I wish I was a more "polished" RN

[Alex_RN, BSN]

I am several months into my first RN job at an LTAC and things are very casual. We are rushed and under-staffed and my initial orientation was geared towards getting me on the floor as fast as possible. Everyone has a different way of doing things, like, for example, drawing blood from a PICC line, or how they chart things. I honestly do not know what the official time frame is for med administration, for example, but I know what we actually do. We have to combine cares as much as possible. I have seen some much-beloved senior RNs do things that I would never do and I have also seen them do things that I thought were very polished and showed skill and finesse.

The official procedures manual is huge and wordy and focused mostly on our computer system. It is a giant dusty binder on a shelf somewhere.

I asked our infection control person a simple question and she gave me a funny look and then outlined a procedure in such a way that sounds great but I know that no one does that way. If you look at our supplies and how much are used, it would be clear that no one is doing this particular procedure by the book.

I try to watch other RNs as much as possible to learn things but we are all so busy it is not as if I can watch them at the bedside. I worry that if I ask too many simple questions it will reflect badly on the nurses who oriented me, who have been here forever.

There is a lot of turnover here and I hope to be at a better job in a year, but I worry that I am learning bad habits and not learning any good habits.

I Google a lot of specific things but is there a resource to learn good nursing habits?

[TheCommuter, BSN, RN]

This might sound really terrible, but I do not remember how to do things by the book anymore. I practice safely, but not by the textbook.

There's a textbook world of nursing and a real world of nursing. Nine times out of ten, ain't nobody got time to practice in accordance with the textbook.

[Hollybobs]

This might sound really terrible, but I do not remember how to do things by the book anymore. I practice safely, but not by the textbook.

There's a textbook world of nursing and a real world of nursing. Nine times out of ten, ain't nobody got time to practice in accordance with the textbook.

Absolutely the case. I was taught to practice so that if in a court of law we were asked "why did you complete clinical skill x in a particular way?" that I could respond with a sound, safe and logical rationale. You can rarely go wrong with local protocol as the foundation of your practice, you just have to become very speedy if you want to follow it to the letter. I've rarely met a nurse that does this and never anyone who is not behind at the end of the shift.

You're asking a question that many good nurses ask when they start off and I think if you continue with this approach you'll become one of the much-beloved RN's you admire :).

I've developed my clinical skills by reading theory: journal articles, recent and well-respected texts, local clinical protocols and the underpinning anatomy and physiology. I've also watched a lot of different nurses do things in a variety of ways and I try to pick the way that is safest and most efficient. I will also adjust for the effect on my patient, stay open to new ideas and I'll discuss the pro's and con's of different approaches with colleagues. It is fun :).

[TheCommuter, BSN, RN]

I've also watched a lot of different nurses do things in a variety of ways and I try to pick the way that is safest and most efficient.

Your point is rather salient. It is always good to remain mindful that there are multiple ways to throw a stone...e.g., there are several ways to correctly and safely accomplish the same nursing procedural skill.

[TheCommuter, BSN, RN]

Moved to the Nursing & Professionalism forum for more feedback.