What are the huge "DO NOT EVER DO" things that new nurses need to know about? calling

Nurses General Nursing

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I am graduating in a few days, and off to be a new registered nurse. I would love to hear from experienced nurses about the "BIG" things that they need to remember or the things they try to avoid. Medication tips, or how to deal with patients...anything would be helpful, and thank you !!

Specializes in ICU.
i've had med errors before for giving what was on the mar, it was there and I had the meds, so i gave them.

Ever notice how much hydroxyzine and hydralazine look alike? two completely different meds, but that's what i got last week. luckily i noticed right away, that would have been the last thing that patient needed.

I'm confused...can you explain this a little more? Thanks!

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speaking of...never trust the pharmacy (someone other than yourself basically) to always send the right meds or put the right meds on the mar. .

The same is also true of trusting them to put the correct meds in the correct bins in the pyxis.

But I will also say that the pharmacist is one of a nurses greatest resources. after 11 years of nursing, I still call them very often to clarify med questions

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Specializes in ED.

It happens. Pharmacy makes mistakes just like nurses and anyone else can. One time (we use the omnicell) I was trying to take out nystantin swish and swallow, and in the right bin was the wrong medication, which looked just like it (I think it wa lidocane susp.) as in the same container but different colored lettering. Or a person returning a medication to the omni can accidentally put it in the wrong bin and then the next person gets the wrong med.

always look at what you have in your hand, check it against the MAR and double check just before giving it.

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Specializes in Neuro ICU, Neuro/Trauma stepdown.
I'm confused...can you explain this a little more? Thanks!

when the med error occured it was my fault for not checking the mar against the written order. the order was on the mar and the pharmacy had sent up the individual dosed packs for the patients day. since i had the pills, and it was on the mar, i gave them. all the double checks between the pill, the pt, and the mar dont matter if the order on the mar isnt on the chart. in this case, it wasn't a wrong dose or whatever, that pt wasnt even prescribed those meds. i have no idea where that order came from, i would assume it should have been for another pt. accidents happen. you cant assume anything. i'm not saying pharmacy specifically makes mistakes, everyone does. btw, they were anticonvulsants and the pt was fine but sleepy:o

the second issue was different. the pharmacy sends little baggies with pts info. on the outside and inside are individually dispensed doses. i was expecting hydroxyzine (vistaril, in this case 50mg po for anxiety). what i got was hydralazine (lowers bp, quite effectively). my point was that's it's scary to think that maybe i or another nurse could have administered that in error. especially since the pt was 16...being reminded of this kinda stuff is what keeps us on our toes!

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when the med error occured it was my fault for not checking the mar against the written order/QUOTE]

Yes, it was your responsibility, but I don't agree that it's your fault.

Here's a pet peeve of mine, and possibly another thread hijack:

I've never worked a nursing job anywhere that didn't preach teamwork from day one. Part of being a member of a team is being able to count on the other members of the team. In reality many days, it can feel like you ARE the team.

I'd say it was the fault of the person who reconciled the mar and did or did not sign off the orders. Sounds like a chain of 'fault' contributed to that one.

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:yeahthat:

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This is a BIG one for me....

DON'T EVER, EVER talk 'over' a pt - or allow others to do so. Assuming....the pt can't hear you, as if sleeping, coma, out from surgery etc. I've seen aides do this when attending to the pt - talking to themselves about the pt - often derogatory - I've seen seasoned nurses do this - talking about the pt's condition, dx, personal stuff - and I've seen doctors do this. What is equally bad is when family members stand at bedside and talk about the pt as if they assume the pt is so out of it they can't hear. Always assume a pt can hear you - even if it is end stage life - always respect someone's privacy. Be mindful that a curtain in a semi-private room is not a wall - Be your pt's advocate if this is happening around them. Say - "Guys, lets discuss this out of the room." or whatever needs to be done. But don't let it happen.

This advice/reminder wasn't only for new nurses but also to remind all of us -

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If you need to open more than 2 vials of a med for an order-recheck it. You may have miscalculated the ordered dose or the dose ordered is incorrect. Have someone double-check your calculations. This is a rule I learned in nursing school that has proved to be very valuable, yet is often the cause of terrible med errors. Sometimes you do need several vials for a dose but if you're grabbing for many, it pays to be extra careful...

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Specializes in Med Surg - yes, it's a specialty.

OK, here's a real list:

Listen when an aide or housekeeper says "he doesn't look right, I just thought somebody should go look at him" Don't say "oh, he always looks like..." - trust me - go look.

If they aren't peeing - tell them you may have to put in a catheter - they tend to try a lot harder after that.

If you have a zillion things to do think - ok, what if I put it off could cause death - make that the first item. What could allow death - do those next.

Just because a pt yells or complains the most doesn't mean they need you most.

Always check your IV sites when you are "just passing through." Sometimes they are going bad. I usually just lay my hand on pts arm at iv site and see if it feels cold or swollen. Can be done in the dark without waking pt. Can prevent further infiltration/damage.

Make a cheat sheet of things you just can't remember. Refer to it as necessary. Don't let anyone make fun of you for using it - they probably need one.

If they are unresponsive - check their blood sugar. Somehow that gets forgotten. I've watched nurses check their vitals, pupils, reflexes... forget sugar - pt has sugar of 12.

Save up minor calls to the doctor and make one call. The doctors will appreciate it. Don't put off major calls. The doctor won't appreciate it. If you can wait 5 mins and add the lab values when they are done - sometimes that's a good thing. Don't wait if pt crashing of course.

If you can't suction something out pt aspirated put in an oral airway and suction through it.

Know the meds that may lower a pts blood pressure and know their pressure before giving the meds. Saves that race to ICU later.

Don't take pills out of pkg before getting to bedside. Some folks ask a lot of questions. It's hard to answer what the little blue pill is after the wrapper is gone.

The tripod position can buy a short of breath pt a few minutes while you race for o2 tubing and page respiratory.

A trach pt can blow a plug out without suction (did this in an emergency once) if you push hard on their stomach as they blow out (like heimlich but lower).

Just because a previous shift says a thing is done doesn't make it so.

Emt's get impatient when coming to pick up pt and paperwork isn't done - did I mention previous shift said it was done?

Hot towels make hard IV starts easier. Just lay them on the site a few minutes.

If the pt says it's too hot (towel, enema etc) it probably is.

IF pt has to drink mucomyst (extra nasty stuff) put in cup with lid and straw. Reduces the vomiting from the smell.

IF the foley doesn't feed in easily - STOP. Don't force it.

Spike the IV bag while it is hanging - spike into the fluid at the bottom not upside down. Keep the fluid chamber right side up. This helps keep air bubbles out of the line - reducing beeps - reducing unnecessary trips to the room.

Don't ignore beeping IV pump too long - IV will clot off or line will be full of air or IV is infiltrating.

If pt has foley and is not urinating - check bladder for fullness. Foleys do clog.

If pt is NPO - see how long. Have had pts go days - without a reason - cause nobody noticed. PT too confused to ask.

On the same note - when was last BM?

Warm prune juice is a miracle cure for old folks who complain they had no BM today.

Check level of IV fluid when you make rounds - know if it will run out when you round next - take fluids along on next round - save trip back to room for beeping pumps.

If BP is low - check pt for nitro patch or paste. YOu don't always know it's there.

If telemetry tech says check on pt - go now or at least send CNA now.

Do what you can at end of your shift to help the next shift start out ahead - check IV fluid levels, finish up paperwork for transfers, start an admission, pass a med due first thing on their shift - most will reciprocate and you will be glad when they do.

IF you hear a crash - check out why.

Confused pt can get loose from IV in more ways than you can imagine.

Agonal breathing can be mistaken for snoring.

Don't sit near the call light to do your charting. It isn't wise to be the "person closest to it" for long term.

IF crushing meds to put through peg tube - be sure they are crushed fine and well disolved. Clogged peg tube is bad and time consuming.

Wear gloves when putting something through peg tube - backwash is nasty.

If pushing charcoal through peg tube (personal experience) - wear something over your scrubs - charcoal is apparently permanent.

Add plenty of water to charcoal going through a peg tube.

Charcoal can go in a peg tube and come out a trach. (You don't want to know)

Don't cover trach pt up with blanket up to chin. (haha)

IF it's in drop form - be sure if it goes in eyes or ears!

Know where suction supplies are located - you won't have time to learn this when you need it most and you discover it's not in the room.

Know the drugs in a crash cart by heart.

Sometimes a lap full or towels and washrags can entertain a confused pt for hours.

Sometimes, if they aren't a big fall risk - just let them wander in room. If they aren't in danger - it doesn't matter.

If confused pt can't find something trivial - like their skillet that wouldn't be in their room anyway - tell them their son/daughter borrowed it.

If confused pt is really upset - it probably isn't related to what they are saying. Ask if they talked to son/daughter today. It's often related to the fact they didn't call. Or to the fact pt feels useless - give them towels/washrags to fold.

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Specializes in Emergency.

:yeahthat: That's a great list.

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Specializes in Gerontology.

Do not ever joke about calling in sick - for example, saying "I have had such bad day I'm going to call in sick tomorrow". Even if you have every intention of not doing it. Because as sure as God made little green apples, you will get sick, have to call in and NO ONE will believe that you are really sick. And they will remember this every time you call in sick!

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Specializes in Gerontology.

Just thought of another one. Do not tell a pt that "If you don't do this you could die". I still remember the pt I told she needed to deep breathe and get moving because if she didn't she would get a clot and die. The very next time I got her up to the BR, she threw a PE, coded and died. That haunts me to this day.

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