What I learned in clincals

[snowwhite2002]

Some of this may seem common sense, but I learned the hard way

1. Anytime your patient has any vital sign outside of the norm immediately

relay this information to the primary nurse. If you can't find her. Call her phone.

2. Don't ever touch a pill. Find a way to split w/o touching. Your instructor

may be different, but we weren't to touch even while wearing gloves.

3. Know your meds. Make sure to look them up, know how they work and if

it will affect the patient's blood pressure you better have that value handy when

getting ready to give it.

4. Put on those gloves. Do touch anything w/o those gloves on. One in our group

grabbed the urinal w/o them and got a U.

5. Make sure you are aware of the indicator for contact precautions. At our facility it was on the door. A girl in our grp walked in the doorway to take shift change report and got a U. Do not take your stethoscope or paperwork in the room. We would put ours in the breakroom.

6. When you go for orientation on the unit. Get a map or make your own. Very important

where the soiled utility, clean utility, linens, etc. are located. My instructor would give NI's for not knowing the unit.

7. If your patient has a mastectomy or shunt. Do not take Blood Pressure reading on that side. There will usually be signs on the door or above the patient's bed. Make sure to look.

8. When changing bed linens make sure you have a trash or laundry bag in room to put the dirty linens in. Don't put on floor, Don't hold near body.

9. Saline flushes should be disposed of in the biohazard receptacle. You can squirt any remaining fluid since the hosp does get charged by the pound. I was told that housekeeping may mistake them as needles.

10. Get help with bathing total care patients. Don't try to do it alone.

11. Do not hang anything attached to the patient to a side rail. Hang it on the framing of the bed. (Foley Cath)

12. When transporting a patient in a wheelchair, always back into door ways elevators as to not knock the patients feet or legs.

Right now I can't think of anything else. But would love to hear anything that you learned in clinical or that you heard someone getting a bad mark for doing.

[Baubo516, RN]

Do not, for any reason, take out your cell phone and look at it. I know some people say they use them to look up meds, but you can usually look up meds on the hospital's computer system, as well. I makes you look like you are texting friends or just wasting time and can be interpreted as unprofessional, especially by nurses who are not of the same generation as you.

Do not turn your back to the patient when charting on a computer in a patient's room. If you must do so, make sure you turn and look at them before you start talking to them. This was mentioned to us by our clinical instructor. Apparently some students were doing this and it made the patient feel he/she was being ignored.

If you do not work as an aide, really take this opportunity in clinicals to learn how to help a pt to the bathroom, change a bed and give a bath. You WILL have to help with these things at some point if you work as a nurse on a hospital unit. Also, if you are willing to help in these ways, you will be a better team player. (Don't assume you will be done with baths and toileting once you are an RN.)

[Concerto_in_C, BSN, RN]

In a med-surg unit you don't automatically freak out because somebody's blood pressure is elevated. Almost nobody out there has a perfect blood pressure. First of all, you determine if the patient is symptomatic. Second, you look at the trend. If you feel like the trend is worrisome, you inform the MD.

If her normal is 98/58 and all of a sudden it's 150 systolic and she says she's not feeling well, that's significant, because 150 is very unusual for this specific person. Don't focus on numbers so much you lose sight of the big picture. There are vitals signs variations according to activity, time of day and other factors.

Hypertension cases tend to be on blood pressure meds at home. Because of the hospitalization, on the first day they go to ER, they tend to miss a day's dose of HTN meds. This is another factor why they may be outside of normal range temporarily, but they stabilize once the MD resumes the home HTN meds.

Also, there are measurement errors due to the wrong cuff size or the cuff being applied incorrectly.

Finally...HTN patient with a very high blood pressure may stroke out if given large amounts of HTN meds, esp. if very high BP is their baseline at home. We need to use caution, and should not always rush to correct too much too quickly.

Nursing school instructurs seems to be fixated on numbers, because they grade you based on your ability to memorize normal ranges...

[NursingNewbie21]

If you get an abnormal bp in one arm don't run And tell the primary nurse just yet! Take it in the other arm THEN if it's still abnormal tell the primary nurse.[/quote']

However, if the patient has an IV site on the other arm DO NOT take the BP on that arm! It may be common sense, but a friend of mine did it her first day on the floor!

[pookyp, LPN]

However if the patient has an IV site on the other arm DO NOT take the BP on that arm! It may be common sense, but a friend of mine did it her first day on the floor![/quote']

Yep! True!

[NurseJamie8]

Always write neatly for care plans!! My first instructor came off all easygoing saying she didn't care what they looked like only the content. At the end of the semester she gave myself and 2 other students CPIPs (clinical performance improvement plans) for near handwriting. Very easy to resolve, just really took my time writing it out but lesson learned! Even the "easy going" instructors can be nit picky!

[schnookimz]

However if the patient has an IV site on the other arm DO NOT take the BP on that arm! It may be common sense, but a friend of mine did it her first day on the floor![/quote']

I don't think that's common sense. Bps are frequently taken in the arm with the iv if it can be done safely and the other arm cannot be used.

[quirkystudent]

If you encounter a not so friendly nurse on the floor.. smile, nod, walk away if you can and brush it off. A few classmates and I recently over heard a nurse tell another nurse while we were in clinical in the hospital "Quite frankly these nursing students are just stupid and asking us the dumbest questions. I wish they would just leave already." Yep. Smile, nod, walk away and brush it off. You will run into the nurses that like to eat their young as I call it. Kill them with kindness because it reflects their character and not yours.

I recently had to give myself this advice only it was my fellow classmates saying negative things about me and I let it get to me.

[pookyp, LPN]

If you encounter a not so friendly nurse on the floor.. smile nod, walk away if you can and brush it off. A few classmates and I recently over heard a nurse tell another nurse while we were in clinical in the hospital "Quite frankly these nursing students are just stupid and asking us the dumbest questions. I wish they would just leave already." Yep. Smile, nod, walk away and brush it off. You will run into the nurses that like to eat their young as I call it. Kill them with kindness because it reflects their character and not yours. I recently had to give myself this advice only it was my fellow classmates saying negative things about me and I let it get to me.[/quote']

I'm the same way. Just smile and keep it moving!

[Stephalump]

Cover. Your. ass.

Because everyone else around you is, so if you don't...you'll be hung out to dry!

[SopranoKris, MSN, RN, NP]

However, if the patient has an IV site on the other arm DO NOT take the BP on that arm! It may be common sense, but a friend of mine did it her first day on the floor!

Not necessarily. You have to judge this based on the patient. What if they had a mastectomy in the past with lymph node removal? It may be you can only use one arm for both the IV and BP or they could get lymphedema from taking the BP in that arm. Trust me, I've seen new admits where they forgot to put a limb alert on patients with this type of history. No draws, no IVs, no BPs allowed on that arm. In those cases, we had to take the BP in the same arm as the IV.

But I do understand about not panicking if you get an abnormal result. Wait a minute or 2, then re-take it to see if you get nearly the same result. Best to be sure you did it accurately. They make us do manual BPs as first year students. I think this really helps us. You can always re-take a BP. You can't take back alerting an abnormal only to find you did it wrong.

[Compassion_x]

When assessing a patient, listen to the apical pulse for a full minute. This allows more time to hear dysrhythmias and such. Never forget to turn the patient over and look at their backside, and listen to posterior side of the lungs when you have a bed bound patient.

An appropriately sized bp cuff can indeed change a bp.

[smalltownhero]

However, if the patient has an IV site on the other arm DO NOT take the BP on that arm! It may be common sense, but a friend of mine did it her first day on the floor!

what if the IV site is on the top of the hand?