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

Nurses General Nursing

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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 !!

If I see a vital sign that is bad enough that I have to call a doctor or give a special PRN med for (like for a high blood pressure) I ALWAYS double check it myself. Even if it's a temp. Many times I rechecked it and it was normal... or it was way worse by the time I was told of the vital sign and when I get to the room. Especially for blood pressures. A lot of times the CNA's are taking so many and they might not have the right cuff size. Find a good cuff size to fit and recheck it yourself... manually. Sometimes those machine vital sign takers aren't corrent. Many times it has said something like 60/30 and you check it manually and it's 100/60, for example. I swear once I got the vital sign sheet back from the CNA and almost everyone had a fever. Something is wrong here. Even though she told me she double checked with a seperate thermometer. I rechecked and only one had a fever. Remember if they were drinking something hot or cold it will effect an oral temperature. Many times the O2 sat monitor won't pick up a patient's true O2 sat. You'll get 60% and the patient says they are fine. Try the other hand, different fingers, give it some time. If you really think the patient is OK and all else fails you can try to see if respiratory therapy has some other kind of o2 sat detector, like that goes over the head or an ear. Or you'll have to call the MD for an ABG to see what their O2 sat is.

Remember if a patient doesn't look right to you, as a new graduate you should ask another nurse to look at the patient for you if you are unsure. We call ICU sometimes to look at patients for us when we're not sure. If a patient is going downhill and the doctor is only giving you crap orders, call him again. First ask the supervisor to look at the patient or an ICU nurse and tell the MD that the patient has been assessed by so and so and feel that this patient needs to be transfered to ICU or whatever. Remind him again of the assessment findings. I think every nurse has been in a situation where the doctor isn't understanding the severity of a patient's condition. Of course, if the patient is DNR or on comfort measures only, then it may affect the aggresiveness of the treatment so keep that in mind. I've had a doctor just order morphine to keep a DNR patient comfortable as it was clear he was dying. It was appropriate for that situation. Be sure to call family when a patient's status is going downhill. I always call the doctor first though, so I know what to tell the family about what is happening.

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Specializes in My first yr. as a LVN!.

As an LVN Intern I have already come across errors the nurses are making @ the facility.So just for FYI... if you have a med. cart and keys to it... never leave them anywhere except in your OWN pocket, or somewhere you will NOT LOOSE them... seems simple enough, but trust me... errors happen to the best of us. Also, if a patient has dyspahgia, why crush K+/ Order liquid... duh! And if a treatemtn needs done, i.e. dressing change, no shortcuts... dont just apply gauze and lots of tape... take the time to do it correctly... geriatric patients have thin, thin skin... a lot of tape coming off will make more abrasions which could lead to more wounds, more dressings, making the patient more uncomfortable. Above all... patient PRIVACY no matter if it's a simple medication w a glass of water or an insulin injection... how would you feel in that patients shoes if your nurse is in too much of a hurry... youd feel like a number rather than a human being...

Of course, this is why I plan to get my RN and BSN... Im more fit for supervisor positions ... very meticulous and I put myself on the other end... Hopefully these tid bits help a lil'.

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If a patient has dysphagia, why are you giving thin liquids??

They are the hardest to swallow, and the most likely to be aspirated.

Have Speech Therapy eval the patient's swallowing. Ours will start a pt. out with thick liquid or applesauce consistency before advancing to thin liquids.

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Specializes in My first yr. as a LVN!.

The liquid K+ gets mixed in w nectar... so it is thickened.

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OK, got it.

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Specializes in ICU.

Make sure the MD ordering extended release meds is aware they can't be crushed and put down an NG tube. Good luck.

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Specializes in ICU's,TELE,MED- SURG.

First thing is listen, talk and if you don't like someone you're working with, do a 180 and don't get into verbal confrontations.

I can't stress getting along with your charge nurse but also knowing that if a floor isn't a good place for you to be, ask for a switch so you'll stay in Nursing and not walk out of it like so many others do.

I've been a nurse for 28 yrs. I still love it but know to really observe and try to get along with people and hold my personal opinions a lot. I have done Charge for many years and still do the same.

In time, you'll see what makes you happy in Nursing. For me, I love agency Nursing best. No stress and can plan my life to the fullest. I started out working staff in med surg,telemetry and then ICU/CCU and can float anywhere except OR. Just learn, make observations and don't forget about good vs not so good experiences.

Double check your meds before you give them and hold back if you are the least unsure. Keep your good habits always and learn from other people's mistakes.

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Don't tell a patient's family that the doctor can kiss your ass, especially if the doctor's nurse happens to be in that patient's room at the time. They tend to frown on that. I got busted big time for that one. :)

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Yikes!!! you really said that??? (You GO GIRL!!)

In my own experience, I've had to restrain myself from flying off at the mouth

on many occasions.

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Specializes in ICU, Med/Surg, Ortho.

Good suggestions from everyone. Let me add:

Never put something off for later. Things may be crazy later.

If you are right, and you know it, Stand up for yourself.

Always help with lifts, turns or cleaning pts. You may be the one who needs help later.

If you are behind - ASK for help!! Don't get so far behind you can't catch up.

Introduce yourself to everyone who comes on the unit. Dietary, housekeeping, PT, OT, Speech. Make use of their talents and abilities.

Doctors are on call 24/7. That's why they make the big bucks. However, make sure you really need to call them. Check to see if you need to call for anything else. Ask the other nurses if they need to speak with that Dr. Have all of your info ready.

If things go crazy, ask yourself "what thing is MOST important" and do that. Then what is next most important (and so on). You can't go wrong if you prioritize.

Review all the orders daily for appropriateness. Should pt still be on IVF, still be npo, should be ambulating, Has pt already had 10 days of antibiotic, etc.

Monitor for trends, you can almost always catch a problem before it gets too big if you pay close attention. (I can not stress this enough!!!)

And MOST important --- LOOK AT YOUR PATIENT!!! Is she pale, shivering, flushed, anxious, splotchy, you can tell lots just from looking. Don't ever forget the patient is a person.

Good Luck and God Bless

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If you hear the statement "Holy s### I've never seen such a thing, eminating from another nurses room, go in to offer help and investigate. It will probably be interesting and it will give you something to talk about later in the break room.

If your hear the statement "Holy s###, I've never seen such a thing, and smell an odor coming from that room, turn around and busy yourself with other matters. Never peak in that room to offer help, or you'll be stuck in a major code brown clean up.

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Specializes in Medical/Surgical.

I am a new grad also but would like to mention something important about meds from my own experiences. ALWAYS CHECK ALLERGIES!!!! I have an anaphylactic reaction to Hydrocodone and every time I have been to the hospital, they have tried to give it to me. The last time, they went so far as to hand them to me and tell me to take them. When I asked what the pills were and the nurse told me, I asked her three times if she was sure she wanted me to take them. She said she was sure so, I told her that it might be a good idea for her to look at the bright red wrist band I was wearing. She looked at it and said "Vicodin isn't on there". I had to tell her that Vicodin contains Hydrocodone which is on there. So, please check allergies and please check the content of medications if you aren't familiar with them. Good luck!!!

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