Safety Tips for New Grad Nurses

[Fntsemi]

Hey there AllNurses peeps, I am a new grad recently hired onto a busy Cardiac Tele floor. I only had 8 weeks of orientation and the learning curve is intimidatingly steep. I am nervous that in trying to speed up to keep up that I may be falling into bad habits and I wondered if some more experienced nurses out there could share some of their top safety tips.

Some that I have already come up with include:

- Always do a thorough systems assessment whenever possible (focused assessments are less helpful since our population tends to have multiple co-morbidiities)

- Ensure patients have a patent IV by flushing at initial assessment and q4 (I'm still working on this one)

- Always review allergies and apply allergy bands upon assuming care (ditto this)

- Check IV compatibility with MicroMedix or your facility's database

- Listen to heart and lungs during q4 reassessments even at night....

[JKL33]

Well, I know you are asking about patient related things, but I have some personal "safety tips" that I think are also essential.

#1 Be observant. Once you practice and practice and hone this skill, it will save you from endless pitfalls of many kinds - patient deterioration you didn't pick up when you should have, body language of family members who are becoming frustrated, coworkers who mean to undermine you, managers who say one thing but mean another, an employment situation where you are not respected/valued. Know where things stand by noticing the details of people, surroundings, and situations.

#2 For the most part, keep your work and personal life separate other than pleasantries with your coworkers.

#3 (Once you get your feet soundly under you) HELP your coworkers whenever you reasonably can.

#4 Walk in the opposite direction of gossip; I don't care how frustrated you feel or what dumb thing you want to vent about. Don't do it, and don't stand around listening to it.

#5 Never argue with patients/families, and be careful not to inadvertently insult them. Practice your verbal, listening, and body language skills just as much as you practice anything else. Remain pleasant. Do your best to respect people. There are times when you will have to set limits or get help with a situation, but following this general rule will save you time after time.

#6 Be humble. Treat others the way you would want to be treated.

#7 Don't be reactionary/take everything as a personal insult.

That's enough to get you started at incorporating personal safety with regard to employment. :)

Lastly, an actual patient care tip: Any patient information that is collected by someone else: LOOK AT IT. It's very easy to forget about your vital signs or your blood sugars, etc. because these are often obtained and recorded by someone else. You have to know what these are!! Do not assume that someone will report all abnormals to you. And even if they faithfully do, just knowing an abnormal here and there doesn't tell you anything about trends. Always, always make a point to synthesize the bigger picture.

Good luck to you ~

[Susie2310]

I recommend reading the current threads where nurses have made suggestions for improving patient safety: "Why do we continue to harm patients?" and "Knaves, fools, and micromanagement."

[Susie2310]

Prioritize your patients and their needs with the sickest, most unstable patient, first.

Have a sense of urgency when providing care.

Make the patient your first priority, not the computer.

[Nurseof10years]

Have some sort of system for writing down assessments/notes that you can't get into the computer right away, it will help organize your thoughts when you do get a chance to sit and chart.

[SafetyNurse1968, BSN, MSN, PhD]

Realize that despite your best efforts you will likely make a mistake. Know that when you make that first mistake, you can recover. You can still be a nurse and you aren't a bad person, or even a bad nurse. When you make that mistake, be prepared ahead of time - know what you are going to do and follow through. Document everything, report through proper channels, and if things get dicey - call legal counsel. Your license is the most important thing and your place of work won't help you protect it. And a proactive tip - seek out learning experiences that involve simulation - any chance you get - that's your best opportunity to make mistakes WITHOUT hurting anyone.

[Fntsemi]

Thank you everyone for your tips and advice. Thanks to you I feel more prepared to tackle my first year. I've also invested in my own Liability Insurance!

[K9lover, ASN, RN]

I would add always listen to the patient. The moment a patient says "that does not look like my med" I halt.

99% of the time it is just a different-appearance, generic, divided doses then there is that 1% where wrong meds put in wrong patients' cart etc...this was a long time ago but even with bar-coding I knew a new grad who made a med mistake when system was down and did not listen to patient.

[caffeinatednurse, BSN, RN]

Any time your medication bar coding system fails, that should serve as a red flag for you. Go through the five rights of medication administration, and if you still feel unsure after that, call pharmacy.

Always stay in the room with your pt while they take their medicine. If you don't, then you have no idea whether they actually took it, dropped it in their bed covers, or threw it away. The only exception should be an absolutely emergency - i.e. you're giving a pt their medicine and you receive notice that your other pt is coding. In that case, find another nurse to stand there with them and make sure they take their medicine.

Pay extra special attention to your confused, elderly patients. It's so easy to miss warning signs for sepsis, pneumonia, CVA, MI, etc. with them. If they're not reacting or responding to you the same way they did 2 hours ago, be concerned. If they have a low grade temp, they're asking you for extra warm blankets, and they're NOT there for an infection, be concerned. Try not to miss the little things.

On the same note, pay extra attention to your patients in restraints (whether that's all 4 bed rails up, soft wrist restraints, 4-point leather restraints, or chemical restraint). Be sure to do ROM, to offer water, snacks, toileting, to check their skin for new areas of breakdown. It sounds so simple, but you'd be amazed just how many nurses "forget" about these patients.

Find your resources (more experienced nurses who appear to hold their own, your charge nurse, lab, pharmacy, RT, that doctor who doesn't mind to answer questions, whoever it may be) and build a rapport with them. You will likely learn more from them than you realize, and their help can be invaluable.

Oh, and listen to your gut instinct! Even if you're wrong, it's better to be extra careful than to be extra careless. :)

[Fntsemi]

I appreciate this! I feel the same way and I take it to heart. Pharmacy is a bit annoyed with a few of us new grads because we call a lot but I honestly feel as if I would rather annoy pharmacy in my first few months than take risks.

[meggiepie24, BSN]

- Don't tell anyone about your Liability Insurance.

- From a lawyer (at an International conference): there are 2 kinds of nurses. Those who haven't been sued yet and those who have been sued. Don't practice out of fear, but out of knowledge that someday you will likely be involved in a lawsuit.

- If a patient and/or family member is upset pay attention to your body language. So often patients and families just want to be heard. Many times I've pulled up a chair and just listened to them. If you've never been a family member of a very sick patient you just don't know how powerless you can truly feel. I know shifts can be super busy but I've found repeatedly that taking 10 minutes to listen at the start of my shift can make the whole shift easier and the patient/family relieved.

- Reiterate what's already been said ... if you have a free few minutes always always ask if you can help anyone else out. Someday you will need others to help you out and people will remember how you were always willing to help. It's just the right thing to do