Things I learned the hard way - page 2

Hello, I am a nurse preceptor and currently trying to put together tips for mostly new grad RN's under my supervision in the ICU. I have a few already, but would love some input from some seasoned... Read More

  1. by   RN always
    I just finished doing my internship and the best advice my preceptor gave me was about documentation..........she told me a story. There was a girl that came in to the hospital with bruises all over her arms. The nurse did an assessment and documented that the bruises were there. After the girl was d/c'd she came back saying that the nurses gave her all the bruises on her arm. When the original documentation was pulled out and shown to her she turned and left defeated. She was looking for ways to get a lawsuit. This has always stuck in my mind. Anyways, good luck
  2. by   shoelace
    Always chart with a jury in mind.
    If your patient starts to "go bad," call the MD, no matter
    what the time of day it is or how much of a ***** she is.
    Sometimes it can be subtle, but if your gut feeling tells
    you that the situation is going to turn ugly, better that the MD
    know beforehand, so you don't get a "Why didn't you tell me before?"
    If you don't feel the MD is taking you seriously, have your
    charge nurse talk to them.
  3. by   NurseRachy
    hehe this sounds a bit funny...because it is, - but it is VERY applicable to me:
    when your nurse says they are gong to faint IMMEDIATELY take over - please don't just assume 'yeah, yeah, you'll be right - it will only be a few seconds more' because this has happened to me 3 times - every incident distressing the patient and embarressing the h*ll out of me!!! Not yet applicable to me - but it was certainly a tip some of my clinical educators learnt!!
    Love Rachel @}-->----------
  4. by   Furball
    Originally posted by researchrabbit
    While it may not be pertinent to ICU (although you tend to get everyone there, so maybe it will be), here are the lessons I've learned observing others work with psych patients...never ever tell a depressed person to "snap out of it", never tell a person with obsessions or compulsions to "just stop it", never tell a person with an anxiety disorder to "relax and the worries will go away".

    If you have a person with hallucinations, be understanding -- the hallucinations are as real to that person as your hand is to you.
    No, this is VERY pertinent to ICU's....lotsa delirium and ICU psychosis out there especially with the elderly.
  5. by   New CCU RN
    Well, I am only coming up on a year in ICU but I have a few myself:

    -Always print out a rhythm strip prior to entering the room (Have had patient code 2 minutes after walking into the room)
    -Know where your code drugs are and how to do a bedside check...and ALWAYS actually do it (we keep Epi, Lido, and Atropine at the bedside)
    -Always check quickly on both your patients before you go in to do a full assessment on the other one. You don't want to find our your pt has been having CP for a half hr while you were in the other room, and his call bell was no where to be found.
    -Always make sure you have a new bag ready to go to be hung when your IVs get low esp pressors or sedation ...whatever procedure needs to be sure to do it.
    -Be sure to ask tons of questions.... ask the nurses, ask the docs, ask the RT's, etc.
    -Get a good gtt book and carry it with you at all never know when you are gonna need to hang something.
    -Beware of the stoic pt.... the one who doesn't ask for anything... he usually is the one that needs the most care and diligence...and most likely is in worse trouble than you think
  6. by   JohnnyGage
    Originally posted by KRVRN
    Make sure your stopcocks are correct when drawing blood from an arterial line. You certainly don't want to have a big mess!
    Heh... the idea that "you only turn the stopcock the wrong way once" is a huge LIE!!

    My biggie is make sure all of your IV lines are labled at the injection ports (including the maintanence lines). You don't want to be injecting things at random when the fecal matter collides with the oscillating air current generator.

    Another big one that a poor new nurse learned the hard way: make sure your patient is lying flat and holding his breath when you DC a PA line and/or introducer. Air emboli are never pretty.
  7. by   JohnnyGage
    Originally posted by BadBird
    -do not be afraid to call the MD in the middle of the night if your patient is crashing
    -do not be afraid to call the senior resident if the resident on call does not call back within a reasonable time or you do not feel that the on call resident is competent, always look out for your patient
    Yeah... if you need to, work your way up the food chain. You can bet that a younger resident will never, never, never blow you off again if the chief resident had to wake up in the middle of the night to straighten up the mess. At the same time -- be sure you're not over-reacting. Talk to the more experienced nurses if you have doubts.
  8. by   passing thru
    NEVER turn of any alarms. NEVER NEVER NEVER turn off an arterial line alarm. If the ventilator keeps on alarming, ...don't figure it is cause the patient is coughing ...and don't keep hitting the SILENCE button..because most likely, ..........the tubing is disconnected somewhere.

    So true,....................... coldfoot.
  9. by   KRVRN
    In neonates,

    Never suction a baby that's already bradying down unless you have absolutely NO choice. Desatting baby, yes suction. Bradying baby, no. You'll brady it further and then you have a HR in the 40's. My rule of thumb... Learned the hard way.

    Never remove an ETT, assuming a baby has self extubated to give PPV via bag and mask without careful consideration. Especially micropreemie. Get someone else's opinion. Sometimes you can't get another tube in and then you'll likely have a code with no airway. Maybe lethal. I've seen it happen, baby died and may not have been extubated in the first place.