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

edc1951 · May 23, 2007

Kelly this list is great. I'll add a new one I learned the other day which seems to work-If a patient has not had a BM and feels constipated (Ca pts very often are) have the massage the area between the lower lip and chin (about halfway between) for 3-5 minutes. If they are too weak or out of it you can do it for them. Also, for pts who may be confused but are going home, suggest to home caregiver that they keep a calendar and mark when pt has BM. This gives them an idea if/when they need to give a laxative and when they do NOT need to. It seems that there are a lot of little old women who get a kick out of laxatives and will use any excuse to get them:-)

RNandlovingit · May 23, 2007

these are splendid. back in the day you learned in school, but you learned "it" after hitting the floor running.
know which way the bed/stretcher tires are aligning before pushing the bed over the elevator gap. yes, i've gotten them stuck nore than a few times. and when you are on the elevator hush. it's nobody's business why you are taking your patient somewhere.
dilute iv meds! i have a long purple hard vein in my right forearm from phenergan and demerol last september. "but my instructor said....2 cc is enough to dilute with......even though i told him 10cc please....smarty pants still skewered me with liquid fire.
know the previous heparin drip order and the dilution. not "i think it's at 3.5cc/hr." same for insulin and fbs.
say thank you. say please. identify yourself to new people and staff. if you are having a sunday/holiday covered dish supper in the back room, offer some food to the housekeeper, the transporter, or the intern who's been on for 24h. he just might be the one who helps you out when he really doesn't have time to.

one of my instructors in nursing school used to always tell us.. if you dont know how much to dilute a med. always follow the rule of 10cc, better to dilute in to much then to risk harm to the patient!

RNandlovingit · May 23, 2007

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.

I love this list.. maybe because i can relate! :lol2:

hidesert · May 27, 2007

The previous posts seem to have just about everything covered. The only thing I can add is don't say "OOPS!" in front of the patient.

This may have been said somewhere but please don't "dis" co-workers, docs etc to pts/families. It is unprofessional and will make them more anxious about the care they are receiving. :uhoh21: It makes us look bad just as much as the person being criticized, and our need to put down other people (even housekeeping, CNAs or the facility itself) says more about us than it does about the person/institution being criticized.

****That said, I am not saying to withhold info the pt has a right to know. What I am saying is in regard to the personal opinions we love to share. Those are things we can share with the proper outlet if we need to get something off our chests, or our mgr if we need to address something questionable, but pts/families are under enough stress already without being drawn into pettiness or squabbles. And of course if there is a problem it is best to go first to the person involved if possible. (You can tell there is personal observation of this phenomenon )

hidesert · May 27, 2007

I have been a nurse for 2yrs and your list is fabulous. Reminders for even little old me, who recently transferred from onc to ICU. Thanks so much.

arbara

mo-mo · May 27, 2007

This thread rocks! These are the million things that take a couple years to get ingrained into your head. Then its just second nature.

One more thing to add is to never, never ignore your gut feeling that something isn't right.

If a patient doesn't look/feel right and vitals look ok and you did another THOROUGH assessment and the charge said its nothing (cuz you gotta give your charge a heads up), do your charting in pts room or at least let the CNA know about your unease. Tell the pt to ring you immediately if XYZ gets worse.

If a Dr. or supervisor tells you to give/do something that doesn't feel right, question it. Don't be challenging or confrontational, be sweet but be firm. "Dr OrthoGuy,I noticed the new order for lovenox, but I'm hesitant to give it b/c she's still having abd pain/ nausea and she has a history of GI bleeds. Dr GILady hasn't been in yet for the consultation you ordered."

If there is an order for a medication or procedure that you absolutely are uncomfortable with, stand up for yourself! Tell your charge what the issue is. If s/he isn't concerned about the issue and you still are, ask him/her to do it or assist. At least document that you verified this order with your charge, and let him/her know that it is documented.

Roy Fokker, BSN, RN · May 27, 2007

always follow the rule of 10cc, better to dilute in to much then to risk harm to the patient!

I've even begun diluting my 30 mg of Toradol in 6 cc or more of saline before giving it IVP. Nothing to do with NSG school or preceptor - everything to do with my own observation of pt. reactions following an IVP.

I know some nurses on my floor who don't dilute it at all!

cheers,

PediASL · May 28, 2007

Make sure to know what service your patient is on. I came in one morning to find the RN for one of our patients had called and recieved an order for the child from the WRONG service. Child was on plastic surgery and ENT was called and GAVE the order and it was processed and not picked up on until the AM. We are VERY fortunate this error did not cause any harm to the child. There are many people invovled in the care of one patient, and although it is reassuring to know an error can be picked up by one of many people in the chain of care, it can also be missed by the same many people...

Wish you the best in your new position!

PediASL

RNandlovingit · May 29, 2007

I've even begun diluting my 30 mg of Toradol in 6 cc or more of saline before giving it IVP. Nothing to do with NSG school or preceptor - everything to do with my own observation of pt. reactions following an IVP.
I know some nurses on my floor who don't dilute it at all!
cheers,

One of my fellow nurses asked me the other day why i was diluting my morphine in 10cc's of NS, and when i told her she said well on this floor we never dilute morphine when giving IV push. I just said well thank you for the advice but this is my patient and I am responsible for her care and I feel safer doing it this way!

BigDog · May 29, 2007

when all else fails chuck the tech and loof listen feel the pt.Gadgets arent magic. rule #2 when you cant find something on a pt ask the pt they know whats up with themselves. Good luck

rita359 · May 29, 2007

I've even begun diluting my 30 mg of Toradol in 6 cc or more of saline before giving it IVP. Nothing to do with NSG school or preceptor - everything to do with my own observation of pt. reactions following an IVP.
I know some nurses on my floor who don't dilute it at all!
cheers,

I second that. I don't think there is an iv push med I don't dilute and give slowly at that.

twotrees2 · May 31, 2007

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 !!

advise from a very cranky ratchety old nurse who precepted me eons ago - whom by the way i respect with the highest regard as her advise has saved me many a time over the yrs- ner assume ANYTHING in this field - clarify anytyhing you are not 150% sure of :)