Simple things new nurses or experiece nurses are not doing?

Melinurse · Aug 25, 2008

As a new nurse still precepting, I thought I had done the right thing in prioritizing my pts. Pt #1- having worsening CHF was having SOB needed Lasix but no order yet. Night nurse did not call MD. ( I did not say anything )Pt #2 - stable, Pt.#3 - pain issues, new for this pt. , Pt #4 - combative, yelling, ( has Down's syndrome ), going to surgery but nothing done ( came in day before ), pt#5 - has a blood sugar of 58 ( gave OJ and a breakfast tray ) recheck after 15 minutes blood sugar is 210 ????? ( pt has no hx in chart of high or low blood sugars ) So I put chart in staff support room to call MD , then my CNA comes to notify me that Pt# 1 has a respiratory rate of 35 and is c/o hard to breath ( I focused on that pt. and forgot about the blood sugar on pt #5 )By now it is 1030am. I get report on a pt#6 who " just had a lap-appy "- PACU says her behavior is a little off, well pt. comes up and is obtunded, responds only to a very firm sternal rub. I was one on one with this patient for almost 3 hours. I get out of that room and family wants to talk about Pt. # 1 change of condition. By now, it is almost dinner time so I have CNA recheck the blood sugar because trays are up and I might need to call the MD. ( I mistakenly heard the CNA say it was 108 ) She got called away and did not chart it right away. When I looked at the chart at end of shift, I saw blood sugar was 180. Darn!!!! So I am responsible but I wish that when nurses follow a new RN, that instead of yelling and making us feel 1 inch tall , that more experienced nurses would use constructive criticism instead.

I am new, not perfect. I will make mistakes and own up to them, but I don't think yelling or making someone feel like crap is the way to go.

Sorry for the long-windedness. Yes, shame on me for not calling, but I was taught that airway, breathing, and circulation was a priority. And that is what I did. Yet, my preceptor did nothing to back me up. No, I am not usually sensitive. I am only writing or as a reminder that when you come onto a shift and not everything is done, well, there might be a reason, so ask. If a new RN has made an err in judgement, give constructive criticism so we can grow and learn from your experience.

lo2210 · Jun 27, 2009

PRN meds are exactly that. Patients turn them down, deny pain. We just don't give pain meds automatically. So if at 2245 a patient declines meds and rings and wants them at 2310, it's totally out othe previous shifts control.

it never fails....and then you feel like a slacker.....

lo2210 · Jun 27, 2009

Interesting to read the things that you are saying nurses aren't doing. It's been eight years since I've worked but I hope to be back on the floor within a few months. At my last job, I worked on a pretty busy surgical unit. The nurses there pretty much all considered themselves to be "old school" and paid very close attention to detail, and I have to say, trained me pretty well. Our nurses were all about "taking the extra step", and went so far to make sure that their patients got a wet wash cloth to freshen up before dinner and were set up to brush their teeth before bed. Needless to say, I and Os were accurate for the most part, and IV pumps were cleared, or you heard about it.

Just wondering how many pt those nurses had at that time?

Deb123j · Jun 27, 2009

Transferring patients with urine collection bag on the BED!!! Even worse, leaving it sitting there. I have seen CNA's, EMT's, and Nurses do this. It seems so basic to know better, yet it happens all the time.

Ummm...where do you put the bag when you're transferring a patient? You can't exactly hang it on the side of the bed...it's likely to get pulled out.

Deb123j · Jun 27, 2009

how do you guys address constipation?
given the amt of narcs most of these pts are on, do you give anything to prevent it?
or ask pt if they have gone?
leslie

I work on a trauma floor, so LOTS of narcs. We give colace, miralax, metamucil, supp. and occ enemas. Also we encourage lots of ambulation if possible. We also have a place in our assessment charting that shows the last BM.

starletRN · Jun 29, 2009

As a new nurse still precepting, I thought I had done the right thing in prioritizing my pts. Pt #1- having worsening CHF was having SOB needed Lasix but no order yet. Night nurse did not call MD. ( I did not say anything )Pt #2 - stable, Pt.#3 - pain issues, new for this pt. , Pt #4 - combative, yelling, ( has Down's syndrome ), going to surgery but nothing done ( came in day before ), pt#5 - has a blood sugar of 58 ( gave OJ and a breakfast tray ) recheck after 15 minutes blood sugar is 210 ????? ( pt has no hx in chart of high or low blood sugars ) So I put chart in staff support room to call MD , then my CNA comes to notify me that Pt# 1 has a respiratory rate of 35 and is c/o hard to breath ( I focused on that pt. and forgot about the blood sugar on pt #5 )By now it is 1030am. I get report on a pt#6 who " just had a lap-appy "- PACU says her behavior is a little off, well pt. comes up and is obtunded, responds only to a very firm sternal rub. I was one on one with this patient for almost 3 hours. I get out of that room and family wants to talk about Pt. # 1 change of condition. By now, it is almost dinner time so I have CNA recheck the blood sugar because trays are up and I might need to call the MD. ( I mistakenly heard the CNA say it was 108 ) She got called away and did not chart it right away. When I looked at the chart at end of shift, I saw blood sugar was 180. Darn!!!! So I am responsible but I wish that when nurses follow a new RN, that instead of yelling and making us feel 1 inch tall , that more experienced nurses would use constructive criticism instead.
I am new, not perfect. I will make mistakes and own up to them, but I don't think yelling or making someone feel like crap is the way to go.
Sorry for the long-windedness. Yes, shame on me for not calling, but I was taught that airway, breathing, and circulation was a priority. And that is what I did. Yet, my preceptor did nothing to back me up. No, I am not usually sensitive. I am only writing or as a reminder that when you come onto a shift and not everything is done, well, there might be a reason, so ask. If a new RN has made an err in judgement, give constructive criticism so we can grow and learn from your experience.

I know this is an old post but I wanted to say that this was what I was thinking as I was reading this thread. It is easy to point out all the things that other nurses are forgetting but who of us can say that we don't forget to do something? And when you have a patient(s) who have breathing/airway issues that's going to be your priority. Your other 4-5 patient bowel and bladder issues are secondary at that point. So some things will get passed on to the next shift. Nursing is 24/7. That's why we have hand-off report.

Now, I know that they really pushed delegation at my school. But sometimes when there is no tech or only one tech and all the other nurses are running around like their heads are on fire it is hard to find someone who can help. All I'm saying in my long-winded way is that we should cut each other some slack. There are some co-workers who are just plain careless or lazy but there are a lot of us out there who sincerely want to do a good job. We just can't find a way to be in 2 places at once. They haven't perfected cloning yet. LOL

Ruby Vee, BSN · Jun 29, 2009

i see people turn off the iv pump when the iv is finished leaving the central line to clot off. what's so difficult about checking to make sure something is running through the line first?

that an emptying out the foley bag are my two pet peeves. i hate coming on shift and finding a foley bag so full it's about to burst!

RN813 · Jun 30, 2009

Couldn't agree more! Some nurses have a hard time with the fundamentals. Other things seem more important with all the new technology.

diane227, LPN, RN · Jul 5, 2009

I don't even bother to call a doctor for this. I check to see if the patient has had recent cultures, if not I order blood cultures x2, CXR, urine culture then give some tylenol. I then call the doctor to let them know what I did.

If I have a patient with chest pain that I assess to be a valid complaint I get a stat EKG, Chest Xray, first set of cardiac enzymes and a BNP. Place oxygen on the patient and give then either morphine or Ntg if they have it. Once I get the EKG I call the doctor with results.

joyouter · Jul 5, 2009

Low grade temps in reg. post op patients who are no immunosuppressed or septic pre op should be initially treated with an MD ' s order for tylenol and with guidelines for temp. increase. I&O fluid balances are of key importance in a patients recovery. A negative balance will alert nurses to dehydration through multiple routes, including allowing for insensitive loss, ie. sweating and drainage from wounds. IV pumps were designed to assist nurses in maintaining accurate fluid balances per shift and the fact that new núrses don't know or are unwilling to learn how point to a major gap in nursing education.

solneeshka, BSN, RN · Jul 19, 2009

But that is what orientation is for. A time to learn the unit and it's habits. We routinely demonstrate to new hires how to do I/Os, clear an IVAC, mark an NG, read the measure of a chest tube. We stand there and ask the patients about bladder and bowel with the new hires and students right by us. They KNOW we ask these questions and when they come back to work on their own it's totally out of the window for some of them. I've lost track of the times patients have told me "it's only you older nurses that ask about my bowel and bladder"

That what orientation is *supposed* to be for. All of you with this great information, become preceptors! My preceptor, nice as she is and much as I like her, was largely absent from my orientation. She would ask me now and again during the shift, "How's it going? You doin' okay?" At the end of the shift, she would tell me all the things I missed - would have been nice to know *during* the shift!

Some of these missed things might just be a matter of time management - it's always hard to remember what it was like not to know something that you do know well, and it seems like a lot of exerienced nurses forget how confusing and overwhelming all of this is when it's new to you. Clinicals in nursing school barely scratch the surface of what you're in for! And many of these mistakes are also made by nurses who are no longer new.

I'm not sure what the answer is, but there has to be a way to get everyone on the same page and on board for keeping up with the details consistently. Anyone out there work on such a unit? And if so, how do you do it?

solneeshka, BSN, RN · Jul 19, 2009

As a new nurse still precepting, I thought I had done the right thing in prioritizing my pts. Pt #1- having worsening CHF was having SOB needed Lasix but no order yet. Night nurse did not call MD. ( I did not say anything )Pt #2 - stable, Pt.#3 - pain issues, new for this pt. , Pt #4 - combative, yelling, ( has Down's syndrome ), going to surgery but nothing done ( came in day before ), pt#5 - has a blood sugar of 58 ( gave OJ and a breakfast tray ) recheck after 15 minutes blood sugar is 210 ????? ( pt has no hx in chart of high or low blood sugars ) So I put chart in staff support room to call MD , then my CNA comes to notify me that Pt# 1 has a respiratory rate of 35 and is c/o hard to breath ( I focused on that pt. and forgot about the blood sugar on pt #5 )By now it is 1030am. I get report on a pt#6 who " just had a lap-appy "- PACU says her behavior is a little off, well pt. comes up and is obtunded, responds only to a very firm sternal rub. I was one on one with this patient for almost 3 hours. I get out of that room and family wants to talk about Pt. # 1 change of condition. By now, it is almost dinner time so I have CNA recheck the blood sugar because trays are up and I might need to call the MD. ( I mistakenly heard the CNA say it was 108 ) She got called away and did not chart it right away. When I looked at the chart at end of shift, I saw blood sugar was 180. Darn!!!! So I am responsible but I wish that when nurses follow a new RN, that instead of yelling and making us feel 1 inch tall , that more experienced nurses would use constructive criticism instead.
I am new, not perfect. I will make mistakes and own up to them, but I don't think yelling or making someone feel like crap is the way to go.
Sorry for the long-windedness. Yes, shame on me for not calling, but I was taught that airway, breathing, and circulation was a priority. And that is what I did. Yet, my preceptor did nothing to back me up. No, I am not usually sensitive. I am only writing or as a reminder that when you come onto a shift and not everything is done, well, there might be a reason, so ask. If a new RN has made an err in judgement, give constructive criticism so we can grow and learn from your experience.

Exactly the kind of thing that was on my mind as I read through all these posts! If by "new nurses," everyone means someone a year out of school, then okay, air your gripes. But for those of us who have a whole month on the floor under our belts, we're still trying to remember where the supply closets and kitchens are, and what the different codes are to get into each! We still get lost on our way back from the bathroom! Our first priority is assessment and meds, and then putting out the fires that arise after that. We're still crawling, we'll get to the walking and running stages faster and with greater confidence (and with tons of appreciation) if you cut us some slack and let us know the things that we can be doing better. And then have patience when you need to remind us 3 or 4 or 5 more times over the next few weeks because our brains are saturated with new information, we've received binders and binders full of orientation information that we have to read and know, on top of studying for and passing the NCLEX and dealing with the chasm that exists between nursing school clinicals vs. actual real live nursing. We'll get there faster if you teach us! I don't know any new nurses who don't want to be doing a better job. Just recognize that it's not possible for us to do it as well as someone with years of experience.