Advice, tips, comments for a soon to be nurse

MsBruiser · Jun 18, 2016

Well. I once programmed an IV pump wrong and dumped an entire bag of medicine into a patient in 10 minutes. In an ICU. Thank god it was 100 ml of insulin and not Levophed. The patient could have died. I felt so awful I wanted to kill myself. It happened the same day we converted from paper charting to electronic charting. No excuse - it happened. But how is learning about that mistake going to help you? When you make an awful mistake (not if - when), it will be something you never thought dreamed you would do.

I would not focus on potential mistakes - but developing safe habits that will hopefully keep you on a safe path for as long as possible. Some advice: 1) Find nurses you admire and do copy what works best for them. Plagiarism is the most sincere form of flattery; 2) Develop / copy a "report sheet" that works for you - this is your paper brain and will keep you from forgetting things and / or making a mistake; 3) Try and develop a systematic approach to everything you do. And realize you cannot do this from day one - you will still be learning. Repetition is your friend - you will quickly develop a keen sense of situational awareness and know when something is not right. 4) If your gut says something is not right - it is not right. Stop. Deep breath. Think.; 5) Always ask questions - use your cooperative coworkers for the excellent resources they are.

And finally, "trust but verify." There is sometimes godawful advice here. I am sure 100 nurses will tell you med-surg is where you need to start. Really? I started in an ICU and have gone on to have a great career. Take advice with a grain of salt and believe nothing until you have either heard or experienced something for yourself.

floridaRN38 · Jun 19, 2016

When I did my practicum in ICU (even though I always knew I wanted to be an ER nurse). I chose ICU Just to see if I liked it. I didn't. But glad I tried it out. I did F up in the ICU. With all the drips. I remember one particular patient I had to up one of their drips. Well I accidentally did the Nitro one. I walked out of the room and had s funny feeling. So I went back in and realized I changed the nitro and not the other medication. Thankful the pt was fine and BP dropped a bit I told my preceptor and all went fine. Also another thing that happened was back in the day we use to label blood with the pts chart stickers. Well I labeled the wrong pt blood. Sent it to the lab. Then once I sent it realized I made a big mistake. Called lab and had it fixed. Never made that mistake again. It is scary. And nobody it perfect. Always just your gut instincts. Ask questions even if u think they are dumb. Still ask Bc u don't want a bad outcome on your pts. Good luck

Libby1987 · Jun 19, 2016

I would choose Med-Surg for my practicum. It may be the only place you can get a job or it may be what you need to achieve your short and long term career goals. As hard as it is to learn to juggle, I'd want to have a head start before it gets real.

Ruby Vee, BSN · Jun 19, 2016

If you get choices about where to do your practicum, do it somewhere you might like to work. Managers (mine anyway) regards the practicum as a LONG job interview and will often offer jobs to students who really impress the nursing staff.

Know what you don't know, and ASK questions. But make sure you're asking intelligent questions. There's a big difference between "Mr. Pee needs a foley -- what do I do?" And "Dr. Imaflamingdonkeybutt just ordered a Foley for Mr. Pee. I've read through the procedure and I have all the supplies on the list, but I've never done this before. Could we go per the procedure together first?" Once you've asked a question, keep track of the answer -- write it in a notebook, tap it into your phone or use your awesome memory skills. No nurse likes to be asked, for the sixth time this shift, "What's the number for the lab again?"

Be respectful of the staff on the unit. You should greet and make an effort to know the name of everyone who works there, from the medical director of the unit to the housekeeping staff. It's not their job to get to know YOU, it's yours to keep track of THEM. (OK, it's really not fair, but you're the new person trying to make a good impression. Not everyone is an extrovert, and the introverts among the staff will be grateful to you and think well of you for making the first move.). Don't eat the food in the break room unless you're invited to, don't hog the computer or the chairs or the chart, speak respectfully to everyone.

You WILL make a mistake. Everyone does. Everyone. Anyone who tells you they haven't is either lying or too stupid to realize they've made a mistake. It's what you do after you make a mistake that makes you a good nurse or a bad one. Be open to the idea that you might have made a mistake -- it's hard to recognize one if you're convinced you're always right. Recognize your mistake and immediately set about mitigating the consequences to the patient. Tell your preceptor, your charge nurse and the provider. Tell your manager or your instructor before they hear it from someone else. Draw the labs, do the monitoring, whatever is needed. Think about how or why you made the mistake and be able to discuss how you will avoid making similar mistakes in the future. Then forgive yourself. That's probably the most difficult part of the process. I was involved in a sentinel event over a decade ago, and there are still times when I wake up in a cold sweat, kicking myself all over again. Not so often now, but for awhile it was every night. I know what I did wrong, I know how my error compounded the errors made by the people who had the patient before I came to work that day, and I know how to prevent that same error from happening again. But forgiving myself -- that's ore difficult. Amazingly, though, patients can survive some dreadful errors as long as you recognize them, own up to them and immediately set about mitigating the damage.

I apologize for the length. Good luck in your last semester of school.

floridaRN38 · Jun 19, 2016

If you get choices about where to do your practicum, do it somewhere you might like to work. Managers (mine anyway) regards the practicum as a LONG job interview and will often offer jobs to students who really impress the nursing staff.
Know what you don't know, and ASK questions. But make sure you're asking intelligent questions. There's a big difference between "Mr. Pee needs a foley -- what do I do?" And "Dr. Imaflamingdonkeybutt just ordered a Foley for Mr. Pee. I've read through the procedure and I have all the supplies on the list, but I've never done this before. Could we go per the procedure together first?" Once you've asked a question, keep track of the answer -- write it in a notebook, tap it into your phone or use your awesome memory skills. No nurse likes to be asked, for the sixth time this shift, "What's the number for the lab again?"
Be respectful of the staff on the unit. You should greet and make an effort to know the name of everyone who works there, from the medical director of the unit to the housekeeping staff. It's not their job to get to know YOU, it's yours to keep track of THEM. (OK, it's really not fair, but you're the new person trying to make a good impression. Not everyone is an extrovert, and the introverts among the staff will be grateful to you and think well of you for making the first move.). Don't eat the food in the break room unless you're invited to, don't hog the computer or the chairs or the chart, speak respectfully to everyone.
You WILL make a mistake. Everyone does. Everyone. Anyone who tells you they haven't is either lying or too stupid to realize they've made a mistake. It's what you do after you make a mistake that makes you a good nurse or a bad one. Be open to the idea that you might have made a mistake -- it's hard to recognize one if you're convinced you're always right. Recognize your mistake and immediately set about mitigating the consequences to the patient. Tell your preceptor, your charge nurse and the provider. Tell your manager or your instructor before they hear it from someone else. Draw the labs, do the monitoring, whatever is needed. Think about how or why you made the mistake and be able to discuss how you will avoid making similar mistakes in the future. Then forgive yourself. That's probably the most difficult part of the process. I was involved in a sentinel event over a decade ago, and there are still times when I wake up in a cold sweat, kicking myself all over again. Not so often now, but for awhile it was every night. I know what I did wrong, I know how my error compounded the errors made by the people who had the patient before I came to work that day, and I know how to prevent that same error from happening again. But forgiving myself -- that's ore difficult. Amazingly, though, patients can survive some dreadful errors as long as you recognize them, own up to them and immediately set about mitigating the damage.
I apologize for the length. Good luck in your last semester of school.

I think u summed it up pretty well even though u said it was long. You r absolutely right about knowing who everyone is from housekeeping to the management. Back when I did mine I was very timid and shy. If I only knew what I knew now !!! [emoji106][emoji4]