Advice for RNs who are still wet behind the ears

[suture_self]

Here's the scenario: I was about to leave for home from my microbiology class, when suddenly another student (a nice lady who moonlights as an LPN) starts up a conversation that... well, I found intriguing.

She said that she knows more than most newly-graduated RNs do. She said she's constantly instructing them on this or that - and that they defer to her and her judgement most of the time.

Like I said, it sparked my interest because frankly, I might be one of those guys one day. I wouldn't be completely helpless, but c'mon... as a newly-graduated nurse, how can I (or anybody, for that matter), with limited clinical experience, be expected to know everything?

And so I'm wondering: What advice can existing RNs and/or LPNs give to RNs who are still wet behind the ears? What kind of dynamic (ie: working relationship) can be mutually beneficial to both helper and helpee? Any stories? Am I opening a can of worms?

[weirdRN, RN]

Thanks so much for all the great advice! Even though I have been working as a nurse for a while that really helps out.

God bless you very good!

I am sooo embarassed. My apologies to Timothy.

[MIA-RN1, RN]

I only have one question. Why would you not admit to not knowing something in front of a pt??? I respect a nurse who can say "good question! I'm not 100% sure of the answer, but if you give me just a second I will find out" and come back to the pt after I have looked it up or asked another nurse.

I would like to know too. In school we were told to be honest and say "I am not sure of that answer. I will look it up and be right back with the answer" then of course, we were to follow thru on it right away.

I have said that to patients and I don't like it but I never know what else to say. It does't sit right with me to say "Let me go take care of XYZ and then I'll be back to explain it to you" because it sounds like you are putting the nurse's needs above the patient's needs. And of course this doesn't mean with meds--I know to have the answers to those questions before they are asked!

[marybethm]

My only advice to new grads would be to listen and observe. Think like a detective. Watch your patients, listen and don't talk too much. Same goes for staff....listen to the people you feel are smart...like nurses, doctors and aides. You can learn a lot more from them than you did in school. I believe most of nursing is on-the-job-training.

[Sylv]

I only have one question. Why would you not admit to not knowing something in front of a pt??? I respect a nurse who can say "good question! I'm not 100% sure of the answer, but if you give me just a second I will find out" and come back to the pt after I have looked it up or asked another nurse.

Probably because he's a man, LOL!

Actually, I think that is a good idea, I may start using that instead of saying, I don't know but I'll find out.

[MIA-RN1, RN]

My only advice to new grads would be to listen and observe. Think like a detective. Watch your patients, listen and don't talk too much. Same goes for staff....listen to the people you feel are smart...like nurses, doctors and aides. You can learn a lot more from them than you did in school. I believe most of nursing is on-the-job-training.

Yes! I have learned more in the few weeks I"ve been working than I think I learned thru school. I don't mean skills--those were well covered. But just the paperwork/time management/ people skills and just what its like to really be a nurse.

[buddiage]

Wow! Thanks for taking the time to post Tim. I have printed your advice...too many good ideas for just one read!!!

Me too. I have a file where I stick good stuff in that is too good to forget. I want to be the best student as possible.

Thanks for taking the time.

[banditrn]

One thing - listen to the experienced RN's, but still use your own judgement! When I was new, and on orientation, a nurse with a lot of experience told me it was OK to 'push' IV potassium!! I knew that I learned in school that this was NOT OK, but she insisted that it was.

Well, I pushed it, but over several minutes, and the patient was fine, but the next AM, when the supervisor found out - she had a cow! And reamed the other nurse. Geez, then I learned to listen to myself, too.

Also, as a nurse, never ever give a med if you don't know at least what it's action is!! When a patient asked, a classmate said 'I don't know.' Made her look really dumb, and the patient had no trust in her after that.

[Altra, BSN, RN]

I only have one question. Why would you not admit to not knowing something in front of a pt??? I respect a nurse who can say "good question! I'm not 100% sure of the answer, but if you give me just a second I will find out" and come back to the pt after I have looked it up or asked another nurse.

Not to put words into someone else's mouth ... but I believe Timothy's example concerned knowing the action of the meds you're giving. This is one area where it's NOT acceptable to have to say, "I don't know, but I'll find out." Imagine the potential fear provoked in the patient by that response in that situation ... and the potential consequences of errors, side effects and/or interactions.

[weetziebat]

Tim, you ought to write this stuff up as an article in one of the nursing magazines!

I was just going to write and suggest Timothy write a book. Loads of excellent tips, and one can tell by your writing you'd make an excellent teacher. Your patients are lucky to have you for their nurse. :)

[xenogenetic]

Great advice, Tim. Thanks. I printed it out as well because your post is a keeper.

[tddowney]

Timothy,

I'm not even a new nurse, just a new student. But an older student, who has been around the block a few times.

Your advice is teriffic. I know it took more than a little time to organize and post it.

Thanks for your help in my nursing career.

Tim

[Indy, LPN, LVN]

Hmm. I didn't think of my rounds as "rounds" but it does make sense. When I'm doing my VS and assessments, I may jot down the beginnings of a "laundry list" on those who have requests. If they have a hard time letting me out the door I'll just say, "I need to make sure all my patients are alive then I'll do ---- (insert whatever the request was) for you." So far it works.

On my "brain" I jot down times that I was in the patient's room. In tiny writing, in a corner, will be a list of times with usually one word or two next to them. If it's a negative assessment, the first time will just be the time I was there, or have "VS" next to it. Next will be a time and "meds" next to that. Etc. More notation if there's pain. My shorthand on that is unrecognizable to anyone but me. That's what enables me to get my charting done in an accurate manner, though. When I go to chart I can see when I was there and what I did. If the patient has a bad turn of events or a code, I can call out info off my brain with confidence the basics. It's a cheat sheet. People get upset that nurses sometimes chart all the patient assessments with the same time stamp on them (non computer charting). Well it would not happen if you knew when you were in the room and the four seconds it takes to jot something down, per patient, adds up to a few minutes spent to make your charting accurate and easier to do.

Be OCD with med administration. Develop your system of pulling meds based on accuracy, not shortcuts, and you will get faster at it. If you feel like bringing your drug book to work every day, do it. Or have one on hand somewhere.

Learn how to act. Act caring, act knowledgeable, act interested in your patients and their families. Even if it isn't your usual method of interaction with people, you can develop a "work persona" that will benefit both you and the patients.

I have to echo what Timothy said about viewing "staying late to chart" as a failure of time management. It is usually half way through the shift when I get through charting all assessments, and get the first four hours of the shift down on paper. When I do 4 am vitals (I work night shift), I like to come back and write the 4 am notes on them right afterwards. So that at 6 am, after finishing all the other paperwork, rechecking the charts, taping report, etc. I can check blood sugars, pass any really early meds, take a look at anyone who didn't need any of that, and take a few minutes to write the last notes on people. Then I get to run around and help people who didn't get organized, or review AM labs as they result, round with doctors if they show up, etc.

There have been some nights when I didn't feel like I could get out of patients' rooms to chart no matter what. Either the "laundry list" and clustering care didn't work or they kept having acute problems. If I'm feeling desperate I can stick the nurses' notes on my clipboard under the brain and start charting while in the patients' rooms. I try to not do that, but it can happen. The reason I don't like it, is I may get in a hurry and chart on the wrong patient.

The latest thing I have got to work on, and feel free to list anything that's worked for you guys, is running people off my unit at 2 am who see nurses sitting down and want to come over and talk. That's my paperwork time, and I get a headache listening to conversation while trying to chart. I've had to rip up my notes on occasion and start over... I like these people so I've got to come up with something that won't piss them off or hurt their feelings, yet will get 'em to shut up or go elsewhere. Hmm.

/ramble off...