What's your best 'Nurse Hack'?

Glycerine82, LPN · Nov 19, 2017

If you have a patient with 6am meds and 8am meds give them all at 7am to be within the hour window and save time.

Essential oils, poo pourri or perfume dabbed on a mask help with especially malodorous wounds

Respect the CNAs and never delegate simply because it's convenient. IF you have time to do it, do it. The more they see you are on their team, the more they will respect you. The more they respect you, the more they will help you.

Look up what meds you don't understand. Plan to do a lot of "studying" at home on your own time. Never give a med if you don't know what its for or what it does.

PeakRN · Nov 19, 2017

Don't DC and OSH IV until you have one that works. Part 2, don't look for a new IV 10 minutes before you are supposed to DC the old one.

Learn to start IVs without a tourniquet.

Start low and work your way up, if you blow their AC you really shouldn't go below it (you tried and didn't blow it but just missed, you can still go below).

Use your resources. Can your ED start ultrasound lines or EJs? Use them. Can't figure out something about a drug and you can't find it out on your own, call the pharmacy. Et cetera.

Hydrogen peroxide is amazing at getting rid of blood in clothing, just make sure you rinse it out right away so it doesn't eat through the fabric.

Don't be afraid to call an RRT or Code blue, it is better to call early and be wrong because you never get that time back.

Know where your supplies are before you need them.

1) cutting the prongs off of a nasal cannula because they're irritating the pt and they keep pulling it out

Please don't do this, it increases irritation (think sharp little ridges from the plastic you just cut) inside the nose and raises the chances of a hospital acquired nasal infection. I worked in a Peds ED and we saw our nasal MRSA rates skyrocket and it took us a while to figure it out, turns out a nurse from another state brought this habit with her.

Wuzzie · Nov 19, 2017

I like the term baby nurse, though I tend to use "youngling". It reminds us to be gentle. And frankly, the look on a new grad's face the first day on the job reminds me of a newborn's face. They both say "what the he** just happened"

As for hacks, if you search for "tips" on this site you'll find an excellent thread or two with oodles of good information. One of my personal faves is using iodoform gauze to counteract bad odors. A tiny snip in your mask or a strip or two tied on the bed does an amazing job of eliminating the stank!

brillohead, ADN, RN · Nov 19, 2017

As soon as you open a package of primary or secondary IV tubing, CLOSE THE ROLLER CLAMP before you do anything else. Make it automatic -- rip open the package, roll the clamp, then continue with the rest of your prep. Otherwise, you WILL spill IV fluids and piggyback meds all over you, the patient, and/or the floor, and you'll look like a dork in the process. Learn from my fail!

Alcohol dissolves adhesive. Super-fragile elderly skin will rip right off the patient when you remove tape, but if you swab the adhesive with an alcohol wipe while peeling, the skin is more likely to stay attached to its human.

Empty a Foley bag into a urinal instead of a graduated cylinder -- the urinal comes with a handle for easy one-handed carrying, and it's also less likely to splash/spill on your way to the toilet to dump it.

KY Jelly makes a good nasal lubricant for dried out noses due to nasal cannula.

Denture cups make good containers for hearing aids... those things are EXPENSIVE, so never let a patient wrap them in tissue and leave them on the bedside table -- ALWAYS put them in a container so they won't be accidentally tossed in the trash.

When doing bedside report, ask the patient what they want to drink to take their meds -- that way you can bring it in with you when you do your med-pass, rather than making an extra trip.

rn&run · Nov 19, 2017

Congratulations! Some people have an easier time being new than others -- I think it really depends on your unit/specialty (how much you like it, how likable you are, and how supportive coworkers and management are of you).

Practice advocating for yourself. The best hack I know is asking for help when you're struggling. Never do something you don't know on/to a patient. You can always ask someone to double-check a new setup (procedure, machine settings, dressing change, charting, etc.) for you.

Learn and use these phrases:

"I don't feel comfortable doing ____, do you have the time to go over it with me?"

"I've never_____, can you show me what to do?"

"I need some help prioritizing. Can I run this situation by you?"

"I've made a mistake. I ________. What do I do now?"

"Thanks for helping me out. I hope you'll tell me if there's anything I can do in return. I really appreciate your support."

chacha82, ADN, BSN · Nov 19, 2017

Not really a hack but things I have learned in my two years of nursing:

If you have a likely discharge, try to get their stuff done first (if everyone else is stable)!

Always take a cup of water into the room to give medications.

As soon as you think of something, DO IT, or write it down where you can see it. Do not say "I'll remember," it just gets too busy.

NEVER post anything about work on any social media. If people think you're unemployed, that's OK!

Agree to swap shifts ONLY if you truly want to or if it is for someone who has covered for you. Assuming that people will return the favor does NOT happen.

If your leads aren't showing up on tele, put a dab of lube in the middle of each foam sticky (the side that goes to the patient).

If you are giving something like bumex and you need multiple syringes, draw it up, give the smallest amount FIRST and discard any unused portion right away.

Turn the chux from "hamburger" to "diamond" and you give yourself a longer runway under the patient.

I agree with the PP above. Have a set of practiced phrases for when you feel flustered or frustrated so that you can speak calmly in any situations.

To the doctor who won't respond to pages: "Patient BP is 68/48. How would you like to proceed?" and DOCUMENT it.

Ddestiny, BSN, RN · Nov 19, 2017

Most of my "hacks" are less task-oriented and more people oriented, but they've served me well.

1. Got family or patients that are suspicious of healthcare/your healthcare team? The natural response to this is to get defensive. Resist that temptation, actively ignore any discomfort, and if necessary fake pleasantness. If anything, over-share. "Mr So-and-So, your K+ is a little low this AM and we are going to need to give you some potassium replacement today. This can happen with the IV fluids we are giving you since you're not able to hydrate yourself. Would you like a copy of your labwork?" When I know I have family members like this I want to make sure that I have the answers available to get things started off on the right foot with them, so I think about what I need to tell them that day (i.e. new updates to labs, status, plan of care for the day) and then I anticipate their questions, so I can have those answers as well. Don't be afraid to give copies of lab reports, radiology reports. If anything this actually puts you in a position of "power" because even the suspicious family member is going to want you to explain things to them. If they're particularly high-and-mighty/looking down on "that stupid nurse" then I will read the forms with them but wait for them to ask the questions about the medical terminology; if they're just scared/angry/concerned about their family member then I stay with my "overly sharing" technique and explain before they ask "this shows where Timmy's hemoglobin decreased and is showing worse anemia. His blood levels are low. This is because of his GI bleed".

2. Before I leave a patient's room, I always ask if there is anything that they need while I'm there. This saves multiple trips, answering a call light in 2 minutes, etc.

3. If the family is at the bedside visiting when I am leaving the room, I change #2 to "Is there anything you need? Have any questions come up about the plan of care?". Repeatedly asking if there are questions, even if the answer is always "no" helps them to see you as willing to answer their questions, open to communication, and wanting to help everyone understand, which helps them to feel better about you and the care received.

4. Whenever I give a family member an update over the phone, I always ask if there are more questions and then I offer them the number to my direct line without them asking, and tell them to "Please call if you have questions, this is my number until 7pm". I rarely ever get a call back that I wasn't expecting but again it helps them feel that I'm there for them and they have my direct line right there. (Please note I only do this for 1 or rarely a maximum of 2 family members per patient. Don't set yourself up to potentially be giving 15 people an update, you don't have time for that. If more people want answers, then either they can be directed to the family members in to know, or if the patient is able you can have them talk to the callers themselves).

5. Harness the power of concerned family members that are just itching to do something to help their loved one -- they just don't know how to do it effectively. If you have someone you're trying to get stronger to go home, encourage them to help be the reminder and the coach for some simple exercises in the bed (i.e. leg raises), using their incentive spirometer, coughing, splinting, etc. Show the family member how to do things appropriately, explain how often [x] needs to be done, then let them run that part of the show. This gives the family member a sense of power and that they're helping during a stressful, and it can help make sure that there's another person giving the reminders to do these important activities.

6. If you have a patient that wants to have you do things for them that you assess that they can probably do themselves (i.e. that middle aged 2nd POD abd surgery patient that won't wipe their own bottom), then ask them who will be doing this for them at home. The average person is not interested in having their family help with such personal cares but less concerned about nursing staff doing it. Remind them that your goal is to get them stronger to get them home, so they need to be working towards all areas of physical independence.

7. If you have a patient that has absolutely no motivation to do anything for themselves even as they are recovering from surgery, acute illness, and continue to ignore education, then it's time to get blunt. "Look, you're 2 days out from surgery and you still have refused to walk. Patients normally walk the same day of surgery to help with pain, aide recovery, and avoid blood clots and pneumonia. The longer you stay in this bed, the weaker you will be. Your surgery is over and you no longer need to be in the hospital from a surgical standpoint. It is coming time to leave, but you won't get up. If this doesn't change, you won't be safe to go home when you leave **pause for effect** And since you're refusing PT, acute rehab in a hospital will not accept you. **another pause** Have you thought of what nursing home you'd like to go to in the meantime?" In my experience it's been very rare to not see a change of attitude after that.

3ringnursing, BSN · Nov 19, 2017

Call yourself whatever you want - I'm partial to Your Majesty personally.

As for hacks, I can't recall any one in particular since I know longer work bedside, but I had em - we all do. You'll get into a routine and eventually create your own time saving methods. You'll observe experienced nurses doing things they've discovered and take what works best for you. You'll do great.

Welcome aboard matey! :cat:

3ringnursing, BSN · Nov 19, 2017

Most of my "hacks" are less task-oriented and more people oriented, but they've served me well.
1. Got family or patients that are suspicious of healthcare/your healthcare team? The natural response to this is to get defensive. Resist that temptation, actively ignore any discomfort, and if necessary fake pleasantness. If anything, over-share. "Mr So-and-So, your K+ is a little low this AM and we are going to need to give you some potassium replacement today. This can happen with the IV fluids we are giving you since you're not able to hydrate yourself. Would you like a copy of your labwork?" When I know I have family members like this I want to make sure that I have the answers available to get things started off on the right foot with them, so I think about what I need to tell them that day (i.e. new updates to labs, status, plan of care for the day) and then I anticipate their questions, so I can have those answers as well. Don't be afraid to give copies of lab reports, radiology reports. If anything this actually puts you in a position of "power" because even the suspicious family member is going to want you to explain things to them. If they're particularly high-and-mighty/looking down on "that stupid nurse" then I will read the forms with them but wait for them to ask the questions about the medical terminology; if they're just scared/angry/concerned about their family member then I stay with my "overly sharing" technique and explain before they ask "this shows where Timmy's hemoglobin decreased and is showing worse anemia. His blood levels are low. This is because of his GI bleed".
2. Before I leave a patient's room, I always ask if there is anything that they need while I'm there. This saves multiple trips, answering a call light in 2 minutes, etc.
3. If the family is at the bedside visiting when I am leaving the room, I change #2 to "Is there anything you need? Have any questions come up about the plan of care?". Repeatedly asking if there are questions, even if the answer is always "no" helps them to see you as willing to answer their questions, open to communication, and wanting to help everyone understand, which helps them to feel better about you and the care received.
4. Whenever I give a family member an update over the phone, I always ask if there are more questions and then I offer them the number to my direct line without them asking, and tell them to "Please call if you have questions, this is my number until 7pm". I rarely ever get a call back that I wasn't expecting but again it helps them feel that I'm there for them and they have my direct line right there. (Please note I only do this for 1 or rarely a maximum of 2 family members per patient. Don't set yourself up to potentially be giving 15 people an update, you don't have time for that. If more people want answers, then either they can be directed to the family members in to know, or if the patient is able you can have them talk to the callers themselves).
5. Harness the power of concerned family members that are just itching to do something to help their loved one -- they just don't know how to do it effectively. If you have someone you're trying to get stronger to go home, encourage them to help be the reminder and the coach for some simple exercises in the bed (i.e. leg raises), using their incentive spirometer, coughing, splinting, etc. Show the family member how to do things appropriately, explain how often [x] needs to be done, then let them run that part of the show. This gives the family member a sense of power and that they're helping during a stressful, and it can help make sure that there's another person giving the reminders to do these important activities.
6. If you have a patient that wants to have you do things for them that you assess that they can probably do themselves (i.e. that middle aged 2nd POD abd surgery patient that won't wipe their own bottom), then ask them who will be doing this for them at home. The average person is not interested in having their family help with such personal cares but less concerned about nursing staff doing it. Remind them that your goal is to get them stronger to get them home, so they need to be working towards all areas of physical independence.
7. If you have a patient that has absolutely no motivation to do anything for themselves even as they are recovering from surgery, acute illness, and continue to ignore education, then it's time to get blunt. "Look, you're 2 days out from surgery and you still have refused to walk. Patients normally walk the same day of surgery to help with pain, aide recovery, and avoid blood clots and pneumonia. The longer you stay in this bed, the weaker you will be. Your surgery is over and you no longer need to be in the hospital from a surgical standpoint. It is coming time to leave, but you won't get up. If this doesn't change, you won't be safe to go home when you leave **pause for effect** And since you're refusing PT, acute rehab in a hospital will not accept you. **another pause** Have you thought of what nursing home you'd like to go to in the meantime?" In my experience it's been very rare to not see a change of attitude after that.

Damn ... I want you as my nurse!!!

Julius Seizure · Nov 19, 2017

ALWAYS ALWAYS ALWAYS check your IV sites regularly, and carefully... infiltrations happen fast and you can't completely prevent them, but being very attentive to the site means you catch it earlier. Also making sure the IV site is as stable as possible helps a lot... as much strategically placed tape, Tegaderm, armboards, etc that will help, different ways of positioning the tubing, etc, though ALWAYS MAKING SURE you can see the site itself to assess it!!!

Also, if you wait till the arm swells up a lot to decide it has infiltrated, you are too late. Compare the arm/hand with the PIV to the opposite arm/hand. You will catch changes in size/color/temp sooner. If the dressing is wet, flush the IV and make sure it isn't leaking at the insertion site.

Always, always listen if the patient says the IV hurts when you flush it slowly with saline. It might feel cold but it shouldn't hurt. You should be able to flush a PIV on a sleeping baby - if a slow NS flush makes the baby wake up and scream/cry, that IV needs to come out. (Assuming that you can access the IV without waking the baby up, but its a good idea to be able to assess that anyway).

If you aren't sure that an IV is still good, you can get a second opinion...but if you/they still aren't sure, err on the side of replacing the IV. It is better to place a new one than wait for the old one to cause a bad/big infiltration. BUT never pull out an old IV until you have already established a new one, just in case you have trouble.

3ringnursing, BSN · Nov 19, 2017

* Tincture of benzoin works great on drying up and healing cold sores.

* Black tea bag for any mucous membrane owies (I've been told works on oral ulcers, fever blisters, abrasions from braces, pharyngitis pain, lady partsl herpes ulcers, and hemorrhoids). I bet it works for episiotomy incisional pain too.

There is a powerful pain reliever in black tea: tannin.

Brew as if making a cuppa - let moist bag cool. I would wager a swish, gargle spit (or swallow) would help with oral ulcers/blisters from hand, foot and mouth viral pain too for those suffering little ones.

azhiker96, BSN, RN · Nov 20, 2017

Advice I received when I was in nursing school, "Our patients survive in spite of what we do to them." You will make mistakes and see mistakes in care. Always let the doctor know and them resolve to do better in the future but don't beat yourself up too much.

I've come up with a corollary, "Some patients will die despite our best efforts." We started a trauma OR case with compressions and epi. Even though we regained spontaneous perfusion and controlled bleeding the pt soon passed away from a herniated brain stem.

I keep a small sheet on each Pt with relevant information on it; allergies, Hx, meds given. That is handy when a doc walks up and wants to know recent pain meds. Also, when I'm ready to call report I add the current vitals and can then call from any phone on the unit and give a good report to the floor RN. After the pt leaves my note goes in the shred bin. Sure, all that info is in the chart but it's a lot faster to have it at my fingertips.