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 !!

[am17sg05]

GOOD AND COMPLETE DOCUMENTATION.It would always save you from something.

[ROSYJO11]

Always take a full and thorough history upon admission. This helps all those involved in the patient's care throughout his/her stay and it helps immensely come discharge time.

If you are quoting a patient , make that clear in your notes.

I have had to testify in court about an admission history I took. It all came down to what I had put in inverted commas. I told them, if it was in inverte commas, it was a direct quote. I couldnt remember the case, it was almost 2 yrs previously. But I knew how I documented and how I was trained. This particular fellow had been hit by a backhoe reversing and he later died. The driver was up on manslaughter charges and it came down to this question :

Did the patient collapse (from his narcolepsy) and then get hit by the backhoe?

OR

Did the patient get hit by the backhoe and THEN collapse. The answer was in my patient history statement with my signature alongside it.

I cannot stress enough how important it is to be thorough, accurate and concise, you put your name to it.

JO

[CritterLover, BSN, RN]

along the "never give kcl ivp" line of thought,

most iv meds are clear and colorless. if you are giving a med iv, and it isn't clear/colorless, check with someone! there are several exceptions to this rule; for example diprivan, lipid emulsions, and the lipid complex of amphotericin b are all neither clear nor colorless. cefipime, while clear, can have a yellow tint. rifampin (i think) is down-right orange. iron infuisons are also rust colored. depending on where you work, you may become familiar with some of these drugs, and will be comfortable with the way they look.

however, just because diprivan is white, thick, and can be given iv, does not mean that maalox, which is also white/thick, can be given that route. often, a cloudy and/or slightly colored look to an iv med is a sign that it has expired.

we hear from time to time about elixers given ivp: tylenol, pain meds, kcl. despite the basic right route that is overlooked in these cases, there is also a lack of common sense that comes into play. with the possible exception of some pain meds, none of these elixers are clear/colorless. most are pink.

[chrissoo]

Always remember never - never be afraid to ask question or verify an order or if you not sure how a certain procedure is to be done as it is always smarter and safer to ask then make a big bad mistake. Another thing dont be intimidated by some staff as a senior staff I can tell you some staff can be mean especially to a new staff. Always remember that everyone has to learn and treat it as a learning experience. to tell you the truth some staff have forgotten that they to long time ago were also new staff. So dont be discouraged and there are still alot nice staff out there too.

[ginarn5]

Check allergies,especially before giving IV antibiotics[Do Not trust that Md has done this]. If you are on the evening or night shift always turn on light before giving ANY med or flush or adjusting pump. If you are working in a nursing home never give IM Haldol before speaking with supervior[even if you have to call them at home!] Remember that IV Levoquin can cause some peoples B/P to plummet, stopping the IV usually fixes this[or so I've heard] I usually run it extra slow until I see how the patient tolerates it. And, as the above writer wrote-- never IV push K+.

[IMustBeCrazy]

1) Don't be a know-it-all. Because you don't. The best case scenario will be your co-workers won't like you, worst case scenario will be you'll soon be looking for a new job.

2) Use "please" and "thank you."

3) If a patient questions a pill/med, ALWAYS double check it. Nine times out of ten the patient will be right.

4) Always have another nurse double-check your insulin/units/order before you give it. As a corollary, it's healthier for the patient and easier for you to hold insulin than to push D50 because you waited and know the patient refused to eat their breakfast.

5) Don't ever assume that just because you're a med surg nurse you won't have to "deal with psych patients." They are on every unit. Hone your psycho-emotional assessments, and use them to assess your patients every time.

6) Always greet/be polite to ancillary staff: Unit Secretaries/Housekeepers/Lab Techs/The Cafeteria Lady. Get to know their names. These people can often make or break you.

7) Complex situations often have simple, easy-to-understand wrong answers.

[TemperStripe]

along the "never give kcl ivp" line of thought.

i'm almost a nursing student and have heard this several times. can someone give me a quick rundown about why this is so bad?

[fultzymom]

I'm almost a nursing student and have heard this several times. Can someone give me a quick rundown about why this is so bad?

IVP Potassium will stop the heart instantly. It is what they give for the death penality lethal injection.

[TazziRN, RN]

GOOD AND COMPLETE DOCUMENTATION.It would always save you from something.

I cannot agree with this too strongly. I think documentation is part of the reason I'm in trouble now.

[BethyJean777]

Always watch your back....don't ever do anything you're not comfortable with. don't take anybody's word for things, make sure you look it up yourself!:monkeydance:

And remember...you'll always have those patients that you just can't please NOOO matter what you do!!!!!:trout:

[VAC]

DO NOT EVER call a doctor after 9pm to ask for an order to dc a foley catheter that the patient adamantly insists be removed (even though the doc's order says, "remove at 6am". Go ahead and DC the cath, chart specifically that the patient "insisted".... carefully monitor the patient for urine output, or lack of, and call the doc only if the patient cannot void after 6 to 8 hours WITH a bladder scan which indicates greater than 350mL bladder volume. Trust me on this one.

That sounds like a OK way to handle it, depending on the reason for the catheter, and pt condition, but I'm not sure I agree with all of what you wrote. On the one hand, the patient can refuse a treatment...but I wouldn't feel comfortable DC'ng something against an order without letting the MD know.

It depends on the 'culture' you're working in. The emphasis is so great on 'keeping the customer happy' where I work that lately I find myself more willing to risk angering a doctor than the patient. I find myself making more and more of these kinds of calls. Then I document the pt request, call made, and doc response, and that the pt was informed. It helps shut the paitent up after they know you tried to get the doc to let them have their way.

I've recently had docs return such a bs call and tell me that the know the pt is a PITA, and that they were expecting these calls... and they weren't too mad at me..

Sorry for the hijack...

[GI Jackie]

DO NOT EVER 100% trust the doctor that says "Trust me". They may ask you to do things that make the little hairs on the back of your neck stand up. Trust your instincts. That doctor has a team of lawyers and a lot of money tied up in his license. He/she will make sure that you go under the bus before he does.