One of the things that I love about being someone’s nurse is that I’m in charge. I’m calling the shots (ha!) and other than the 10 minutes that the doctor is at the bedside, I’m the boss. Nurses have so much autonomy now. When your critical thinking skills are on point, you know all your resources, and feel confident in what you’re doing, you are .. well, a rock star.
I love that there is so much I do and initiate because of my personal nursing judgement. I love when other nurses and physicians come and ask me, “So what do you think? What should we do?” Or when I catch something, call the doc and suggest something, and they’re like, “hey, great idea!” or “good catch!” – that is some serious job satisfaction right there.
So, how do you get there? If you’re a brand new nurse, getting to that point seems impossible. Well, it absolutely is not. You will get there. I believe that something that is important to becoming an awesome, safe, and confident nurse with sharp critical thinking skills is knowing your weakness. I think we need to be aware of things we aren’t so hot at so we can.. well, be hot. Hehe.
I have a few nurse practitioner, physician assistant, and physician friends that work in different areas of the hospital. I highly value their opinion because not only are they are great providers but also are highly respected by the nursing staff. They know how tough our job is and know they need us on their team. Because of their keen understanding of nursing, I asked them the following questions:
What are some common mistakes that newer nurses typically make?
What do you wish all of your nurses knew?
I asked this because we, as nurses, can ask/answer each other this question and get similar answers but I think it’s important to ask the same question to people that are not nurses. We need to ask the non-nursing members of the health care team this question to ensure we are at the top of our game because we work so closely with other departments and members of the health care team. Below, I have paraphrased their answers.
Using PRN medications incorrectly
For example, if Ativan is ordered and the indication is listed as “seizures” and the MD rounds to see what PRN meds they’ve received in the last 24 hours, and they got two doses of Ativan for agitation and they’re zonked, it’s not appropriate. So, make sure to check your indication for the med before you use it. Also, legally speaking you can’t use a med for something other than its indicated use. Just because it’s listed as a PRN, doesn’t mean you can use it whenever you want. You must use it for it’s indicated use.
Giving a definitive time for when the doctor will round
As we know, lots of unpredictable things can occur during the day. The same is true for MD’s. They may intend to round at 1400, but they’re also first call and have an emergent case and can’t round now until 1700. A good rule of thumb when you get that dreaded, “when will the doctor be by?” question.. always let them know the general time they round and then add in that “if an emergency occurs, it could be much later, so it is difficult to predict”. That’ll cover both of you. I also say to the families that if for some reason they’re not there when the doc comes by, I’ll ask them to call the family member for an update.
Not painting the same picture as the medical team
Death/dying/poor prognosis conversations are tough and you want to be consistent with the ground work they’ve laid. I’ve screwed this up before and felt terrible.
Personal story from my first year: I got a stroke pt from the ED. The MD told the fam how dire the circumstances were. I didn’t read his note and I just went off of the small amount of info I knew about stroke recovery to educate the family. I gave too much hope after the doc had already worked really hard for them to understand their mother was essentially dying. I undid all of that. I gave this poor mourning daughter a tiny speck of hope that she clung to when I should have just said, “I’m so sorry” and comforted her.
I suggest reading notes if you can’t touch base with the doctor or if the previous RN is unsure about plan of care goals. You don’t want to undo work they’ve done or confuse the family. Also, if you disagree with the way the physician is handling it (which is totally okay and happens sometimes), talk to your manager and see what to do next.
Have mutual respect for the entire care team
If you’re a jerk to CNA’s, transporters, pharmacy.. everyone, including the doctors, notice that. It doesn’t make them think you’re a good nurse, it makes them respect and trust you less.
Nurses and techs joke around a lot in the nursing station and it can get kinda dicey. Sometimes docs do too, but know when to pump the breaks. Talking about needing personal scripts in front of a doctor that’s your coworker is an unwritten, never-ever do that, rule. So, if you need your ADHD med refilled or your PCP didn’t listen to you when you said you really needed something to relax, don’t vent about it in the nurse’s station within earshot of your physician coworkers or patients/families. It’s awkward and unprofessional, but that line can get easily blurred when everyone is having a good time.
Also, joking around is good because it does foster a fun work environment, however know when to get serious or do something quickly. If you’re having a laugh with a doc while they’re putting in orders for STAT labs.. you need to stop joking and go get the labs. Patient care is always, always the priority, which can be easily forgotten when everyone’s having a good time. We’ve all been there; just notice when you need to get down to business.
Doctors, techs, non-nursing members of the health care team.. what else would you want your newer nurses to know?