Oh so many questions from a nursing student ..!

[glovedgoddess]

Hi there I have finished my 2nd yr of nursing and am currently doing my summer practicum. The one thing that I have been really struggling with is the "gray areas" in nursing, I have been getting really frustrated lately because I feel as though my schooling has not prepared me for many little things that take up soo much time! let me explain:

1) I ALWAYS get times for vitals signs confused! When are routine, bid, tid and qid vitals signs taken? Shouldn't I always take vitals when I go into assess a patient first thing in the morning? And right before end of shift so that they are up to date for the next shift coming on? And by 'twice a day' does that mean waking hours = day or 24 hours = day. (starting to see my ridiculous confusion??)

2) When filling out documents such as pre-op checklists, how am I supposed to know what my scope of practice is?? for example, one column reads "blood refusal"..am I as a student nurse allowed to ask a patient if they wish to recieve blood if an instance occurs that they may need it? I asked my supervisor this question and all she did was agree that "yes, there are gray areas aren't there"...uh huh and your not helping:mad:!! anyways..when there is a lot going on in a morning and I have more than one patient going down for diagnostic tests, the last thing I want to be worrying about is how to fill out a sheet! I asked an RN how to fill out the sheet and she only answered a few of the questions. WHY don't they teach us these things in school?!

3) How can I become more efficient with time and organization? I know that experience helps but I need to know some tips for right now. Recently I have started to jot down what needs to be done for my 2 patients throughout the day and I have been remembering more things. However, I was doing a dressing today and I forgot a couple things so I had to run out of the room to grab them..of course when I returned I remembered I had forgotten one of the things. I do this ALL the time. I always think to myself "okay, slow down and I think about what I am doing and what I need"..but I still FORGET!! In and out of rooms all day long is the story of my life!

4) Random Question: I was doing a dressing last week on a pt with severe road rash. Just wondering how do you know when a wound should be treated as completely sterile or not? I am awful with visualizing the procedure in my head of how I should approach the wound dressing. I have been taught the sterile field concept, but I always manage to mix up steps or forget to put something on the sterile field or put the sterile gloves on too fast and open a package off another dressing I need (and contaminate the gloves!!) UGH! ...uhh...back to my question...with road rash can't I just open a sterile tray for the cleansing part and than apply the dressings with clean gloves or no gloves (being careful not to touch centre of dressign) cause they are sticky?..its just so much easier to have the supplies lying on the bed in front of me and open them one by one when I need them instead of having to make a estimated guess of how many supplies I will need and flopping them on the sterile field! With road rash many ppl treat it themselves at home, so can't is just be treated as a "clean" prodecure instead of "sterile"?

5) How do I get more aggressive with my head-to-toe assessments and remember the things I am supposed to ask (so I once again..do not have to be running in and out of pts rooms returning multiple times to ask them things like "oh by the way..when was your last BM and are you passing gas?" that's uncomfortable for me and obviously for them). It's not as bad when I am already in there and asking all the questions at once...by the way when you other nurses out there do assessments does it feel like you ask 101 questions everytime?

6) Tube feeds: when flushing tube (ex. NGT, PEG) pre and post med do you use 30ml of sterile water if it is not specified in the drs orders? Also would you record it on intake sheet as 90mL (pre flush 30ml, med with water 30ml, post flush 30ml).

OR if orders specify flush q4h with 50ml h20 and you are giving a med, would you preflush with 20ml, give med with 10ml, post flush with 20ml to stay within flush specifications??

7) IV push: when admininstering an IV push med what is the better way to do it?:

(a) kink tubing while infusing/pushing .5 ml of med than unkink let solution flush for 15 secs and repeat until done for the duration of the correct administration time? OR

(b) infuse/push med over correct infusion time.

**what is the difference and why do ppl do it either way??

WAAAAAAAAY more questions to come...I appreciate your input 100%! Thanks so much!:redbeathe

[Summer Breeze]

I'll try to respond to the best of my ability. I just graduated from nursing school in May. I don't work as an RN yet, but everything finally made sense to me during my senior year. Especially during my senior clinical role transition (capstone, internship, practicum, whatever people call it!)

1. As a student nurse, we were always required to obtain our own set of vitals. It honestly varies with the patient and how often VS should be taken. I've had patients who were q1, q2, or q4, etc. q4 VS were usually like: 8am, 12pm, 4pm, 8pm, etc. So vitals are basically done around the clock. This also depends on what shift your working. With practice you'll honestly get it down! Maybe look through the patients chart and see what times they were done. =) Or when you obtain report, just clarify and be like "so should I take VS at __ and __?

2. I'm not entirely sure about this one. Do you work with a clinical instructor? For me, all of my charting was always double checked by my instructor or the nurse I was working with for the day.

3. This is how I organize myself: On the back of my report sheet for each patient, I will mark down the hours that I work. (12 hour shifts for me) and for each hour I would mark down when to take vitals, draw labs, do blood glucose, reposition, meds, etc. Just look through what is ordered for your patient for the day and organize yourself that way. It really helps! Make sure to do it for each patient. So every hour I would scratch off everything I've done. It helped.

In regards to materials that you need for certain procedures, this just varies! I feel as though the more experience you get, the better you become at being able to figure out which materials you need. Just relax and go over the proecure in your head, so you won't miss anything. If you do, don't worry! It's okay to forget something, you're still learning. =)

4. I honestly can't answer this one very well. I always did wound changes sterile. I've never had a patient with road rash though! Ask your clinical instructor. Sorry I'm no help! lol

5. I go from head to toe. We had a class on physical assessment, and I honestly practiced on so many people, even stuffed animals I had at home. lol! Practice makes perfect. =) Try to constantly practice so you can get in a routine and remember every question and step. Just go from system to system, it will become second nature with more practice.

6. I think the norm is 30ml. But this could vary on the unit/hospital you work at. Input will always be whatever the amount you push. =)

7. I just push the med or use an infusion pump with the correct duration. I know some nurses put medications "high in the line" I never saw that during clinical, but during my practicum that's how many of the nurses pushed some meds. But it was small amounts for itty bitty peds patients. And this also varied on how fast their fluids were running. But I'd definitely push the med within the correct amount of time.

Hopefully I was able to answer some things. Hopefully someone with more experience can help! I feel like I need to be in the hospital environment ASAP. I miss it all.. I feel like my skills are lacking right now! Ah!

But anyway, great questions. =) Don't hesitate to ask your clinical instructor or nurse you are working with these questions! They are there to help, and they'll probably be able to clarify things better.

[glovedgoddess]

Thank you Summer Breeze, you helped quite a bit actually =) The new grads I have worked with so far have been so incredibly knowledgable and seem to know their stuff inside and out! Good luck with the beginning of your nursing career!