10 Important Unwritten Rules for Nurses

by | Oct 8, 2019 | Mental Wellness and Self Care for Nurses, New Nurse | 5 comments

You won’t learn this in nursing school, but your life will be so much better once you read (and follow) this list. These 10 unwritten rules for nurses or unspoken rules of nursing might seem like common sense, but someone had to say them.

As a nurse, we work as a team. We help each other and support each other. That’s what this list is all about. Some of the rules on this list are meant to be funny and you’ll probably laugh and go “same!” And some are honestly going to help you just be a better nurse.

10 Unwritten Rules for Nurses

I recorded a podcast episode version of this post with fellow nurses, to listen to it, simply click play below.

This podcast is available on Apple Podcasts, Stitcher, PlayerFM, iHeartRadio, Libsyn, Spotify, and Amazon Music.

10 Unwritten Rules for Nurses and How to Follow Them

You’ll probably read this list and agree with at least a few of them, if not all of them!

1. If you ask someone to help you change your patient, you should take the business end

You know those times when your patient defecated and you really need help rolling and changing them? If you ask another nurse to help you out, you should be kind and take care of the dirtiest part of the job.

Think about it. No one likes to be asked for help only to realize they are expected to do the worst part for the other person.

So clean the poop yourself. And if some of that poop gets on you? Working in dirty scrubs (and by dirty, I mean someone’s blood, urine, feces, drainage, or sputum came into contact with you) is non-negotiable, even if it’s a small amount. You do not need to ask us to watch your patients while you go get situated. We already agree to watch them, so go change, like, STAT.

2. Don’t leave drips dry for the next shift

Before you leave and clock out, make sure all the patients have enough fluid to last for a little while. It’s not cool to clock in and begin rounds, only to discover that multiple patients are going to run out of fluids within the next hour.

This is especially important in the ICU or for patients who will experience severe physical reactions if their fluids or meds stop.

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3. Make an effort to clarify things with the provider before the end of your shift

This next rule mostly applies to those who work the day shift. Try as hard as you can to clarify things with the provider before you leave. This applies to the night shift when/if the provider rounds before the day shift can arrive. If this does happen (a provider rounding before 7 a.m.), it’s typically surgeons rounding before they go to the OR to scrub in. Make sure any clarifying questions are answered for the day shift nurse so he or she doesn’t have to interrupt the surgeon for something routine while they’re operating.

It’s not cool to leave unanswered questions or unfulfilled orders for the night shift to deal with. This is because the night shift nurses will then have to contact an on-call physician for something that could have and should have been handled earlier that day.

The next shift nurse won’t like it, and neither will the on-call provider. It’s just easier to have as many questions as possible answered by the attending physician while they are there during the day.

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4. Don’t go find a CNA to do something you can quickly do yourself

If you are in the room with a patient and need something quick and easy, don’t waste time finding a CNA to do it. Just get it done yourself. It’s amazing how much time is wasted looking for a busy CNA when the task only takes 5 minutes.

For example, sometimes, while you’re in the room with the patient, they will need to use the bathroom. If you’ve got the time and the patient won’t take too long, take them yourself. It may take you longer to find the CNA than to do the task yourself.

By doing small tasks yourself, you also show the CNAs that you respect them and their time too.

Of course, you have to be smart and discern whether something is a simple task and you have time to do it, or whether it will take longer and you have too much going on. So if you do have the time, do it yourself.

If you can demonstrate that you respect your CNA’s time, they will see that, appreciate it, and respect you more. Along these same lines, never, EVER say the words quiet or slow on a nursing unit. This unspeakable act will cause a domino effect of terrible things to occur that will cause the unit to be so painfully busy, we will all beg for mercy.

5. Break down pumps of D/C’d lines

If you have a patient on an IV drip and it gets discontinued, stop it in the chart, stop it on the patient, and then follow through and break down the pump(s).

It is your job as the nurse to tear down the pumps when that order is discontinued. Housekeeping cannot touch IV fluids or meds. So if you don’t tear it down you are leaving it for the next nurse to deal with. Plus, if you don’t flush the line correctly and break it down, you are risking clotting the line(s). Whenever you discontinue fluids or continuous IV meds, make sure you break it down entirely, flush the line, and dispose of it properly. If you discontinue it – it is your responsibility.

This rule goes back to the same principle that I shared earlier on this list. Do what you can to respect everyone’s time and don’t leave a mess for others to clean up.

When dealing with IV’s, you only get two tries for each IV. If you can’t get it after two tries, get someone else.

6. If I ask you to verify a drip, we go into the room together and I pull it up

Next, if you have a patient on a drip – like a PCA, pain button, or insulin drip – and it requires a second nurse to verify it, you should pull it up and talk the other nurse through it completely. Don’t expect the other nurse to do all the work.

Open the chart and pull up the med you’re talking about (and the corresponding lab value if needed). Let the nurse work through the algorithm and see if they came to the same conclusion as you.  While they’re doing that, you can begin to physically change the rate of the pump (if indicated).

Don’t just say, “Hey, Heather go verify my insulin in 22. Let me know when you have it pulled up.”

Rather, “Hey, Heather I need to make adjustments to my insulin drip. Can you verify it with me? Thanks.”

I know this seems small, but one approach respects someone’s time, and one doesn’t. After they’ve come to the same conclusion, you can tell them how you got to the number you did if needed. It also enables you to make the change to the pump in real time as they are verifying things, and you’re both truly doing it at the same time.

7. Clean your room

At the risk of sounding like a parent, throw away your trash and clean your patient’s room so they’re presentable.

If the next nurse has to clean your trash off of the keyboard simply so they can log in, that’s a problem and very inconsiderate.

Before you leave your patient’s room, take a few seconds to throw away the loose trash on the computer desk and the patient’s bedside table. If you’re getting to the end of your shift and there are old meal trays left, take them out. It doesn’t need to be spotless, but at minimum, the mess and trash that you’ve created should be removed.

8. Reasonably complete as much as possible for your patient before the next shift

Now, hear me out here. I’m not saying every single task needs to be done on that admission who rolled on the floor 50 minutes before shift change. There’s a balance in providing continuous care to patients.

Try to do as much as possible for your patients before the end of the shift. It’s not reasonable to expect someone to stay an hour after their shift to complete things the next nurse is perfectly capable of handling. What’s not cool is when a patient hasn’t had routine or urgent things addressed.

You know, like the admission who has been on the unit for 6 hours and doesn’t have a diet order… or the patient who returned from their procedure two hours ago needs their fluids hooked back up… or the admission orders from four hours ago haven’t even been released.

9. Don’t bring something lame for the potluck

In case you haven’t noticed, nursing is a team sport. We rely heavily on one another. Naturally, we tend to get close to one another in the process. Potlucks are a fun way to bond and build rapport with one another away from the bedside. Therefore, when you show up with some forks that we could get from the cafeteria anyway, it looks and feels like you’re not really invested in the team. This unspoken rule for nurses is a big one.

Take advantage of this unique opportunity, especially as a new nurse, to bring something enjoyable for everyone to share. Now, I’m not saying you need to spend $40 and stay up all night creating some elaborate side to bring… but if you’ve got a phenomenal cookie recipe, the best buffalo chicken dip, or make a mean Caprese salad – make it and bring it for the team to enjoy.

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10.  If you need help – ask

As new nurses, we tend to try to do as much as possible ourselves. If we begin to drown, we just hope others will notice and jump in to save the day.

There is no shame in asking for help. We’ve all been there. We know what it’s like to not know how to do something and we are more than happy to answer questions.

Keep in mind there is a right way to ask for help. Be kind, be direct, express gratitude, and be honest about why you are asking for help.

If you act entitled or communicate in a way that makes the other nurse think you are just trying to pass off your job onto them, that’s uncool. But it’s ok to advocate for yourself and get help when you are feeling like an overwhelmed nurse. Just make sure you are expressing that clearly.

If someone says they can’t take it anymore and needs a break, you cover their patients while they step outside. No questions asked.

Unwritten Rules for Nurses Video

Our Unspoken Rules Of Nursing

As a nurse, you can probably relate to these unspoken rules of nursing! This is what not to do as a nurse (and how to rock at your job). Hopefully they will help you navigate the culture of your unit, whether you’re a new student or employee!

The TOP Rule for Nurses: Follow the Golden Rule

These rules for nurses can be summed up with this: treat others how you want to be treated. How you feel about your job has a lot to do with how you interact with your fellow nurses and CNAs. Are you being kind and considerate and respecting their time?

Working as a nurse is hectic! There are so many things going on, and it’s easy to get wrapped up in your own head. Reach out to the other nurses on your shift and be honest about what you are feeling and experiencing.

When you work as a cohesive team, life as a nurse is so much easier. And I don’t care if this is your third day in a row or seventh of eight, we are here for this shift right now. 12 hours at a time – LET’S GO.

What unwritten rules for nurses did you find most helpful?

Leave your insights below!

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    Picture of Kati Kleber, founder of FRESHRN

    Hi, I’m Kati.

    Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

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    5 Comments

    1. Ree

      I have been a RN for years and now I am a NP but these rules should be taught in school and hang in every hospital!!!

      Reply
    2. K

      I’m a CNA who plans to be an RN and I appreciate this list so much. Several of these also affect us CNA’s and go back to what you directly mentioned about us. Please respect us and our time. We work so hard to support our nurses and if we are treated flippantly or as if we are only there to clean up after nurses, it feels terrible and makes us not want to work with you. There is one nurse at my hospital who is so notorious for what you mentioned in #4 (among many other things) that we will try to switch assignments with other CNA’s just to not have to have her as our nurse. Thank you for writing this list. It’s definitely important for all healthcare workers to be as considerate as possible to one another since we are all busy.

      Reply
    3. Old Fool RN

      Rule #11
      If you are a dedicated bedside nurse, avoid administrative meetings at all cost. This is where members of the administrative/academic nursing office sitter complex really like to prove their mettle in that they have way more moxie than a lowly clinical practice nurse. These meetings and their lack of relevance to the real world of clinical practice will suck the life out of you!

      Reply
      • JM

        I agree and that goes along with quality department too. They are evil!

        Reply
    4. Mary G. Cooper

      I appreciate the practical advice in rule #5 about owning up to mistakes. It’s a tough lesson but an essential one.

      Reply

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