What's your best 'Nurse Hack'? - page 2
I'm a soon-to-be new grad RN (only 29 days!! woo-hoo!) and I am curious to know from the seasoned working nurses: What is your best 'nursing hack' or advice for a baby nurses like me?... Read More
Nov 18Quote from hherrnYou can also use a speculum for the same thing. Dive in, push it open and up towards the belly button, and you'll find the head of the penis.Nursing hack?
I assume you mean an un orthodox short cut.
Depending on the breathalyzer unit- PT too hammered to blow. Place mouthpiece in pts mouth. Have somebody manually squeeze lips to create seal. Put suction on exhaust end, pulling a breath through the breathalyzer.
I can't advocate this next one, but the person who passed it on said it works.
Obese male needs a foley, but you can't find Waldo. The gopher isn't sticking his head up. You know it has to be in there somewhere, but you can't find it.
60 cc cath (not Luer) syringe. Remove plunger. Hook suction to small end of syringe. Place other end on the gopher hole. Apply suction. Grab that thing by the neck as soon as it sticks it's head up.
Nov 18Learn to write your labs on your brain (report sheet) using the fishbones. It will save time in writing down all the information.
Nov 18Quote from Racer15I learned this one the other day!! The trauma junior (?) asked me if I had some lube for my patient's face. I must've looked really confused because he laughed and quickly clarified that it helps to remove the dried blood! hahahaKY jelly on dried blood. Smear it on there, let it sit for ten minutes, the blood comes right off. One of my favorite ER tricks!
I love reading all of these awesome hacks! Great thread.
Nov 18Trach is hard to suction...like a partial plug but not really an entire plug? Bag em'. Use the ambu bag to clear the partial plug, then suction it back out. Works like a charm.
Nov 18When I started nursing, I was shown to empty Jackson-Pratt drains (AKA JP drains or bulb suction drains) by squeezing the contents out into a measuring cup/graduated cylinder. Its not perfectly accurate, especially for small amounts and I was always worried that I would knock over the container and make a mess. Instead, attach a syringe to the opening of the drain bulb, pinch the tubing closed between the patient and the bulb, and suck the drainage into the syringe.
This probably isn't as useful in adults, but in pediatrics you often have small scales in every patient room. Got some kind of surgical drainage bag that isn't able to be emptied? Weigh the bag on the scale at the beginning and end of your shift and then you know how much fluid has accumulated during the shift (grams = ml).
Don't put narcotics or any keys that have to do with accessing narcotics in your pocket. It is so easy to forget and accidentally walk out of the hospital with them.
Nov 18Quote from Racer15That is a better idea.You can also use a speculum for the same thing. Dive in, push it open and up towards the belly button, and you'll find the head of the penis.
Nov 18Yaunkeer hooked up to suction for people who say "I'm feeling sick". I suction vomit right from the mouth... so much better then having to clean up a bed and change gowns... I was surprised when I first learned this how many people will wrap their lips around a yaunkeer and let it suction their vomit.
Crushed meds in an ice cream sandwich... for those that have a hard time swallowing... it works better then applesauce or pudding.
If you are a person that enjoys keeping a journal/make a list, I would write down a weekly goal of improvement and then each day something you did to work towards that goal..... or just a note each day on a couple of things you did well that day (and don't forget doing the caring part). There are new nurse that come on here all the time, feeling overwhelmed and like they'll never get it. If you keep a record of what you've learned and can now do well, you can look back when you get discouraged and see how far you've come.
Nov 18To me a "hack" is a way to solve a problem in a novel fashion.
1) cutting the prongs off of a nasal cannula because they're irritating the pt and they keep pulling it out
2) Putting the nasal cannula prongs in the pt's mouth because they're mouth breathing and not getting enough O's through the nose
3) Putting an infant pulse ox probe onto a patient's earlobe when you've got poor perfusion on the fingers and toes
4) When doing a pulse ox on a baby, cover the probe by putting the sock back on; it can help get a clean signal and the kid starts to ignore it when they can't see it.
5) To give feeding or meds through a PEG tube MIC-KEY when you don't have the connector: Use the catheter from a 14 or 16 IV angiocath...
6) Don't forget the tincture of benzoin for people with flakey skin, oily skin, or sweaty skin...
7) If you have to draw blood on a super tough stick, look for superficial veins on the foot and use a 25ga butterfly
8) Not a hack but know how to determine an actual GCS... far too many people just estimate or guess.
9) During your break, go through the supply carts... over and over until you know *what* is stocked and *where* to find it.
10) Don't get greedy on your IVs... often times a 22 will suffice, even for CT contrast studies and you can still give maintenance fluids, abx, IV pushes, and emergency meds (RSI and ACLS) through a 24.
11) When putting in a Foley on a lady, use a couple of sterile 2x2's - one on either labia - to help provide some traction as you expose the urethra
12) Get to know all the ancillary staff. You'd be amazed how much easier they can make your life if they like you and respect you.
13) If you ask somebody to come start a line for you, have all the supplies there for them and stay around and offer to clean up after them so that they can get back to their other tasks.
14) Same thing... if you're asking someone to transport for you, have the patient all packaged up for them when they show up.
Nov 19Slushies for patients who don't want to drink (esp good with kids): Microwave two-three popsicles (unwrapped of course) in a styrofoam cup for about 45 seconds (or depending on your microwave- till they're soft enough to scrape off the stick but not liquefied). Pour in a little Sprite, crush up the popsicles in with the Sprite, you have yourself a very refreshing, rehydrating drink that patients may actually be excited to drink (again I work in pediatrics but everyone loves slushies!!!)
Also... snack, cold drink, etc can make a big difference to patients (who are not NPO/sedated of course!!) I've found that when I have time to take that minute to ask them about that and bring it to them right at the start of the shift, results in a whole new attitude and positivity of interaction that lasts the rest of the shift... I don't know why it works but it seems to!! Which makes the whole shift easier with said patient/family, usually saving time in the long run, even though takes that extra minute at first. Obviously NOT possible every shift by any means, but it is something that if you have time, makes more difference than you might think.
Never run when you can walk... Never stand when you can sit... Conserve your energy!!! :-)
Have your patient gulp ice water (if possible) while you're placing an NG tube.
Make sure at the START of your shift that all emergency equipment you might possibly even remotely need for that patient, is in their room and functional. Such as: suction open with appropriate suction device for patient attached (and saline bullets available, if applicable), oxygen source on with mask available, bag-valve mask if patient has a trach or unstable airway, a new pulse ox probe if the one the patient has is falling apart/not sticking well. Oh and of course a large basin if the patient has ANY hx nausea; NOT one of those tiny little emesis basins but one of the big ones, you know what I mean!
Sometimes taping the med-port shut on a G-tube that is receiving continuous feeds... is a good idea. That sucker can pop open easily on some patients then your formula is all over the bed.
Be sure to unclamp appropriate clamps on feeding tubes, IVs, etc after you start a new infusion or change something i.e. hanging an antibiotic, giving a GT or IV push med, etc.
If you work night shift: Learning how to be as silent as possible with your assessments if patient is sleeping... always have a good penlight you can use for light to see what you need to see.
ALWAYS ALWAYS ALWAYS check your IV sites regularly, and carefully... infiltrations happen fast and you can't completely prevent them, but being very attentive to the site means you catch it earlier. Also making sure the IV site is as stable as possible helps a lot... as much strategically placed tape, Tegaderm, armboards, etc that will help, different ways of positioning the tubing, etc, though ALWAYS MAKING SURE you can see the site itself to assess it!!!
If a patient (or their parent/family member) says all of a sudden that, "Something is really wrong... I just don't feel right/he just doesn't look right..." PAY ATTENTION bc more often than not, those feelings turn out to mean something (in my experience).
You can never have too many pens in your pockets!!! Those things grow legs. Also, your stethoscope. Keep it with you all of your shift; be VERY wary of "lending" it to someone for "just a minute" you may never get it back haha. :-)
Do your best NOT to let people interrupt you while you are preparing your medications.
I might add more later. Although this post is extremely too long already haha... I like this thread!!
Nov 191. When starting a bed bath make sure the lid to the lotion is on tight and throw it in the basin, it will be nice and warm by the end of the bath.
2. That same lotion will work really well to get that sticky impossble to remove bm off, put some lotion on a wipe- all rub it in and let it sit for just a bit and it will come right off without rubbing the patients skin raw.
3. When giving g- tube meds fill up your graduated cylinder, mark the volume and then when done note what's left- way easier than trying to keep track of I&O for all 20 0800 meds. (2nd on the coke for g tubes- and diet does not work as well)
You'll learn tons of tips and tricks on your new floor but some "hacks " to avoid from the start
1 Never EVER just click and chart along what the person before charted , make sure your charting is purposeful, I have seen so many errors that went back days because one person clicked the wrong box and everyone else just clicked ok
2 Follow your facilities procedures even if some people "like to do it like this" , because you may have to justify your actions some day and no one can argue with policy
3 Try to leave your rooms neat and stocked - your colleagues will notice and will make a positive impression right off the bat
4 Avoid people who gossip about coworkers - if they are talking badly about them when they aren't there chances are you might be the topic when your back is turned.
Lastly have fun, it will be hard - especially at first , but there will be great folks , and hopefully an awesome preceptor. A good attitude goes a long way. My floor got a ton of new nurses at one point and most were happier working with those who were willing to learn than the one that had more experience but was like pulling teeth to move and may as well have been speaking to a brick wall for all the interaction that we got. This person should have been years ahead and the newbys were flying by just due to attitude. Good luck.
Nov 19If you have a patient with 6am meds and 8am meds give them all at 7am to be within the hour window and save time.
Essential oils, poo pourri or perfume dabbed on a mask help with especially malodorous wounds
Respect the CNAs and never delegate simply because it's convenient. IF you have time to do it, do it. The more they see you are on their team, the more they will respect you. The more they respect you, the more they will help you.
Look up what meds you don't understand. Plan to do a lot of "studying" at home on your own time. Never give a med if you don't know what its for or what it does.
Nov 19Don't DC and OSH IV until you have one that works. Part 2, don't look for a new IV 10 minutes before you are supposed to DC the old one.
Learn to start IVs without a tourniquet.
Start low and work your way up, if you blow their AC you really shouldn't go below it (you tried and didn't blow it but just missed, you can still go below).
Use your resources. Can your ED start ultrasound lines or EJs? Use them. Can't figure out something about a drug and you can't find it out on your own, call the pharmacy. Et cetera.
Hydrogen peroxide is amazing at getting rid of blood in clothing, just make sure you rinse it out right away so it doesn't eat through the fabric.
Don't be afraid to call an RRT or Code blue, it is better to call early and be wrong because you never get that time back.
Know where your supplies are before you need them.
Quote from ~♪♫ in my ♥~Please don't do this, it increases irritation (think sharp little ridges from the plastic you just cut) inside the nose and raises the chances of a hospital acquired nasal infection. I worked in a Peds ED and we saw our nasal MRSA rates skyrocket and it took us a while to figure it out, turns out a nurse from another state brought this habit with her.1) cutting the prongs off of a nasal cannula because they're irritating the pt and they keep pulling it out