Experienced Nurses:If you would have known then what you know now you would have....

[NoeIssa]

Experienced nurses if you knew then what you know now what would you have done differently. For example one nurse told me when deflating the balloon of a foley make sure to use more than 2 10 cc syringes to make sure all the fluid has come out. What tips can you give to new nurses that you have learned over the years that you wish you would have known as a new nurse.....Thanks

[freefalr]

simple things, many already posted by others above.

always, always trust your instincts. trust your gut.

never be afraid to ask questions. become known as "the inquisitive one."

never be too intimidated or afraid to advocate for your patient.

always protect your physical self, 'cause no one else is lookin' out for you, and you can sustain serious injury that will revisit you for years.

[leslie :-D]

jopacu said it, but i am reinforcing that you need to prioritize.

i would also caution you to trust others (colleagues) slowly and judiciously.

stay away from the drama and all ensuing gossip.

do not ever do something you are not prepared to do...

no matter how pressured you are.

take that minute to look it up, confer w/someone else.

stay true to yourself, your ethics.

when you do so, you are doing what is right for your patient(s).

as stated, never be afraid to advocate for your pt.

when doing so, remain professional (i.e., UNemotional), articulate, prepared and confident.

which leads me to nurse's notes.

document, Document, DOCUMENT.

whether you are noting conversations, observations, interventions...

if you didn't chart it, it never happened.

naturally this especially applies to those situations with less-than-stellar outcomes, or dealing w/disgruntled folks.

finally, recognize your limitations.

we are not superheroes or bionic beings.

we can only do so much.

do not let anyone treat you contemptibly or disrespectfully.

a healthy dose of self-respect and confidence, will bring you far in our profession.

you won't start out this way but with ongoing contemplation (with a couple of dopeslaps back to reality;)), you won't let anyone bring you to your knees, desperately pulling your hair out.

NO ONE HAS THE RIGHT TO DEMAND/EXPECT THIS OF US.

healthcare is a business.

so let's do away with the compassionate, do-good mentality.

ceo's see $$ as their bottom line.

they don't give a damn about you or me.

heck, they don't give a damn about the pts.

they just want their money.

so it is up to us to walk that tightrope...

where we do good for our pts while keeping the attack dogs off our backs...

which goes back to prioritizing.

i'm so sorry...didn't expect to ramble.

just continue to come here and vent, share, grieve, celebrate.

it's a great place to hang and learn from the pro's and everyone else.:[anb]:

wishing you only the very best.

leslie

[ellakate]

Leslie, thanks for the ramblings. This is the type of discussion that was taught in "Nursing Ethics" when I went to my hospital school. Is this a required or available course? My guess is, probably not.

[RhiaRN75, RN]

I wouldn't change too much- even my most horrible job taught me valuable lessons. I have a ton of advice, though. There are so many little things that make life easier!

*Ask questions!

*Trust your gut feeling.

*Document. Take a class on documenting and legal implications in nursing.

*If you keep going back to...'Maybe I should call the Doc', do it. Even if it's the most evil doc and 0300- call and document.

*Get parameters for 'don't bug me' orders. For example- 'Don't call me again for a high blood pressure', needs parameters. Systolic over 200, 210, 250? Just what is 'high'? Write a vague order if the doc leaves you no choice, but it's not defendable in court.

*Don't trust anyone for something you're ultimately responsible for. It's too much of a risk. Likewise, don't accept order such as "Ok to use central line" written by a surgeon but before placement was verified. Verify first. Consider how you would explain your action/inaction in court or to the BON.... a butt-chewing is usually not so bad w/ that thought in mind.

*The IV comes out last. Preferably after pt is dressed, papers signed, and about to wheel out the door. I learned that lesson as a CNA, when a pt coded after the IV was D/C'd pending final discharge arrangements.

*Extra tape under an IV opsite is a PIA. It makes an IV difficult to d/c, it's a germ catcher and infection risk, makes the IV more uncomfortable, and really doesn't secure it any better. IV's in the hands, esp. for the elderly, have more of a risk to infiltrate or get caught on something. If you have to put an IV in the hand, secure the tubing to a bracelet at the wrist/FA area- the pt can then move their hand and the tubing will have enough slack so that it won't be accidently dislodged. Don't tape down IV's flat and tight- the hub will put a pressure point on the skin, it's uncomfortable, and more likely to dislodge w/ movement. However- IV's seem to work better for kids in the hand. Never wrap an IV so that you can't see where the angiocath enters the skin or assess for infiltration.

*Paper tape will bond to a pt if left on for a while, and become a sticky goo worse for the skin then silk/micropore tape. When removing a permeable tape like silk/micropore, rub it down with a few alcohol preps and it will come off easily.

*SkinPrepskin/protectant/barrier is an awesome product. (The ones that look like little alcohol preps and stink) It makes tele leads, opsites, and duoderms adhere better. It's great for a sweaty/confused/kid/frailskin pt. It also creates a thin film, so the tape is actually sticking to the skinprep and not the skin. It prevents irritation from tape and incontence. It also is the single best thing to keep tape on a nose for NG tubes, IMO. Make sure it dries completely first, and that the skin in not raw.

*Providine/betadine wipes can make a teeny or faint vein easier to see- use it and then wipe w/ alcohol to create a light orange tint- the blue color of a vein is enhanced by this. You can also get an LED red-bulb replacement for a small mag light to make a cheap wee-light/venoscope substitute. You have to have an LED one though, so it won't get too hot.

*If you wonder whether or not you should report something to your hospital social worker or DSS- do it.

*D/Cing restraints when possible is great.... believing a anxoius vent/trach pt who promisies to not touch the trach is not a good idea, however.

*Restraints on any type of post-op joint replacement pt can cause damage to the new joint if the pt wiggles and fights enough.

*NEVER let a pt get between you and your only escape route. Or an irate visitor, doctor, or coworker for that matter.

*Don't accept an assignment/another pt if you truly cannot safely care for them. No job is worth your license.

*Being yelled at by a doc is ok. Losing your license for not reporting something is not ok.

*Learn CYA/defensive charting.

*Turning the above three pieces of advice into a weapon, matter of principle or power-struggle is not ok.

*If you're not familiar w/ a med/procedure, look it up, even if you don't have the time.

*Taking extra time to fluff/pet a needy pt will save you time in the long run. Likewise, a power-struggle over pain medicine w/ a clock watcher is not worth the time involved, unless you can document a good reason- ie 'upon entering pt's room to administer requested PRN for c/o 10/10 pain, pt was found resting quietly w/ eyes shut and resp. non-labored, prn x held'. Worse case senario, turn it over to the ethics commitee. Never document that a pt is only 'asleep'- what if it's coma/death/decompensation/overmedicaion instead of sleep? Instead, use the above eyes shut, resp unlabored example.

*If your pt is crashing, still ABC-ing but you don't hold much hope of that continuing, call a code.

*If you dread going to work every day, it's time for something new.

*Don't get caught up in politics/gossip. Don't play middle man for a Doc v/s another doc/pharmacy/RT/etc.

*Don't document anything concerning an incident report. Don't sign-off an order to complete an incident report- even if you do. 'Orders received at such and such a time noted' is about as far as I'd be willing to go. If you see such an order, copy it and attach it to the incident report- risk management and your lawyer will thank you. Once mention of an incident report is in a legal document, like the pt's chart, it admissable as evidence and implies error.

*Don't use redflag words in the chart, such as error, wrong pt, wrong time, med missed, med late, implications of other people's action/inaction, opinions, staffing issues, etc. I don't mean don't chart it, but no need to call undue attention to something. "Dr. updated about levaquin order, and levaquin given at x time" is much better then "levaquin given three hours late and Dr. notified of the error". Likewise, 'NurseNancy missed x intervention" guarantees you a subpeona later on and opens up the opportunity for you to have to describe you thoughts on NurseNancy's action/inaction, and scrutiny as to why you didn't report NurseNacy's unsafe behavior and can put some guilt back onto you. Same for staffing- if at any time you document/imply short-staffing as a reason for an occurance, you put yourself at risk for having to explain why you accepted an assignment if it was unsafe and puts guilt back on you.

*Pick your battles- it makes you more credible when you do need to stand up for/against something.

*Ativan 0.5 mg or less is just enough to make a demented pt even more restless, but not enough to induce sleep. Ambien is likewise a horrible drug for the elderly.

*Bedrails will not keep a determined pt from falling. It will make the fall more dangerous because the pt will try to climb over the rails.

*Kick out visitors if you need to. I once entered a tele pt's room to find about six adult children hovering, holding each hand, asking over and over 'are you ok, do you hurt, etc' and at one point singing hymns loudly. Pt was anxious, unable to sleep, and developed chest pain. No wonder. I booted all but the calmest and most rational one of the lot out. On the other hand, if your pt is comatose and actively dying, the family reasonable- allow as many in as feasible. Some pts hold on until they 'see' the family they wanted to see- even if comatose. Some will linger until the family accepts and can say goodbye- then they pass peacefully.

*If Momma has ten children, try to reach a consesnses as to one person who can be the 'go to' person. It may decrease the need to update 10+ people of Momma's every doc visit, procedure, condition, and the like.

*If a pt says "I'm gonna die" calmly, pay attention. They just might do so.

*DNR's are great, but if a pt is of questionable DNR status, you can't fix death afterwards. Also- tele, lasix, etc. is not necessarily uncalledfor in a DNR pt. DNR doesn't mean don't treat, and in the case of meds like lasix, it's a comfort measure. It's not pleasant to become fluid overloaded and drown- even if death is expected. Tele can warn you that death is imminent, and prevent someone from dying alone.

*I was taught in Nsg School to reorient confused pts. This is admirable, but not always feasible. Sometimes it just makes the pt more agitated and distrustful. Just go w/ the flow, and the pt will be calmer if you do. I had an elderly pt who was usually not confused but was experiencing sundowning+post-op fog+hospital psychosis- he kept asking the staff out on dates, and complaining that we took too long to get ready. We found him at one point about to get out of bed because "Woman, your hair looks fine, we're going to be late." Attempts to reorient only made things worse. I finally told him at one point "Just take a nap- you know it takes forever for us girls to put our face on and look beautiful"- and after a bit of grumbling and 'you look fine' and what not- he went right to sleep, slept all night, and woke up oriented w/ no memory of his date requests.

[mytoon38]

I would have followed my dreams and become a Veterinarian!