many tasks of nurses is to insert these into veins for ease of inserting medications.
21. Responsibility: Nurses have the burden of keeping medicines organized and giving the right medicines and the right doses at the right times while still keeping a smile and dealing with irritating patients, doctors and respiratory therapists.
22. Assistance: One of the many tasks of nurses is to help doctors perform their tasks, whether it be stitching wounds, inserting chest tubes, bandaging boo boos, inserting lines, performing surgery, or other. Doing some of these task require a lot of skills and patience.
23. Skills: The more often you train or perform a task the better (more proficient) you become at it. Some tasks are rarely performed, yet nurses must practice and train in order to keep these skills up
23. Training: The process of learning and maintaining adequate skill levels and confidence.
24. Practice: The process of doing procedures to maintain your skills. The more you use your skills the better you become at a given task.
Types of Nurses:
1. Consensus: About 80% of RNs fit into this category. These RNs respect, seek out, and listen to the opinions of other members of the staff. They tend to work well together as members of the team to come up with a "consensus" as to what might be wrong with the patient and what to do about it. They are aware that they lack the experience in all areas, that they don't have all the answers, and are willing call upon their coworkers, including doctors and respiratory therapists, to help them to best care for their patients. These are similar to your gallant doctors.
2. Contents: These nurses are set in their ways, and prefer not to sway from their routine. They believe they know what needs to be done, and they do it. They tend to not seek out other opinions, and usually don't consider the opinions of others. They consist of about 10% of all nurses. They will often perform procedures (such as increasing oxygen) without seeking expert consultation. These are similar to your goofus doctors.
3. Prospects: These are your newbie RNs or, perhaps, soon to be RNs. Most are eager to learn and are more than willing to go out of their way to help out. Some are mature, independent and trustworthy enough to work on their own, while others have less confidence and need quality assistance. Look at these folks carefully, because in a year or two they will morph to a different type of RN. Some will grow dogmatic and become contents, while others will grow and smile and become consensus. These consist of about 10% of all nurses.
4. Cordial: We all hope that Beginner RNs turn out to be of this type. They know they do not hold all the answers, have a friendly disposition, and are more than willing to take the extra step, even when they're burned out. They tend to smile and lend a helping hand to patients and coworkers. Their ears are always open. They are most often social, may often bring in treats to work to keep the peace, and are likely to remain in one department for several years, if not their entire nursing career. You'll find them mainly on medical/surgical floors, although they generally don't fit in fast pace departments such as critical care and emergency. Some people refer to this type of RN as Happy or even Friendly RN. Most staff and most patients love cordial RNs. They almost seem to be flawless. These usually consist of most LPNs and about 20% of Consensus RNs. Most of them work on the med-surg floors, but a small percentage wander down to the ER and critical care.
5. Receptive: These are your nurses who are constantly looking to become better nurses, read medical journals, magazines, read online sources such as blogs and articles, and are more than willing to listen and retain the wisdom of their fellow workers. They like to learn not just to better themselves, but the institution as well. They tend to be more observant and receptive when it comes to new ideas. They also tend to be proactive (or think quickly) to emergency situations. They can be friendly, but tend to be more serious and bossy under pressure, and may even appear to be condescending at times. They may start their careers on medical/ surgical floors, but generally branch out to more challenging areas such as emergency and critical care. Many are likely to further their careers by earning their bachelor's or even Master's degree, and it is from this group you get your future supervisors, administrators, nurse practitioners, and occasionally doctors. They consist of about 20% of Consensus RNs.
6. Dogmatic: This type of RN has a definitive way of doing things. They are relatively laid back in their personality (type b personality) however they have created a set way of doing things to protect themselves from making mistakes. Patients love them because dogmatics tend to be overbearing and attentive to their patent's needs. If a doctor orders for teeth to be brushed every two hours, they will do it every two hours whether it's needed or not, and whether they have to wake the patient or not (patients don't like this part). They are also very particular about specific doctor orders, and call to report even slight variances. For example, if the doctor writes an order to maintain a sat of 92%, they will call the doctor and RT even if the sat is 91%. They will often guilt you into staring at the monitor hoping the vitals improve by your looks alone. Thus, they are known to make a big deal of trivial things. In this way, they tend to irritate doctors and RNs. Although they are so nice it's hard to stay mad at them. However, patients can be guaranteed to get a good wash per shift, to be rotated regularly, have fresh blankets and sheets and towels and a good assessment frequently. Any slight change in lung sounds will be noted. But, the bottom line is, they do this because they legitimately want the best for their patients. Bosses love them too, because, like type A or anal RNs, they are perfectionists with their charting. They make good friends, and are relatively happy except under pressure. Oh, and one more thing, their rooms are spiffy clean. If you leave something laying around they will not say anything, but they will clean it up. They consist of about 10% of Consensus RNs.
7. Compulsive: Like Dogmatic RNs, they are guaranteed to do full assessments, and will do everything the doctor orders to a tee whether they think it's needed or not. They will never question a doctors order. Actually, they are under the belief that if the doctor ordered it, it's needed. If you say something is not needed, they will defend the doctor as a "god." They too will have you staring at monitor values that are "barely" below the accepted range. But if an RT refuses to continue staring at the monitor saying something like "that sats fine," he will get mad at you and tell you that you are not caring for your patient. If you don't follow the rules, or directly follow a doctor's order, he will approach you. He's also prone to writing variances for even the silliest of detail. They are type A personalities, although are generally very precise and attentive to their patients. Yet they too can be overbearing, and tend to be hard to work with. Unlike Macho RNs, they often seek the help of others, but tend to get upset when others disagree with them, or don't provide the answers they want. Therefore, it's easier to pretend to agree with them than to show them how they are incorrect. They expect equal perfection from their coworkers, and are known to look over your back. Sometimes they are referred to as snoops, or sometimes worse. So, when you are working with these RNs, you need to careful. Oh, and one more thing, if you leave your ABG kit lying on the patients bed, they will make you well aware that you messed up their room. These consist about 5% of consensus RNs.
8. Macho: These tend to take things in stride, and not make big deals over trifles. They would be content to live with a sat in the mid 80s, will use common sense, and will not call RTs and doctors over such trivial things. They tend to use the word "common sense" a lot. They tend to be cool. They tend to have a dry sense of humor. Many tend to be men, but not all. Nothing seems to bother them, and they do a good job with their patients with the advice of others or without. They tend to have a high degree of intelligence, yet are often seen reading science fiction or mystery novels in their free time as opposed to medical stuff. They tend to hold their own. They tend to work in CCUs, and are very confident. They consist of about 5% of Consensus RNs.
9. Complainers: Nurses do not have as much time to complain as RTs do because they are busier. When RTs complain, they complain about stupid doctor orders or how doctors refuse to give them autonomy. RNs complain not about their job per se, but about the hospital in general -- too many patients, not enough pay, too many rules, change is not needed, paper charting was better, insurance isn't fair, so and so gets treated better by the boss, etc. They tend to be busy bodies while taking care of their duties. When you pass them as you are entering work, they are known to say things like: "You definitely don't want to be here tonight," or, "Welcome to hell," or, "This schedule sucks," or "I hate Michelle, she's always picking her nose." For the most part, complainers tend to be stuck working on med-surge floors, and consist of about 20% of all Consensus RNs.
10. Busybodies: These RNs consist of the RNs you never really get to know because they are busy, busy, busy. They are fast moving, going from room to room, chart to chart, and phone to phone. They never run, but walk at a vary fast pace. They tend to be thin. Some of them work on the med-surge floors, but the majority work in the emergency room. The tend to be very business-like, but when you get a chance to sit down with them they are very fun to talk with. Yet they are known to take off mid sentence. Getting a complete conversation in can be a challenge. Likewise, they are not good listeners. Actually, they are awesome nurses and are very knowledgeable. Because they are so busy, some of them tend to skip corners. The RT bosses may complain to them occasionally, but considering they are such great workers, they don't make a big deal about it. These consist of about 10% of Consensus RNs.
11. Arrogants: They always have that smirk on the corner of their lips, and walk with their heads high. They are usually friendly and easy to get along with, but they tend to believe that they know everything and don't need to hear from you. Since they know so much, they tend to compete for supervisor jobs, and seek to become RN Bosses. When they do become RN Bosses, they tend to not keep many of their friends. These consist of 15% of Content RNs.
12. Old-Schoolers: These are very wise and sagacious RNs. They can pick up on even the most simple thing wrong with the patient. Their patients are usually well taken care of, and they have little need for other members of the team. They are not arrogant by any means, and are usually great teachers. The problem with this type of RN is they are set in their ways, and are not quick to adapt to changes. They tend to believe in old theories such as the hypoxic drive theory, prefer paper charting to computers, and may tend to wine when they are told to break from their routine. If you are not intimidated by them, they can be fun, or at least educational, to work with. About 50% of Contents are Old School.
13. Content Contents: They are happy-go-lucky and when we RTs tell them a treatment is not needed they will look at you with crazy eyes. They do this not because they don't like you, but because they don't understand why you just didn't do what you were told. They say things like, "The patient is wheezing. He needs a treatment." They tend to refer to RTs as ancillary staff, and have little use for them other than for them to do what they are told. They are usually opposed to protocols and rapid response teams (RTT) because those elevate RTs to the same level as RNs, and they know that shouldn't be. And, even if a hospital has an RRT, they will never call for one. Attempts to educate them are futile. They are wonderful people and make great friends otherwise, and are great nurses, but they are incapable of learning new things. They consist of 25% of Content RNs.
14. Besetting: I'm sorry, but these guys tend to not be happy -- ever. Nobody gets along with them, probably not even the patient. But when all is said and done, they are very good with their patient when it comes to picking up on things early. However, when it comes to little things like brushing their patient's teeth or giving baths, they think those tasks belong to lesser people like Nurses Aids. Unfortunately, these RNs tend to work in Critical Care Units where AIDS are far and few. They have few friends. They hate you and more than likely you can't stand to work with them. If you do something wrong, they will not be nice and give you a warning, they will simply crab to you and make you feel miserable, or they will simply go over your head and write you up. They consist of 5% of Content RNs, so thankfully they're a rare breed.
15. Boors: They tend to be very similar to Macho RNs as listed above, except that they have no use for "ancillary staff" other than to provide their duties. They consider anyone besides doctors and nurses as ancillary, so RTs are ancillary. If they ask you to do something, you do it and do it now. If you don't do exactly as you are told, you will have to deal with the consequences. They are usually very quiet, and are very opinionated at the same time if you get them going. They can also be hot heads if you say something they disagree with. They will put you on the spot. If you ask a question, they will ask a question back. They hold grudges, and may go days without talking to you if you said something to irritate him. For example, if you are discussing politics with him, and everybody in the room disagrees with him, he may give you all the cold shoulder. He's modest, smart, quick witted, and can be hard to work with. He has no problems making enemies. But if you are intelligent or important, you may be his best friend. They are rare and far between, or less than 5% of Content RNs.
16. Chiefs: Here we lump all levels of RNs from supervisors on up. Usually, but not always, RN bosses come from the ranks of the Receptive (85%) or Arrogant (15%). Arrogant RNs don't necessarily care what people think about them, but Learners do. Learners go out of their way to please. The farther away from the duties of RN work the RN Bosses become, the greater the chance that The Institution moves ahead of The Person. That doesn't mean they won't try to be friendly, but the bottom line is not necessarily keeping the patient load low, but making money for the institution and keeping their own bosses happy and keeping their jobs and the higher wages that come with it. The RN bosses closer to the working staff (the supervisors, the lead RNs), tend to fit in nicely with the other workers. They do not complain. They are very helpful. They tend to be good workers. Yet they are often political, defend policy regardless of usefulness, and generally will tell you what you want to hear and then either ignore you (Arrogant) or make an attempt to help through the general chain of command -- a process that's really slow. As a general rule, they don't like to make waves, and the longer they have their jobs, the smaller the waves become.