the top 10 tips new nurses should know

The top 10 tips new nurses should know. Are you a new nurse, or do you know a nurse? In honor of nurses week I wanted to share the top 10 things I have learned after being a registered nurse for 10 years

On May 6th 2007, exactly 10 (!) years ago,  I graduated nursing school!  In honor of nurses week which runs yearly from May 6th through May 12th, I wanted to write a post about the top 10 things I have learned through the years that I wish someone had told me when I was a new nurse.  Through trial and error, making mistakes, and constant learning, I have become the nurse I am today.  I hope these tips help you out whether you are a new nurse or a “seasoned” nurse as they like to say :-).

The top 10 tips new nurses should know. Are you a new nurse, or do you know a nurse? In honor of nurses week I wanted to share the top 10 things I have learned after being a registered nurse for 10 years

1.) Know your patients

Really, know them.  Know their diagnoses, the background story of why they are in your care, and what medications they are on, at the least.  I always try to talk to my patients and find out a little more about their life as well.  Remember, they are people too and not just your “knee replacement patient” or whatever it may be.  They have families and life experiences too.  Treat them with respect.

2.) Trust your patients

For the most part, people know their bodies pretty well.  I know I do.  I know how different medications affect me.  For example, I cannot tolerate IV narcotics and I found that out that hard way after I had surgery.  If someone is telling you they can’t have a certain medication, or they have to do something a certain way, LISTEN TO THEM!  Yes the doctor may have ordered something and you might even think the person is crazy but trust me the patient is usually right!

3.) Check each patient’s room for supplies

It’s good to get into the habit of checking the patient’s room when you go in to do your assessment. The main three things I usually look for are:  Is there an oxygen hook up?  Is there an ambu-bag above their bed? {You never want to not have one of those when you need it}.  Is there a suction set up and an extra yankauer…. just in case!

4.) Prepare for the worst

I don’t want to sound morbid but you should always be prepared for the worst outcome possible.  If you are doing a bedside procedure with the doctor make sure you have all your supplies available, organized, and already set up.  This includes having the code cart outside the door if you think you might need it.  Even if you don’t end up needing it, better safe than sorry.  Have an ambu-bag with oxygen ready just in case.  Have extra flushes available. Literally anything you think you may need, just have it available.  This will save you from running frantically down the hall and tearing the supply room apart trying to find something in an urgent situation.  Wouldn’t you want your nurse to be prepared if they were doing something to you? Exactly.  Be that nurse!

5.) Know where your patient’s IV is and maintain it’s patency

This is so so important in my opinion.  When you go in to see your patient take note of where their IV is, what size it is, and flush it to make sure it works.  If something goes wrong you need to know where their IV is ASAP and let me tell you it is extremely stressful to try to start a new IV in a an emergent situation.  Further, in an emergency your patient will need at least one large bore IV.  Meaning, a size 20 or greater.  So if they only have a tiny 24 that’s just barely hanging on, maybe you should be the one to advocate for that person to have a midline, PICC, or central line placed, depending on the situation.

6.) Repeat after me: anything can happen to anyone at anytime

While I was in nursing school, one of my clinical instructors who I thought was a little “out there” at the time, used to say this to my group every day.  But you know what, she was 100% absolutely correct.  Think the patient who is sedated and restrained is fine to leave unattended?  Think again!  That person is about to self-extubate from their vent and rip their foley out with the balloon inflated.  That patient who you think is the most stable of your bunch?  Well the aide just walked in and found them unresponsive and now you’re in a code blue.  Your stable migraine patient is seizing in the bed when you walk in to check on her.  The calm alzheimers patient who you just set up for dinner?  He just threw his tray on the floor, ripped his IV out, and is now combative.  Take it from me, I have seen it all.  These examples are things that have happened to me and I can list about 100 more.  Don’t get comfortable, don’t assume.

7.) Don’t be afraid to ask for help

Any experienced nurse will tell you they are most afraid of new nurses who think they know it all and don’t ask for help.  Those are the ones who are going to make a serious mistake.  We are all willing to help.  If you don’t know the answer to something don’t guess.  Ask!  Call the pharmacy, ask the doctor, go to your charge nurse.  When I was working in the ED I had already been a nurse for almost 9 years but there were SO many things I still didn’t know.  Each unit is different.  Each hospital has different protocols.  I was not afraid to ask questions and make sure I was doing my job safely and correctly.  That should be your main goal.  How would you like to be in the hospital and have the nurse guess at what she was doing?  You wouldn’t! And that is completely unacceptable practice! Which brings me to the next point…

8.) Double check yourself

Seriously.  If you aren’t sure, ask.  This applies to anything.  For example, medication dosages, how to administer a medication which includes how slowly to push, what to dilute it in, what rate to run it on a pump, and if the person needs to be on a monitor when you administer it.  If you aren’t sure about how to perform a procedure ask for help and have another nurse come in the room with you.  I had done home care for a long time and recently went back to the hospital.  When I went back I was a little rusty at inserting IV’s and foley caths etc. so for the first few times I had another nurse come in for moral support and guidance.  There really is no shame in asking for help.  I know I am a capable RN.  But it had been a while and I wanted to make sure I was still using the correct techniques.  I even had them double check my charting because every place has different guidelines on how your charting should be.

Do yourself a favor and cover your butt.

9.) Go with your gut

This one sometimes comes more with experience, but even new nurses have instincts.  Nurses do tend to develop a great intuition about the people they are taking care of.  After 10 years I can just look at someone and know that they look bad and something may happen.  Sometimes I just have an off feeling so I am able to notify the doctor and say “hey, something is not right.”  Their vitals may look good, their labs may look fine, but darn it an hour later they are crashing and you just knew something like that was going to happen.  It didn’t take me the full 10 years to develop this. Sometimes you will just know something is off.  Pay attention to it because you are probably right.  You can’t always go by vital signs and lab values.  Things can change in a split second. {See # 6}

10.) Put yourself in their shoes

This goes along with # 1 and 2.  Patients are well, people.  Just like you and me.  Sometimes we lose sight of that when working day in and day out and on those long 12 hours shifts.  Nursing is always a list of tasks that need to be done before your shift is over.  I think at times trying to balance that and give good care to your patients becomes a challenge.  But try not to forget they are people.  They have a life outside of being in the hospital.  They have a family and friends.  No one wants to be sick.  Not many people enjoy being in the hospital.  The golden rule in life also applies here:  Treat others the way you would want to be treated.  Now, I do realize that some people are just jerks.  I have been yelled at for things that were not my fault, harassed, spit at, punched, kicked, called incompetent etc.  You cannot and will not please everyone.  But I find for the most part if you try to be nice and put yourself in the patients shoes, most people appreciate it and will reciprocate.

For the others just remember this: you can’t fix crazy. 

Extra tip: if something goes wrong try not to beat yourself up.

As a new nurse I took a lot of things personally.  I went home crying more times than I care to admit.  I would blame myself if someone coded on my shift or something bad happened.  Again see # 6.  Things happen.  People are in the hospital or receiving nursing care for a reason.  You cannot control everything.  I have seen people die who I would NEVER guess would die.  I have also seen people live that I was CERTAIN were going to die.  Hence when it’s your time, it’s your time and there’s nothing that is going to change it.  There is someone upstairs…. don’t forget who is really in control.  As long as you practice safely and do your best there is no reason to beat yourself up.

Random tip: get yourself a pair of Danskos!  It took me 8 years to figure that one out but it was a complete game changer for my feet ? .

To all the nurses out there, thanks for all that you do!  Our job is hard but rewarding.  If you know a nurse, thank them this week!

Other seasoned nurses, put your two cents in the comments as well and let me know what you think!

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