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Six (clever!) everyday nursing tips

In nursing school we learned ‘by the numbers’. We were taught each skill step-by-step, one-by-one.

We graduated and moved on to ‘real world’ nursing and realized that not only do we not have the time to go by the numbers, but that the numbers can be changed, combined and in some rare instances re-arranged.

Over the years I’ve learned a few ‘skillz’ that seem to be invaluable to me during my day:

Pre-filled syringes

Be sure to remove the cap and then retract the plunger on the syringe (as if you are aspirating) BEFORE you depress the plunger. There is compressed air hidden in the needleless leur-lock. If you depress the syringe first after the initial removal of the cap you will squirt saline like a laser in whatever direction you are pointing (there are numerous ceiling tiles that can corroborate my story).

Gastric tubes (Nasogastric and Orogastric)

This is in reference to maintenance. When ever you are administering meds, flushing the tube, clamping the tube, etc. be sure to instill a small bolus of air in your syringe prior to your task. Example: If you are giving a 30ml fluid bolus, add 5 or even 10ml of air to your syringe before you’re administration (it will be at the top of the syringe when the syringe tip is to the sky). We all know how messy the maintenance of these tubes are. If you instill the small amount of air beforehand, the remainder of the fluid will be flushed away from the end of the tube (by the air) and you won’t have any excess tubefeeding or fluid regurgitating or dripping back at you and onto your patient or their linens when you disconnect the syringe from the OG/NG tube.

OH, and the theory of using soda to clear a clogged tube doesn’t always work. Hot water seems to do the trick most of the time, but each to his own.

PICC lines

When drawing blood from a line that will not draw here are a few tips that seem to help. Always lay the patient flat if possible (no Trendelenberg usually does not work). Abduct the arm greater than 90 degrees and /or flex the shoulder greater than 90 degrees. Have the patient turn their head away from the side of the PICC (turning towards may work occasionally). If all else fails have the patient take a deep breath and hold it (if possible). I actually got a magical blood return once by having them hold their breath and bear down simultaneously (it was the oddest thing?).

Tape

Skin tears are not something a nurse or a patient wants. When removing tape try wiping the exterior exposed tape with an alcohol swab prior to removal. I have no idea why this works, and it seems to correlate with only certain kinds of tape. Regardless, it’s worth a try if it will prevent a skin tear.

Alcohol pad

Can remove pen mark stains and streaks in scrubs. You may need to use a little elbow grease

Can remove ink and most markers from your skin. The back of my hand is my portable notepad during my day sometimes.

For some strange reason an alcohol pad placed on the bridge of the nose seems to slow down or even stave off nausea (This only works sometimes, but when it does it’s pretty darn cool and useful as an interim until you can retrieve an anti-emetic).

Multiple IV drips

Label everything the first time you enter the room. If you don’t have an electronic reading on your IV machine tape the name of the medication on the machine itself. Also label ALL the IV tubing. Place labels as close to the patient as possible. I usually pick the first access point closest to the patient (Leur-lock) and place my label just above or below it. This is invaluable during an emergency and when choosing compatible IV infusions.

Yep, these are ridiculously random, but invaluable non-the-less. Any other sure-fire tips that seem to lighten the load for you during your day??

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13 Responses to Six (clever!) everyday nursing tips

  1. juttajj

    on some of the prefilled syringes (the ones with the screw on caps) you can depress the plunger before unscrewing the cap to relieve the pressure. You feel a little “pop” like the seal is broken.

  2. Todd Dubois

    Thanks Sean. Love these tips. I actually have learned the pulling back on the syringe first to free it up, and the alcohol to remove the tape/tegaderm tips my self, but I look forward to trying the others in the future. Keep them coming!

  3. Ani

    Thanks for these! Especially the getting pen marks off of scrubs – I HATE when that happens – especially in the corners of pockets!

  4. ImaKingskid RN

    Hey, Sean…In regards to using the back of the hand as a notepad, I have my own personal solution: I wrap a long piece of paper tape around my wrist and make notes as I need to. Once my wrist is full, I unwrap to the clean tape, tear it off, and I’m good to go again. Yes, it fades when it gets wet, but so does the writing on the back of the hand. The tape works great for me — thought I’d pass it along.

    • Sean Dent Scrubs Blogger

      Interesting idea… I may have to try that one. Thanks!

  5. callibug9

    when I worked on the floor, this little daily habit saved me many a time. the shift being 7-7, I would start at 5pm getting all my pt’s their dinner, getting their I & O’s documented, giving eve meds, charting that last note, etc…because if the s***’s gonna hit the fan, so to speak, it will do it during those last couple hours and/ or at shift change. So if you alread have as many of your ducks in a row as possible, you’ll be scrambling a whole lot less!

  6. Karih717

    Great tips! I love alcohol pads- so many uses. Since I’m a grammar geek, though, just thought I’d mention that it’s “nonetheless” (‘in spite of…”) :-)

  7. Nurseborn

    I completely forgot about the anti-emetic effects of placing the alcohol swab under the patient’s nose – Thanks for the reminder!

  8. ScrappyEDRN

    As an ER nurse a lot of our patients come in covered in tiny pieces of glass from MVA’s. Wrap some tape around your fingers (sticky side out) and use that to pick up the glass off of the patient’s skin.

    If your ER/unit/floor is as customer service driven as ours is…when discharging a patient I tell them my name again and tell them they can call me personally if they have any questions up until I get off at 7 (or whenever). One thing this does is remind them of my name for the Press Ganey survey they get–and it is also very good service because how many of us walk out of the doctor’s office and suddenly remember that very important question we forgot to ask! I very rarely get a call but the few times I have they were very good questions!

  9. firefly84

    1) Another easy way to deal with the air lock on saline syringes is to tap the side of the syringe on something hard (bed rail or counter). That will take care of it and then they are ready to go when you use them.

    2) taking tegaderms off…if you can get the corners started pull straight out, not up, on both sides and it will release off the skin without pulling at all. Requires a little practice but works very slick.

    3) NG and feeding tubes ~ if flushing, use lukewarm water. A lot of nurses flush with cooler water and patients get stomach cramping. This avoids it.

    4) Hemostat ~ always carry one. Useful for pesky IV tubing that won’t disconnect, clamping foley’s for UAs and clamping NGs to avoid anything coming back out

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