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 disability.

HI everyone

check pts id, meds, illness symptoms reported by the pt.

Never say I know when its a lie. Always use the experience as a learning opurtunity.

Offer help when you can it will be repaid.

With Drs orders always check if uncertain there is always someone who knows.

Always great advice time to enjoy nursing.

Get to work ON TIME, or at least 15 min to review your assignment and get organized.

TAKE A BREAK to eat/hydrate or even try to get off the floor even though you are busy...you need to take care of yourself so you can take care of pts...:uhoh3:

Try to document as you go, so you are not staying late to state what you did hours ago (you might not narrate it exactly as it happened, or when it happened)...

:monkeydance:

Give a report following the state incentive- SBAR

Situation, Background, Assessment, Response :balloons:

DO NOT EVER think you can remember everything..refer to the chart for info on the patient, or to text books/medication books...there are so many new drugs and you could benefit to refresh your mind on any disease...

Not every day is smooth- take a deep breath, try to be peaceful and think carefully with every action.:lol2:

take care---

Specializes in PEDS ~ PP ~ NNB & LII Nursery.

Accept the fact that you will learn more now than you EVER did in nursing school and that you WILL make some mistakes along the way. Just pray they are little ones and remember to learn from all of them no matter how small. If and when those mistakes happen... make SURE you figure out how and why it did!!!!

ALWAYS ALWAYS ALWAYS follow your 5 rights to med administration. No matter how busy or behind you may be.

If your not sure about anything... ASK! Experienced nurses love to know that you are willing to find out what you don't know or at least make sure what you THINK you know is correct. It keeps you safe and gains their trust.

Good luck! Don't Freak out and by all means... HAVE FUN!!!

rags

Specializes in PEDS ~ PP ~ NNB & LII Nursery.
Try to document as you go, so you are not staying late to state what you did hours ago (you might not narrate it exactly as it happened, or when it happened)...

I agree! We had a nurse who saved all of her charting for the last couple of hours. She took excellent notes through out the night and this worked well for her, but... She had a family emergency one night and needed to leave immediately. However, because she had not charted anything on her pt's she was unable to take off and her mind was on her family rather than her charting. She struggle through (even broke down for a few minutes) and was then able to take off. I felt so horrible for her, but there was nothing I could do to help. If she had needed to give some meds or take care of some other scheduled intervention I would have been able to just say, "GO! You are needed else where" but I couldn't do her charting for her (it wasn't simply recording the vitals she had taken) and she certainly couldn't leave without getting it done.

We don't like to think about the bad things that can come up, but we do need to be prepared if they do.

Just a little story to maybe help you remember to keep on top of things. Even when you're busy.

rags

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

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.

Hello, 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.

cheers,

Jo

rosyjo11,

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 ;)

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

At 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.

Specializes in Oncology, Cardiac.

as 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.

michelle

you 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.

:redbeathe :paw: :heartbeat

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.

Specializes in O.R., E.R/Trauma, I.C.U., Med-Surg, Tele.

Never, 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!!!

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 !!

Hello.Always remember that no-one wants to be in hospital-be nice and understand mood changes when people are ill.

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