The Unwritten Rules of Nursing

[Music] what's up guys welcome back to the fresh iron podcast my name is Katie cleaver hey I'm Elizabeth Mills and I'm Alyssa Stafford and today we are going to talk about the unwritten rules of Nursing there's a lot of them there's a lot of them and we're probably gonna think of more as we talk but these are not in your nursing textbooks these are not in your policies and procedures but this is kind of like these are the cool not cool things do nursing is a very team kind of a thing it's not like you go do your own thing in a silo you know I mean like by yourself we got to rely on one another a lot so we're gonna tell you the things that you need to be you don't look like a jerk you'll be part of the cool crowd be cool guys I don't need to be perfect but you need to be considerate and be cool and so katie is looking out for all of us and saying don't bring something lame to the potluck can I say that let's say you know you're it's the holidays and it's Thanksgiving and you know everybody we do a potluck normally in Thanksgiving and you have worked Tuesday and Wednesday and you're working Thanksgiving it is I think okay to bring like some pie yeah okay that's fair point that is fair I don't need you to go make this like gourmet meal right I don't need you to drop a hundred bucks on this and spend like days making I don't need that don't hear me say that but if if you like show up with like a stack of napkins or like all like bold like they look like you picked them up like no and I also like don't like it when someone doesn't bring anything at all and they eat a bunch yeah not cool yeah like this you don't participate you don't get to eat ya get you a burger I'm quitting this stuff like okay and I say that and I'm saying this like joke annually but okay the potluck is a way for us to like bond it's kind of it's like a team thing right I I'm making something and bringing it to the team to share with everybody and this is this is just like a way to build rapport and to get closer with people and and I don't I think if you're a newbie and you come you show like you're working and you saw and you bring don't bring anything you bring something really lame like you don't care it shows you don't care yeah you know what I mean and I'm not so if like I'm not saying like you have to make this beautiful thing but if you go to store and you grab some sugar cookies or some really good potato chips good ones not not like the generic like the brand-name good multiple bags in the Cape Cod Pringles Oh God okay but I want but my end of the day it's like it's like that's a way for us to bond and to show that we care about the team and if you just like like don't bring anything you don't care it kind of like hey we're we're all in this together let's enjoy this together yeah you know because you'll be working holidays together sure well I mean it's it's inevitable so also though don't try to show up the nurse that's been there for 20 years who makes the best case oh and also bring cases there are about we need to know those they're sacred cows who you know know how to make really good like the girls egg rolls yeah and don't try to outdo her nope or meatballs not cool dude those crockpot meatballs so you just ask around like what do people are you speaking from experience must stay in their Lane that what's happening here was very hard to make and I just you know I know some people who make really good egg rolls and it's like what those I want those dead girls I don't want any other kind I don't want to feel pressure to have to feel like I have to try something else intake for those girls yeah well or with that hoisin sauce you know nobody's like I think it's fun to be like if there's something you're good at making like oh I don't want to brag guys but I make the best chocolate chip cookies yes you do and I think about those sometimes guys oh yeah what a minute how do I not know that you may have a little insulted you didn't react that amazing and so the thing is I'm good at that I know I'm good at that and I will bring that and I will rock it I got up at 3:40 to fly here it was delayed for hours whatever in cross-country travel that's like a way that people can get to know you you have to have a chocolate chip chocolate chip cookie off I'm just saying I make some pretty good ones you might okay you make oh no best this cake kind of custardy than a name of ours yes making or that's something that they love like if somebody came in with seven kids and Pringles oh and they've like time altogether that would be cute okay so don't bring something claim to the talk next next one don't believe in drips trial is very frustrating as in so I think it doesn't matter I mean it does matter if it's vasoactive it's a really bad thing yes but even regular maintance IV flow is there's nothing more annoying than starting your shift trying to go find three different fluids for recommendations yeah like I want you to think about when you're handing your patients like what condition you're handing them off in I would rather have all the drips situated then then having everything look perfect in their room or whatever like it is really frustrating when you are starting a very busy day to have to go through and and get those especially if you don't order them from pharmacy oh my gosh it's very frustrating me dangerous it can so beacon it's like and I've seen times where it's like the nurse is starting their shift they're vaso is are their leave oh is going at an incredible rate and there's like like 10 minutes left in the bag come on so be considerate there's really not cool to leave drips dry conversely it's very cool to make sure your to set your next shift the next nurse up for success and not saying like you know give them a couple hours right like see if you can like give him an hour to to be able to get into their shift meet that he'll say hello to all of their patients yeah you know maybe clock in before their eyes start going off that's preferable and I just as a general rule like nurse hack kind of thing is if I have a vasoactive medication I program only half the volume in so that when that beeps then I make sure that there's another bag available so if it's something that comes from pharmacy I've got time to get it from pharmacy if it's something that's in our machine then I can go get it from the Machine and really honestly like we we do 7:00 to 7:00 so at 6 o'clock I'm looking at everything that's hanging in all my patients rooms and if anything looks slow there's another one right there mm-hmm it's just part of my national routine it's really frustrating to be getting report in patient a and then patient B's IV pumps going off cuz the IV tubing is dry yeah I would come so quick talking point to is if you're getting report and you see it's about to go dry or it's beefing you can say are you gonna get that before you leave yeah because they're so there are some things that are not cool to expect that off going nurse to stay to do and we'll talk about that but that is one of them that it's like no you you're not you you should take the extra couple minutes to go get that and make sure that it's not you're not going on well I make sure that the patients that I just assume care ever okay exactly so it is so in a business like assertive hey are you gonna take care of that before you leave and I think that's a habit that you have to start out early as a nurse doing because then it becomes second nature and you don't even thinking about it anymore and then and then you're teaching other nurses and then they that's their second nature and then you do then you got a unit of people who are being considerate right hopefully all right next one so let's say it's 10:30 in the morning it's a one of those beautiful mornings where you saw all your patients you got them all situated there tucked their fluffed they're medicated and you're like you know what I'm gonna get myself some coffee this is a this is not a normal day okay before you go run off for a break I would like it would be cool if you asked other nurses especially if you know another nurse is like dying if they needed some help before you went on a break fair fair fair not fair I sense hesitancy no no I think no I think you should maybe you know I'm not gonna well but I'm not gonna go in every single room to look for every single nurse but if I see a nurse outside or I see something going on or I know because you can sense when nurses are really struggling yes you can you can sense that I'm like hey what's up I'm getting ready wanna break what can I help you do um I'm not I don't I wouldn't say that I actively go into every or that's honesty ya know I mean I wouldn't especially forget a big unit like but it but let's say you got a pod partner yeah you know your CNA is not dying to before you leave their unit and like are kicking it right I mean I think I want you to take breaks when you can get them absolutely but if we've got somebody dying not not a patient I'm sorry if we had a nurse who is drown who's in the who's in the red and is like on the verge of tears I think it is kind of you to help offer to help them before you go have a break and also not be mad when you ask people if they need help and they take you up on it yep because golly I can't tell you how frustrating that is to have someone running around all the rooms hey do you need help and then they're halfway out the room before you answer them and then you say yeah can you get a set of labs on this patient I really need to do that but I'm so far behind and then they look at you like really you're gonna ask me to do that like yeah like don't get mad about that like so yeah don't don't don't ask people for help or if they need help if you're not if you're gonna be like mad about the answer yeah like not cool I would have rather you not even asked me yes and I think too if you are if you know if you're really behind and someone asks you then yes give them a tastic hey check my med list can you see what I'm behind with on meds or can you check my orders but if you're doing okay you know and you really don't need if you're if you're in the in the yellow green and you're and you're doing all right and you know your break you know you're gonna get your break probably in an hour then maybe let that person get a break too because I feel like sometimes I think if you it's kind of that self-care thing as a nurse like yes I think you need to be a team player and I think you need to ask and you know being gate being gauged that's a theme here and in you know be willing to help but also like if you have busted your butt for three and a half hours and you're like oh my gosh I need five minutes mm-hmm then take it taking it yes um so yeah because you can't go go down that other side of like I can't take care of myself until everybody else is okay like yeah you have to act along and I see it happen a lot and um you know I mean that's you get you get really worn out that way and you know and then you stop doing it all together yeah so it's really tough like settling into having that balance of okay you know what I'm gonna I'm doing okay right now I'm gonna ask people for help because I'm actually in a place to help them I'm not going around to ask people for help if they need help just so I can say I did it right and then but also being like okay like I know I've busted my butt I need a couple minutes and I'm gonna take them yeah not not waiting till everybody's perfect and gone to lunch before I go to lunch and you know because that's not I mean realistically that's just not I think rares I think when you're doing the help thing that it's a balance between the pay the person that's asking for help yes and then the person that's offering it yeah because you know I don't think it's fair for someone to ask for help when all they're doing is playing on their phone yes okay I just got hypertensive I hate when people do that right like if you're if you're seriously busy you got things going on with your patients I need help I'm more than happy to or our shop or whatever okay yeah no I'm not gonna I'm not gonna no I'm just not and I've seen it before where it's like okay I got an admission no check out this on my oh my gosh look at this on them what did this person say and then they're like chatting for like 30 minutes when they could have acknowledged the orders gotten a few things started gotten things rolling for the next shift and then they act like they didn't have any time to get things done it's like this is not cool yeah super not cool it's the responsibility on beds and that actually flows into the next one so I actually phrased this a little differently so I was gonna say so so let's say your patient needs a bed change and it's a two-person situation and I asked you for help I should take the business end of that transaction so if you're dealing with the code Brown Cobra so you need to be the one that's cleaning the booty yes so like Elizabeth's say I'm I say Elizabeth um you help me change mister you need to do what's being expelled out of the ATM you need to take those dollars that's your money sometimes it's green but like so for those of you that have not like routinely changed patience if someone has been found and they need their need to be changed what you know and it takes two people one person holds them up on their side safely and so they're not injuring themselves or the patient and then the other person cleans and it's just it would be it's cool - if it's your patient to take care of the not as pleasant part of that task because the first first swipe the first of the first pass is the dirtiest usually the most most of the work and then by the time you get that situated and then you roll them to the other side the person you ask to come help make sure we're squeaky clean mm-hmm and pull the sheet and the pad through and you know I think it's cool if yes I would agree with that because if because if you asked me to come change a patient with you and every time you're like alright what's hard is when you start it and then you're like you know you're you're the one that's you're the receiving end so you're I knew there's a reason you're cleaning up oh I think my max was three three full benches [Music] if you ask for help in changing your patient you should it's cool if you take the business-end next don't be leaving the unit all of a sudden for like 30 minutes and not telling anybody oh no I mean I get it like some people have to pump right they're breastfeeding that's pump maybe they I don't know what you have to do off the unit and I'm not gonna explore that but you're responsible for patients you're the ones who knows about your patients and you can't just like go down the cafeteria for 30 minutes and it's not your lunch and patients are calling out and that kind of thing not cool to do that you have to hand off I mean that you have to provide some sort of handoff before you leave the unit somebody has to assume care of your patients while you are physically not there right so just just disappearing is not no it's not an option it really is actually yeah so providing that handoff and it's not just tailors with him going to lunch it's hey Elizabeth do you mind keeping an eye on Joe station a patient be patient a little pressure limit is this they are on this med patient B has had a lot of pain today but I just gave them pain medicine so it's not time for anything else you cool with that cool with that you know beautiful yeah because then if you say I'm gonna go to lunch and you have a train wreck that has a lot going on and you don't let anyone know about that like it's not saying not cool and so here's another one don't leave the patients room a mess if when I get to log into the computer if I have to move all of your syringes and your wrappers from your flushes out of the way so I can log in not cool it's like why is the patient's room that messy like come on no it looks bad so it looks bad to the nurses it looks back to the patients and Families yeah you don't want to appear like a you know unorganized like sloppy slob you want to portray the a professional I know what I'm doing I'm taking care of what needs to be done and that includes putting trash on the trashcan I know and you know and what's important to know as patients and family members don't know what can be thrown away they don't always know what trash actually you know like um sometimes you might have a vial you took all the met out and it's trash they don't know that or like leaving things out various linens that maybe they're dirty or but they seem clean like they don't it's we need to do that and it really doesn't take long but when I clock in there's trash all over the the bedside table and all over the keyboard and there's three there's their breakfast lunch and dinner tray sitting in the corner right but not in a nursing textbook but not cool all right right right um your phone your thumbs no your your cell phone oh we need to talk about this do you get gee did you guys want to take the lead on this one I mean I think I'm sorry but when I see and this happens way more now than it ever has and you know I don't know about you know where everybody works I know at work now we have cell phones that we get we have to sign out for at work every day so we have that cell phone and then I see so many nurses now with their personal cell phones constantly texting or shopping or on it and and to me it just it looks so unprofessional to me it tells me that you are not focused on your job and then when we really are on our work cell phones because that's a lot of times how we communicate with providers and other nurses etc you don't know the difference and so if I see you constantly on your phone I don't think you're looking attention to your alarms and especially if your alarms are going off and you're still on your cell phone like I mean when I started as a nurse we didn't have I think I still had like a flip phone I would you know oh I had the one we have a full keyboard I'll let you slid out yep mm-hmm I think maybe I had a razor I don't know um but we just didn't have and I I mean I think it's taken away from I definitely think it's taken away from paying attention to our just competing for attention it is it yeah it is a distraction and it's like okay oh I'm in the middle of a kind of text conversation I wanna make sure I get back to him so I'm gonna hurry up and do this task in here and then you're not paying them as much attention you know it's very easy for your attention to be taken there and to be less diligent with what you're doing at the bedside and - if you think about it like let's let's say you're your dad's in the ICU and you're terrified and his blood pressures all over the place and you don't know if he's gonna make it and the nurse comes in and she's about to administer a medication and her and you see her pick up her phone and answer a snapchat like and see like see snapchat come on I see em and your dad is like on death's door right here and you're just like what the heck yeah like I know that this is like noir like this is her his or her every day in this you know but like have some respect and some reverence for the seriousness of this environment a man like Mike it's I feel like that's disrespectful to the experience of the people in the bed and in the room even if they annoy you and they frustrate you and you you're so annoyed with that family or whatever it is like that doesn't they're still probably experiencing some trauma and they're probably experiencing a nightmare and now they're seeing like their their nurse distracted not cool and I tell you what nothing is more of a turn-off I I saw this last year it was a new nurse it was her first day of orientation and she's just she has a day where she's just learning where things are she doesn't have patience her preceptor doesn't have patience and she's at the nurse's station on her phone texting away and like it's your first day and this is my first impression that thirty of you and it's never it's not respectful I know I tells me that you really don't care yeah yeah yeah so that's another generate a newer generation might not think that but that's that's a hard that's a hard thing for me too yeah because we're on the nurse's station is not just colleague to colleague that is one thing and I don't love it we also have people walking by and anybody and I know the thing is is people will I think people justify it with why see the doctors on their phone all the time well okay I get that I get that many liars but like a lot of their stuff is on the phone too and like they're not at the bedside constantly right where the patient's family can see what's on your screen they can they can walk by the nurse's station about that if you want to think about it that way think about have you ever been in a room with a provider and their cell phone went off that they're talking to the family and their cell phone goes off and they pause the conversation to look at their cell phone and/or answer it and how that looks to the family I don't want to in that moment now the family doesn't know if it's an emergency or not they have no idea they know it's a doctor but think about that cringe that you have for a moment they're just talking to their loved one about something serious going on and they stop and answer their phone so now picture that that's you what does that look like from the outside and it's not a patient it's personal stuff right right because I can kind of understand it from the with the provider because it's its patient stuff they have their alarm turned up because it's patient stuff it's not their Instagram notifications and and so especially when the family can see it it's like oh you're texting with your boyfriend right now and you're trying to talk to me about a DNR yeah come on yeah like I don't know I think that's some unwritten rule but I think it's easily crossed over and that I think has a lot to do with the informal leaders on the unit and what they do and what they and and everybody's just gonna follow suit right yeah agreed all right guys the next one we want to talk about is documentation with electronic medical record we do have this lovely function where you can copy and paste documentation but where it's not cool is when you copy and paste somebody else's documentation now caveat maybe you work at a hospital where you were not allowed to copy and paste at all or you might not have that function but if your copy and pasting copying and pasting someone else's documentation that's not cool no it's really not I mean you you really have to be my full of that because you don't you have to read what they've written mm-hmm it there's nothing more annoying than cup seeing a copy and paste of a misspelling for example I mean you know it's been copied and pasted yes or you know you're not catching the fact that the central undressing was changed every hour yes I mean renders your documentation as garbage because if it gets damaged in a court of law yeah I can I can easily say everything that you've charted is crap yep because it's clearly copied and pasted yeah I mean in the nerd world we our patients change all the time so you know how they respond to painful stimuli at 8 o'clock in the morning it's probably different than how they responded at 9 which is probably different than how they responded it's in so you have to be mindful of that and changed that every time but you know if Elizabeth's working night shift and her patient is sleeping because it's night shift and I came in in the morning and I'm just copying and pasting her her documentation and was my patient sleeping all day to awake alert oriented right into something where when we're doing they go well it is illegal and it's also really like we're turning our documentation into just something to check off our list not something that's accurately reflecting what is going on in front of us and then then what's the point then right there's you might as well have not documented anything if you're just gonna copy and paste something that's not actually going on just so you can check off that you did it and I but I want to say we have to document a lot we did frustrating I think didn't you count one time how many boxes we check I do one it was like two hundred and somethin or oh it's something absurd I did a blog post page 2014 called wire nurses always on the computer I think it's still alive I'll put it in these show notes that'd be cool but it it but it was absurd the amount that we have to document is absurd and we are also constantly being told to document more what we're being told to do more but we're never given more time to do it so something has to give right and a lot of people will just copy and paste documentation I've seen it where they copy and paste on the hour every hour for all of their patients that's also garbage because you can't simultaneously in the same room at 8 o'clock on five patients and again if that's brought up in a court of law you're not practicing appropriately at all because it's you're lying right so I think it's uh I've also I've definitely we've all seen it people copying and pasting and it's completely inaccurate and it goes back to my thing about don't ever trust a previous nurse no matter how much you love them mmm-hmm like and how much you trust them in general to be a good nurse we're all fallible humans that'll screw up and click the wrong box or you know you know and if you're copying and pasting it you're having something completely inaccurate see and you know I I like to look my first assessment is I will look and see what the nurse documented before me I do too is it's a flag if something's different exactly that's wise to do I have last filed clicked so I can see what the last thing yes because that helps you note oh wait a second didn't hear a murmur yeah let me go my god listen again or yeah I hear a murmur did but like so that's helpful but when you start copying and pasting where that's very easy to to really open yourself up to inappropriate document and adding the part of providers make clinical decisions based off of your documentation mm-hm so if you're also doing an accurate documentation we could have inappropriate clinical decisions being made as well yeah there's a lot there's a lot that goes into that so don't get into that bad habit get get very efficient at churning an assessment oh for sure don't don't copy and paste other people guys all right one more one more guys one more what do you tell me one day well be gracious yes and and express gratitude now I want to so there's this mentality where it's like well if you're an adult and you're doing your job I shouldn't have to say thank you people have that mentality right a lot of people do I don't like that I don't either no I'm not saying that if you do the minimum expectation of your job that you should get showered with praise no but if you well if your tech is kicking butt and doing great on bed baths you can say hey thank you for doing that or if your patients call light went off and someone got it for you hey thanks for doing that like extending gratitude to people isn't it is part of a well-functioning team yep right like and I can't express that and you know I think if you think about it from a standpoint like for me it means so much when family members recognize the work that we do and sometimes a heartfelt thank-you from a family member means way more than a trinket from leadership somewhere yeah you know so I think this thing can be true for us and our co-workers is I really appreciate mmm Tasha I really appreciate Tasha being a wonderful singing and if I say thank you to her at least ten times a day I don't think it's enough like it's she's amazing at what she does but oh yeah and and saying that and recognizing that it really it really shows that you value your coworkers it makes you want to help them it makes them want to help you more they're gonna be appreciated appreciated genuinely appreciate like if you think about as a nurse when if you've ever had a provider say hey thanks for getting that ordered unreal that vaster thank you for getting that CT done or what like how like thanks yeah like that was nice to know that and being able to extend that to other people and pass that along and and allow somebody to have I don't know just feel good about something that they did I think that that and and also your role as the nurse like let's say you're a little experience or maybe there for a year and you tell the nurse that's been there for two weeks thank you like that really speaks to people it's very small yeah small encouragement goes so far it does especially if you walk in every day you never you're never told thank you you're never acknowledged in any capacity and you function in this silo where you just keep your head down do your job and you shouldn't expect anything like that's not a great place to work but if you walk in and you know what when when you show up for people and you help each other out and everybody's saying thank you and and acknowledging the work that we do and we're encouraged and people are expressing gratitude that creates such a much healthier environment and people are much more inclined to treat one another and their patients well and give each other grace because this is tough being a nurse today is hard and the more that we can support each other through that the better as opposed to like just do your job and you don't you don't know I mean it you know you don't know where you know what that nurse or CNA what their day was like the day before you know it's it's you are on your feet usually 13 14 hours a day at work you go home you know you don't know you know people have to go home take care of their families they probably get little sleep they come back the next day it's just our our work is really really hard and I think it's all the more reason to to be show gratitude yeah because it is not easy and if you can feel appreciated for it yeah no I mean you offer that balance though because I have seen people perform poorly and expect praise you know what I mean and I don't want it it is it earned I notice it like doing the absolute minimum like we're consistently talking here about being engaged and going for it and leaning in and that kind of stuff but we have somebody who's disengaged who finally does the minimum expectation of their job and they want to be praised I'm not talking about that situation I want people to know that like that is a different situation that that person needs to have a count we need to have consistently have accountability conversations and follow-through and and that needs to be dealt with in a different way but I'm talking about people who are shown up every day that are helping each other out that are that are doing you know taking some time to do a good work like we should like never underestimate the power of encouragement and gratitude to one another for that kind of stuff absolutely yeah so those are some unwritten rules guys don't be bringing cups to the potluck don't copy and paste documentation take care of the business end of situations you're soliciting help for don't use leave the universe out telling people keep that room reasonably tidy you don't need to be like hands and knees and mopping the floor but I think trash should be thrown away I'll make sure I get all of them don't be leaving those drips dry and that whole conversation about helping people and that balance alright guys well that rounds out our episode if you want to head to fresh or in let me tell you make sure I tell you the right number fresh are n calm slash 45 for the show notes of this and some freebies I'll have there if you want to rate and comment on this podcast I'd be super cool we appreciate that and thanks nurses stay fresh [Music]

Channel: Kati Kleber, MSN RN

Views: 27,646

Keywords: kati kleber, fresh rn, freshrn, katie kleber, katy kleber, nurse, nursing, nurses, nursing tips, tips for nurses, unwritten rules of nursing, nurse rules, nurses rules, nurse unwritten rules, nursing rules of conduct, role of nurse, nurses rock

Id: 0S9aOhj-ag0

Length: 37min 2sec (2222 seconds)

Published: Tue Jun 02 2020