Simple things new nurses or experiece nurses are not doing?

[RN28MD]

:confused:new nurse has a post op patient who is running a fever, she/he gives patient tylenol for it. But experience nurses say a blood culture should be drawn. Why are the new nurses not doing this. Does this happen at your hospital that new nurse are forgetting to do. But not only new nurses I have seen this happening with experience nurses too.

[hes2371]

My #1 pet peeve are sloppy IV's. Coming in to assess a patient and seeing their line has gone dry due to the nurse priming a line with a 1000cc bag, and then putting that the bag has 1000cc to be infused in the pump makes me want to pull my eyelashes out . Also, leaving an open IV tubing dragging on the floor is so careless! I don't mind cleaning up other stuff from the previous shift, but for some reason wasting IV tubing and setting up the patient for injury by being so careless annoys me to no end!

And when they do that with a PICC or central line. don't they realize that air can get into their line and cause A LOT of problems!!!!!!!!

[crystalcnd]

Several things to address...

1. Some of you have mentioned that when you have a patient who has a fever or who is constipated you automatically give certain meds. On our Med-Surg unit we can not administer meds unless a doctor orders them. That means that if a patient develops a fever at 2AM you must call and wake up the doctor to get meds ordered.

2. I&Os. Our nurse aides document patient oral intake and output and do a very good job at it. We have I&O sheets that hang in each room and when a patient drinks something or eats something it is documented on this sheet. Also, when a patient has output it is documented. If they are incontinent it may be documented as X1 and if they are not incontinent it is documented in volume either through a foley cath or using a hat/urinal. We have cheat sheets on each board in the patient rooms, right next to where the I&O sheets hang. It has the measurements for popular things that the patient might consume. Like a small cup of coffee is _____ cc or a popsicle is ____ cc. This also helps that we can quickly look to see what a patient has consumed or there output without having to go to the computer.

3. If you notice than a new nurse, or even a nurse aide has messed up or forgotten something, tell them in a calm manner. Jumping onto someone, especially in front of patients or patient families can be very embarrassing to your coworker.

4. Amen to the person who suggested that RNs put a patient on the bedpan, take them water, etc. without hunting down the aide. I get so upset when I see coworkers who will spend more time hunting down the aide to tell them that the patient needs the bedpan or needs a cup of ice rather than doing it themselves. Yes I understand that we are all busy but for the most part you could have done that simple task in the time it took you to find the aide. Just because you are an RN or an LPN doesn't mean you are too good to clean poo!

5. Please answer the call light. I don't think it should just be the aide's job or the unit secretary/ward clerk's job to answer call lights. Our unit has a policy that if you are within 3 feet of the call light when it rings, answer it. I've seen so many nurses who will stand right outside a patients room or right next to the call light at the desk and never check to see what that patient needs. It's everyone's job to answer call lights!

[YngAnabaptistRadical]

The last night I worked, I walked into a room, and my patient with a trach had no suction catheters or Yankaur at the bedside. Her tube feeding was empty (and alarming).

Is it that difficult to ensure that frequently used supplies are replenished (such as dressing supplies), and that tube feeds (and IV fluids and continuous bladder irrigation bags) aren't empty or nearly dry for the next shift? I hate coming on to empty fluid bags.

And you know, some nurses will say "I used the last drain sponge and now we're out on the floor" and leave it at that. Okay, that is why the good Lord created the storeroom and its wondrous order form.

Naomi Grace RN

[OrthoRN09]

BOWEL CARE!!!! I can't tell you how many times I will come on and have a post op patient for the first time and they will not have had a BM for 3-5 days!!! Please people, address this early with oral interventions. Even if the patient says, but I haven't eaten anything in ____ days. It is much easier on the nurse and patient then suppositories, enemas, and even worse manual disimpaction! AAARRGGHHH!!!

[RheatherN, ASN, RN, EMT-P]

i would love to help mentor. anyone who is reading that has anything to do with this, PM me..

-H-RN

[Aniroc]

Just wanted to say that this is an awesome thread! I'm about to start my new grad position in Medicine and want to develop a good routine/method to start me off right. Its commentary such as what I have been reading here that really helps out us newbies get our heads on straight. I think the best advise that I could give (because i have been lucky enough to work as an undergraduate nurse with two F/T preceptorships) is to make use of all the time you have in a patients room. Think ahead, survey the enviroment and patient for priority care, and if you need help ask for it! Then chart when you have a breath and then make your rounds again. Keep a good flow and eventually you'll cycle through all of your assessments, charting and priority care.

[babedollRN]

Rn1989 brought up some good points; IS, TCDB, and getting OOB. Others brought up good points as well, keeping track of I & O's, and making sure water is there for the patient and in reach if not NPO.

[AMarie85]

Surgical patient with a fever??? Give them their IS and see if that works.....

TCDB, OOB just as other posters have said.... These are the best nursing interventions before even having to give tylenol or call for an order for blood cultures..... (usually our orders state Tylenol PRN for fever greater than 38 or something like that depending on the MD)

Once you learn that your nursing interventions work better than more invasive interventions you really start to feel more comfortable with common post op complications.... I'm a new nurse and I'm just figuring this out as well.

For example if I have a pt who has difficulty voiding after surgery I have learned that getting the pt OOB works well rather than throwing a foley in.....

[BanoraWhite]

4. Amen to the person who suggested that RNs put a patient on the bedpan, take them water, etc. without hunting down the aide. I get so upset when I see coworkers who will spend more time hunting down the aide to tell them that the patient needs the bedpan or needs a cup of ice rather than doing it themselves. Yes I understand that we are all busy but for the most part you could have done that simple task in the time it took you to find the aide. Just because you are an RN or an LPN doesn't mean you are too good to clean poo!

Working in a nursing home I have seen that done so many times...Nurses would come to me and say they just walked into so-and-so's room and their blankets need pulling up or something trivial like that. How long does it take to pour a cup of water or re-adjust a blanket ???

The nurses I always respected the most were the ones that would jump in and do the "menial work" like helping to toilet or feed when they had the time...The ones that told us "I'm a nurse, I don't clean up poo" never lasted.

[tewdles, RN]

I worked, recently, as the hospice RN for terminal patients who remained in the acute hospital setting. Because I was generally only caring for 3-8 patients on any given day (often on different nursing units) I was very available to assist with the ongoing care provided by the techs...this allowed me to have a VERY collegial relationship with them. I had the time to help with baths and repositioning. We very quickly developed relationships based upon providing the best, most compassionate, anticipatory care that we could...as a team. While the unit nurses did not have the time that I did, some commented to me that they noticed a difference in the patient care tech performance when they were or had worked with my patients. I think I had the time and ability to demonstrate to them that we are a team, each with similar and sometimes overlapping but also distinctly different duties and responsibilities. The sum of our efforts is a good patient outcome (hopefully).

My observation was that the experienced nurses were better able to fit a bedpan or water or whatever into the busy schedule, while the less experienced nurse would flip quickly to delegation and thus seek out the tech.

Experienced nurses sometimes develop personal practice which works for them but is not frequently enough examined and tweaked to accommodate current evidence based practice. Experienced nurses sometimes get quickly defensive if someone asks them a question about a practice or process they are using...probably a result of working in an area where they are not valued and are always justifying and defending their function. Inexperienced nurses sometimes ask before they think...often the answer they need is pretty self evident and available but not right in front of their face. Inexperienced nurses sometimes bludgeon their older peers with idealism while the experienced nurses suffocate the young with realism which can evolve quickly into bitterness.

[Sparx28]

i've been a nurse for 9 months now and I must say that I just adore the nurses who take the time to teach. You can either choose to be a curse or a blessing to your coworkers. We all forget things. I've collected specimens that were ordered 2 WEEKS ago too. There are lots of little pet-peeves we hold and when these things come up, instead of complaining about "night shift" or "day shift" or so-and-so, say it directly in a calm and supportive manner to the nurse. I didn't chart Dignicare (like Flexiseal) output once and a nurse said, "i noticed you didn't do this yesterday..." and she told me to write the current level as well as the amount (i just wrote the level). And she explained how it appears on physician IO sheets. Easy, 1-minute fix.

remember the basics...communication is key and realize that the learning curve takes time.

encouragement is a better motivation for change!

[NursKris82]

I know this is probably a venting post and that's cool, but as a fairly new nurse myself I want to remind everybody that often times a new nurse cannot see the big picture yet. When I first started a year ago, all I could do was tasks and the questions I was asked by more experienced nurses blew my mind. I didn't have the experience or practical knowledge yet to see a bigger picture. Now, I'm able to see things on a much larger scale and connect dots that I never knew existed. :) I so appreciate the team I work with and all the experienced nurses that helped me to really learn to think like a nurse.