General Rules for Med Surg

[icthusRN]

So today I was reading a post about an RN who hung blood with D51/2NS instead of NSS. Many of the comments said that as a general rule always hand blood with NSS. This is not something I would instinctively know or remember in school. What are some other "general rules" from you more experienced nurses for us younger nurses? I had my own experience with a "general rule". The nursing school I went to never taught us to insert IV. They said hospitals are moving towards IV teams and if the facility that hires us wants RNs to insert IVs, they will teach us. They facility I work at does have RNs insert the IVs. I did my research, including watching youtube videos and reading a our facilities Mosbys skills for IV insertion. Nowhere do I remember it said IVs must point away from the heart. I inserted one IV in the forearm that point up towards the shoulder. Thankfully, everything was okay. However, I, even after doing research, did not know this simple rule (my charge nurse who found the error probably questioned my right to practice ), a rule many of you know. Is there anything else like this that comes to your mind to remind nurses?

[pixierose, BSN, RN]

This is a big piece of why so many hospitals are so reluctant to hire new grads. They resent having to spend a lot of time and money teaching new grads the basic clinical stuff they need to know to be able to get through an ordinary shift, things that the hospitals believe (rightly, IMO) people should have learned in nursing school.

Like I said, it's absolutely infuriating. I'm paying out-of-pocket for outside classes that teach me skills I should be learning in school. A school that is highly regarded, has a high NCLEX success rate, and all that jazz.

I resent it as well.

[NICU Guy, BSN, RN]

Sometimes it is the hospital that ties the hands of the schools. We were taught how to insert IVs, foleys, etc in lab, but in the hospital we could only do them with the instructor present. Nurses could not supervise the skill. Hospital called it a legal issue.

[BeachsideRN, ASN]

I'm thankful that my program has us learning skills from day 1. However, I've seen students in BSN programs simply observing in clinicals, not participating.

[msrn313]

I have never seen/started an IV pointed away. Also, always hang NS with blood, and I wasn't taught IV insertion in school either. What are you taught in school anyway? Feels like you learn all on the job hah

[whitneyraeRN]

The first time you hang blood, someone should be with you.. The first time you do anything, someone should be with you! I had a new nurse have to do a zassi the other day. We talked through it, I opened a kit and we talked through it (with numerous nurses), then she did the task with her preceptor. Even with 4+ years experience, I've learned when it's best to ask for help. I carry 6 pts on a medical floor. If I have to put a foley in a female, I take someone with me the first time so it's done on the first try, or you're wasting time. I am also always more than willing to help other nurses... Whether it be a foley, IV, changing, bathing, etc. Two are quicker than one, then you can return the favor. If you're sitting does during a shift, ask others what you can help with. If your fellow nurses don't do this, look for a new position...

[blackribbon]

The first time you hang blood, someone should be with you.. The first time you do anything, someone should be with you! I had a new nurse have to do a zassi the other day. We talked through it, I opened a kit and we talked through it (with numerous nurses), then she did the task with her preceptor. Even with 4+ years experience, I've learned when it's best to ask for help. I carry 6 pts on a medical floor. If I have to put a foley in a female, I take someone with me the first time so it's done on the first try, or you're wasting time. I am also always more than willing to help other nurses... Whether it be a foley, IV, changing, bathing, etc. Two are quicker than one, then you can return the favor. If you're sitting does during a shift, ask others what you can help with. If your fellow nurses don't do this, look for a new position...

Are any of you ALLOWED to hang blood alone? Both hospitals I worked at (the smallest in our town and the largest), required two nurses to sign off on starting a blood infusion and again for each time you hang a new unit. If someone was relatively new to nursing, I make sure that the set up is correct before we even start the signing off process to verify the blood and the patient are correct. I am new enough...(2 years med/surg) that I double check my set up before even sending for the blood.

[blackribbon]

As for the accu-chek, who cares if someone learns this in nursing school or not? It takes less than 10 minutes to learn and is done primarily by the NAs. I'd rather someone know how to think like a nurse which is what the care plans show. I rather work with a new nurse who knows her stuff and can recognize when something isn't right even if she only seeks help because she doesn't know what to do ... than have some one with a million skills but doesn't stop to consider urine output or that a sudden spike or drop in BP can be just as worrisome regardless of what the numbers are. None of our area nursing schools teach how to place an IV, it is understood that the hospital will teach that (I have heard "liability" is the reason). I was taught how to put in a foley in school, but didn't do a female one until I was an RN because I never had a female patient who needed one while in clinicals. (I was successful the first try with a more experienced nurse standing over me talking me through it.)

I had an instructor who said any trained monkey can be taught to do most of the skills we are required to use. We are paid and licenced to be able to think which includes knowing when NOT to do something ordered and contacting the doctor instead as well as being able to do what is ordered. I would be more concerned about a nurse not understanding which way the blood flows and the problems of putting an IV against the flow than I would about a nurse who asks for help when she needs to place an IV because she has minimal experience. I personally think working in a small hospital where I had to draw my own blood for labs was the best confidence builder for learning how to access veins for IVs. Now I seldom do either because we have specialized people to do both and am very rusty.

[annonymouse]

OK; so I learned never hang blood with anything but NS. I learned that the IV needs to be inserted such that the input will flow towards the heart. Nothing should be added to a TPN line ( which is ALWAYS dedicated) ...and I would even question that if an MD told me to do so..( charge nurse, house supervisor...); TPN lines and parenteral nutrition lines and all bags changed q 24 hours despite whether they are empty or not. PICC lines used to follow SASH protocol but now we do not use heparin to lock the lines anymore because of HITT; and always use a 10cc syringe when flushing and locking.

Just a few of the things I remember from school that haven't seemed to change too much. I don't get however, RNs being turned out without learning how to start IVs. How can a nurse feel confident without knowing that she can STAT put in an IV?

Also learned in clinicals, if one does not doggedly and aggressively seek experiences, one WILL NOT GET THEM....and when on the first real job...will feel completely helpless because there is no past experience with which to work with. Most preceptors I had could have cared less if I learned ANYTHING. Mostly they resented the fact that they were given a student; and made it painfully obvious to me. I never learned how to doggedly force my experience in clinicals. Wish I had...cuz I had to learn everything on the job. At that time it was like; ok, you got your two weeks of floor orientation and here you go....take your eight patients and may God be good to you! Humph!

Now when i get to be with a student, I actually aggressively push them toward doing all kinds of stuff; no matter how scared they are about it. I know that if I'm standing right there, they can't really mess anything up. And I try to make sure they know that they are completely competent to do the task...spend lots of time fostering their confidence. Because if I ever have to be a patient, God Forbid, I sure the heck hope my RN feels confident and competent enough to give me an IV STAT, or relieve my bladder STAT.....no ***** footing around.