Things I learned the hard way

  1. 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 nurses and the new grads. I hope to write down little tips and things to look for under the title "Things I learned the hard way". Anything from assessment to implementation is welcome.
  2. Visit Scout_4 profile page

    About Scout_4

    Joined: Sep '02; Posts: 3


  3. 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.
  4. 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!
  5. by   sharann
    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!
    Were you watching me last week?!?!?!:imbar
  6. by   canoehead
    No matter how frustrated you are with someone know that eventually they will get better (or were better) and if you became impatient the shame of facing that person once they are in their right mind is not worth the brief relief of blowing off steam.

    This applies to drug seekers too- eventually someone will come back and say "all that pain was caused by ____, don't you feel stupid for treating me like crap?"

    ALWAYS listen when someone tells you they feel worse. It'll save your butt a hundred times.
  7. by   amy
    The stories that correspond to these tips could be an awesome thread itself...but here goes!
    1. The folks doing charcoal should always get the wash basin and not the emesis basin in case of stomach upset.
    2. When administering charcoal ALWAYS wear gloves!!! And a face mask if children are on the receiving end!
    3. If a certain nurse starts out giving you a hard time, killing her with kindness will NEVER work. Tell her to back off. Immediately.
    4. Re: doctors; see #3.
    5. You will get exactly as much crap as you will take. Start out by being the sh**less wonder!
    6. Don't say it; it will happen...ex) giving lopressor to rapid a-fib, after no relief with adenosine, cardizem, and something else..cardio says :"don't do anything silly while I'm gone" to pt, he LITERALLY walked out of the room, and pt became hypotensive, poorly perfusing, and alt LOC. THEN we attempted cardio-vert x 3. No luck. Thought we were going to lose her. Same rule applies for "quiet", "so-and-so patient", "arrest", etc.
  8. by   BadBird
    -always attatch the collection bag to the rectal trumpet before insertion.
    -always check the connections on pressure tubing before connecting (espesically arterial lines)
    -always check your IV sites at the beginning of your shift, if the patient codes you need a patent line
    -always believe your patient if they say they are going to die
    -always check your own calculations for drips, don't assume that what is programmed on the pump is correct
    -always check your IV's, many times the fluid has been changed and the old fluid is still hanging.
    - always check the 5 rights when it comes to medication administration, no matter how long you have been a nurse
    -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
  9. by   Dr. Kate
    Always double check a medicine the patient says they've never taken before or don't recognize.
    Never completely trust what you get in report, time has passed since the off-going nurse last saw the patients.
    Once the ER nurse finishes report on the medical diagnosis, ask him or her what's really wrong with the patient.
  10. by   RNConnieF
    Be afraid, be very afraid when your patient says "oh by the way" what follows is NEVER good.
  11. by   Coldfoot
    If someone asks you to observe a finding/procedure/behavior, always put on gloves. At some point they will ask you to hold this/press here/empty that.
  12. by   christianRN
    Badbird's suggestions were particularly good. I always check EVERYTHING when I start my shift; have found many things that haven't been as they were charted/reported. I also check the actual orders for the past day or so, at least. Always make sure suction and ambu bag are hooked up and ready to use.
  13. by   amy
    place attends under/upon pt at first incontinence episode!
  14. by   baseline
    Always release the pressure from a pressure bag before taking out the tubing !

    Never trust a new orientee to understand that grabbing an opened bag of PRC by the middle will create a LARGE mess........and alot of paperwork.........