Image: iStockphoto | Thinkstock

Regrets, I’ve had a few…but then again, too few to…wait, what?

Nurses make mistakes. Lots of them. Most of the time we catch ’em before they become a big deal. Maybe you’ve pulled a medicine at the wrong time or called a patient by the wrong name, or done something vaguely harebrained that won’t necessarily cause harm, but will cause embarrassment.

Nurses make the same mistakes as other nurses, which can be both a comfort and a source of fear. Herewith, Auntie Jo’s list of mistakes you’re gonna make sometime, and how you can learn from them and recover from them.

1. Making a medication error
This is the biggun. Every nurse now in practice has made at least one, usually without knowing it. My first came early in practice, when I double-dosed a patient with metoprolol. Thankfully, the patient wasn’t harmed—he was tense enough about being in the hospital that all I had to do was monitor him closely and be alert for hypotension. Still, it taught me that triple- and quadruple-checking medications—especially when you’re in a hurry—is hugely important.

2. Omitting some sort of treatment or doing it to the wrong part of the body
There is no worse order than “apply to affected area TID.” If you’re not aware of what the affected area is, you’ll be left staring at the patient’s apparently intact skin, wondering what to do with that little tube of ointment. Preventing an error requires research into the chart and maybe asking the doc what the heck is going on.

Or…let’s say you’re confronted with a myriad of tubes coming out of somebody’s abdomen, unlabeled, and apparently draining several things within the same three square inches. Which one do you flush? How do you tell? Again, this usually requires either searching the chart for clues or (easier) asking the doc which tube is which, and labeling them yourself. You’d be amazed at how many surgeons turn patients over to the post-op team without doing a basic thing such as labeling their drains.

3. Calling a patient by the wrong name
To us, it’s nothing more than an embarrassing slip. To the patient, it’s a huge deal: What else has this nurse confused on me? The only thing to do is apologize—profusely—and continue on with such attention to detail that the patient is reassured.

4. Calling a doc without all the necessary information on hand
This is something you learn early on, especially if you start on the night shift. Never call a physician without the chart in front of you and every single pertinent piece of information about your patient on the tip of your tongue. Especially don’t call the doc at 3 a.m. if you’re not already primed with information and suggestions. Believe me when I tell you that it took me several times, not just once, to learn this.

5. Making an utter, incomparable fool of yourself in front of patients and colleagues
For a colleague of mine who works in public health, it was ending a counseling session with a newly diagnosed HIV+ patient with the words “Stay positive!” For another colleague, it was badmouthing a member of management within that person’s hearing. For me, it was tripping as I came into a room and (after bouncing off several pieces of equipment) ending up in the doctor’s lap.

Unfortunately, while the first two mistakes can be prevented (think before you speak), the last one can’t. The remedy in that last case is to make sure you’re still fully clothed, brush your hair out of your face and laugh it off.

Remember: No matter the error you’ve made, somebody else has done something worse. If your error hasn’t harmed anyone, the best thing to do about it is report it through the correct channels (error reporting helps change bad processes or confusing protocols) and then keep going. Making a mistake doesn’t make you a bad nurse; it just makes you human.

This post originally appeared in The Head Nurse blog.

Robert Kneschke | Veer

I’m not a big fan of New Year’s resolutions, but this is the time of the year I wish we could openly call out our coworkers for their habits and idiosyncrasies that tend to drive us all up the proverbial wall.

I thought I might send an open letter to all “those” coworkers out there and address just a few of these occurrences that can get under our skin.

Dear fellow coworker,

It’s about time you started carrying your weight. Innocence and forgetfulness are one thing, but blatant disregard for your fellow nurse is starting to wear on us. Here are just a few things we’d like you to think about in 2012:

1. Be on time. No, that does not reflect the time you swipe your badge. If you’re going to spend 15 minutes gossiping and another 15 getting your gear and preparing your coffee, be sure to arrive ahead of time so that when you DO clock in, you’re ready to roll.
2. Lay off the cologne/perfume. We’re not out clubbin’. If I’m gagging in your presence, how do you think the patients who require oxygen are going to feel?
3. Look in the mirror before you leave for work. Wrinkled, mismatched and faded scrubs do not scream professionalism. Nor do white pants with colored undergarments. I’m jus’ sayin’.
4. If you must smoke, figure out a way not to take 30 minute smoke breaks four times per shift. You disappearing for who knows how long gets quite taxing. I may take up the darn habit just so I can take those long breaks.
5. Answer the damn phone when it rings. Really? You’re telling me you don’t hear it ringing right next to you?
6. While we’re on the subject of your hearing, maybe you could find some time to answer a couple of call bells while you’re at it. Yes, I see you over there making every attempt to look busy when the call bell goes off. Sorry, it’s not working.
7. Leave the darn magazines at home. Please. How do you find the time to read a magazine during your shift? What am I missing?
8. Figure out a way not to yawn in my ear when giving report. Please.
9. Oh, and while we’re talking about report, could you PLEASE be more concise and on target. While I can appreciate attention to detail, does it really take you that long to convey your findings?
10. By the way, thank you oh-so-much for repeatedly leaving me dry and empty IV bags!

And a bonus one!

If you have a patient who has a suppository order at the beginning of your shift–could you find way to give it so that I’m not ALWAYS cleaning up the mess (literally!). Once or twice maybe, but every time? C’mon?!

In my book, this list is actually short. I could go on and on about the “little” things that always become big in our nursing world. I think the golden rule applies here, gang.

Anyone care to add to the list?

P.S. These suggestions were compiled from more than one source.

James Peragine | Veer

Some things just get under your skin. Call them habits, quirks, idiosyncrasies, or just plain annoyances–we all have them. Better yet, our coworkers have them!

It doesn’t matter which floor or unit you work on, it doesn’t matter how many years of experience you have, and it doesn’t matter what shift you are working. There is at least one coworker we all have worked with or crossed paths with that possess some of these.

Nothing breaks down a team quicker than passive aggressive “quirks.” Here are some things your coworkers are dying to tell you:

There is a difference between delegation and flat-out shirking your duties 

Ever have that coworker who just doesn’t posses any time management skills? Or one who decides he or she doesn’t want to do something? So he or she polishes it up to look like great team work dynamics. “Let’s delegate to the unlicensed professional all the duties I don’t like to do. Better yet, since I’m bad at starting IVs, how about I just wait to the last minute and beg for help, instead of just trying myself!”

Stop pawning off the “dirty” duties 

When you ask for assistance in a room and your patient just exercised his or her bathroom privileges, STOP passively getting us to do the dirty work. No, no, no, I’ll be more than happy to hold during the turn. Besides, the last time I checked, this is your patient, and part of our responsibility is to assess and reassess. Can’t do a whole lot of assessing from the wrong side. Grr.

Taking the wheel is okay, but it’s not a permanent job 

Transporting patients is no easy task, ever. Whether it’s in a cart or a bed, pushing and pulling it is tough enough. Now add some transfusing IVs, multiple drains, tube feedings and possibly mechanical ventilation and you have an entirely different animal. Navigating down halls, in the elevator and through doorways requires a great deal of ingenuity, but it also requires a great deal of physical labor. The steering portion of this entourage is usually the least taxing. Do us a favor and be sure to have your hands full and take on the brunt of the labor some of the time.

In the end there are a TON of things that we do and see that irk us. For the most part, we can brush them off and keep moving forward, but every once in a while we need that give-and-take. Be sure to put yourself in your coworkers’ shoes the next time you need your team. You’ll be thankful you did!

Jupiterimages | Polka Dot

“Mikey will eat it.” Isn’t that how the Life cereal commercial went?

Well, the ER staff are the Mikeys of the hospital. I swear, anytime someone has a meeting and there is food left over it somehow always ends up in the ER break room. It is strange how the hospital always thinks about the ER when it comes to leftover food and not leftover beds!

If they truly felt sorry for us it would be the other way around…

The strangest food combinations can be brought down and within an hour ALL of it will be consumed. Once, sandwich meat, rice, fruit, and meatballs ended up in the break room. Yep, all gone almost instantly. The presence of food in the break room travels as fast as word of a natural disaster. It is almost as if there is a secret flashing light that goes off to let everyone know “Hey! Free weird food in the break room!”

I have even had parties at home and brought the mounds of leftover food or cake to work the next day and sure enough, gone! Even at nine in the morning, somehow cake will go missing. Every once in awhile I partake in the free food but those of you who have read my blog before know I have a thing with potlucks and unknown food origins so usually the food ‘donated’ to us grosses me out.

However, if there is ever a chocolate chip cookie that makes its way down to our group lounge area, I will scoop it up every single time!

Does your department get the leftovers like ours does?

Corbis Photography | Thinkstock + Scrubs

Recently I was fortunate enough to participate in an independently funded academic program geared towards gaining a better understanding of geriatric health care management. And boy, did I learn a lot about what my fellow team members think about nurses.

It was a joint task force consisting of medical students, pharmacy students and nurse practitioner students. The goal of this program was to expose the aforementioned health care professionals to the reality of our present day health care system in a team-learning environment. In that way, they could gain a better understanding to the complexities of geriatric care while at the same time preparing them for collaborative care management.

Up until recently it’s always been the the accepted practice to follow the hierarchy of care management. The physician is the primary care decision maker and the pharmacists and other licensed health care practitioners follow their decisions.

Not that this is a bad thing, or the wrong thing. But as you and I both have discovered over the years, it’s not the most ideal thing. In order to meet the needs of our ever changing (and increasingly complex) patient population, health care (including nursing) must grow, change, develop and adapt.

It was realized many years ago that collaborative decision making and care is light years better, more efficient and safer at managing complex health problems than any one individual (or profession).

So instead of MD, PharmD and NP having to learn ‘on the go’ and iron out the wrinkles concerning team didactics and utilizing each others strengths to maximize their patients outcomes after they graduate, this program is attempting to teach these professionals how this concept works even before they graduate and move on into their roles as practitioners.

I guess the rudimentary analogy is: A hand is stronger than a single finger.

This program consisted of traditional learning curriculum presentations mixed in with numerous didactic team-oriented ‘role-play’ scenarios that reflected ‘real-life’ decisions making challenges for a health care team.

I learned that our fellow health care team members have no honest idea of what advanced nursing education and training entails. Many were not aware of the requirements, let alone our previous experiences. I didn’t consider it good or bad, I considered it startling. I guess I went under the assumption that physicians and pharmacists worked with us every day, they have to know and understand our professional training??

I learned a great deal about medical and pharmacy school education as well. I have a better appreciation for their knowledge and skill. If my fellow health care professional students learned a tenth about me, what I learned about them, then I am excited for what our future holds.

We learned what a good team functions like, we learned what a bad team suffers from. We learned how to take a step back and view the challenges from different perspectives. And above all we learned to appreciate what each person brought to the team.

I don’t know about you, but this ‘new’ program should become a staple and requirement of every professions curriculum. What better way to ensure the very best care for our patients?

iStockphoto | Thinkstock + Scrubs

It’s officially been one month since I’ve been an official, practicing, peds nurse! And while I’m still learning, here’s a list of 5 of the “gems” I’ve learned so far.

1 - Real nursing is not like nursing school – for some reason I am reminded of this every time I put on sterile gloves. In nursing school, even the simplest tasks like donning sterile gloves felt so huge because you were always under scrutiny of an instructor watching your every move. When you’re on your own just you and your preceptor, you begin to realize that you can handle those little things so much better when you’re accountable for your actions because you love your job, not because you’re trying to get an A – and THAT makes all the difference.

2 – BE PREPARED. I was a girl scout for 6 years and while none of our activities required much preparation, the rule still stands with me, and now more than ever – BE PREPARED!!!  It doesn’t hurt to carry an extra flush in your pocket with some spare caps for your tubing. It’s better than having to go in and out of your patient’s room over and over, and saves some very valuable time on a busy day!

3 – Always be thorough – If you’re charting and you’re ever not sure if you need to say something, think about it this way: If you were brought to court to defend what you did, and someone who doesn’t know anything about nursing were to read it, would they know what you did?  And then go from there.

4 – Time management isn’t something you learn in a day – it’s something you have to keep working on for your whole career. I feel like I am getting better, but there’s always something that comes your way when you least expect it. It’s all about learning to get things done efficiently and thinking one step ahead. It takes time to learn, but you get there (hopefully).

5 – You become a part of an extended family. A part of the family of nurses, a part of your patient’s family, especially for those who spend their lives in and out of the hospital. When you’re working with family, there’s  a bond you all share, and you have to learn to cherish that bond, and work with it. Because after all…. And I guess this counts as a rule number 6: You’re never alone! When things get crazy or your confused about something, remember that you have your fellow nurses there to help you out – don’t try to figure it out on your own!

There’s still a lot to learn, but I am getting there. Being a real nurse is so much different than the last 3 years in nursing school – and it’s so worth it!

Jupiterimages | BananaStock | Getty Images

I was trying to take a small leave – just for some R&R – from my job, but my coworkers wouldn’t leave me alone.

Then it hit me why we nurses can’t ever step away long enough to get the rest that we need. Yes, some of us are incurable workaholics. Some of us are incapable of putting our own needs before the needs of others. But I think the main reason is that  our manipulative coworkers draw us back when we try to get away!

The following is an excerpt from the chapter “Sisters of the Air” in A Nurse’s Story: Life, Death and In-Between in an Intensive Care Unit by Tilda Shalof.

“Yo, Tilda! Listen, since you’ve gone incommunicado, I’m calling to tell you the latest news. The hospital has a new mascot.

“She’s this huge woman who sits outside the front entrance every day in a wheelchair, calling out to everyone who walks by. I swear, she’s the world’s ugliest woman. Her legs are wrapped in drippy bandages and she’s holding her IV pole with one hand like it’s an umbrella and smoking a cigarette with the other.

“She gets people to collect cigarette butts off the lawn and then she stuffs them all into one butt and has a free smoke! Then she chatters away all day about how she used to be in show business, but the doctors took out her ribs and shocked her and now she can’t shovel snow any more. She keeps calling out that they’re using her as a guinea pig, a scapegoat and a miner’s canary—all because of the bomb that was dropped on Hiroshima.

“Get the picture? Then at the end of the day, the Wheel-Trans bus comes and—what that poor driver has to put up with—takes her away!”

Of course, I burst out laughing, but tried to stifle it. It wasn’t right to laugh.

“Thanks for that information, Justine. I can hardly wait to meet her,” I said.

“So, Til, when are you coming back to work?”

“Let me talk to her,” I heard Laura say and could just picture her grabbing the phone from Justine. “Get your butt back in here, Oh Sensitive One. We need you. Do you know how short-staffed we are? We have two doubles and a sick call—one of them Nell Mason, of course—and I’ve been on the phone all morning calling for overtime. Some team player you are.”

Frances was next. “How ya doin’, Tillie? Oh, we miss you so much. Come back already. You’re not going to quit, are you? We’re all going out for drinks this week, it’s Justine’s birthday. Can you join us? Work has been so interesting lately. We’ve done lots of transplants—lung and liver—and we even did something new—a combined kidney, pancreas, plus liver and intestinal transplant on a young boy who had a rare idiopathic coagulopathy. He’s doing really well for a guy that was so sick when he came in, with clots throughout his abdomen and pelvis, one of them obstructing his—” “Time’s up, Jabber Jaws,” I could hear Laura tell her. It sounded like Laura was trying to yank the phone away.

“Old Bossy Boots here won’t let me talk any more. You come back soon,” Frances managed to call into the phone as Nicole got on the line to tell me she was dating someone new—a nephrology resident, Oliver, who had rotated through our ICU and was very well liked—and she was very happy. “This might be the one,” she said.

Then Tracy came on the line to tell me quietly—she wasn’t ready to tell the others—that she was pregnant. She was a few weeks along, but she and Ron had been trying for a long time and were ecstatic.

I called Rosemary the next morning and told her I was ready to return. Would you do the same for your team?

Excerpted from A Nurse’s Story: Life, Death and In-Between in an Intensive Care Unit. Copyright © 2004 Tilda Shalof. Published by McClelland & Stewart Ltd. Reproduced by arrangement with the publisher. All rights reserved.

click to purchase

iStockphoto

I guess it should be no surprise considering what we do on a daily basis. We are the coordinators of care, the wranglers, and the sieve where almost all of our patients’ care is poured and filtered. So if we can’t navigate the didactic of the team concept, our patients are in trouble.

As students we are put through the rigors of group projects. The majority of my projects have applied to research projects, but they sure haven’t been limited to just that subject.

Sometimes you get to pick and choose your group and group members, other times you get the luck of the draw and are assigned to a group. This equates to working conditions if you think about it. You sometimes get to choose whom you work with and where, while other times you can be ‘pulled’ to a foreign or neighboring unit.

The group didactic can be quite enjoyable and simple, or miserable and complex. I’ve experienced both during my time as a nurse in both the academic and professional setting. One thing is for sure, the only thing you ever have control over is your own thoughts and actions. No matter what you may want or need from someone else, in the end you have to figure out how to make it work so that it benefits everyone.

There will be personality conflicts, scheduling differences, work ethic challenges, deadline stressors, and of course the occasional ‘what the heck happened’ moments (I sometimes call that the curve-ball syndrome). Regardless of the situation, the only way things work out is when everyone knows their part, does their part, and communicates their part effectively, efficiently and equally.

I don’t know about you, but every time I work within a group a learn a little bit more about my self. More about my strengths, my weaknesses, and of course my habits. I have subconscious tendencies that are both a help and a hindrance to me and the group. And I’m still trying to sharpen my communication skills to this day!

I haven’t met a nurse that looks forward to group projects. I think we all approach group projects the same way we encounter ‘change’ – we’re not big fans of it, but we know it’s inevitable.

I also look at it this way. Remember how I gave the comparison of getting assigned to groups and getting to work where you want? Well that comparison is synonymous with our patient assignments aren’t they? We sometimes get to choose the assignment we want or know is going to be good, and other times we have to bite the bullet and take that assignment that we know is going to put us through the ringer. Does that mean we provide less care?

Not in my opinion.

Hemera | Photos.com | Getty Images

Here is the best piece of advice I can give to any RN out there when delegating to their CNA team members:

Never delegate out of sheer personal convenience

Too many times I have seen/heard/witnessed an RN/LPN delegate a task to a CNA simply because it was inconvenient for them. We all know the stories and the urban legends of CNAs always doing the dirty work (bed baths & bedpans to name a few), while the RN/LPN walks away. I have seen them answer a call bell, learn that they need to get their hands dirty. They walk back out of the room and call/delegate the task. There are actually individuals out there that believe that once they are licensed, they don’t need to get their hands dirty???

I’m here to publicly apologize to any CNA reading this. Contrary to popular belief, this is not the norm, nor is it acceptable to most of us currently practicing! I still strongly believe that the most important assessment skills can be learned from getting my hands dirty. I learned that from a CNA!

The professional rapport you have with your CNA can make or break your career. I make it a point to strengthen that relationship, because when the going gets tough and the you-know-what hits the fan, my fellow CNAs are often times the ones that keep me afloat.

What goes around comes around folks. If you cannot make the time to get your hands dirty, the CNA will not have the time to keep you from ‘drowning’ in your time of need. It really is that simply. It’s called teamwork.

A nurses’ aide (Certified Nurses Aid – CNA) is the unsung hero of the nursing world. When someone asks what you do, never simply say “I’m just the aide”. When we speak of bedside care and we refer to the ‘team effort’ this part of the team is probably the most under-appreciated, yet most needed team member. They are the silent majority. When they are doing what they do best, you sometimes (more often than we like to admit) forget they are there. But, when they are absent it turns your whole world upside down. Thank you for all that you do!

By the way, this post was inspired by a previous Scrubs post: Top 10 things you’ll need in your CNA survival kit. Be sure to take a look.

Darrin Klimek | Digital Vision | Thinkstock

The old African proverb, “It takes a village to raise a child” resonates loudly with the growth and maturation of any nurse. I’m not talking just new nurses or new grads. This applies to all levels of experience and all levels of skill & education.

I think, at least for me, that the old proverb means simply that we are a product of our environment. It’s never just ‘one person or persons’ responsibility or ‘fault’ (although I hate using that word in this reference).

To make the comparison. While the child’s parents have the majority of responsibility in ‘raising’ their child, the parents are not with them 24/7. The child’s life is a sum of their experiences in and out of the home.

The same goes for a nurse. While the nursing school instructors / preceptors / managers / leadership team members have the majority of the responsibility ‘molding’ and ‘shaping’ the nurse, they are not with them 24/7. The nurse and their progress in their career is the sum of their experiences.

Now, this isn’t a discussion about blame or a debate on quality of care and responsibility. I’m simply bringing to light the obvious nature of our profession. We not only touch (impact) every walk of life, but those same foot steps touch (impact) us.

Here’s a personal story to help deliver this message.

In my previous career I was attending a sports banquet. The guest speaker was a home time ‘hero’ of sorts. He was a local success story that had was quite the success story in his chosen career path. He was the token guest speaker that night, and I cannot ever forget the message he relayed to the crowd.

He told the story about how great it was being successful, but that the road to success was littered with failures, falls and restarts. It was a great story about how he overcame the odds (I won’t bore you with that part of the story).

The ‘take home’ point of his story was that every night he goes home, on his way out of his place of business, he makes a conscious effort to seek out environmental services personnel. He greets them and thanks them for their hard work on an almost daily basis.

He not only does this, but he knows their names. All of them. He greets and thanks them all as a person.

The oh-so vague point of this story is that no matter how successful a man he is, he never forgets how he got there and how he continues to be there. If the environmental service team doesn’t excel at their job, he cannot excel at his.

He wrapped up the story by asking a simple question. Do you know your environmental services / house keeping personnel’s names? Why not?

Do you know the names of these awesome people where you work? Why not?

It takes the concerted and focused efforts of all members of your team to deliver high quality care. Everyone from the physician, the nurse, the aides, the secretary, ancillary staff, transporters, and volunteers play an integral part in the success of your career (no matter where it may take you).

Let’s put it in more simple terms, have you ever had to do their job? ‘Nuff said.

It truly takes a village to raise a nurse. To think anything less is robbing you of some of the greatest moments as a nurse.