skills help

grinnurse, RN · Jun 29, 2005

I have been on a MS floor for 3 weeks now and here are a couple of the tips that I have learned so far-some of you may already be aware of these but I thought they were pretty darn cool :chuckle

When putting on TED hose-YUCK b/c they are so hard to get on- take the package that they are in (usually plastic bag), cover the pt feet w/the bag, roll the stockings up (like putting panty hose on) and slip them over the plastic bag on the feet to get up to the ankle and pull them on up!! Makes it so much easier!!

If you don't have pumps that back prime your line and you have to hang another bag, to avoid getting air in the line (this only applies if you are running NS or something else and everything is compatible)hook the secondary tubing to new bag to be infused, lower it from primary infusion bag and that kind of back primes the line for you!!

Hope this will help someone else who is working at one of the not so "Modern" hospitals!!

nurscee · Jul 1, 2005

I have been on a MS floor for 3 weeks now and here are a couple of the tips that I have learned so far-some of you may already be aware of these but I thought they were pretty darn cool :chuckle
When putting on TED hose-YUCK b/c they are so hard to get on- take the package that they are in (usually plastic bag), cover the pt feet w/the bag, roll the stockings up (like putting panty hose on) and slip them over the plastic bag on the feet to get up to the ankle and pull them on up!! Makes it so much easier!!
If you don't have pumps that back prime your line and you have to hang another bag, to avoid getting air in the line (this only applies if you are running NS or something else and everything is compatible)hook the secondary tubing to new bag to be infused, lower it from primary infusion bag and that kind of back primes the line for you!!
Hope this will help someone else who is working at one of the not so "Modern" hospitals!!

Great tips!!!!! Thanks!

rosemadder · Jul 1, 2005

these are a couple of really simple tips:

for iv sticks always use the dominant arm (the veins are bigger in your dominant arm)and be sure and put the touniquet on really tight (most new nurses don't really tighten it up enough)

if you have problems with foleys on women (cath slipping into the lady parts) first place a betadine swab (or big swab) in the lady parts...this helps the urethra become more accessible and keeps you from placing the catheter in the lady parts by accident. if you have problems with foleys on men then the cath could be coiling inside...it helps to insert the cath slower and hold the member upright more firmly.

if you have problems getting blood from a picc or central line sometimes positioning can make a difference. i have had patients stand up and easily get blood whereas laying down i couldn't...i also put pressure around the outside of the site and that too works sometimes.

nurscee · Jul 2, 2005

Keep these coming. I think this would make a good book for new nurses. These are the kinds of things we wish we knew.

If anyone has any time management ideas, I could sure use them. Sometimes I feel like I'm chasing my tail.

rosemadder · Jul 2, 2005

Keep these coming. I think this would make a good book for new nurses. These are the kinds of things we wish we knew.
If anyone has any time management ideas, I could sure use them. Sometimes I feel like I'm chasing my tail.

Time management is the key to becoming a successful nurse...It is one of the most important skills you will need.

1. One thing I have learned is never put off charting at all...it doesn't take but a second to write a note ...for example if someone calls out for pain meds quickly write that note before taking them the med (you will find that it takes only seconds). The nurses who work late are the nurses who save all their charting until the end of the day--this will never work plus you can't remember adequately what you did when and for whom--also writing yourself notes to chart by later is not a way to save time...just do the charting throughout the day.

2. Never put off something when you get a lull in time that you can do then...for example: if you have a dressing that's due that day and you get a moment -do it then...don't think "well I have all day, I'll do that later"...later many never come. Do what you can as soon as you can.

3. Pull your meds (if the facility allows) early and have them ready to give. A normal routine for me during a day shift caring for 8 med/surg patients went something like this:

a.get report (I always come in 15 mins prior to shift time to get a jump on the day--it helps a lot)--I've only been out late twice since becoming a nurse.

b.pull 8 & 10o'clock meds from pixix and put in patients drawers (don't open them--just put in the cups and have ready)--put a dot beside their time frame in the Mar so you will know you have pulled them. Flag any scheduled narcs that will have to be pulled at the time to be given (up to the 10oclock meds). make mental note of pain meds that can be given this am and what time.

c.do assessments being sure to check ivs for infiltration (if any are going bad--turn them off ..you can restart in a bit), if anyone asks for pain meds at this time --tell them when they can have them (or if it's time run get them depending on how many more patients you have to assess--if you're down to assessing one or two then take the pain med back after you finish as long as the patient is not 8/10 in pain)....all these assessments should not take very long -the more practice you get the faster you can do them--save the patients with 8 oclock meds until last and you can give them as you assess or run them back if it's not quite time. If someone has questions about their care (labs, md plans, etc)..make a note and tell them you will get back to them with that information--later on you can look this up as it is not priority.

d. now quickly chart chart chart as fast as your fingers can write--charting the assessments and first note, don't double chart --anything on your graphics does not need to be repeated...most new nurses overchart --avoid this as it wastes time. If there were any real problems noted this will be the time to page your md unless you know he's coming at that time. You can wait on him to call while charting.

e. if it is 9 oclock start giving 10 oclock meds (which you have prepulled). this doesn't take long when the meds are ready. Save the patients with NG, Dopphoff or Peg meds last and the patients getting schedule narcs you can save until 10 oclock (so you can pull the narcs on time).

f. after med run now go back and finish charting assessments if you have not finished or you can restart those iv's at this time (personally I wait until I have the assessments done). (of course if they were getting blood you're going to have to ask the charge nurse or iv team earlier if they can restart your iv)--if they can't you'll have to restart that one on your own when you find the problem (not later).

g. straighten and neaten your area as you go. After charting assessments (or during), make sure your vitals have been charted and double check them (CNA's should be telling you if their are any problems with vitals but you need to make sure you know your cna's habits--this will come with a little time). This is also a good time to check your I& O's and make sure they are charted and voiding as necessary.

h. now start treatments...dressings,etc. Be sure you take everything you need when you go to do dressings and take extra...also check fluid levels as you go on IV fluids, bring an extra bag in the room if you're going in and hang on the pole until you need if you know you're going to need them.

I. EAT LUNCH

J. Pull afternoon meds-put in drawers.

K. If you have most of this done in the am you will be ready for unexpected things plus doctors orders coming in, admissions, discharges...etc.

I know is seems overwhelming at times but this is the time to prioritize problems...is an IV going bad a problem...not really if you catch it in time--as long as the patient's arm is not swelled up--(then of course you will want to grab a hot pack or ice depending on which your facility does) you can wait to restart the IV for a little while...if the MD comes in and asks about it ..just tell him the iv went bad and you're going to restart it. Utilize your CNA while also letting them know you are there to help if needed. Don't do things like bed changes when the patient wets the bed unless you have time. If you have time help the CNA if at all possible so when you are busy they can expect you to do your job...i've found that a team approach works best with CNA's and if you have time to help someone on and off the bedside commode then do it...if not let your CNA. If you are willing to do some of their tasks when they are busy and when you have time they will be much more ready to help you.

Hope this helps some. Anyone feel free to private message me if you want to talk...!!! GOOD LUCK

presC. · Jul 4, 2005

thank you for all the informations rosemadder and the willingness to teach us new nurses. you have a kind heart. :) as well to you grinn.

i'll make it sure to print all your tips/suggestions.

kellyo, LPN · Jul 9, 2005

Rosemadder, where do you work? I live in NC. Will you PLEAAASE be my preceptor???:) :) Thanks for all of your advice!

Bijou-Spice · Jul 9, 2005

rosemadder wow!!! thanks for taking the time to share your wisdom. That was awesome!!!!! :bowingpur

TypicalFish · Jul 9, 2005

To anyone who posted pointers here, do you mind if I print them and keep them? I have a notebook that I am trying to keep pointers, tips, advice, ideas, etc in to read, and re-read. Thanks, I'll check back for your "ok".

rosemadder · Jul 10, 2005

Glad to help in anyway...feel free to personal message me at any time you have questions anyone...I've not been a nurse but two years (so I can remember well starting out) but I'll help all I can. Reprint anything of mine you need!

leogoat · Jul 10, 2005

THANKS FOR THE ADVICE.

I'm starting BSN at Johns Hopkins in Sept. Nervous and excited.

Time management is the key to becoming a successful nurse...It is one of the most important skills you will need.
1. One thing I have learned is never put off charting at all...it doesn't take but a second to write a note ...for example if someone calls out for pain meds quickly write that note before taking them the med (you will find that it takes only seconds). The nurses who work late are the nurses who save all their charting until the end of the day--this will never work plus you can't remember adequately what you did when and for whom--also writing yourself notes to chart by later is not a way to save time...just do the charting throughout the day.
2. Never put off something when you get a lull in time that you can do then...for example: if you have a dressing that's due that day and you get a moment -do it then...don't think "well I have all day, I'll do that later"...later many never come. Do what you can as soon as you can.
3. Pull your meds (if the facility allows) early and have them ready to give. A normal routine for me during a day shift caring for 8 med/surg patients went something like this:
a.get report (I always come in 15 mins prior to shift time to get a jump on the day--it helps a lot)--I've only been out late twice since becoming a nurse.
b.pull 8 & 10o'clock meds from pixix and put in patients drawers (don't open them--just put in the cups and have ready)--put a dot beside their time frame in the Mar so you will know you have pulled them. Flag any scheduled narcs that will have to be pulled at the time to be given (up to the 10oclock meds). make mental note of pain meds that can be given this am and what time.
c.do assessments being sure to check ivs for infiltration (if any are going bad--turn them off ..you can restart in a bit), if anyone asks for pain meds at this time --tell them when they can have them (or if it's time run get them depending on how many more patients you have to assess--if you're down to assessing one or two then take the pain med back after you finish as long as the patient is not 8/10 in pain)....all these assessments should not take very long -the more practice you get the faster you can do them--save the patients with 8 oclock meds until last and you can give them as you assess or run them back if it's not quite time. If someone has questions about their care (labs, md plans, etc)..make a note and tell them you will get back to them with that information--later on you can look this up as it is not priority.
d. now quickly chart chart chart as fast as your fingers can write--charting the assessments and first note, don't double chart --anything on your graphics does not need to be repeated...most new nurses overchart --avoid this as it wastes time. If there were any real problems noted this will be the time to page your md unless you know he's coming at that time. You can wait on him to call while charting.
e. if it is 9 oclock start giving 10 oclock meds (which you have prepulled). this doesn't take long when the meds are ready. Save the patients with NG, Dopphoff or Peg meds last and the patients getting schedule narcs you can save until 10 oclock (so you can pull the narcs on time).
f. after med run now go back and finish charting assessments if you have not finished or you can restart those iv's at this time (personally I wait until I have the assessments done). (of course if they were getting blood you're going to have to ask the charge nurse or iv team earlier if they can restart your iv)--if they can't you'll have to restart that one on your own when you find the problem (not later).
g. straighten and neaten your area as you go. After charting assessments (or during), make sure your vitals have been charted and double check them (CNA's should be telling you if their are any problems with vitals but you need to make sure you know your cna's habits--this will come with a little time). This is also a good time to check your I& O's and make sure they are charted and voiding as necessary.
h. now start treatments...dressings,etc. Be sure you take everything you need when you go to do dressings and take extra...also check fluid levels as you go on IV fluids, bring an extra bag in the room if you're going in and hang on the pole until you need if you know you're going to need them.
I. EAT LUNCH
J. Pull afternoon meds-put in drawers.
K. If you have most of this done in the am you will be ready for unexpected things plus doctors orders coming in, admissions, discharges...etc.
I know is seems overwhelming at times but this is the time to prioritize problems...is an IV going bad a problem...not really if you catch it in time--as long as the patient's arm is not swelled up--(then of course you will want to grab a hot pack or ice depending on which your facility does) you can wait to restart the IV for a little while...if the MD comes in and asks about it ..just tell him the iv went bad and you're going to restart it. Utilize your CNA while also letting them know you are there to help if needed. Don't do things like bed changes when the patient wets the bed unless you have time. If you have time help the CNA if at all possible so when you are busy they can expect you to do your job...i've found that a team approach works best with CNA's and if you have time to help someone on and off the bedside commode then do it...if not let your CNA. If you are willing to do some of their tasks when they are busy and when you have time they will be much more ready to help you.
Hope this helps some. Anyone feel free to private message me if you want to talk...!!! GOOD LUCK

:rolleyes: