Psst...New Nurses

Sarah Matacale, BSN, RN

I realize that there are so many articles, blogs, books and inspirational bookmarks, coffee cups, and laminated lanyard tags that tell you how to be a great nurse. You learn throughout nursing school how to calculate BMI, use your posture to leverage a patient, "therapeutically communicate" and to give an orange the proper dose of insulin for the blood sugar you just checked with fake sugary blood. Not surprisingly there are some "real life, hands on, I have been there in the trenches for a few years and lived to tell a tale or two ", pearls that I want to share that work. These few tips will save you time, frustration, tears (yours), and will increase your job satisfaction and patient satisfaction.

Before you leave the patient's room, ask if there is anything else they need

This one is huge! Listen up people...you will save yourself tons of time and frustration in the long run each day if you do this. I can promise you that when you are rounding with you're 8am meds, if you just go in and hand the patient their meds and leave, the call bell WILL go on as soon as you are 2 doors down! Here's the rest of how this scene plays out..."Susie, your patient in 202 needs fresh water." You bring water and leave again to continue with med rounds..."Susie...your patient in 202 is out of straws"....head to pantry, grab straw, deliver and leave......"Susie, your patient in 202 needs to use the bathroom"......"Susie, 202 would like sheets straightened"..."Susie, 202 has family here and would like to ask you some questions".....AHHHHHHHHHH! Multiply 202 times the 10+ patients you have today.

Here is my "go-to" of how to work with 202's. When you go into the room, smile and boldly and cheerily say good morning! Ask about the patient's night as you clean up their bedside table. Check on straws, cups, and tissues. Dump old pitcher of water. Tell patient you will be back in second as you get them a pitcher of fresh water with ice (people love that hospital ice), grab straws, cups etc while you are there. When you come back in and put it all on bedside table, chat with your patient about your crazy kids this morning, your animal's antics , really anything personal to open communication. Tell your patient what pills they are taking and for what. Discuss medical plan for the day, tests, labs, time doctor is expected in etc. Any questions 202? Ask if patient needs to use restroom, if yes, straighten sheets or change them if needed while out of bed. If no, straighten the sheets out. Ask if patient is warm enough or cool enough. Place the bedside table, call bell, and channel changer in reach, ask if patient wants blinds open......and last but not least, "Is there anything else I can do for you? I will be back to do an assessment at (such and such) time." Bam! Five to 10 minutes and the patients will love their attentive nurse and not want to bother you knowing you will be back soon. Bonus is that you visually did a pretty thorough assessment of 202 while you were in there.

Know Where To Go When You Don't Know

Yet another biggie. You will NEVER know all you need to know. However, if you know where to go to find out then you'll be in good shape. On any unit, you will soon figure out who the seasoned staff are. There are always those with special "skills sets". Some are great with inserting IV's; some foleys; some know a ton about cardiac rhythms. Call pharmacy as a resource for any and all questions related to medications or interactions, allergies etc. Use your drug reference handbooks. There are always a few super awesome easy to talk to physicians, nurse practitioners, or physician assistants that love to share information and answer questions. Be friendly, ask questions about disease processes, medications, patient histories or whatever you may have questions about. Be a sponge with any knowledge you can get your hands on. Never be afraid to ask.....I have always been bold and outgoing with questions and I stick my nose and ears on primary physician and specialist conversations. I butt in on wound care during dressing changes, radiology during procedures etc.

Let me share a little story of my own. When I came out of nursing school, I went straight to work as a hospice nurse for 5 years. Nothing more unnerving than coming out inexperienced and working in a location where you are autonomous and have no other nurses with you. So one of my first patients had a colostomy and I was to do her ostomy care and assessment for her during my visit. I never had the ostomy experience in my 4 years of nursing school. I read about it, passed the test doing care on a "torso mannequin", but real life is something different. OK, I can think critically, figure this out somehow, right? What did I do? "Mrs. XYZ, why don't you show me how you care for your ostomy so that I can see that you and your family know how and also it will allow me to do it the same way you do when I come". Yup, Mrs. XYZ unknowingly taught me ostomy care! Education opportunities come from many angles.

Be Prepared!

As a seasoned nurse and the wife of a physician, I can tell you that no doctor wants you to call them with a question or wanting a new order if you don't have all of the information necessary together, and IN FRONT OF YOU. Let's say your patient is in respiratory distress. When you call, you better know: your patient's lung sounds, respiratory rate, amount of oxygen on, medications given, allergies, changes in the patient's overall condition, pertinent labs, etc. Have your computer up and running, logged on. Have paper to jot orders on. Most importantly be by the phone! Most hospitals now have nurses carrying their own phones. If you do put out a call and have to go care for your patient, tell everyone around that you are waiting on Dr. PQR to return your call. Don't go potty then, do not get on the phone with pharmacy on the number the doc is supposed to call you back on. If your patient is in distress, call in your team to help while you talk with the doctor, after all you know the most about your patient.

Another area to be prepared for is talking with patients and families. First of all, know who you can talk with (permission) and what you can share. Be aware of who is in the room with the patient if you are sharing personal information about their care. Know what will be going on with your patient thru the day, including labs, tests etc. Explain in common, non-medical language what is going on with their care or diagnosis. I always consider myself the translator between the doctor and the patient. As nurses we bridge a lot of gaps and the medical jargon is just one of those areas, so be prepared to explain what's going on. It is OK to tell the patient that you are unsure about something and need to look into it further, just make sure you provide an answer before you leave for the day. That builds trust in you and for the nurses coming after you.

Remember Why You Are a Nurse

Everyday start fresh. On your way to work, remind yourself of the reasons you became a nurse. I like to say, most of us were born nurses. We are caring, compassionate, smart, quick thinkers, adaptable, team players and we want to make a difference in someone's life or death everyday. Some days that happens, some day not, but take the few extra minutes when you are in a patient's room to get to know your patient. Small talk about things unrelated to being in the hospital. I live in the south, so when meals come and I help set up, I ask about grandma's biscuits, or if my patient likes to cook. Food is the universal leveler y'all...everyone can small talk about food. In these small things, you get those moments that you went to school for. These small moments make the day brighter for you and your patient. I can't tell you how many chin hairs I have plucked (Btw...designate a family member to tend to that renegaid if you are in the hospital...they pop up when least expected), hair I have curled, faces shaved etc. All to make a difference to that one patient and watch their family glow when they walk into the room and mom has her famous red lipstick on. In other words, humanize your patient. In the current healthcare world, everything is technology, task, and chart. Nothing touches your heart there. Your patients can feel very lost and scared in that world. Bring it back to the basics of biscuits, small talk and hand holding. I do want to stress that as a good nurse, your skills will be picking up subtle changes in your patient during those times too. Skin changes, bowel and bladder habits, confusion, dyspnea, new onset weakness, etc.

To wrap it up, I hope you can tell that I love the art of nursing on so many levels and always have, despite any role I have taken in this field. You make all the difference. Somedays you may leave crying in frustration and failure, but many other days you will leave feeling like you mattered to someone. You gave that patient a piece of you. Hopefully this will help some of you with the down and dirty, tips to survive your shift! Nurse on my colleagues!!

Psst...New Nurses

Before you leave the patient's room, ask if there is anything else they need

Be Prepared!

Remember Why You Are a Nurse

About Sarah Matacale, BSN, RN

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