Easy, dumb, common new grad mistakes - page 2
I'm about to start my first real nursing job, and I know that I will forget things, and make some mistakes. I was hoping to start a thread where people could share some common mistakes they've... Read More
Jul 30, '13Remember to remove the tourniquet after starting an IV. "Gosh it looked so good....I just can't figure out why it isn't dripping better." OOPS!!
Jul 30, '13Quote from julz68And when you spike IV fluid, make sure your tubing is clamped, so it doesn't prime by gravity, then end up with air bubbles all throughout once you get to the pump and try to prime it again!When you hang a piggy back, remember to open the roller clamp!
That was my first dumb mistake.
Jul 30, '13Thanks for all the words of wisdom! I'm starting my first job next week and I'm suuuper nervous and excited! I just want to be a good nurse and I hope I can do it!
Jul 30, '13If you need a surgical consent signed for a confused patient, and family is at the bedside, assume the family is leaving in 30 seconds. Grab them ASAP and ask them to wait a few minutes before you lose them and have to track them down by phone.
I also ask the ER nurse to ask the family to come to the floor for when I get an admit from ER. Families often take off when the patient transfers if not specifically asked to stay. A brief chat with family gives me a clarified understanding of the patient's baseline behavior. For example, I once had a confused but interactive patient suddenly stop eating, talking or even making eye contact. The family (after being contacted) was able to confirm that it was "normal" for him and occurred several times a month for a few days.
Jul 31, '13I just finished my first year and the things that help me most is after loading my pockets with alcohol swabs, flushes, pill splitter and white board marker and getting report is to review the charts, make a brain sheet of meds by time and check boxes next to my "to-do's that also includes finger sticks by time with a space to write the sugar and how much insulin they get next to it, its a great reminder of my to-do;s and i add to it throughout the shift as new orders get written, and i admit is feels great to see things checked off throughout the shift. I use similar strategies on my patient's white boards so they see their plan written out and things checked off, or the list updated. It helps me feel organized, and the patient informed. Once I have my brain sheet, I grab meds and my stethoscope, listen to my patients and do a quick assessment before rounding with the rest of their meds. That gives me a good feel for their status, mental and physical, immediate needs and organize their white boards. Good luck!
Aug 4, '13When you are hanging blood after you prime the tubing don't forget to clamp the tubing attached to the NS. You don't want to get blood in the bag of NS.
Aug 6, '13Thanks for all the great advice, keep it coming! After my first couple weeks with my preceptor, I haven't made a (major) mistake, but right now I'm so paranoid I'm quadruple checking everything I do. I did incorrectly connect a syringe of morphine to my patient's IV and pushed it out all over him, but luckily he was nice and my preceptor is amazingly calm and patient.
Aug 6, '13Quote from SubSippiThat's because we have all been there, done that, and no harm, no foul..... and my preceptor is amazingly calm and patient.
Aug 6, '13Depending on how report is done on your unit, these things may/should already be givens... But these are a few things that I've come to find realllly important.
1) check the I/Os. First, see that they're appropriate (regarding mL/kg/hr for output) and second, that they were actually documented. My real life learning situation: RN giving report says "yea he's been eating and drinking well". But not until a few hrs later did I see intake for that shift was recorded as ZERO. Way easier to rectify when the off-going RN is still on the unit!!
2) check the most recent vital trends. Off-going RN says "yea she's been afebrile, signs stable". Until you go to chart and see that the HR has been stable, at 130s...for a 13yr old... (was he agitated? upset? in pain? tell me more so I can appropriately assess his next set of VS...)
3) check the meds. even if you can just eyeball them at this point. Find out why anything was held (off-going RN: he's been having diarrhea all day, so we're holding miralax) or see if anything was missed. Sometimes it wasn't charted correctly (we've had increasing problems with the computer either not saving or running out of power mid-med admin... problematic? yes!), or was accidentially skipped. If it's a fresh post-op, double check whether the off-going nurse has already retimed any meds (ie-the antibiotics)--if not, find out when it was given intraop. Easier to get this info from the RN who learned it in report than by sifting through the file yourself...
4) For peds, is the family there? Are they helpful/hands on?
Ugh-As much as I love giving this advice, I hate that it reminds me how report on my unit tends to be/IS way less organized than it should be!!! Mid-New years resolution = improving that. Stat.
Other advice not tied to report: Get a full set of signs EVERY TIME you call a doc for a concern or semi-concern. Not for a "your fluid orders are conflicting" kinda call, but then again, you might wish you had a fresh set of vitals then, too
PS- pretty much every shift I do, I learn something that changes the way I practice, even in just a tiny way! Good luck!Last edit by newkidnurse on Aug 7, '13 : Reason: added
Aug 17, '13I had coke sitting In a peg for hours and it wouldn't unclog. So I called the attending to notify of my interventions and still no luck. So an hr later she makes rounds and if I see the a DR go in my pt room I always try to follow in. So this pt is mrsa+ and thank god we gown up.
We are hovered over the bed and I go to " show her" just how clogged this peg is by attempting to flush it. Well I had it clamped below and it bulged badly just like before.....except this time it bursted wide open showering me, the attending, the pt, the clean sheets, walls, cabinet and mirror with exploded peg gunk and flat coke.
We had a laugh about it , after I screamed and ummm she agreed for. GI consult to fix the peg.
Tips: -when " playing with/ fixing" a peg, wear a mask!!!
- make sure the clamp is clamped before you withdraw a syringe and unclamped when delivering Rx/ bolus cuz it will back flow/ burst.
Feeding by gravity gets dangerous.....I had a pt cough while the gravity feeding ( how they * tell you* is best practice* and it overflowed all over.
- keep a big towel/ pad to cover the pt and your clean sheets just in case
:-)Last edit by SNB1014 on Aug 17, '13
Aug 17, '13If you are putting crushed meds in water/whatever through an NG, OG, or PEG... for god's sake hold on to the tube and the syringe together! If you just have the syringe sitting in the tube, and the crushed meds clog up the tube and you apply extra pressure to the syringe, the force of the pressure WILL separate the tube and syringe and send the contents of your syringe flying all over yourself and your patient. Just remember that you want the meds to be in the patient's stomach, not all over your...