What are the huge "DO NOT EVER DO" things that new nurses need to know about? calling

[katiebugg]

I am graduating in a few days, and off to be a new registered nurse. I would love to hear from experienced nurses about the "BIG" things that they need to remember or the things they try to avoid. Medication tips, or how to deal with patients...anything would be helpful, and thank you !!

[Nascar nurse, ASN, RN]

Trust the patient when they try to tell you something. Had an alert and oriented 90 some yo LOL in LTC. Kept losing weight, so I kept doubling up calories, adding supplements, Megace, etc. Finally casual conversation w/ resident "Gee, I just can't get you to gain one ounce". She asked for details of weight loss then said, ya better check my thyroid. Long story short, I got the order despite arguement w/ Dr. and sure enough she was correct!

[Ruby Vee, BSN]

"because the doctor ordered it" is never a good rationale for doing (or not doing) something. make sure you know why the doctor ordered it.

if you know better than to do something (pushing kcl comes to mind) don't do it even if the doctors ordered it.

in a teaching hospital, part of our job is to keep the interns from killing the patients.

never push things off on the next shift because you don't know how to do them, don't like doing them, or "cs didn't send the supplies."

when asking for help, ask nicely and graciously accept advice you are given. (you don't have to follow it, but be gracious about accepting it.)

ask questions, but try to look up the answers first.

know your resources for looking up answers -- drug information, policies and procedures, etc. are always available.

try to be cheerful and positive at all times. (never one of my strengths, but i've learned over the years that people will forgive a lot of mistakes if they like the person who made them. if you aren't well liked, one mistake can get you!)

if you make a mistake, admit it as soon as you realize you've made it and set about making things right. it's amazing what patients can survive, as long as nobody tries to cover up a mistake.

always be truthful and honest. don't chart what you haven't done, haven't given or haven't assessed.

the fact that you'd ask this makes me suspect you're going to do very well in your first job. good luck, and let us know how you're doing and which of these nuggets were most helpful.

[NPinWCH]

With all the technologies we have it's sometimes hard to remember that there is a person attached to all that data. ALWAYS treat the patient not the numbers. I can't tell you how many times I assessed my patient with "stable" VS/ECG/mental status...and had my gut tell me somthing else (heck sometimes it was even the patient saying "somethings just not right" or "the pain is different than before"). Sometimes it's what our senses tell us, not what our machines tell us, so feel free to listen to an apical, ascultate lungs, use a manual BP cuff and do a more complete assessment if you feel you need to. Conversely, the machines can sometimes show you something that will scare the crud out of you, while your patient is doing quite fine.

Ask questions, lots of questions, if a doc likes to teach-learn, if a more experienced nurse offers advice-listen, and please don't think or say, "But that's not the way we learned it in school". Try not to judge every comment a nurse may make about his/her patient, it's hard sometimes to keep from being jaded...especially if it's something you've dealt with before.

[PMFB-RN, RN]

Never allow a co-worker or doctor to treat you as anything less than a professional. Never allow a doctor to demean you. Not only is it hard on you but you are just setting up the next nurse the doc gets peved with to be treated badly.

Remember that docs (some) only treat nurses badly becuase nurses have been tolerating it.

[JessicRN]

Never document that you gave a pill or did a dressing change knowing that you didn't. Never call or talk to the MD without being prepared or having the information in front of you. And never assume something was done, afterall when you assume it often makes an ass out of u and me.

-Good advice also never falsify a report or take meds from someone else's medication slot if you do not have any.

-Never talk about your patients in the cafeteria or elevator (just because you do not use a name does not necessarily mean you are not in violation of HIPPAA). If someone can tell who you are talking about then you are in Violation and can be fired. ALWAYS think HIPPAA before giving answers to friends or family of a patient about their condition as well.

[ICRN2008, BSN, RN]

For peds nurses, never dismiss what the parents are telling you about their child.

Most moms and dads, especially those of chronic kiddos, know their child's routine better than you do. Remember, they take care of their child 365 days a year and you've known the kiddo for a few hours. If they say that a behavior is abnormal or their child "doesn't look right", follow up with more specific questions. It might be nothing, but it could be that they're picking up on their child's deterioration earlier than you ever would.

If your order doesn't jive with what they do at home and they're questioning you, take the time to investigate. Page the MD to get orders changed if necessary.

[cathyjorn]

The golden rule always applies. NEVER ask someone to do a task that you can do yourself. Never treat another person/pt/staff member/doctor any way that you would not want to be treated yourself.

[canoehead, BSN, RN]

Say thank you at least hourly, and I'm sorry at least daily.

If you are angry with someone, do what they ask anyway if it doesn't affect patient care, then address the issue later when the smoke has cleared. (This has saved my job a few times).

IV push is the most dangerous way to give a med, don't do it if you are at all unsure. Call the pharmacy, talk with another nurse, call the doc, and make it a group effort.

[Ruby Vee, BSN]

remember that docs (some) only treat nurses badly becuase nurses have been tolerating it.

i beg to differ with you. i doubt very much that the only reason anyone treats nurses badly is that the nurses have been tolerating it. if the person didn't have the tendency to treat nurses badly, he wouldn't know whether or not they would tolerate it!

[FUNNYGIRLRN]

I am a new grad in the ER and I have learned (the hard way) to always have all of your pt information and facts togeather before approaching a doctor for a medication order. They are not just going to write you an order without information so be prepared to answer their questions.

[SouthernLPN2RN, MSN, RN, APRN, NP]

Don't be unfriendly to anyone on your new unit. I've noticed that some of our new people get chummy with their preceptors and the most experienced nurses and are downright rude to other less experienced folks. You never know who'll help you when you're in a bind and you don't want to alienate anyone.

If you need help, ASK! Don't get overwhelmed alone.

Good luck!

[Agent99]

1. Be polite and respectful to EVERYONE on the unit. Remember, you are the newbie. Everyone on the unit has an important job to do. Introduce yourself to everyone. Say please and thank you.

2. Check and double check your medications and orders.

3. Always make sure your patient is ok. Check your patients right after report, and frequently throughout the day.

4.Be a patient advocate. Speak up for them, act as if they are your family member. You are caring for the sick, weak and vulnerable. You are their voice.

5. Ask questions, don't be afraid. Don't ever think you know it all, because every day is a learning experience even for nurses with 20 years under their belt.

6. A sense of humor goes a long way.

7. Be honest and truthful. Be reliable. Once you get a bad reputation it is very hard to turn it around.

8. Try not to gossip. Hospitals are the worst gossip mills.

9. If an experienced nurse offers her help, advice, tricks, etc. always listen carefully and thank the nurse for her time. Even if you don't follow the advice, or accept the help, consider it for the future. Don't say "i know i know" or come off like a know it all.

10. Get enough sleep before your shift, eat a nutritious meal and be at work on time and ready to work. Make sure you take breaks and plan fun things to do on your days off.

That's all I can think of now, you have gotten a lot of good advice here. Good luck!