What are the huge "DO NOT EVER DO" things that new nurses need to know about? calling - page 6
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.... Read More
May 9, '07Hello, it seems you are not getting enough of the 'do not ever do' things that I think you are seeking such as the push K+ advice.
A lot of the 'do not ever do' things are medication related so be aware of contraindications of the drugs you are administering.
In the hospital where I work we have a book dedicated to all IV drugs. Even after 17 yrs in nursing I still look in it on a regular basis to see how to administer the drugs, what fluids they are compatible with, how quickly they go in, how to make them up.
IV pushes are common where I work so this book is invaluable. Even though the narcotics dont 'need' to be diluted for a push, I always do just in case the syringe 'gives' and pushes too quickly.
IM and SC injections : ALWAYS jack back after inserting the needle to make sure you are not about to inject into a vein.
Some other practical advice may be
1. if the IDC isnt draining, before seeking help, check for kinks, look right up to the insertion point. You may need to push the catheter in a bit further, check the fluid level in the balloon. I am lucky enough to have the use of a bladder scanner on my ward so i can see if the problem is the production of urine or a mechanical problem with the IDC. Sometimes the IDC needs a gentle flush to remove sedement build up at the tip.
2. if the NGT isnt draining even on aspiration when you think it should be, push it down further. Sometimes you may get 200mls out then nothing for the next few hours. This could be because the tube wasnt sitting in the bottom of the stomach and you've only drained the top off.
3. IVC not working? Flush it. Not working still? check for a kink in the cannula at insertion point. Check for a kink beneath the skin due to positioning (elbow, wrist). Not working still? Pull it back just a fraction and try again. This is presuming there are no signs of infiltration or thrombophlebitits.
4. If your IV fluids are not on a pump, check HOURLY for the correct rate. A positional cannula can have 1L run through in 2hours quite easily.
5. IV fluids with added KCL should always be run on a pump. If for some reason that is not possible then use a burette and measure it in hourly doses. This rule applies for paediatric IV fluids as well.
6. If you ever find yourself thinking 'it'll be right', it probably wont be.
7. Paediatric patients need to have their IVC checked hourly. My friend's child has a permanent scar on his foot from his admission to hospital as a baby of just a few months old. Despite the pump constantly alarming, the nurses never unwrapped his foot to check the cannula site. It remained wrapped up for 3 days and when finally removed, his foot was raw from rubbing on his fresh baby skin, raw and sloughy. No padding was put between the cannula hub and his skin
8. do not give blood thinning injections into the abdomen of patients following abdominal surgery, use arm/leg instead for your subcut site.
9. do NOT feed patients post op following major abdominal surgery. The doctor will order when he is ready for their stomach to tackle food and it will usually start with ice then water then clear fluids then free fluids then a light diet then normal diet. Sound obvious? One of our hemicolectomy patients went to CCU post op (this was planned) and he was fed a steak and vegie meal within hours of his return. He actually had four big meals before the doctor saw it and put a stop to it.
10. if you have to mix up concoctions yourself eg CT prep make sure you have followed directions and mixed thoroughly. I say this because in two days, two lots of prep on my ward were incorrectly mixed. One was too concentrated with 300mls less water than was needed. The other wasnt mixed properly and when the patient got to the last 100mls he found a lot of 'glob' sitting in the bottom of the jug. This meant both of them drank the solution in the incorrect concentration which would affect the quality of the CT.
Different specialists have their own preferences for care, KNOW YOUR SPECIALIST. What is the norm in one hospital may not be the norm in another. Different surgeons using the same ward will also have their own preferences. EG one will always want his drains vacced, the other will never want their drains vacced
ECG: turn off the powerpoints at the bed as even if the bed makers say there is no interference, there usually is and your ECG will be affected.
Regardless of the hospital policy, always get your IV/IM/SC orders double checked before administering. Case of new RN giving Mylanta 20mls IV instead of oral (even though policy was for double checking)
Hope this helps out. Do you know what area of nursing you will be in?
Let the staff you meet know that you want their knowledge and ask straight up if they could tell you anything they think would be useful to you.
Look for ward specific information folders. We keep care paths on all our regular surgeries as do the other wards in the hospital where I work. they cover post op care from day 1 to discharge and doctor's preferences.
May 9, '07rosyjo11,
WOW!! such wonderful advice from all of the experienced nurses on allnurses, thank you all very much !! I am excited to begin working in July on a stepdown unit. I will be caring for three patients previously on a general ICU, and now in stepdown (intermediate care). The advice I have received here is truly invaluable and very appreciated. please keep it coming
May 9, '07At least at my hospital, where I usually serve as a charge nurse, the charge nurse means I have a team of pts to care for as well as charge duties (nursing shortage? what nursing shortage?). So please, I don't mind the questions, but feel free to attempt to look ANYTHING up first. We have computer resources, drug books, charts on the walls. If you can't find it, I'll be glad to help you.
Also, that time called orientation. Great time to get yourself up to speed. Don't whine about 4 pts when I'm taking care of 8 and helping you. TAke the time to develop your own systems, learn the paperwork, look up the stuff you don't know, ask questions and get experience. If you are caught up (cause we gave you 4 simpler pts since you are new), help the techs, help the other nurses. Heck, volunteer to go pick up our lunch (makes us want to answer those questions even more if our bellies aren't growling).
Don't judge an experienced nurse IN FRONT OF the pts. Ask later why or say something at the time (if pt is at risk) but say it NICE. I have had a new nurse offend me in front of a pt - didn't feel inclined to be as helpful to her after that, figured she just knew more than I did (haha). By the way, that involved a choice of tape for an IV site.
May 9, '07as hard as it is to lose a patient, remember that your other patients don't know this. remember to always go into the next patient's room with a smile on your face, they deserve it and they may or may not know what just happened. another thing i remember my preceptor telling me is that even though you are concentrating on your patients, there is a whole unit out there. offer help if you are able to, or at least ask before you leave if anyone needs your help. this will come back to you a zillion fold.
May 9, '07you have received a wealth of infomation here and i agree with all of it. i would also advise you that if something doesn't seem right, (dose of medication, type of medication, patient appearance, etc., etc.), question it and check it out. also remember that even the doctors and 'experienced' nurses are humans and therefore can make mistakes. the last and most important thing i would say is learn not to judge or classify your patients!!! i hate the terms "frequent flyer", "psych patient", "drug seeker", and all the other "quaint" labels we tend to use in this profession. learn to listen to what your patient has to say and remember that until you have walked in their shoes you really don't know what it is like (and even if you have had a similar experience, it is just that similar but not the same). don't lose the compassion that is so vital to our profession. lastly, don't ever forget that our profession allows us the privilige to share in peoples lives in a more intimate way than any other. we share their joy, sorrow, triumphs, pain, losses and intimate moments. for some of us we are their with the first breath of a newborn infant and for others we are their with the last breath of life, what a wonderful gift we have been given to be able to do this. so, enjoy the journey, like all journey's in life it will have it's peaks and valleys but it is a wonderful profession in which to grow.
[font=lucida sans unicode]i shall pass through this world but once, therefore any good that i may do to any person let me do it now let me not delay for i shall not pass this way again.
May 9, '07Never, ever, EVER act like you know something when you are unsure. Most of the "experienced" nurses when I was new told me time and time again that they trusted me more because I was never afraid to ask questions. Now that I am one of the "experienced" nurses, I feel the very same way.
Also - even though it takes a little more time, ALWAYS look up your meds before you give them. Your patients may ask questions about them and why they are being given the meds. Save yourself alot of walking back and forth to the med cart - take the pills still in the wrappers with you, as well as your drug guide. Open all the blister packs at the bedside. This way when they say "what is that blue pill for", you won't have just opened 10 pills at the cart and not remember which one the blue pill is (this happened to me a MILLION times as a newbie)...
Best of luck to you!!!
May 9, '07Quote from katiebuggHello.Always remember that no-one wants to be in hospital-be nice and understand mood changes when people are ill.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 !!
May 9, '07NEVER NEVER say the "Q" (quiet) word, if you do, it wont be for long, and people may throw things at you.
also never ask anyone to do something that you would not be willing to do or have not done yoruself. Your CNA's and LPN's will have a TON more respect for you and be more willing to help you out.
May 9, '07re:i beg to differ with you. i doubt very much that the only reason anyone treats nurses badly is that the nurses have been tolerating it. if the person didn't have the tendency to treat nurses badly, he wouldn't know whether or not they would tolerate it!
well, as eleanor roosevelt said: "no-one can make you feel inferior without your consent." no doctor, or anyone else in th healthcare setting will mistreat or disrespect you if you do not allow it. if it happens once make sure the perp understands it's not to happen again. we work with doctors not for them. just as aides work with us and not for us. working as part of a team, not as a subordinate, helps lessen the chances of dsiprespect towards you and helps you less disrespected. a doctor can no more do his/her job without you than we can without them. but yes, there are some real jerks and they are to be handled as such-like the new intern i had once:he had ignored my 3 pages so i had him overhead paged. he called with an attitude and told me to "get on with it." i had called him because he had not had the resident co-sgn his orders and i wanted to give him the chance to change the colace t.i.d. he'd ordered for a 79 y.o.woman admitted with diarrhea of unknown origin. instead i told him i would see him in 1 minuyte ( i knew where he was) or i would call his orders directly to the resident. his curiousity got him. he changed the order and actually thanked me. sometimes it is the same stresses that we have that affect them as well and age old hierarchical patterns make them think they have powers and priviledges they do not.
other than this i agree wholeheartedly with all that has been said, especially about meds, respecting the more experienced nurse and all the other members of the team as well, and above all, the patients and their family.
i would add: wash your hands and observe sterile technique. the highest number of infections acquired are nosocomial and the most common of them is uti. whether it is a straight cath or indwelling for lt or temp do not let down your guard or take shortcuts and make sure perineal care is being done properly.
May 9, '07Quote from rngreenhorn:trout: Lending a helping hand when another nurse's patient has just made a disastrous code brown mess will win their respect and they will be willing to help when it's you staring at a big mess wondering where to start. Same with CNAs. Cleaning up patients isn't just a CNA's job.If your hear the statement "Holy s###, I've never seen such a thing, and smell an odor coming from that room, turn around and busy yourself with other matters. Never peak in that room to offer help, or you'll be stuck in a major code brown clean up.
May 9, '07A HUGE ditto to what Grace90 just wrote. Walking away when you know you'd appreciate the help in the same situation is not just rude it is disrespectful. It's why the thread about nursing myths is so long. I believe the orifginal post was meant to be funny though and I'd like to believe that most nurses would help a fellow nurse or CNA though I know that isn't true. If we want respect from others it's a good idea to act in a way that will engender it.
May 9, '07OMG! [
If your hear the statement "Holy s###, I've never seen such a thing, and smell an odor coming from that room, turn around and busy yourself with other matters. Never peak in that room to offer help, or you'll be stuck in a major code brown clean up.[/quote]