Tips 'n Tricks: Pearls the Newbies Need to Know

[Music in My Heart]

I've been thinking about what simple advice we could give to those new to our ranks... a bullet list kind of thing... Tips 'n Tricks... Pearls... ED Nurse-Hacks...

Here's the one that I was thinking about that provoked this thread:

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+ Wear a gown and a face-shield to every trauma, every code, every time.

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It's much easier to discard PPE that you didn't need than to find a shower, clean scrubs, and time for post-exposure labs after you were inadvertently sprayed with ickiness.

A couple days ago, we ran a code for 30 mins or so on a drowning victim... multiple attempts at multiple lines... fem stick by an intern... vomit... feces... difficult airway... you know the story... so after it's called, several of us are working to get the victim tagged-n-bagged... the attending walks in and, for some unknown reason, presses on the guy's upper abdomen... at which point blood came shooting out of his NPA... all over the tech.

I've seen way too many people get blooded, etc for lack of PPE... and once the whole thing starts, there's no time to get the PPE in place.

It took me quite awhile to adopt this approach because the 'salty' ones didn't do it and I didn't want to look green. Now... I don't give a rip what I look like as long as I don't have blood goobers dripping off of me.

So, ED noobs... PPE for every trauma, every code, every time.

[TexanTough]

-You can't dilute valium.

-If families are going to be in a room with a patient and are capable, utilize them to assist with the patient's care.

-Label your meds as you draw them up. Which syringe is zofran? Which syringe is 2mg Dilaudid?

-Don't be timid or a doormat. Be assertive if you are advocating for a patient (especially in a teaching hospital environment).

-Know your stuff. This comes with time, but if you have a question, ask a provider. Don't ever say "I don't need to know that." You never know when your clinical proficiency will prevent a provider from killing someone.

-Along the same lines as above, if you don't know something...ASK. A great approach is to say, "refresh my memory on ____" if you feel intimidated because you don't know something.

[Lunah, MSN, RN]

Bring a protein shake - it is easier to drink some basic nutrition than it is to try to eat something fast with your hands.

Keep spare scrubs/socks/shoes/underthings in your car or locker. One complete set.

Pee when you can, because if you put it off, it'll be 6 more hours until you get a chance.

You can make a "smellulizer" with a nebulizer, hand sanitizer, and a little water. That mist can de-funk a recently vacated room.

Sodium bicarb will neutralize stinky feet.

Don't underestimate the power of a warm blanket.

Be kind, even in the face of unkindness. It's rarely personal.

[NewYorkerGirl]

I'm a newbie, but I've already learned the values of nursing shoes. The blood wipes right off! I was drenched by a trauma patient while transferring him from the ER. I was so glad I wasn't in my $140 running shoes...

[Julia77]

When giving a call light, consider saying something like, "Please call me if you're having an emergency, or you feel chest pain, shortness of breath or...(specifics) and otherwise I will be rounding".

I am happy to help my patients, I do have compassion, but I absolutely must prioritize and cannot be adjusting blankets and beds every five minutes for one patient. One q5 minute call light user (I want up, down, new blankets, etc.) patient informed me, "But you are HERE, for my comfort". I replied, "I am here for emergencies first, then health and safety, and then comfort.

Julia

[Ruby Vee, BSN]

People who feel bad-- act bad---whether it is physical or emotional. That phrase alone helps me tolerate less than polite, nice people and makes me change my approach.

And then there are those who act bad just on general principles.

[canoehead, BSN, RN]

If you have a trauma coming in, go pee. You may be busy for the next 3-6 hours, or more.

[emtb2rn, BSN, RN, EMT-B]

If you have a trauma coming in, go pee. You may be busy for the next 3-6 hours, or more.

Yeah, same for cpr in progress, code stroke, etc. when you get told medics inbound to you, hit the restroom.

[DafnaYakter]

Remember your ABCs!

do you repeat pain assessments and vitals

watch out for abnormal labs a try to let the dr know about it

it's better to go a little slower at first, than to cut corners...

As much as possible, before you go to the doc about a patient, be prepared with a request for what you think is appropriate.

Be ever mindful of their teeth, nails, fists, and feet.

Loose restraints are worse than no restraints... if they need to be restrained, they need to be restrained well.

If you have to pin them down, pin across the articulating joints.

Know where are your spit masks... and double them up if they're real spitters... the experienced ones know that they can spit on a single layer and then blow it through onto you (I learned that the hard way.)

[Guest219794]

If you know a code or seriously sick pt is coming in, have a snack and a pee.

Then, prep the room.

check o2, suction, supplies, etc.

And, if possible, remove extraneous furniture, and make sure you have easy access to a laundry basket, large garbage bin, and biohazard bag.

I am not especially neat, but all the crap that ends up on the floor is a hazard.

[bvalerio23]

Coming from a tech--

Not all techs are good, some are meant for the floor, some are natually built for critical care. If you have a feeling your tech is not going to be satisfactory, address is professionally and within the correct channels. Telling other RNs that so-and-so tech isn't qualified or isn't good just turns ALL techs against you. We can make your shift a breeze, or we can **** off a patient before you even get in an assessment, loose blood, etc.

Another point to make is that most techs are not offended if you ask us to do something/ask us to stop doing something. Some RNs don't want techs starting IVs, and that is okay - its a preference thing. Some RNs rely on techs to an absurd amount to the point that it comes off as laziness. Just as RNs have their favorite Nurse Managers or Charges, techs have their favorite RNs and some they resent to work.