Simple things new nurses or experiece nurses are not doing?

Neferet · Jan 28, 2010

What bugs me the most right now is new and experienced nurses and CNAs wiping pts from back to front! And most of these times, there is poop! Grrrrrrrrrrrrrrrrrrrrrrrr! What can be harder than wiping pts from front to back?. Easiest way to avoid UTIs and for some reason "trained" professionals can't even do this itsy bitsy thing to keep pts safe from infection! Wipe front to back okay?! Reduce the risks and complications of UTIs, money and ABXs to treat it, and decreases risks of systemic infection that can lead to death of a pt. Same for foley caths....wipe "away" from the urethra....wipe the poop way...not towards.

I can't believe this! I mean do these people do this to themselves too or just the pts? I seriously doubt that they wipe themselves from back to front, spreading poop into the lady parts and urethra. I'm really annoyed by this, so please....be nice to your patients who can't wipe themselves.

Info for new nurses:

A low grade fever is normal after post-op. I agree with Jlmb214rn on this one. But however, if higher, doc should be made aware, and meds ordered for it or blood cultures done if the doc wants. Never hurts to do cooling measures for low grade fever. I too, don't treat the first temps, unless indicated. At our hospital we don't treat until 100.5 or higher with Tylenol. And you don't want to treat temps anyways until the doc knows, and you know that they don't want a blood culture before you give the Tylenol.

After surgery encourage pt to TCDB and us Incentive spirometer. Make sure pt voids within 6hrs after getting general anesthesia. We usually give ice chips post -op but make sure pt is awake before bringing it in the room.

Our hospital I/Os are done in every 8 hrs....11-7, 7-3, 3-11 again. Say for example if you are there at 3pm, and doing I/O's.....Start like at 2:30pm so you can get it all done in time. Pour all the water that is left in the pt's cup back into the pitcher liner (because they did not drink it) and then measure what is left in the pitcher liner. Subtract that amount from what was originally in the pitcher, and you will get the amount that they drank. If they drank other fluids, add this to the total too. Whatever they did not drink, you shouldn't add it. For example if they spilt 800ccs at 12am, and you know they only drank 100cc. 100ccs will go on the I/O's sheet and then just refill their pitcher back to 800cc (or the total). And at time of I/O's you'll be able to calculate how much they drank from the new 800ccs in the pitcher, and then add it to the 100cc that they drank earlier....So that will be the total they drank from 7-3pm. At this time also you will go to the volume history on the IV pump and see how much was infused. The last shift was suppose to clear it before they left...from 11-7. So whatever total left should be the total for your shift. For example if the pt is getting 100cc/hr, it should be around almost 800cc for your shift, and you will take down this number and write the IV intake on the pt's beside. Press "clear" to clear it from the pump because you've already recorded it. At this time you will empty their catheter bag and also record the amount on the I/O's sheet. If they have draining bags, you should check on them at the beginning of your shift and empty them as necessary and chart the amounts when you do. And empty and chart these also at this time for the 3pm I/Os. And then, you can chart how many times they voided. After all this is done, make sure you calculate the total. That is from 7-3pm how much was in or out. ...and then these number are what you will report to the next shift.

If you don't have a running IV bag, just clear the pump after every time you run an antibiotic or something, and chart it in somewhere in the right time slot. Then you can total it at 3pm.

Every time you turn off a pump, pt's IV should be flushed, and the clip closed. No blood should be seen in IV lock if possible. Put a cap on the IV tubing if you're planning to use it again. Piccs, and Central lines flush with a 10cc NS, and flush regular locks with a 5cc NS (some facilities use heparin, follow your hospital's protocol). IV tubing should be thrown away if they were opened more than 72 hrs.

Make sure stools are charted correctly with description: 1x med loose stool, 1 xtra-large hard formed, 1 x med loose stool ....and then the total will be,......2x med loose stools and 1 xtra-lard formed. Check if pt had BM for past three days....check for abdominal s/s... If pt states that stool is difficult to pass, but they have an urge to poop and feels like it is right there, usually doing a digital will help if there are no serious s/s of distress or colon obstruction, or bleeding, etc. Check orders for bowel care, and give if pt has it if no BM within 3 days or so depending on your hospital.

When hanging IV,'s set the volume a little lower than what's in the bag. For example I always set a 1000ml bag with an infusion volume of 950ml. That way it won't run dry. Different amt for different pumps, so get used to the pumps you use. Also for kids, should never hang a bag of 1000ml, if you could hang a bag of 500mls...because kids overload easily. If you are running and IV for a kid at 50cc/hr, you may want to set the volume at 100ccs. That way the pump will stop and beep in two hours, and prevents overloading risks.

If pt is allowed to have reg diet without fluid restrictions, family can bring drinks. All they have to do is leave container in the room or alert you how much was dranked. Same for I/O's. If they don't have a catheter, place a hat in the bathroom or a urinal, or commode and have the pt pee in it. When you come into the room, you can always check on it, empty it, chart it....and then at I/O's time you can total it. With restricted fluids, alert family not to bring pts anything because they are on restricted fluids, and nurse must be the one to allow them how much water to drink in a certain time period.

I hope that when you guys are transferring pts, you guys are getting help. No need to hurt your backs on heavy ones. Sometimes I will hook the catheter bag to the chair they are transferring to if it's long enough and won't pull. Other times I'd have someone help me transfer, and I can hold the bag in one hand. If they are getting onto the commode, sometimes I hook it onto there instead... and make sure that they get on the commode safe without tugging on the cath.

Everything dirty and used goes into the dirty utility room. Every new and unused is in the clean utility.

Anytime you hang an IV medication ..Say for example a antibiotic...make sure you know what it's for. If not, look it up in the IV book, and write the med and page number down. See the book tells you to check any labs, or VS, etc, before giving the IV. Also sometime there will be labs that show if an organism is susceptible to this med or not. And if it's not, you have to alert the doc. On this page it should also tell you the what fluids to dilute with, what rate to give it, what to side effects to watch for, parameters on when not to give it....etc....

Then look under the "dilution" area in the book. Here you will find which fluids it can mix with. And check the MAR to see what fluids are running in the pt's primary line. If they're compatible in the book, then it should be okay. If you're running K+ in the primary line, and the secondary (for example the antibiotic) is not compatible with the primary fluids. Then I usually use a "primary line" tubing to prepare the antibiotic, pause the primary line, infuse the antibiotic first, and then hook up the primary solution again after the antibiotic is done. If you have two IVs that need to be infusing at the same time...for example if you need to hang the ABX, but also the pt's K+ is low and needs to be infusing...then I would sometimes start another IV in the other arm and run two IVs at once. If this happens then you just have to know their effects on the body. Check your dilution, push rates, etc. If you do an IV push or secondary IV and you see precipitation or the fluids in the IV tubing turning a different color, then they are probably not compatible. Must stop the IV immediately.

When priming IV line...make sure you close the valve first. Squeeze fluids into the drip chamber....and then open the valve, and then take off the cap at the end of the tip.....and run it until a few drops come out at the end. Place the cap back on, making sure you don't touch the end tip. Sometimes you will have trouble getting it to run faster, just press on the bag a little and that should help. Always do a visual...look at your tubing to see that it doesn't have any bubbles. If you do it right, there won't be.

There is no such thing as giving meds without orders.....know your state laws. Some hospitals will have protocol orders...and those are okay. But if you don't have an order for something that is not a standing order, or protocol order......get one.

You will forget a lot of stuff...but perfect makes practice. You can only put yourself down where you are slob and too lazy to study and learn. But we're your willing to learn and when you are learning day by day, then that's how it is. Be assertive, but don't brag about what you know to the more experienced nurses. If there is an error, address it professionally with the coworker alone, but don't accuse. If you are a new nurse, you will not know everything, so don't feel bad. Get as much training, and ask as much questions as possible, because when you become a nurse longer, you'll feel more stupid asking questions that you should have known years ago...trust me... Asking questions is expected of you.

Take a deep breath, it will get better, and sooner or later...all this IV, basic care stuff will be so easy...you'll need time to get it done, but you won't even have to think hard about it. The critical thinking is the importance focus under all of this.

Hisown · Feb 8, 2010

Thanks Neferet for all the tips! Would be really helpful to me in my practice as a new nurse.

MntnGirl · Mar 24, 2010

This gets me all revved up: Transfering a patient in airborne isolation precautions and the person transfering pt has a mask on but the patient doesn't. Put a mask on the patient people when transfering patient out of their room - PLEASE!!!!

starletRN · Mar 25, 2010

Wow! I can't believe people have to be told to put a mask on the patient. That's a no-brainer.

Kim, HHRN · Apr 19, 2010

I'm SO glad I found this thread. This has REALLY opened my eyes a great deal on my "duties" as a nurse besides the obvious things. School is so fast and filled with so much info, it's hard to remember it all. This is a great reminder.

SillyInScrubs · Oct 18, 2010

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.

Please excuse my ignorance here, but I'm new and was just wondering about whether or not doing these things is outside of the scope of practice for a registered nurse? Could you somehow get into trouble for ordering tests, EKGs, and labs and giving oxygen without an order (I know it's OK with standing orders, but I mean if you do not have them)? I am very concerned about the legal aspects of care and want to cover my butt as much as possible!

nursingcares, RN · May 11, 2011

^^^^

Originally Posted by diane227

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.

"Please excuse my ignorance here, but I'm new and was just wondering about whether or not doing these things is outside of the scope of practice for a registered nurse? Could you somehow get into trouble for ordering tests, EKGs, and labs and giving oxygen without an order (I know it's OK with standing orders, but I mean if you do not have them)? I am very concerned about the legal aspects of care and want to cover my butt as much as possible!"

I'm wondering the same!!!!

HRSBSNRNC · May 12, 2011

The biggest thing I see with new nurses and even some experienced ones is task forcused nursing without the critical thinking. If there was some way to improve on that we would be golden.

starletRN · May 12, 2011

The biggest thing I see with new nurses and even some experienced ones is task forcused nursing without the critical thinking. If there was some way to improve on that we would be golden.

It's so easy to slip into that habit. I think the biggest contributor to that is the time crunch. Having to get so much done in a certain period of time. The paper work comes to mind the most. Some nights I feel that's all I do is paperwork.

Seas · May 12, 2011

I am glad to have found this topic. I am a new grad with ADN degree who is starting first job at hospital in 3 weeks. Even though some posts were offensive for me (come on, we are new grads, some things come with experience!) , all the posts REALLY helped me. Keep them coming! =]

HRSBSNRNC · May 12, 2011

Seas.....Congratulations. Being a nursing instructor as well as a practicing nurse I tell my students all the time that the new graduate that asks lots of questions and trying to understand a different case a night/day are the ones who will be the most successful. The new graduate that does not ask questions and acts like they know it all scare me. I have been a nurse for 7 years and I learn something new every night I work.

Best of luck to you!

HRSBSNRNC · May 12, 2011

.....Also, set up pain management plans with your patients. It will help you become a very successful nurse!