The most valuable thing(s) you've been told

AmyRN303, BSN, RN · Sep 7, 2014

When something looks funky on a monitor, assess and treat your patient, not the monitor. This comes in useful when the bandaid O2 sat monitors start wigging out because of sweat or becoming detached. Wouldn't want to treat a walking talking patient for asystole either just because their leads came off

ICURN3020 · Sep 8, 2014

When something looks funky on a monitor, assess and treat your patient, not the monitor. This comes in useful when the bandaid O2 sat monitors start wigging out because of sweat or becoming detached. Wouldn't want to treat a walking talking patient for asystole either just because their leads came off

I've seen it happen....had an agency nurse working in our unit (nothing against agency nurses, she just happened to be one) who actually called a code on an awake and stable patient!!!

I don't know if she was unfamiliar with our monitors or what, but how embarrassing to have to tell all the responding departments, "Ummm, nevermind" because of course they all want to know what happened and why the code was cancelled

delphine22 · Sep 8, 2014

If you didn't chart it, it wasn't done.

If you sign your name/initials/fingerprint on it, you're responsible for it if it's wrong. I never sign heparin without looking at the pump myself, and I'm "that nurse" that makes sure the narc is wasted in front of me.

Bedside report, bedside report, bedside report. I hated it so much when my facility implemented it. Then I went somewhere where it was organic and "just the way we do it," and it's really wonderful. Report can be like playing telephone -- errors get passed along, especially about history, and you need the pt to correct them. Also, it keeps the previous shift from leaving me with a blown IV if I catch it during shift change.

Related: check all your peripherals with a full flush the very first moment you can. If you don't, that'll be the day you have a code and none of your 3 access points works.

Make your own report sheet, or always make sure you write your stuff in the same place on your paper. That way you know if something's missing.

It's OK to tell a family member who wants to tell you a long story about their distant cousin, "Excuse me, I need to go check on my other pt." You do have work to do and it helps to set boundaries, that you will be polite but you can't chat all day.

Always always always dispose of flushes and syringes in the sharps, even if they are luer locks. IVDUs will fish them out of the trash and use them to put stuff in their PICCs.

Hand hygiene in, hand hygiene out. Make sure the pt sees you doing it.

If the pt is blind or has issues with fine motor skills, take a telemetry electrode and place it over the callbell so they can feel the raised snap part. Makes it much easier for them to find.

Nurses are as superstitious as professional sports players. If you are super prepared for something bad, it usually doesn't happen. I park temporary pacers outside the room of certain pts, or keep my friendly purple box of atropine right by the sink. It works, people! :-)

paramedic-RN · Sep 8, 2014

So I also don't like bedside report for several reasons, I think it's almost just as good to do it outside the room and then go in where both of you lay eyes on the pt and then just do a little intro. If it's a stroke pt you can do a neuro check and confirm with off going nurse if there's any changes. But I know it's touted as the best way to do things, where I work we don't do it so I have yet to witness how nice it apparently can be. One thing that I'm sure if helps cut down on are those nurses that give you a long drawn out report with unnecessary details like

"omg my night was so busy, this one was a handful, he would get out of bed every 15 mins and I kept telling him "Mr. Jones you have to stay in your bed" but he just wouldn't listen his bed alarm kept going off and it was just me and linda so I had to keep running out of my other rooms to check on it and then his daughter came, nice women we chatted for a while she actually use to be a nurse and blah blah blah irrevelant details. I'm like hurry up woman I got stuff to do!

delphine22 · Sep 8, 2014

One thing that I'm sure if helps cut down on are those nurses that give you a long drawn out report

Absolutely. At the hospital where we did it all the time, on a PCU floor, report started at 1845 sharp and everyone was done by 1910, with five pts. At my other hospital, report starts late and drags until 1930 or even 1945. So much chit chat! I even feel myself falling into the trap, bc we sit down together instead of standing/walking.

I try to encourage it by saying, "C'mon, let's walk!" when it's time for report. I introduce the oncoming nurse, manage up, and say, "I'm going to tell him/her a little about you, let me know if I get anything wrong." Then I basically read everything on my paper, like I would in regular report, making sure to include the pt from time to time -- "How many times did you move your bowels today, Mrs. Smith?" -- so I'm not ignoring them.

These are all private rooms, which is all I have experience with.

Only two things I don't say in the room with the pt: psych issues (as in, they or their family are a PITA) and how often their PRN pain meds are scheduled, if the pt doesn't know. I almost choked a nurse who said during the bedside report that the Dilaudid was ordered q1h. :bored:

parascribe · Sep 8, 2014

If you didn't chart it, it wasn't done.
If the pt is blind or has issues with fine motor skills, take a telemetry electrode and place it over the callbell so they can feel the raised snap part. Makes it much easier for them to find.
Nurses are as superstitious as professional sports players. If you are super prepared for something bad, it usually doesn't happen. I park temporary pacers outside the room of certain pts, or keep my friendly purple box of atropine right by the sink. It works, people! :-)

That's a great tip, thanks. As to superstition, I tell people I didn't use to be superstitious, then I became a paramedic. Being a nurse reinforces it.

My first mentor gave me a great line "Always remember, we take care of other people's emergencies." Over the years that's been a great help in maintaining a professional distance.

firstinfamily, RN · Sep 9, 2014

Discharge planning begins with admission. Before you know it the discharge time comes and you realize no one has given the patient any education! All and I do mean all shifts can do this.

Lev, MSN, RN, NP · Sep 9, 2014

Do your own assessment, every shift, even if caring for the same patient 3 days in a row.

I love my cat! · Sep 18, 2014

I remember these from Nursing School:

-The quietest patient can also be the patient in the most pain. The loudest patient can also be the patient in the most pain. Pain is subjective and treat/medicate that patient as such. Check your judgments at the door.

-If you think you can't/don't/won't make a mistake-you are a very dangerous Nurse and should take some time a way from the field. Immediately.

-Not all sick people look sick.

-You will have co-workers who do not like you, no matter what you do. Sadly, the harder you try to make them like you, the meaner they will become. Don't take it personally. Treat them professionally, but put your efforts into the people who do appreciate you!

-Don't play Doctor by withholding scheduled drugs because you think your patient is an addict or a drug seeker. Leave that diagnosis up to the patient's Physician and medicate as ordered.

jcbhappy · Sep 22, 2014

thou shall not put your face or body in front of any human orifice!!!