The Super Nurse Podcast

Check out SuperNurse.ai for comic book style learning, vilians and super nurses! If you’re a nursing student studying for NCLEX or a new grad nurse trying to understand metoprolol beyond “it lowers heart rate,” this episode of The Super Nurse Podcast breaks down beta blockers in a way that actually sticks. Understand NCLEX pharamcology better. Metoprolol is one of the most tested cardiac medications on NCLEX and one of the most commonly administered drugs in med-surg, ICU, and primary care. But mistakes happen when nurses only memorize that it lowers blood pressure and heart rate. In this episode, we go deeper into hemodynamics, myocardial oxygen demand, beta-1 receptor physiology, and heart failure management so you can apply this medication safely at the bedside. You’ll learn: The 3 negatives: negative chronotropy, inotropy, and dromotropy Why metoprolol is about myocardial preservation, not just rate control The critical difference between metoprolol tartrate vs metoprolol succinate (and why it matters for heart failure mortality) The 34% mortality reduction in heart failure and what nurses must understand about sustained beta blockade Bedside safety checks: apical pulse, systolic blood pressure thresholds, daily weights The heart failure paradox (why patients may worsen before improving) Masked hypoglycemia in diabetic patients — a classic NCLEX safety question CYP2D6 metabolism and why some patients crash on “normal” doses Depression, nightmares, fatigue, sexual dysfunction — and how to assess for intolerance The black box warning: why beta blockers must never be stopped abruptly This episode strengthens your clinical judgment, prioritization skills, and pharmacology understanding so you can move from memorizing drug cards to thinking like a nurse. Perfect for: Nursing students New grad nurses ICU nurses Anyone studying cardiac medications or beta blockers for NCLEX prep Don’t just memorize metoprolol. Understand the why behind slowing the pump to save the muscle. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for comic book style learning for nurses. The 2 A.M. Hypotension Scenario BP: 90/50 Urine output: decreased Heart rate: rising The nurse’s role: Recognize instability early Assess for signs of fluid deficit vs overload Gather supporting data Communicate clearly to the provider Monitor response to interventions 🧠 Applying the Clinical Judgment Model 1️⃣ Recognize Cues Hypotension Tachycardia Decreased urine output Mental status changes Lung sounds Neck vein assessment Skin temperature This is bedside nursing power. 2️⃣ Analyze Cues Ask: Does this look like low preload (hypovolemia)? Does this look like high preload (volume overload)? Is this possibly a pump problem? Your assessment shapes how you communicate. Example: Instead of: “BP is low.” Say: “BP is 90/50, urine output has dropped, neck veins are flat, lungs are clear, and mucous membranes are dry.” That’s critical thinking. 3️⃣ Prioritize Hypotheses Perfusion is always priority. Kidneys and brain are sensitive to decreased cardiac output. 4️⃣ Anticipate Likely Interventions Based on assessment, you may anticipate: If low preload: Fluid bolus order Blood products If high preload: Diuretics Vasodilators If vasodilation (like sepsis): Vasopressors Volume support Anticipating helps you: Prepare supplies Ensure IV access Monitor closely Advocate confidently 5️⃣ Implement Orders Safely When interventions are initiated: Monitor lung sounds Monitor urine output Monitor mental status Monitor blood pressure trends Your reassessment determines next steps. 6️⃣ Evaluate Outcomes After fluids: Did BP improve? Did urine output increase? Are lungs clear? After diuretics: Is breathing easier? Is oxygenation improving? Is output increasing? Clinical judgment is continuous. ❤️ Hemodynamics in a Nursing Context Cardiac Output = Heart Rate × Stroke Volume You are not calculating it at bedside — but you are interpreting its consequences. Low output signs: Confusion Decreased urine output Cool extremities Delayed capillary refill Preload (The Stretch) Signs of low preload: Flat neck veins Dry mucous membranes Clear lungs Low CVP (if present) Signs of high preload: JVD Crackles S3 Peripheral edema Your assessment informs provider decisions. Afterload (The Resistance) High afterload: Hypertension Vasoconstriction Low afterload: Sepsis Warm flushed skin Bounding pulses Recognizing patterns = safer advocacy. ⚠️ Cognitive Traps Nurses Face Anchoring Bias Assuming tachycardia = pain. Instead ask: Is the heart rate compensating for low stroke volume? Alarm Fatigue If alarms are constant, cues get missed. Customizing alarm parameters improves safety. 🧠 The Bigger Message Nurses do not write the orders. But nurses: Recognize deterioration first Gather the right data Communicate clearly Prevent delay Catch wrong assumptions Reassess continuously That is advanced practice within nursing scope. 🏁 Key Takeaways Don’t chase numbers — assess the patient. Low blood pressure always needs context. Know the difference between dry and drowning. Anticipate likely interventions. Reassess after every change. Your communication can prevent a crash. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for super fun AI powered learning AI Is Changing Drug Discovery Artificial intelligence is revolutionizing biology by: Predicting protein structures in hours instead of years Designing precision drugs that target disease at the molecular level Improving clinical trial recruitment using AI-driven record analysis Reducing the cost and failure rate of drug development This shift moves medicine from “trial and error” to rational drug design. What This Means for Healthcare As new therapies are developed faster: More targeted biologics enter clinical practice Personalized medicine becomes the norm Treatment protocols evolve rapidly Patient questions become more complex The science may be accelerating — but understanding still requires a human bridge. Why Nurses Matter More Than Ever As AI speeds up discovery, nurses: Translate complex molecular therapies into understandable language Provide emotional reassurance in a tech-heavy system Catch inconsistencies or clinical red flags Advocate for patients navigating experimental treatments Apply ethical reasoning when algorithms fall short AI can design the therapy. Nurses guide the human experience. The Evolution of Nursing in the AI Era When memorization and pattern recognition become automated, what remains is: Clinical judgment Ethical oversight Communication Empathy Contextual thinking The nurse is not being replaced. The nurse is being elevated. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Why Sepsis Is Still the “Final Boss” Affects nearly 50 million people globally each year Mortality increases significantly with delayed treatment Traditional tools (SIRS, qSOFA) have major limitations Alarm fatigue is real — especially with high false positive models 🧠 The Diagnostic Dilemma Why SIRS Falls Short High sensitivity Extremely poor specificity Flags post-op patients, anxious patients, pain patients Why qSOFA Misses Early Cases Low sensitivity Identifies the crash, not the warning signs Often too late in elderly and beta-blocked patients 🤖 How AI Is Detecting Sepsis Earlier 1️⃣ AI + Routine CBC Data Machine learning analyzes neutrophil morphology Detects immune activation before WBC spikes Uses existing hospital lab data Predicts sepsis before culture results return 2️⃣ TREWS (Targeted Real-Time Early Warning System) Real-time monitoring of dozens of variables Reduced mortality when acted upon within 3 hours Faster antibiotic administration Human bias still impacts outcomes ⚠️ The Epic Sepsis Model Problem High false positive rate 109 alerts per 1 true sepsis case in one study Teaches alarm fatigue Must be validated locally 📝 AI That Reads Nursing Notes (Natural Language Processing) System: SERA (Sepsis Early Risk Assessment) AI scans: “Patient seems confused” “Family concerned about mental status” “Decreased urine output” “Lethargic and pale” ✔️ Predicts sepsis up to 12 hours before onset ✔️ Combines hard data + soft clinical intuition ✔️ Quantifies nursing judgment 💉 AI and Fluid Management: The Big Controversy Using reinforcement learning models trained on ICU data: AI frequently recommended: Less fluid Earlier vasopressors Individualized hemodynamic balance When clinicians matched AI dosing: Mortality lowest When they deviated: Mortality increased This challenges the “30 mL/kg for everyone” model. Welcome to precision resuscitation. 🧬 Sepsis Phenotypes (Alpha, Beta, Gamma, Delta) AI identified four distinct sepsis types: Alpha – Least severe, better outcomes Delta – High mortality, severe shock and organ dysfunction Implication: We may be failing sepsis drug trials because we treat all sepsis the same. Future: Phenotype-driven order sets. 🔍 The Black Box Problem Clinicians ignore alerts if they don’t understand why. New explainable AI systems: Show lactate trends Highlight dropping platelets Identify subtle BP changes Build trust through transparency AI must show its homework. 💡 What This Means for Nurses AI will not replace nurses. But nurses who understand AI will: Advocate differently Question protocols Navigate algorithm vs standing orders Lead the cultural shift You may soon be the mediator between: The algorithm The attending The protocol The patient That’s leadership. 🎯 Key Takeaways Sepsis detection is shifting from reactive to predictive. AI can use simple labs like CBC to detect early immune changes. Not all sepsis models are equal — validation matters. Natural language processing quantifies nursing intuition. Precision fluid management may outperform blanket protocols. AI augments — it does not replace — nursing judgment. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Get more at SuperNurse.ai - taking nursing school knowledge to the bedside with AI powered tools and comic-book style learning. Why Sepsis Still Keeps ICU Nurses Up at Night 166 million global cases (2021) 21.4 million deaths 31.5% of all global deaths Mortality >40% once septic shock develops COVID caused a surge, especially in adults >70 🧠 The Shift: SIRS → Sepsis-3 Old Model: SIRS Temp high or low HR >90 RR >20 WBC high or low Too sensitive, not specific New Model: Sepsis-3 Life-threatening organ dysfunction Caused by dysregulated host response “Severe sepsis” eliminated Septic shock = vasopressors to maintain MAP 65+ AND lactate >2 despite fluids Clarity > over-triggering. ⚙️ The 4 Mechanisms of System Failure Mitochondrial Dysfunction Cytopathic hypoxia Oxygen present, cells cannot use it Rising lactate despite normal O2 sats Immunothrombosis Microclots trap bacteria Blocks microcirculation Organ ischemia Endothelial Damage Glycocalyx destruction Vascular leak Third spacing, edema Immune Paralysis Immune exhaustion Apoptosis of immune cells Secondary infections weeks later Sepsis = total systems failure. ❄️ Cold Sepsis: The Dangerous Trap Hypothermia is deadlier than fever Indicates metabolic exhaustion Cold, clammy patients get missed Fever requires energy — cold means collapse Do not rely on fever alone. 🤖 AI in Sepsis Detection TREWS Machine learning Tracks nonlinear trends Reduces mortality & antibiotic delays SERA Natural language processing Reads nursing notes Detects “patient looks unwell” Validates clinical intuition Future: Prediction 48 hours before crash. AI reduces alarm fatigue by increasing specificity. 💊 2021 Surviving Sepsis Campaign Updates ⏱️ Antibiotics Timing Shock/high likelihood → within 1 hour Stable, possible sepsis → up to 3-hour diagnostic window Speed + accuracy balance. 💧 Fluids 30 ml/kg still standard starting point (weak recommendation) Balanced crystalloids preferred (Lactated Ringer’s, Plasma-Lyte) Normal saline → hyperchloremic metabolic acidosis SMART trial supports balanced fluids for kidney outcomes Assess fluid responsiveness dynamically Avoid “saltwater drowning” in ESRD/HF patients. 💉 Vasopressors Norepinephrine first-line Safe to initiate peripherally (18–20 gauge proximal site) Do not delay for central line Hypotension harms immediately ❌ Vitamin C Cocktail No longer recommended Large trials did not support benefit 👩‍⚕️ Nurse-Driven Protocols Barriers: Staffing shortages Environmental constraints Lack of authority Solutions: Sepsis 6 protocols Nurse-initiated lactate & fluid protocols Advocacy as a clinical skill Empowerment saves lives. 🏥 Post-Sepsis Reality Post-Intensive Care Syndrome (PICS): Cognitive decline PTSD, anxiety Long-term organ dysfunction 2021 guidelines recommend: Social & economic screening Medication reconciliation Follow-up for deficits Survival is just step one. 🔮 The Future: Endothelial Immunothrombotic Storm Emerging concept: Treat sepsis as vascular disease Target endothelial repair Manage microclots independently of infection Treat the vessel, not just the bug. 🎯 Key Takeaways Sepsis is system failure, not just infection. Hypothermia may be more dangerous than fever. AI tools are shifting care from reactive to predictive. Balanced fluids > normal saline in large resuscitation. Peripheral pressors are safe and life-saving. Antibiotic timing now includes nuance. Survivorship requires long-term support. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI powered learning, community, and comic book style nursing education!Alarm fatigue is cognitive desensitization caused by sensory overload.When your brain hears a danger signal repeatedly with no true danger, it adapts.It filters.It reclassifies the sound as background noise.That adaptation protects you in everyday life.But in a hospital?It can delay life-saving action.The Numbers We Can’t IgnoreNearly 9,000 alarms during just 25 routine procedures in one studyMore than one alarm per minuteOver 500 alarm-related patient deaths reported in five yearsA 74% reduction in false alarms in systems using short algorithm delaysThis isn’t “annoying.”It’s systemic.False vs. Nuisance AlarmsFalse AlarmThe monitor is wrong.Motion artifact mistaken for an arrhythmia.Nuisance AlarmThe monitor is technically correct — but clinically irrelevant.A brief dip outside a rigid factory setting.Most alarms are non-actionable.And yet every single one interrupts your thought process.The Cognitive Cost to NursesEvery alarm forces a mental shift:AssessEvaluatePrioritizeDismissNow multiply that by hundreds of interruptions per shift.The result?Mental fatigueIncreased error riskBurnoutEmotional exhaustionIntention to leave the professionThis isn’t weakness.It’s neurologic overload.The Patient ImpactAlarm-heavy environments increase stress hormones — especially at night.That contributes to:Sleep disruptionDelirium riskDelayed healingFamily anxietyErosion of trustWhen families hear alarms constantly and staff appear calm, it creates confusion and fear.We’ve adapted to the noise.They haven’t.Practical Strategies Nurses Can Use Tomorrow1️⃣ Fresh Electrodes & Proper Skin PrepClean the skin.Let it dry.Replace electrodes daily.Poor signal quality creates technical alarms.Better prep = fewer interruptions.2️⃣ Customize Alarm LimitsFactory defaults are not individualized care.Assess your patient’s:Baseline vitalsDiagnosisClinical trajectoryAdjust limits so alarms signal change — not normal variation.Make the monitor work for you.3️⃣ Use Alarm Pause ThoughtfullyBefore turning, suctioning, ambulating, or procedures.Prevent predictable alarm cascades.Protect the unit’s cognitive environment.4️⃣ Advocate for Smarter SystemsEvidence supports:Alarm champions who review trendsData-driven parameter adjustmentsShort algorithm delays to filter artifactDirect-to-device alerts instead of overhead noiseUnit-wide alarm auditsTechnology should reduce cognitive burden — not amplify it.The Super Nurse PerspectiveThe monitor is a tool.The patient is the priority.If the screen says emergency but your assessment says stable…Trust your clinical judgment.Always assess the patient first.Quick RecapAlarm fatigue is:A cognitive conditionLinked to patient harmContributing to nurse burnoutA system issue — not a personal flawSolutions begin with:Better signal qualityIndividualized settingsCommunicationAdvocacyWe don’t have to accept chaos as normal.Nurses are the guardians of the clinical environment.And we deserve tools that are as intelligent as we are. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI powered learning, comic book style nursing education, and more on how to be a super nurse!🩸 The Bleeders and the ClottersAnticoagulants, Thrombolytics & Emergency Reversals🎯 Core ConceptAnticoagulants → Prevent clotsThrombolytics → Dissolve clotsReversal agents → Stop bleeding emergenciesNursing priority = balance clotting vs bleeding safely🔴 AnticoagulantsHeparin (Unfractionated)Monitored by PTTGoal: 1.5–2.5× baselinePrevents new clots (does NOT dissolve existing clots)Red FlagsHigh PTT → bleedingPlatelet drop ≥ 50% → suspect HITHIT = immune reaction → causes clotting despite low plateletsReversalProtamine sulfateMust give slowly (rapid push → severe hypotension)Enoxaparin (Lovenox)Low molecular weight heparinNo routine PTT monitoringInject into abdomen (2 inches from umbilicus)Do NOT expel air bubbleDo NOT rub injection siteWarfarinMonitored by INRGoal: 2–3 (higher for mechanical valves)Requires consistent Vitamin K intakeReversalVitamin K (non-emergent)PCC (Kcentra) for major bleedingFFP = slower + large volumeDOACs (Direct Oral Anticoagulants)No routine INR monitoringMonitor renal functionRenal failure → accumulation → bleeding riskReversalAndexanet alfa (Xa inhibitors)Idarucizumab (dabigatran)🔵 ThrombolyticstPA (Alteplase)Dissolves existing clotsUsed for ischemic stroke, massive PETime window: 3–4.5 hours from last known wellBP must be < 185 systolic and < 110 diastolicMonitoringNeuro checks every 15 minutesWatch for new headacheMonitor for bleedingCritical LabFibrinogenLow fibrinogen → treat with cryoprecipitate🧠 Clinical Pattern RecognitionMatch the drug to the lab:Heparin → PTT + plateletsWarfarin → INRtPA → FibrinogenDOAC → Renal function🚨 High-Risk ScenariosHeparin + platelet drop → think HITWarfarin + high INR + bleeding → hold + reversetPA + sudden headache → stop infusion + CTDOAC + renal failure → accumulation risk🩺 Key TakeawayKnow:What prevents clotsWhat dissolves clotsWhat reverses bleedingWhich lab confirms the problemThat’s how you manage the bleeders and the clotters safely Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI powered learning, comic-book style nursing education, and a great community!Why Speed Matters in Cardiac PharmacologyCardiac drugs aren’t interchangeable — and neither are their administration speeds.The difference between pushing in 2 seconds versus 2 minutes can mean:Rhythm conversionSevere hypotensionBronchospasmOr cardiac arrestToday’s framework:Push FastPush SlowNever PushAssess Before PushRule 1: Push Fast — AdenosineUse: Stable narrow-complex SVTMechanism: Temporarily blocks the AV nodeHalf-life: Less than 10 secondsWhy Fast?If you don’t push it rapidly (1–2 seconds with immediate flush), it metabolizes before it reaches the heart.Nursing PearlsExpect brief asystole (6–7 seconds)Warn the patient about chest pressure and “impending doom”Use lower doses in heart transplant patientsNot effective for ventricular rhythmsClinical Judgment: If you're unsure whether it’s SVT or something else, adenosine can help reveal the underlying rhythm.Rule 2: Never Push — Potassium ChlorideThis is a high-alert medication.Why Never?Rapid potassium destroys the resting membrane gradient.The heart depolarizes — and cannot repolarize.Result: Immediate cardiac arrest.Safe AdministrationNever IV pushPeripheral max: 10 per hourCentral max: 20 per hour (ICU with monitoring)Always mix thoroughly (invert bag at least 10 times)Toxicity Clues (MURDER)Muscle weaknessUrine output decreasingRespiratory distressDecreased contractilityECG changes (peaked T-waves)Reflex changesThis is a system-safety drug. Treat it with respect.Rule 3: Assess Before Push — DigoxinNarrow therapeutic window.Digoxin and potassium compete at the same cellular pump.Low potassium increases toxicity risk.Always AssessApical pulse for a full 60 secondsHold if under 60Review potassium levelMonitor for visual changes (yellow halos)Watch for nausea, confusion, or bizarre symptoms (like smelling flowers)Antidote: Digoxin immune fabBest strategy: Prevention through assessmentRule 4: Push Slow — IV MetoprololUse: Rate controlWhy Slow?Rapid administration can cause:Severe hypotensionProfound bradycardiaLoss of compensatory sympathetic toneNursing PearlsGive over 1–2 minutesMonitor heart rhythm and blood pressure continuouslyUse caution in asthma/COPD (beta receptor selectivity can spill over)Beta blockers can mask hypoglycemia symptoms in diabeticsNever stop abruptly — risk of rebound hypertension and ischemiaQuick RecapPush Fast: AdenosineNever Push: Potassium chlorideAssess Before Push: DigoxinPush Slow: MetoprololSpeed is physiology.Administration is pharmacology in motion.Clinical judgment is what makes you safe. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.AI for AI-powered learning, community, and comic-book style nursing education. Burnout Is Often the Wrong DiagnosisBurnout is commonly framed as exhaustion that improves with rest.Research shows many nurses are experiencing moral distress, not fatigue.Mislabeling the problem leads to ineffective solutions.Moral Distress → Moral InjuryMoral distress occurs when nurses know the ethically correct action but are prevented from taking it due to institutional barriers.Repeated moral distress leaves behind moral residue, which accumulates over time.This “crescendo effect” eventually leads to moral injury, a psychological and ethical wound similar to trauma seen in combat settings.Real-World Example of Moral InjuryEthical compromise isn’t limited to end-of-life care.Even “routine” decisions—like performing substandard care due to hierarchy or time pressure—can violate professional values.Phrases like “you got this” can function as silencing tools rather than support.The Scope of the CrisisResearch projects over 600,000 experienced nurses leaving the workforce by 2027.Hospital nurse turnover costs average millions of dollars annually.This represents a massive loss of clinical intuition, expertise, and mentorship.Institutional BetrayalNurses report feeling abandoned by organizations during and after the pandemic.Unsafe staffing, unrealistic expectations, and lack of voice deepen moral injury.Moral injury is reinforced when systemic failure is reframed as personal inadequacy.This Is Also a Biological InjuryStress responses from moral distress cause measurable changes in metabolism and hormone pathways.When nurses say, “This job is making me sick,” the data supports it.Moral injury affects both mental and physical health.Futile and Non-Beneficial CareICU nurses face ongoing ethical conflict around care that prolongs suffering.Legal ambiguity (“yellow lights”) often leads clinicians to continue care they believe is unethical.Fear of liability forces nurses to participate in care that violates their moral compass.What Actually Works: Evidence-Based SolutionsThe R3 Initiative (Renewal, Resilience, Retention)A systemic model developed through academic and clinical collaboration.Mindfulness as awareness—not avoidance—of ethical threat.Self-stewardship to protect energy, empathy, and integrity.Ethical practice tools to articulate and navigate moral conflict.Integrated into nursing education and residency programs.Schwartz RoundsInterdisciplinary forums focused on emotional and ethical experiences.Reduce isolation and increase psychological safety.Help prevent moral residue from hardening into injury.Nurse-Led DebriefingBoth immediate (“hot”) and scheduled (“cold”) debriefings.Significantly reduce burnout and moral distress.Allow processing before trauma is carried home.GROSS Project (Getting Rid of Stupid Stuff)Leadership-driven removal of redundant, low-value tasks.Especially effective in reducing EHR burden.Signals respect for nurses’ time and expertise.Inclusion as WellnessPolicies that marginalize identity (e.g., appearance norms) contribute to burnout.Belonging and authenticity are foundational to workforce resilience.You cannot build resilience in a workforce that feels excluded.Core MessageResilience is not about enduring harm.It is about having the skills, systems, and support to do the job without losing yourself.If you’re exhausted, you need rest.If you’re morally injured, you need change—and community. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Visit SuperNurse.ai for AI powered learning and super fun nursing resources!Episode NotesWhat Is Respiratory Rescue?Respiratory rescue is the moment when a patient who was stable minutes ago suddenly isn’t breathing. The key isn’t panic—it’s pattern recognition. This episode teaches you how to identify the cause of respiratory depression so you can treat the physiology, not just the symptom.🚨 Scenario 1: Opioid-Induced Respiratory DepressionKey cluesBradypnea (low respiratory rate)SedationPinpoint pupilsMechanismOpioids suppress the brainstem’s carbon dioxide drive by binding to mu receptors.AntidoteNaloxoneNursing trapNaloxone wears off before many opioidsRisk of resedationRisk of acute pain, withdrawal, agitation, and flash pulmonary edemaClinical pearlWake them up enough to breathe—not enough to fight.🚨 Scenario 2: Magnesium Sulfate Toxicity (The “Mag Drag”)Key cluesLoss of deep tendon reflexes (first sign)Normal pupilsLater: respiratory depressionDecreasing urine outputWhy reflexes matterLoss of patellar reflexes signals rising neuromuscular blockade before breathing fails.AntidoteCalcium gluconate (given slowly)Critical safety pointCalcium gluconate does not remove magnesium—it buys time while the kidneys clear it.🚨 Scenario 3: Residual Neuromuscular Blockade After SurgeryThe problemPatients can appear awake but still be paralyzed after anesthesia.Old reversalNeostigmineSlow onsetCauses bradycardia, bronchospasm, and secretionsRequires atropine or glycopyrrolateModern reversalSugammadexEncapsulates rocuronium directlyRapid reversalFewer cardiopulmonary side effectsNursing takeawayKnow which reversal agent was used—your monitoring priorities change.🧩 The Big Idea: Antidotes Are Not the EndAn antidote doesn’t fix the problem—it buys time.Naloxone wears offMagnesium is still in the bodyParalytics can re-emergeYou didn’t save the day—you saved the minute. Now save the hour.🎯 Who This Episode Is ForBedside nursesICU, OB, PACU, and med-surg nursesNew grads building clinical judgmentNursing students preparing for boardsAnyone who wants to think like a nurse, not just follow orders Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI powered learning and super charged nursing education resources. Episode Notes / Key TakeawaysBurnout vs. Moral InjuryBurnout is exhaustion from excessive demands and insufficient resources.Moral injury is the result of participating in or witnessing actions that violate a nurse’s moral and professional values.Burnout improves with rest; moral injury does not.How Moral Injury DevelopsBegins with moral distress: knowing the right thing to do but being unable to act due to constraints.Repeated moral distress leaves moral residue, which accumulates over time.Eventually hardens into moral injury, changing how nurses see themselves and their profession.Why the ICU Is Ground ZeroHigh prevalence of qualitative futility: treatments that prolong biological life while violating patient dignity.Nurses experience a constant double bind between advocating for patients and complying with institutional demands.Futile care also raises ethical concerns about justice and resource allocation.Institutional BetrayalOccurs when healthcare organizations fail to protect staff or act against their stated values.Intensified during the pandemic through unsafe staffing, inadequate protection, and isolation policies.Leads to loss of trust, guilt, and long-term psychological harm.The Real ConsequencesIncreased rates of PTSD, anxiety, depression, and suicide risk among healthcare workers.Physical symptoms, nightmares, emotional numbing, and disengagement from the profession.Drives quiet quitting and early exits from nursing.Why Resilience Training Isn’t EnoughMindfulness and self-care place responsibility on the individual rather than the system.Can feel invalidating or gaslighting when the root problem is ethical harm.Moral injury requires moral repair, not better coping skills.What Actually HelpsSchwartz Rounds to process the emotional and ethical dimensions of care.Ethics consultations and moral distress support services.Leadership acknowledgment, shared decision-making, and restoring nurses’ voices.Treating moral injury as an occupational hazard—not a personal failure. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Visit SuperNurse.ai to access AI-powered courses, real-world nursing scenarios, and tools designed to help you think and communicate like a confident nurse—especially in high-stress moments.In this episode, we tackle one of the most universal fears in nursing: calling a provider in the middle of the night. Whether you’re a brand-new nurse or still building confidence, this conversation walks you step-by-step through how to prepare, what to say, and how to escalate concerns safely.What you’ll learn in this episode:Why provider communication errors are a leading cause of sentinel eventsHow nighttime cognitive fatigue affects provider responsesThe “pregame” mindset: having your data, vitals, and chart ready before you callThe 20-word challenge to eliminate rambling and sound confidentHow to use SBAR effectively without sounding roboticWhy the “R” (recommendation) matters—and how to use it safelyScripts that reduce tension, including “non-emergent but time-sensitive”How to escalate concerns using CUS (Concerned, Uncomfortable, Safety)The difference between passive, aggressive, and assertive communicationWhen and how to use documentation language to protect patient safetyThis episode is designed to move you from fear-based calling to clear, professional advocacy, helping you become the nurse your patient needs—even at 3 a.m. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for super powered nursing education and AI powered learning. Episode Notes / Key PointsWhy Nurses Are Really Leaving the BedsideNurse turnover is often driven by moral injury, not fatigue.Moral injury occurs when nurses know the right action but are prevented from taking it.Burnout vs. Moral InjuryBurnout = exhaustion that improves with rest.Moral injury = a violation of conscience that does not resolve with time off.Common Triggers of Moral InjuryNon-beneficial or futile care.Compromised patient dignity.Policies and productivity metrics overriding ethical judgment.Fear-based decision-making and lack of nurse voice.Why Self-Care Isn’t the SolutionMindfulness and wellness initiatives address individuals, not systems.These approaches can feel dismissive when the root issue is ethical harm.Moral injury cannot be “fixed” with better coping strategies alone.What Moral Repair Looks LikeNurses being genuinely heard.Access to ethical and moral support.Shared decision-making at the bedside and organizational level.Leadership acknowledgment of harm.Healthcare systems aligned with professional nursing values.The Bigger PictureMoral injury is an occupational hazard, not a personal failure.Retaining nurses requires systemic change, not resilience training.Protecting the moral foundation of nursing is essential for the future of healthcare. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI powered learning, comic-book style downloads, and super fun lessons for super nurses!What’s Really Failing in IV AccessOver 2 billion peripheral IVs are placed globally each yearTraditional landmark-based IVs fail 33–69% of the timeNearly 50% of catheters are removed unintentionallyRepeated failed attempts drive unnecessary central line placementWhy Escalation Isn’t FailureThe “escalation problem” occurs when failed PIV attempts lead to PICCs or central linesCentral access increases risk for:CLABSIsThrombosisMechanical complicationsUltrasound-guided PIVs act as a rescue strategy, not a luxuryUltrasound-Guided IVs (USGPIV): What ChangesMoves IV insertion from tactile guessing to visual confirmationAllows assessment of:Vessel depthDiameterVein wall healthFirst-attempt success increases to 91–98%The Technique That Saves the LineShort-axis (“donut view”) preferred for peripheral IVsMaster the creep method:Advance needle → stopSlide probe → advance needleRepeat until lumen entryCritical insight:A flash means the needle is in the veinThe catheter may not beAdvance the entire device further before threadingWhy Upper-Arm Veins WinBasilic and brachial veins:Larger diameterMore stableLess nerve densityFewer infiltrations, longer dwell times, less patient painThe DIVA Score: Removing Ego from AccessIdentifies difficult access before attempts beginRisk factors include:ObesityEdemaDehydrationFrequent hospitalizationsIV drug historyScore ≥3 → skip blind attempts and escalate earlyVascular Access Teams (VASTs): The ROIInefficient IV access costs $1.5 billion annuallySpecialized teams save:~$83 per patient~$45,000 per CLABSI preventedFaster access = better bedside nurse productivityMidlines & Clinically Indicated ReplacementMidlines can last up to 29 daysIdeal for week-long therapiesShift away from routine 72-hour replacementPreserve vessels, supplies, and patient comfortNear-Infrared Vein VisualizationHelps visualize superficial veinsImproves equity across skin tonesBest used as an assessment tool, not placement replacement🎯 Key Takeaways for NursesBlind IV starts fail too often to be ignoredUltrasound isn’t advanced practice — it’s evolving standard careA flash is not the finish lineDIVA scoring protects both patients and nursesVascular access is about vein preservation, not just “getting a line” Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI powered learning, printables, and super fun courses!Nursing education is shifting from memorization toward clinical judgmentResearch shows up to 65% of hospital adverse events are preventableApproximately 50% of novice nurse errors are tied to poor clinical decision-makingExplanation of “failure to rescue” and why early cues are often missedLimitations of traditional ADPIE thinking in real-time clinical careIntroduction to the Clinical Judgment Measurement Model (CJMM) as nursing process 2.0Comparison of ADPIE (linear) vs CJMM (iterative, real-time decision-making)Breakdown of the six CJMM cognitive steps:Recognize cuesAnalyze cuesPrioritize hypothesesGenerate solutionsTake actionEvaluate outcomesReal-world postoperative scenario illustrating clinical judgment in actionHow “worst-first” thinking improves prioritization and patient safetyRole of anchoring bias in novice nurse errorsPractical strategies to build clinical judgment, including the “so what?” methodImportance of SBAR communication in translating judgment into actionWhy unfolding case studies act as clinical “flight simulators” for nursing studentsHow Next Gen NCLEX question formats mirror real bedside thinkingThe emerging role of AI in nursing education—and its impact on judgment formation Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI powered learning, comic book style printables, and fun and different ways to learn. Episode NotesApril 1, 2026 marks the official rollout of the new NCLEX test plansCore nursing content has not changed—how it’s tested hasIntroduction to the Clinical Judgment Measurement Model (CJMM)Why 50% of novice nurse errors are linked to poor clinical decision-makingExplanation of “failure to rescue” and its role in NCLEX redesignDifference between ADPIE and CJMM (linear vs. iterative thinking)Breakdown of the six CJMM cognitive skills:Recognize cuesAnalyze cuesPrioritize hypothesesGenerate solutionsTake actionEvaluate outcomesWhat polytomous (partial-credit) scoring means for studentsHow unfolding case studies and bow-tie questions test real-world nursing judgmentWhy memorization alone is no longer enough to pass—or practice safelyPractical study strategies to build clinical judgment instead of flashcard fatigue Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI powered learningSGLT2 inhibitors known as the “flozins” including Jardiance, Farxiga, and Invokana lower blood glucose by forcing the kidneys to excrete sugar in the urine, normal blood glucose does not equal metabolic safety, SGLT2 inhibitors reduce insulin signaling and increase glucagon leading to rapid fat breakdown and ketone production, euglycemic DKA presents with severe metabolic acidosis despite glucose readings that appear normal, common symptoms include nausea vomiting abdominal pain weakness fruity breath and deep rapid respirations, nurses must check serum ketones and blood gas rather than relying on fingerstick glucose, the SAD MANS sick-day rule identifies medications to hold during acute illness including SGLT2 inhibitors ACE inhibitors diuretics metformin ARBs NSAIDs and sulfonylureas, dehydration dramatically increases risk for acute kidney injury and DKA, urine output is the earliest and most reliable indicator of kidney distress, SGLT2 inhibitors must be stopped 72 hours prior to surgery per updated FDA guidance, treatment of euglycemic DKA requires IV insulin with concurrent dextrose infusion and close potassium monitoring, prevention through patient education sick-day kits and early nursing recognition is far safer than ICU-level rescue care Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI-powered learning, printables, and guides from an expert nurse!This episode explores the unprecedented wave of healthcare strikes unfolding in 2026 and why nurses are reaching a breaking point, examines national strike data and staffing shortages fueling the movement, breaks down the financial tension between staff nurses and high-paid strike nurses, explains the documented increase in in-hospital mortality during strikes and why institutional knowledge loss matters, compares deontological ethics versus utilitarian ethics in strike decisions, clarifies how the ANA Code of Ethics supports collective action, defines the “new grad ethical ghost zone” during probationary periods, outlines the risks new nurses face when striking or crossing the picket line, addresses doxing and social retaliation concerns in the digital age, explains why striking is not patient abandonment when proper notice is given, breaks down the 10-day notice requirement under the National Labor Relations Act and how liability shifts to hospital administration, reviews federal protections even in right-to-work states, highlights modern strike demands including enforceable staffing ratios, AI guardrails, and violence prevention, explains how AI staffing algorithms are impacting bedside safety, provides practical steps to identify your union and anticipate strike activity, teaches nurses how to quietly access contracts and information without retaliation, identifies current national strike hot zones, and emphasizes why labor literacy is now a core professional survival skill for nurses. Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI-powered learning, comic-book style printables, and common sense courses. Episode NotesKratom is a dose-dependent substance that acts as a stimulant at low doses and an opioid at higher dosesHigh-potency extracts, including concentrated 7-hydroxymitragynine products, are driving increased hospitalizationsStandard urine drug screens do not detect Kratom, creating a major assessment blind spotNurses must ask targeted history questions about herbal teas, powders, energy supplements, and brand names“Toss and wash” ingestion carries serious airway and aspiration risks due to thick, hydrophobic powder residueKratom toxicity can present in three primary ways: opioid-like respiratory depression, stimulant-induced agitation, or seizuresSeizure risk is increased due to Kratom’s adrenergic effects and its inhibition of key liver enzymes that metabolize many medications“The wobbles” is a critical slang term indicating neurotoxicity and increased seizure riskLong-term use may cause hepatotoxicity, jaundice, pruritus, hyperpigmentation, and dental changesKratom withdrawal is severe and often leads to patients leaving against medical advice if not treated aggressivelyBest practice withdrawal management includes buprenorphine, clonidine, and gabapentinChronic Kratom use creates cross-tolerance, complicating anesthesia and post-operative pain controlNurses must approach assessment without judgment to reduce stigma and improve disclosureLegal status does not equal safety, and Kratom represents a growing clinical and public health concern Need to reach out? Send an email to BrookeWallaceRN@gmail.com

Check out SuperNurse.ai for AI powered learning tools and printables!Episode Notes: Surviving Nurses Eating Their YoungUnderstanding the ProblemWhat “nurses eating their young” really means in clinical practiceLateral violence and horizontal hostility in modern healthcareWhy this behavior persists despite “zero-tolerance” policiesWhy It HappensOppressed group behavior within hospital hierarchiesThe dangerous “rite of passage” myth in nursing educationPost-pandemic compassion fatigue and survival-mode nursingChronic understaffing and high patient acuity as accelerantsWhy It MattersHigh new-grad turnover linked to lateral violencePatient safety risks when nurses are afraid to ask for helpPsychological consequences: anxiety, PTSD, and moral injuryThe Survival GuideCognitive Rehearsal: Using prepared scripts to respond calmly and professionally in the momentPower-Shifting Language: Setting boundaries without escalating conflictThe Socratic Method: Turning hostility into accountability through curiosityFinding Allies: Identifying “work moms” or “work dads” who can mentor and shield new nursesStrategic Documentation: Creating a private paper trail focused on patient safety, not emotionsWhen the Culture Is ToxicWhy psychological detachment is nearly impossible in abusive environmentsKnowing when the unit cannot be fixed from the insideUsing today’s nursing shortage to protect your mental health and careerBreaking the CycleChoosing mentorship over intimidationHow experienced nurses can shape safer, stronger unitsEnding generational trauma in nursing cultureTools for the Next GenerationHow SuperNurse.ai supports nurses with AI-powered educationBuilding confidence, communication skills, and clinical judgmentHelping nurses dominate their shifts without sacrificing their mental health Need to reach out? Send an email to BrookeWallaceRN@gmail.com