How to MASTER the Foley Catheter Insertion + Advanced Tips & Tricks

Aug 25, 2022 | 3 comments

How to MASTER the Foley Catheter Insertion + Advanced Tips & Tricks

Published: August 25, 2022

Last Updated: March 6, 2023

William Kelly, MSN, FNP-C

Author | Nurse Practitioner

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A foley collection bag half filled with urine

What is a Foley Catheter Insertion?

Foley catheter insertion is one of the main procedures you will learn as a nurse in school, and you will have to put in a LOT of foley catheters if you work as a bedside nurse in the hospital.

The term ‘catheter’ is just a term that refers to a flexible tube that is inserted into a part of the body. Some examples include an intravenous catheter (IV), cardiac catheterization, and urinary catheters.

Foley catheters are also referred to as indwelling urinary catheters. These are essentially just a tube that is inserted into the bladder to allow urine to drain into a bag instead of staying in the bladder.

A foley is intended for both short and long-term use, both within and outside of the hospital.

Foley catheter insertion Indications

Foley catheter insertions are ordered for various reasons, but long story short. -they are ordered when the patient cannot effectively drain their bladder. It’s also ordered when this is anticipated (like with surgery… see below).

Urinary Retention

Urinary retention With obstruction

Also called a bladder outlet obstruction, this is when something is blocking or obstructing the ability of the bladder to empty.

Common causes include Benign Prostatic Hyperplasia (BPH), tumors, blood clots, or severe constipation. Other causes include infections, scarring, strictures, or trauma.

Neurogenic Bladder

This is when the bladder doesn’t work normally due to a central cause – aka there’s something with the brain. This could be from a stroke, degenerative diseases like MS, spinal cord injuries, or nerve damage.

Pharmacologic Urinary Retention

Certain medications can lead to the bladder being unable to fully empty itself, requiring a foley catheter insertion.

Medications that weaken the bladder muscles include anticholinergics like Tricyclic antidepressants and diphenhydramine (Benadryl).

Medications that increase the tone of the prostate and bladder neck include decongestants, stimulants, or other sympathomimetics.

There are many other medications that can cause urinary retention, including muscle relaxers, certain antipsychotics, hormones, or even NSAIDs and opioids.

Other Reasons to place a foley catheter

Acute Hematuria

If a patient has significant bleeding in their urine, a foley catheter insertion can be ordered to monitor their output.

When there is significant amount of bleeding, this often clots, causing an obstruction and a distended bladder, along with severe discomfort.

A three-way catheter is usually placed and CBI (continuous bladder irrigation) is started to prevent the patient’s urinary tract from obstructing again.

Urine Output Monitoring

Patients who need strict I&Os done may have a foley catheter insertion ordered. This is often critically ill patients in the ICU, like with severe CHF or renal failure.

For hourly output, make sure your foley bag has a urometer. This way the urine first drains into the urometer, then each hour can be emptied into the main collection bag.

Intubated Patients or critically ill

Patients who are intubated and many of those who are critically ill are unable to empty their bladder on their own. To prevent skin breakdown as well as monitor their urinary output, foleys can beneficial.

All the Tubes

After intubation, once the endotracheal tube is placed, that isn’t the last tube you have to worry about.

Immediately after intubation, you will need to place a foley catheter, as well as an Nasogastric or Orogastric tube to decompress the stomach and prevent aspiration.

Surgery

Foleys are placed before/during surgery to monitor fluid status and prevent bladder overdistention.

Immobilized patients

Patient’s who are immobilized from spinal cord injuries, strokes, or pelvic fractures often have foley catheters placed.

Hip fractures will almost always be going for surgery anyway, so a foley can help offer quite a bit of comfort.

Open Wounds

If the patient is incontinent and has open sacral or coccygeal wounds, sitting in their urine can make the breakdown worse and make it more difficult to heal. A foley can help promote wound healing in these cases.

Patient Comfort (End of Life)

Patients who are reaching their end of life often are very weak and uncomfortable, and a foley catheter insertion gives them one less thing to worry about and can make them feel more comfortable overall.

Incontinence?

Foley catheters really shouldn’t be used to manage urinary incontinence. This is an inappropriate use of foleys and the potential complications and longer hospital stay outweigh any benefit.

When to NOT put in a foley?

There really is only one absolute contraindication to a foley catheter insertion, which is trauma with hematuria. This should be managed by a urologist.

There are some relative contraindications, which include urethral strictures, recent UTIs, or artificial sphincters.

Of course, benefits and risks should always be weighed. Introducing anything invasive into the body increases the risk of causing infection, which is very common but can be lethal. See monitoring parameters below.

What are the different types of Urinary catheters?

While this article specifically focuses on foley catheter insertion, there are other types of urinary catheters that work similarly but may be used for alternate scenarios.

Foley Catheter

This indwelling catheter is placed in the bladder and left in place. This foley catheter insertion is ordered when ongoing use is anticipated. It is secured to the patient’s leg and drains into a leg bag or a larger collection bag that hangs on the patient’s bed.

Straight Cath

Sometimes referred to as intermittent bladder catheterization, this is for once or as needed emptying of the bladder. This often ordered for short-term urinary retention, where the benefits of putting in an indwelling foley don’t outweigh the risks (i.e. infection).

This drains into a plastic collection chamber for drainage. Once the urine is completely drained, the catheter is immediately removed.

Suprapubic Catheter

This is when a catheter is surgically placed through the peritoneum by a urologist or general surgeon. You’ll see this stitched in place below their belly button. This is placed in some patients with chronic incontinence/urologic issues. Nurses should never replace these.

Three-way Cath

No – this isn’t THAT kind of Three-way…

Also called a triple-lumen catheter, this is essentially a larger catheter that has 3 tips.

The urine drainage port, which is in the middle and is connected to the tubing to drain into the collection bag as usual.
The balloon port, which is used to inflate the 10mL balloon once successfully placed.
An irrigation port, which is not found on regular foley catheters. This allows irrigation to be manually done, or allows CBI (continuous bladder irrigation) to be connected to prevent clotting.

A three-way is typically only ordered for significant hematuria when clotting and obstruction are occurring or trying to be prevented.

Coude Catheter

This is a catheter with a special-shaped tip that helps you maneuver past an enlarged prostate.

Using a Coude

Make sure nurses are able to use coude catheters at your facility. This may be reserved for Providers or Urology to use.

Foley-catheter-insertion-Infographic-different-foley-types-smaller

There are some alternatives to foley catheter insertion that can sometimes be used. These are non-invasive so they do not carry the same risks as causing infection. These are excellent solutions when the main issue is incontinence.

Texas Catheter

Also called a condom catheter, this fits over a man’s penis that drains incontinent urine into a suction canister.

Purewick Catheter

This is the same concept but placed in incontinence women attached to suction.

Choosing a catheter size

Just like IV sizes and gauges, foley catheters have specific sizes as well. For foleys, these sizes are called “French units”. Each french unit increases the size of the diameter of the catheter by 0.33mm

For most adult patients, a 14-16 Fr catheter is standard. If you are worried about obstruction from sediment, a larger size is better. If you are worried about blood clotting, a three-way may be a better option.

Neonatal

3.5 - 5 Fr

Pediatric

6 - 10 Fr

Adult

14 - 16 Fr

Three-way

20 - 24 Fr

kangaroo nasogastric Tubing

Your facility may or may not have specific foley catheters for infants, depending on which facility and unit you work on.

Some units may use the purple kangaroo PVC nasogastric tubing to catheterize infants and toddlers. These are also sized in French units, so using a 5 french is common. Make sure you are always following facility and unit protocols.

Foley Catheter insertion procedure

Collect your Equipment

Make sure you have all of the required equipment for the procedure. This usually includes:

Foley catheter insertion tray

Foley Catheter connected to tubing & foley bag
Lubricant
Betadine swabs or solution/cotton swabs/forceps
Sterile gloves

Cath-secure device or tape
Sterile gloves

Prepare the Patient

Make sure to explain the procedure and obtain verbal consent from the patient. Also verify there is an order (verbal or otherwise) to insert the foley.

Ask or help the patient remove everything from the waist down, and place them in a hospital gown. Position them supine.

If they are female, have them extend their legs in a “frog” position. Males can remain with relaxed legs.

Foley-catheter-insertion-Prepare-the-patient

Pre-clean and pre-locate

It can be super helpful to clean the peri-area before setting up your equipment. You can do this with soap and water, or bath wipes depending on your facility’s protocol. This area is. notclean enough for most hospitalized patients, but this also gives you an opportunity to visually inspect and pre-locate the urethra. “If you can find it clean, you won’t miss it sterile!”

Lighting is Everything

Setting up for the actual procedure may be just as important as actually performing it. Make sure you have proper lighting in order to see where you need to go. If the room has one of those adjustable overhead lights, this would work perfectly.

Set up your equipment

Wash your hands and open your foley kit, which is best placed in-between the patient’s legs. Open up the sterile drapes of the kit so you can have access to the sterile contents inside once you get sterile.

Foley-catheter-insertion-Prepare-your-equipment

Apply Sterile Gloves

Apply sterile gloves as this is a sterile procedure. This minimizes the risk of introducing pathogens into the patient’s bladder, which can cause infection.

Extra Sterile Gloves

The foley tray kit usually comes with gloves, but these are small and not very stretchy, and often rip (especially for someone with larger hands).

This is where an additional pair of sterile gloves come in handy. You can choose your specific size, and these gloves are much stretchier and easier to maneuver (anyone else a 7.5?)

PrEP Sterile Field

Once your sterile gloves are on, utilize the sterile drapes inside the kit to carefully place underneath the patient’s buttock, and place the fenestrated drape over their vagina/penis. Be careful not to touch the patient or bed with your sterile gloves.

Foley-catheter-insertion-Open-foley-tray-kit

Lubricate the Catheter

Remove the catheter from its plastic covering, and place it inside a sterile lube package. The lubricant will help glide the catheter into the urethra, and placing it in the package will help keep your catheter from flopping around.

Your kit may instead have a pre-filled syringe with lube. If so, this is squirted onto your sterile tray, and stick the catheter in the lube where it isn’t going to fly off.

Foley-Catheter-insertion-Lubricate-catheter

Attach Syringe to balloon port

Attach the 10mL pre-filled syringe to the balloon port on the foley.

Testing the balloon?

It used to be standard practice to test the balloon by inflating. the full 10mL into the balloon and then allow it to flow back into the syringe. This is no longer recommended and has the potential to stretch and distort the catheter and lead to more trauma during insertion.

Clean with Betadine

Using pre-packaged betadine swabs, or betadine and cotton swabs/forceps, gently cleanse the region surrounding the urethra.

In females, swab in one direction front to back on the left, then the right, and finally down the middle.

In males, swab in one direction around the left side of the glans, then the right, then down the middle.

Prepare for Insertion

Now that everything is ready, it’s time to get ready to insert the catheter.

In females, spread apart the labia with your non-dominant hand to better visualize the urethra and make sure nothing gets in the way.

In males, retract any foreskin and stabilize the penis between your rounded hand.

Insert the Catheter

Insert the catheter into the urethra with steady force. Advance until you see urine in the tube. Once you do, advance a little more before blowing up the balloon.

A sterile gloved hand holding the vagina open, and inserting a yellow catheter inside the urethra. There is betadine surrounding the urethra and vulva.

A sterile gloved hand holding the penis, and inserting a yellow catheter inside the urethra. There is betadine surrounding the urethra.

If at first you don't succeed...

If you meet resistance, do NOT try to apply more pressure and force it through. Remove it and consult the Provider/urology, as the patient’s prostate is likely enlarged or there are tracts or strictures.

In women, if you don’t see any urine backflow within about 5-6 centimeters, you are likely in the vagina. Do not reuse this same catheter as this will likely cause an infection. Leave the foley in place and get a new sterile kit to retry the procedure. Aim superior to this foley.

Blow up Balloon

Steadily push the 10mL syringe to blow up the balloon. Inflating the ballon should keep it in place within the bladder.

Retract the catheter

Gently pull back on the foley until light resistance is met. This is. to ensure the balloon is resting right at the bladder neck.

Secure the Catheter

Secure the foley to the patient’s thigh using a cath secure, stat-lock, or tape. This is to ensure that the foley doesn’t get caught on anything or cause urethral trauma.

Place Collection Bag

Place the collection bag below the level of the bladder but off of the floor. This prevents backflow which could lead to infection.

foley-catheter-keep-below-level-of-bladder

Collect / Drain the Urine

Collect any urine that you may need and send it off to lab, otherwise measure and empty the urine, and document accordingly

How to Remove a Foley

Removing a foley should be quick and easy. Verify the order before doing so, or if the patient insists it be removed then remove it regardless (as long as they aren’t confused).

Collect your equipment: You really only need an empty 10mL syringe.
Unsecure the catheter: Remove the catheter from any cath-secure, stat lock, or tape that is securing it to the patient’s leg.
Deflate the balloon: Hook an empty 10mL syringe to the balloon port and drain a full 10mL from the balloon. Remove the syringe.
Remove: Gently pull on the catheter to remove it. There should not be any resistance.
Dispose: Dispose of the foley catheter, tubing, and collection bag into a biohazard bag if possible.

Foley Catheter Assessment & Monitoring

Assessments of the catheter should be performed each shift along with your head-to-toe assessment. If there are any new or related symptoms or discomfort, this should be assessed more frequently.

The biggest thing to watch out for is signs and symptoms of a UTI, as foley catheters increase this risk.

Urine

Assess the urine. Is it draining? What color is it? Is there any blood, pus, or sediment?

Skin

Is there any skin breakdown, erythema, or discharge near the insertion site?

Tubing/Collection

Assess the tubing and collection bag, checking for any leakage. Make sure it is secure and in place, and that the collection bag always remains below the level of the bladder.

s/s of infection?

The main thing you are going to monitor for is the development of infection (UTI) and sepsis from the foley catheter. This is usually evidenced by fevers, tachycardia, and frequently altered mental status in the elderly hospitalized patients.

Foley Catheter Insertion Complications

During and after foley catheter insertion, be on the lookout for complications that may occur.

Infection (UTI)

Infections are a common complication of UTIs. While common, UTIs can be severe and even kill patients, so preventing this is very important.

Using sterile technique is super important during the procedure to decrease the risk of infection. Also, make sure the collection bag remains below the level of the bladder at all times to prevent backflow.

Epididymitis

Foley catheters can rarely lead to epididymitis in males and sometimes extend to orchitis (infection and pain of the testicle).

Bladder perforation

While rare, catheters can cause a bladder perforation. If so, the patient will develop extreme pain, bloody urine, and signs of peritonitis (abdomen rigidity and rebound tenderness, etc).

Bladder stones

Bladder stones can form due to the presence of a foreign body within the bladder. This can lead to obstruction and pain.

Urea-splitting bacteria (like proteus mirabilis and Pseudomonas aeruginosa) are more likely to cause these stones.

Bladder fistula

A fistula is when a false passage forms between two different organs due to chronic inflammation, such as with a chronic Foley catheter. These are rare but can lead to significant complications, and infections, and will need surgery to fix it.

Foley Catheter Care

Managing a foley catheter after the foley catheter insertion is just one more aspect of the patient that you will need to care for.

Assessment

The foley should be assessed with each head-to-toe shift assessment. You should be monitoring for things as below.

Clean Meatus

Clean the insertion area with soap and water daily

Ensure Tubing secure

To secure the tube in place and prevent any urethral trauma, secure the foley to the patient’s leg. Many facilities will have Cath secures, but basic medical tape can also be used instead.

Collection Bag

Keep the bag below the level of the bladder to prevent backflow. This should be drained often as well.

See if the patient is ordered I&Os, and chart how many mLs are emptied each time.

Collecting Urine

If a UA is ordered, you can now obtain and send this after the foley catheter insertion.

Everything online will tell you NOT to use the collection bag to obtain urine samples, as they may be contaminated. But nothing seems to distinguish a foley that was just placed or one that has been already drained and in place for some time.

However, if you just put in the foley, the bag should still be sterile, so some nurses do consider this first urine as a sterile sample. Whether or not this is appropriate is unsure, but always follow your facility protocols.

The recommended method to collect urine from a foley is to clamp the foley and withdraw urine from the collection port with a needle and large syringe, then transfer the urine to a sterile specimen cup.

To learn how to actually interpret the UA results, you can check that out here!

Routine Changing of Foley

There is no reason to change a foley catheter simply based on time. There is no evidence to support routine change, and it is not recommended by the ISDA or the CDC. Foley’s are often ordered to be changed if there is obstruction, it is not working correctly, there is infection, or if it is being discontinued altogether.

And now you know exactly how to place a foley like a pro! Let us know in the comments if you have any other helpful tips or questions!

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10 Tips for a New Charge Nurse

Aug 5, 2021 | 0 comments

10 Tips for a New Charge Nurse

A charge nurse is so important in keeping a hospital department running smoothly. Whether in the ER, ICU, or inpatient floor settings – the charge nurse is essential to the team.

Many times being a charge nurse comes with years of experience, but sometimes it comes with less than 1 year! (believe me – I was one of them!) Many units may have high turnover, and you can find yourself being a charge nurse with a year or less experience.

While this is nerve-wracking, it is possible to do a good job as a charge nurse, even with not-so-ideal nursing experience.

Here are some charge nurse tips to help you on your way to becoming an amazing charge nurse to serve as a resource to your team.

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What Is the Role of a Charge Nurse?

A charge nurse is the “nurse in charge” on the unit. They are the leader of the team (at least for the shift). They are often the nurses on the floor during the shift that has the most experience and knowledge.

Their job will differ depending on which unit they work in, but usually involves:

Keeping the floor moving (admissions and discharges)
“Floating” and helping the nurses
Being used as a resource (aka answer questions)
Sometimes taking their own patients as well

In the emergency department, a major role of the charge nurse is throughput. That means keeping the department moving: getting patients who are admitted, discharged, or transferred out of the department, and making space for new patients coming in.

They may even need to take some of their own patients on a busy day/night, and may need to function as a triage nurse after certain times during night shift or when short-staffed (which let’s be real – is basically the norm).

10 TIPS FOR NEW CHARGE NURSES

Tip #1: Know The Policies

A major job of a charge nurse is to know the policies inside and out. This is basically the rules of flow of the specific department, aka “how it all works”.

This includes policies related to the admission, discharge, and transfer process; medication administration policies, transfusion policies, and more.

These policies will be specific to each facility and department, and a nurse will naturally learn these over time with experience on the floor.

However, each facility should have some sort of intranet (online database) or printed resource with policies, which you can look up, print, and save as needed.

Tip #2: Know Your Backup

While it’s ideal to have a charge nurse who has years of experience on the floor, this is just not always possible. Nursing turnover is real, and many departments struggle with nurse retention, especially on night shift.

You may find yourself becoming a charge nurse on night shift with as little as one year of experience or less.

As a nurse with a year of experience or less, you simply cannot be expected to know everything, including all of the policies and how to troubleshoot any situation that arises.

While this can be terrifying, there are resources that are available to you if you just don’t know the answer.

Even though you are the charge nurse of the floor, there should be a “higher-up” that you have access to.

During dayshift, you may have access to the department director or nursing managers. They can often be contacted by telephone if needed even after they end their workday.

During night shift, there is usually a nursing supervisor of the hospital as who can answer questions.

You can also call other charge nurses on other departments to ask for advice during a situation.

If there is an in-house hospitalist team, they can also be used as a resource for medical concerns, or you can call the attending.



Example

I moonlight as a night shift hospitalist, and had a charge nurse on a med-surg unit with less than 1 year experience reach out to me as she was concerned with a patient’s HR going in the 30s during sleep. This patient was asymptomatic and had been bradycardic in the 50s while awake. She was concerned because she had never seen a HR consistently that low, even during sleep. I reassured her that this was okay and even expected in this specific patient, and if he developed any symptoms or abnormal rhythm to notify us immediately.

Tip #3: Good at Throughput

A charge nurse’s primary responsibility is to keep the department moving. This is super important in the emergency department but is important on any nursing floor.

Patients come into the ER and often need IVs started, labs drawn, transported to imaging and back, medications administered, call bells answered, and discharge instructions given. Patients who are admitted need report called and need to be transported to the floors.

Delays in throughput are common, especially within the ER, and may be due to:

The nurse being backed up due to too many patients (all too common) or a critical or needy patient
The Provider being too busy to discharge or admit their patients immediately
Lab or radiology delays
Admission delays (i.e. floor nurse too busy to take report)
Admission holds (not enough beds upstairs)
COVID test results
Delays in transportation

A charge nurse can help minimize many of these delays and keep the department moving by being proactive.

They can discuss transport patients, clean stretchers, make phone calls, help out their nurses, and remind the Provider to reevaluate and disposition their patients! These are all ways the charge nurse can help become an expert at throughput.

Tip #4: Help Out

The nurses in the department are busy and overworked. You can say that again!

Being chronically understaffed is all too common. This means nurses are often behind in their assessments, procedures, medication administration, and charting. This can seriously impact throughput as well as patient satisfaction and worst of all, patient outcomes.

As the charge nurse, you will need to find time to help out your nurses wherever they need it. You may need to place IVs, transport patients to or from radiology or the floors, obtain EKGs, triage patients, and give medications that are ordered.

Not only does this make you a good team player, it helps the whole department run smoothly.

There’s nothing worse than a charge nurse who seems to sit there and do nothing the whole shift… DON’T BE THAT CHARGE NURSE!

Tip #5: Charge Nurse by Example

As a charge nurse, it is your job to lead by example. You may not have a formal manager position, but your selection as a charge nurse for a shift means that you are the team leader, at least for the shift.

Don’t do one thing and expect another from your nurses. Constantly help out when you can, maintain good rapport with the patients, providers, and ancillary staff, and conduct yourself with professionalism and integrity.

Get my ECG Cheat Sheets!

Everything you need to know on how to read a rhythm strip!

Tip #6: Stay Calm in Crisis

It is so important to stay calm during emergencies and crises as a nurse, but especially a charge nurse.

It will be your job to put out fires left and right, as well as make sure the nurses on your unit handle emergency situations appropriately.

Emergency situations happen in the hospital all the time – it’s the name of the game. But it’s not just life and death that will test you.

Families may be yelling at you because they’re angry or frustrated, and patients will literally be trying to die on you.

Staying calm is easier said than done, but one thing that helps you stay calm is KNOWING YOUR STUFF.

If you know what the policies are, and what to do in specific emergency situations like cardiac arrhythmias or codes, then you will be more prepared. This should give you a sense of calm, especially when these emergencies inevitably arise.

There is nothing more stressful than uncertainty.

Tip #7: Good Team Player

Being a good team player is important for any nurse, but especially a charge nurse. There are many ways to be a good team player.

Be a hard worker and willing to help out other nurses. Don’t expect them to return the favor later, but if they are a good team player they eventually will.

As a person who is in “charge”, it’s important to not play favorites. The nurses will resent you, and you need to be as fair to them as possible. This means don’t give your “besties” easier assignments or fewer admissions.

Always have your teams back. Understand situations from their point of view and give them the benefit of the doubt. Nurses aren’t perfect and do make mistakes, but be sure to support them however you can. Don’t immediately throw them under the bus.

These traits are important for not only charge nurses but any leadership position.

Tip #8: Stay Organized

Staying organized is so important for nurses. Charge nurses have an even bigger need to stay organized, because they aren’t just managing their own patients. They are managing the entire department or floor!

Knowing who has what assignment, which patients they have, and what needs to be done is important. In stressful environments, it can be easy to know you have so much to do, but not even know where to get started.

Staying organized is key. Get there early if you need to, make lists and prioritize what needs to be done. Chart in real-time to avoid the backlog of charting weighing you down and making you more stressed.

Also check out: How to Stay Organized as a New Nurse

Tip #9: Good at IVs and Procedures

As the charge nurse, you will be used as a resource. Your nurses will come to you if they have difficulty placing an IV or other procedure, or if they have never done the procedure before.

It is a great idea for the charge nurse to be great at IVs – because this is a common need on any department, but especially within the ER.

Placing lines and drawing blood work is essential for throughput and good patient care, and excelling at this procedure is a great skill set for the charge nurse to have in their scrub pocket.

Practice, practice, practice. Make sure you know all the IV tips and tricks as well.

Related content:

10 IV Insertion Tips for Nurses
How to Start an IV

Tip #10: Good at Rhythms and Codes

Probably the most stressful part of being a charge nurse is having the pressure of knowing what to do during emergency situations. These are usually intubations, code blues, or other emergent cardiac arrhythmias.

Knowing your cardiac ECG rhythms is so important for every nurse, but many nurses struggle with this. As the charge nurse – you need to be an expert at this as your nurses will be coming to you for advice or interpretation.

You should know all about each drawer of the code cart, the code cart meds, and how to reconstitute them, and definitely know how to use the defibrillator!

This includes knowing:

Cardiac defibrillation
Synchronized cardioversion
Transcutaneous Pacing

You should also be familiar with the basics of how to recognize a STEMI.

If you feel like your ECG rhythm interpretation and cardiac arrhythmia procedure knowledge can use some work, I have a digital course that I think you’ll find super helpful!

If you want to learn more, I have a complete video course “ECG Rhythm Master”, made specifically for nurses which goes into so much more depth and detail.

With this course you will be able to:

Identify all cardiac rhythms inside and out
Understand the pathophysiology of why and how arrhythmias occur
Learn how to manage arrhythmias like an expert nurse
Become proficient with emergency procedures like transcutaneous pacing, defibrillation, synchronized shock, and more!

I also include some great free bonuses with the course, including:

ECG Rhythm Guide eBook (190 pages!)
Code Cart Med Guide (code cart medication guide)
Code STEMI (recognizing STEMI on an EKG)

Check out more about the course here!

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30 Inpatient Nursing Hacks for Med-Surg Nurses

Apr 12, 2021 | 3 comments

30 Inpatient Nursing Hacks for Med-Surg Nurses

William J. Kelly, MSN, FNP-C

Author | Nurse Practitioner

Med-Surg nurses can utilize nursing hacks to their advantage in order to save them time and make their shift more manageable!

Nursing hacks are tips and tricks of the trade, sometimes new and sometimes old, which help “get the job done” quick and efficiently, while still maintaining quality care!

If you’re not using these Med-Surg Nursing hacks, you are missing out!

Urine Hacks
Poop Hacks
Gastric Tube Hacks
PICC Hacks
Blood Hacks
Artifact Hacks
IV Hacks

URINE HACKS

Ok – Med-Surg isn’t all bodily excrement – but you will run into pee and poop this in most aspects of nursing within the hospital.

There are so many poop and pee hacks to read through, you might need to take a bathroom break afterwards.

1. Cough and Wink

It is no secret that it can be difficult to insert a urinary catheter into some female patients.

This is because there is so much variation in each patient’s anatomy, and the patient’s body habitus can make things difficult to see.

Positioning, lighting, and assistance are all important, but sometimes it can still be difficult to hit the mark (in this case – the urethra).

If you are in position and are having trouble finding where to go, have the patient clear their throat and cough. This should cause the urethra to “wink” at you if visible, making your target stand out.

2. Foley²

If you think you know where you’re going, or if you go in blind and end up in the vaginal canal – you may need to try again.

One thing you should NEVER do is take the foley out, and then reinsert the same foley into the urethra (hello UTI!).

Instead of taking out the first failed foley – leave the foley in place in the vaginal canal and open up a new kit, aiming above the catheter within the vaginal canal.

This can help you hit the mark. Second times a charm – right?

3. Beta-Block it Up

No – I’m not talking about metoprolol.

In a foley kit, there should be a betadine swab or stick that is used to clean the area before insertion of the catheter.

After cleaning the area correctly, leave the betadine stick in the vaginal canal. Similar to the double foley trick, this should “block” the vaginal canal.

If you aim above this – this could increase your chance of success! Don’t forget to remove the betadine stick when you’re done!

4. Kerlix It

Every patient on Med-Surg is different, and sometimes variations need to be made!

For patients with larger vaginal canals, you could use a thicker material such as a clean roll of kerlix to essentially “block” the vaginal canal and helping you enter the urethra without much difficulty.

5. Double Glove

When putting on a foley, sterile technique is required to prevent infection.

However, the cleanup once the foley is inserted can be messy, and your sterile gloves will be saturated with lubricant, betadine, and body fluid.

To make it easy, before applying sterile gloves, put on a clean pair of gloves after washing your hands.

Then apply sterile gloves as needed (you may need a bigger size).

Once the foley is inserted and you are ready for cleanup, take off the soiled sterile gloves, and clean up everything else with your second set of clean gloves.

You should be able to secure the foley with these clean gloves as well.

6. TransPeeTation

It’s inevitable with Med-Surg nursing that your patient will need to be transported all over the hospital for tests.

Additionally, they will usually be encouraged to ambulate to keep up their strength and prevent blood clots.

Transportation can be challenging with a foley and the last thing you want to do is have the foley get caught up on something and rip out, so this is where this nursing hack comes in handy!

If your patient wants to get up and walk, tie a glove around an IV pole at a level below the bladder.

Hook the foley onto this glove to use as a portable hook!

7. Purewick

Not so much a nursing hack – but more of a reminder.

Don’t forget that foley catheters are not the only option you have, and they do come with risk as they are invasive and often can lead to infection.

Many hospitals have Purewick catheters which hook up to suction to prevent the patient from lying in their own urine and causing skin breakdown.

This can be a great option for elderly female patients with urinary incontinence.

Also check out: 10 Nursing Hacks Every ER Nurse Should Know

STOOL HACKS

Another unfortunate aspect of Med-Surg nursing – you will have to clean patients up when they poop themselves.

It’s honestly not a big deal, and you will quickly not even think twice about it.

BUT – there are nursing hacks that can help you in some of these instances!

8. Double Glove Again

Foley’s aren’t the only instance where double gloving comes in handy!

When cleaning up a messy poop situation, be sure to double glove or even triple glove with clean gloves!

Your gloves will inevitably become soiled and you will then be able to remove the soiled pair and continue cleaning the patient without issues.

Additionally – imagine if you only had one pair on and one of them ripped. Dead.

9. Shaving Cream Cleaner

We should be checking on our patients often and making sure they do not sit in their own pee or poop for too long.

However, med-surg nursing is busy, and sometimes the poop becomes dried onto the patient’s skin and can be difficult to remove.

Bust out some shaving cream which you should be able to find in the clean utility.

Apply the shaving scream to the crusty poop on the skin, give it a few minutes, and wipe it off with soap and water or cleaning wipes.

It should wipe off without issue!

10. Constipation Cocktail

The only person more concerned with a patient’s bowel movement than you is the patient themselves (better yet – their family members).

If the patient is worried they may be constipated and are hoping to have a bowel movement, you could reach out to the physician and ask for something

If the patient is truly uncomfortable, reaching out to the Provider is the best option.

Another option is to get prune juice, put some butter in it, and microwave it for 20-30 seconds.

This will melt the butter and the prune juice should be warm.

The best part is this often works, there are no significant side effects, and you don’t need an order for it.

Of course, if your patient is having significant abdominal discomfort or nausea/vomiting, you should be reaching out to the Provider regardless!

11. Prolapse Relapse

It was my first week off of orientation as a brand new nurse on a Med-Surg nursing floor, and I had a patient complain of rectal pain.

I checked it out and WOW – that did NOT look right. What I was seeing was my first-ever rectal prolapse.

This specific patient had a history of this from happening, and you can reduce the prolapse as a nurse.

This can be done by applying some lubricant and applying firm pressure toward the patient’s rectum.

However, sometimes large prolapses can be difficult to reduce.

For this nursing hack, sprinkle some sugar on the prolapsed rectum and allow to sit for 15 minutes.

This dehydrates the prolapse, causing it to shrink and making reduction easier.

Get my ECG Cheat Sheets!

Everything you need to know on how to read a rhythm strip!

GASTRIC TUBE HACKS

Nasogastric (NG) tubes are a nursing procedure that is unpleasant but often necessary. This is usually ordered for small bowel obstructions (SBO).

Sticking a tube into the patient’s stomach from their nose allows suction to decompress the stomach, alleviating symptoms such as nausea, vomiting, and bloating.

It also decreases intrathoracic pressure and improves the venous return to the heart when the patient is ventilated, as well as reduces the risk of aspiration.

While NG tubes can really help your patient, unfortunately, the insertion procedure can be somewhat difficult. There are some nursing hacks that you can use on your med-surg nursing floor when an NG tube is ordered!

12. NG Twisted Ice’d Tube

During insertion of an NG tube, sometimes the tube has a tendency to curl in the oropharynx and not enter the esophagus as intended.

In order to help this, curl the distal portion around your finger, and freeze it in ice water for 10-15 seconds. This will help it keep its curled shape.

Insert the NG tube (with lube of course) with the curl in the direction of the pharynx (downward).

Right before the oropharynx, twist the tube 180 degrees. This ensures now that the “hook” is facing posteriorly, and shouldn’t curl out the mouth.

13. Numbogastric Tube

NG tube insertions are uncomfortable for the patient, but once it is in they should get some relief.

In order to make an NG tube insertion more tolerable, you can numb up the area first, and there are a few ways to do this.

You can get a Urojet with 2% viscous lidocaine and squirt it up the patient’s nare in which you intend to insert the NG tube.

Do this 5 minutes beforehand (you will need an order). While this is proven to decrease pain, it can increase the difficulty of the insertion (sticky!). See here for the full technique!

Additionally, 3-4mL of lidocaine (2-10%) can be placed in a nebulizer and given to the patient until gone. Then immediately insert the NG.

While this does reduce pain during insertion, it can increase the risk of epistaxis.

14. The Medication Pulverizer

This one is interesting, but it can make crushing meds for a PEG tube easy!

Open an empty 10mL syringe. Take out the plunger completely, and place the pills inside.

Re-insert the plunger up to the pills, and then aspirate 3-5mL or so of tap water.

Next, plug up the end with a clean gloved finger, and pull back the plunger, creating a vacuum. This should crush the pills inside!

You can then squirt this into a larger volume before administration into the Peg tube.

If you need help visualizing this, check out this quick video!

PICC HACKS

PICC lines are central lines placed peripherally in the hospital setting. These are often placed on patients with very difficult access or those who will require long-term therapy such as antibiotics.

With med-surg nursing, you will have to become comfortable dealing with PICCs: administering medications through them, as well as drawing blood.

Unfortunately, PICC lines can get clogged up which can make either task difficult.

But fear not – there are some nursing hacks that can help!

15. Switching the Positions for You

Whenever you are having a difficult time flushing or aspirating blood from a PICC line, there are some maneuvers that the patient can do which may be able to help.

A central line occlusion can be mechanical (think kinks!), Postural (based on positioning), from medication precipitates, or from small blood clots (a thrombus).

Often, this is positional and simple maneuvers can help with flushing or blood aspiration. Moving the arm position (raising it above their head) sometimes can help.

You can also have the patient turn their head in the opposite direction, take a deep breath, and cough. This can increase pressure and change the positioning of the catheter and lead to successful flushing or aspiration.

16. CathFlo Bro

Sometimes there is a partial or complete occlusion of the central line by a thrombus. You will notice significant resistance when flushing or aspirating (or complete resistance).

In this instance – Alteplase can be used. This is the same medication as TPA given for strokes, but at a much lower dose and intended to remain within the central line.

When there is a partial occlusion, alteplase (also known as Cathflo in this instance) can be instilled into the PICC (2mg in 2mL). Allow to dwell for 30-120 minutes, however long it takes to successfully resolve the blockage.

If there is a complete occlusion (aka you can’t flush it at all), you can use a three-way stopcock, create negative pressure with an empty syringe, and then slowly flush the alteplase through. This can take some time, and make sure you follow your facility’s policies and procedures.

When you have given it 30-120 minutes, aspirate 4-5mL of blood and waste, then flush through with sterile saline.

This can be repeated twice in a row if not successful the first time.

Also check out: 20 Tips for New Nurses In the Hospital

BLOODY HACKS

Blood is something that all nurses will have to deal with in some capacity – especially nurses within the hospital.

Whether our patients are bleeding, we are drawing their blood, or a procedure causes bleeding – it will inevitably get all over.

Of course, nurses should be using universal precautions and hopefully, the bleeding is controlled. However, sometimes it can get messy and be difficult to clean up.

Dried blood can be very difficult to clean, and there are a few nursing hacks that can help!

17. Alcohol Swab

A well-prepared nurse always has alcohol swabs in their pocket.

If you have trouble getting a small amount of dried blood off of a patient’s skin, bust out the swab and start scrubbing.

This is somewhat effective, although soap and water or cleaning wipes will likely do just as well. So this is especially useful for small amounts of blood.

18. Hydrogen peroxide

Hydrogen peroxide can be used to get dried blood out of clothing and off of skin.

When hydrogen peroxide meets your blood, oxygen is created and bubbling/foaming is seen. This breaks down the blood and allows for it to get out of your clothing and off of dry skin.

Following up with soap and water or cleaning wipes is beneficial.

19. KY Lubricant

Lube is useful for so many activities (both in and out of the hospital), but did you know it can also help with blood?

Specifically, it helps get rid of dried blood on the patient’s skin.

Leave the lube in place for a few minutes and then come back and wipe it up. This will usually make the removal of the blood a piece of cake. Ultrasound Gel works too!

ArtiFACTS of Life

Many patients on a Med-Surg nursing floor will have telemetry / cardiac monitoring ordered. This is a great tool we can use to monitor a patient’s heart rate and rhythm, but sometimes there can be difficulties obtaining a good tracing.

Poor tracing of a cardiac rhythm is termed “artifact” and there are many different potential causes.

Artifact can be from excessive patient movement, tremors, or shaking; but it can also be from improper application of the electrodes.

If your patient’s monitor has excessive artifact despite not moving or shaking, try these ECG nursing hacks:

20. Replace the Electrodes

The electrodes could be old and dry, decreasing the conduction and quality of the ECG tracing.

Electrodes should typically be replaced every day.

21. Clean the Skin

Dead skin cells, dirt, and grime can all interfere with the conduction of the ECG.

Before applying the electrodes, try washing the patient’s chest with soap and water or a cleaning wipe.

In a pinch, using an alcohol wipe over the areas in which you are placing the electrodes can help exfoliate the skin.

Allow to dry before applying the new electrodes.

22. Shave it Off

Hair can be a big interference when conducting cardiac activity.

If the patient is excessively hairy in the areas where you need to place the electrodes, you may need to shave them to get good conduction.

23. Change the Equipment

Sometimes the wires or equipment is the problem. Switch out the equipment or wires and see if you get a better result.

24. Remove interference

Electrical signals from other equipment can interfere with the telemetry monitor and cause artifact.

Make sure the wires and telemetry box are not in close contact with any other equipment such as an IV pump.

Make sure the patient’s electrodes are not overtop of a pacemaker or ICD!

25. Make Due

Sometimes no matter what you try, there still may be some artifact. Try adjusting the amplitude and changing the lead view to obtain the best view with the least amount of artifact.

I also have a video course all about how to read ECG rhythm strips, which you should check out if you’re interested!

IV HACKS

Now this is a section that deserves it’s own post, and lucky for you I have one here!

On a Med-Surg nursing unit, you won’t have to put in IVs as much as the ER, but it is still a skill that you will have to use and improve on. Patient’s IVs go bad all the time and they may need replacement.

I will outline some basic hacks here, but be sure to read the full article as well if this interests you!

26. Try Defying Gravity

Use gravity to your advantage! Hang the extremity below the level of the heart (off the bed).

This will cause vasodilation of the veins and increase your target vein! This will make it easier to see, feel, and cannulate!

27. Heat it Up

If Gravity isn’t enough, you can try a nice warm compress or hot pack! This will also cause vasodilation and increase your chance of success

28. Nitroglycerin

You can obtain an order for a small amount of 2% Nitroglycerin ointment to be applied to the area in which you plan to cannulate. This will also cause vasodilation.

29. Blood Pressure Cuff

Using a bedside blood pressure cuff can help you from blowing a vein. Pump the pressure cuff just above the patient’s systolic pressure.

This will prevent excess pressure from the tourniquet, but still enough to engorge the veins.

30. Start Digging

If you don’t see a flash of blood on your first advancement, don’t give up just yet.

Pull the needle and catheter back, re-palpate the vein, and attempt to insert in the direction of the vein again. If the patient can tolerate this, it will prevent extra pokes.

Also check out:

References

NG Tube:

Lidocaine gel as an anesthetic protocol for nasogastric tube insertion in the ED.

Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial

PICC Line:

Central lines: Recognizing, preventing, and troubleshooting complications

IVs:

Facilitated intravenous access through local application of nitroglycerin ointment

Attributes:

“De-Noise move (CardioNetworks ECGpedia)” by CardioNetworks is licensed under CC BY-SA 3.0

Want to Learn More?

If you want to learn more about how to read an ECG and cardiac arrhythmia – check out my ECG Rhythm online video course out now!

It’s specifically designed for nurses, and not only teaches you how to identify each arrhythmia, but also why and how they occur, and what to do about it!

If you’re not ready to take that leap yet but still want to learn more about ECG rhythms – be sure to download my free ECG Cheat Sheet below!

You may also like:

20 Tips for New Nurses In the Hospital

Feb 17, 2021 | 8 comments

20 Tips for New Nurses In the Hospital

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This post may contain affiliate links, which means I get a commission if you decide to purchase through my links, at no cost to you. Please read affiliate disclosure for more information

Lets be real – you can use some tips for new nurses! Nursing school is tough, and actual nursing is even tougher!

There is so much to learn, so much responsibility to have, and so much stress!

Use these tips for new nurses to help you become an organized, efficient, well-liked, and hard-working new nurse!

TIPS FOR NEW NURSES:

1. Get there early

As a new nurse – you still have so much to learn. Unfortunately, you’re probably going to need to arrive at work 30 minutes early to begin preparing for your shift.

They should have your patient assignment ready, and you can begin looking through the chart. Make sure you write down important information like admission diagnoses, their attending physician or care team, when medications are due, and trends in vital signs.

See if they have any upcoming procedures or tests that you need to be aware of. This will help you stay organized. It also gives you more context when you get report from the previous shift.

2. Come prepared

Make sure you come prepared for your shift!

This means make sure you get plenty of sleep and have the mental alertness to care for 4-6+ patients simultaneously!

Additionally, it means bringing your must-have nursing gear. If I ever forgot to bring one of these, my shift was always negatively impacted.

This nursing gear includes:

Related Content: Essential Nursing Equipment for 2021

3. Have a positive attitude

Working as a new nurse is anxiety-provoking and stressful! No matter how stressed you get, make sure to maintain a positive attitude.

A negative attitude will rub off on your patients and on your coworkers. As a new nurse – don’t get into the habit of complaining. This can tarnish your reputation and is not a good look for a new grad.

Now – this doesn’t mean you can’t speak up for yourself or your patients!

Even if everyone else is constantly complaining, make sure you stay positive!

4. Say yes!

One of the most important tips for new nurses is to always say yes!

No – I’m not talking about when they call you in to work overtime. I mean say yes to new learning opportunities.

If someone asks if you want to watch or assist with a procedure – say yes! As a new nurse, there is still so much to learn and so much experience to gain. You will only get this experience by saying yes.

This also looks very good and gives a good impression, because new grads are expected to be eager to learn.

5. Develop your own system

Developing a system is important as a new nurse. Humans are habitual in nature, and once you develop a system, the rest will fall more easily into place.

Write important information down on your patient care sheets so you have quick access. If you don’t write it down – you most likely won’t remember! This is especially true when you are juggling 4-6 patients at a time.

Keeping all your patients straight takes time and experience. So until then – you need to be extra sure to write it down and develop your own system.

Related Article: How to Stay Organized as a New Nurse

Get my Free Nursing Report Sheets!

Use these sheets to write up on your patients and stay organized!

6. Don’t obsess over charting

Getting comfortable with the charting system can take a while. This means charting will take you a bit longer when you’re first starting out.

As nurses, you will have so many tasks and responsibilities to manage at the same time. The thought of all the charting you have to do in the back of your mind is only going to stress you out even more.

Focus on patient care first, and then the charting.

On the other hand, I also recommend real-time charting when possible, especially once you are proficient at charting. This will increase your efficiency.

Even then, pressing patient care matters more than charting, so always prioritize!

Related Article: Top 6 Charting Tips for Newbie Nurses

7. Look everything up

This isn’t nursing school anymore – you’re allowed to look everything up!

Nursing is an open-book occupation!

If there is something you’re not sure of, either ask someone or look it up. There are so many valuable resources that you can use as a nurse when it comes to your patients.

8. Know Which Resources to Use

Don’t just use Google or Wikipedia. There are better evidence-based resources to use as a medical professional!

Most facilities will have an UpToDate subscription. You might even be able to download this on your phone after making an account and logging in at your facility. This can be somewhat difficult to follow, but it has the most accurate up-to-date medical information out there for medical providers!

Other online free resources include:

Drug information can easily be found on Uptodate or Epocrates.

Some great nursing textbooks to have are:

Med-Surg: Medical-Surgical Nursing made incredibly easy
ICU: Critical Care Nursing made incredibly easy
ER: Emergency Nursing made incredibly easy or Sheehy’s Manual of Emergency Care

Make sure to also look at your facility protocols. These are often jam-packed full of great information as well as how your facility expects you to perform certain procedures or handle certain clinical situations, specific to your facility.

Related Article: Top 5 Apps for ER Nurses

9. Don’t be a know-it-all

Humility is so important at this stage.

Even if you’re really smart and did great in nursing school – you have so much still to learn.

Some people overcompensate when stressed by acting like they are very comfortable with everything and already know everything.

This is one of the biggest mistakes to make as a new nurse and one of the most important tips for new nurses.

Letting your pride stand in the way of learning is dangerous to your patients.

Even if someone teaches you something you already know – don’t say “Yeah I know” – just say “thank you”.

This leaves a good impression and lets everyone know that you are committed to learning and becoming a great nurse.

10. Ask for help

Don’t be afraid to ask for help!

If you aren’t comfortable with a procedure – ask for assistance! Nobody expects you to be an expert.

You are a new nurse and you are expected to speak up if you don’t know something. If you don’t – this can potentially harm your patient and you will not learn for the future.

Additionally, if you are drowning and need some help, ask another nurse or the charge nurse for assistance. They will help you as best as they can.

11. Bounce ideas

And speaking of asking for help, another one of the tips for new nurses is to bounce ideas off of each other.

Sometimes you might not be 100% sure what to do in certain clinical situations, but you might not necessarily need to ask the Provider.

Your patient’s blood pressure is high but you’re not sure if it’s high enough to worry? Ask another nurse, preferably one with more experience.

This can save you the stress of calling the doctor for every little thing. With time, you will learn what you can just note or document, and then what you will need to notify a Provider about.

But for now – don’t be afraid to ask another nurse’s opinion!

12. Keep studying

Even if nursing school is over – that doesn’t mean you can stop studying! Another one of the tips for new nurses is to keep studying.

Use some of the resources listed above to read on your days off. Don’t spend all day studying – but always be committed to learning.

That means you need to take initiative and put your continued education as a top priority.

I attribute a large part of my success as a nurse and then as a young NP.

13. Give great report

Learning to give a good report can take time, and not every report you hear from an experienced nurse is the model of what you should be following.

This additionally becomes important when relaying information over the phone to a Provider or specialist who may not be very familiar with the patient.

In nursing school we are taught SBAR, but I always felt like this left some gaps (maybe I just wasn’t using it right).

I modified the SBAR to the IMSBAR. This is perfect to use if the Provider or other health professional is not very familiar with your patient.

This means you need to include the patient’s information, their relevant medical diagnoses, and then the reason you are calling with the SBAR.

You can read more about this here.

14. Delegate appropriately

As a nurse, you now have the responsibility of delegation.

This means you can request certain tasks be completed by other CNAs or technicians, LPN/LVNs, and sometimes even other RNs.

This does not mean that they have to do anything you say, even if they’re below your paygrade. Never have an elitist attitude.

When you delegate, make sure the task is appropriate for their skill level and the patient is stable. Provide any instructions clearly.

15. Don’t be lazy

Make sure you are not delegating tasks that you can easily do yourself.

If you are busy providing medications or are very busy – of course, delegate a task like placing a patient on the bedpan or doing an EKG.

However, if you have the time – just do it yourself. This leaves a great impression and your CNAs and patient-care technicians will appreciate that. They are busy too, and we are a team!

Always have a kind demeanor when delegating, and never talk down to someone – even if they give you an attitude.

If they refuse, delegate to someone else or do it yourself, and bring your concerns to the attention of your charge nurse.

Your hard work will show to your colleagues and Providers, and they will respect that.

16. Take your breaks

Nursing is hard work! Time flies and work can feel like a tornado of stress and anxiety.

Your department should have a system set up where you are entitled to your breaks.

Don’t refuse these. Even if you have so much charting left – take your break, eat your food, and relax as best you can.

Most facilities will give one 30-minute break and two 15-minute breaks for a 12-hour shift.

And don’t chart during your break – use that time to de-wind and get ready for the remainder of your shift!

17. Prioritize your body

Like Megan Thee Stallion says – Body…ody-ody. Take care of your body while you work.

This means use proper body mechanics while lifting patients. It also means wearing compression stockings and wearing comfortable footwear.

Also, don’t hold your bladder all shift. This is a common nursing joke, but your patients can spare the 2-3 minutes it takes to use the bathroom (aside from a code situation).

Anything you can do to decrease the stress on your body is important. If you “just don’t have to pee”, then you are probably not drinking enough water. Make sure to drink plenty of water throughout your shift!

The number of times my pee was the color of iced tea after a hard shift… NOT healthy!

18. Don’t clock out

I mean – obviously, you’ll have to eventually, but what I mean is don’t clock out too early.

It is common to stay late as a new nurse to finish charting. Unfortunately, this is a necessary evil.

But don’t let anyone guilt you or talk you into clocking out before you actually are leaving.

If you are charting – then you are still working! This is one of the tips for new nurses that is important because your time is valuable!

Clock out when you are on your way out the door – this ensures you get paid for all your hard work.

19. Take time for yourself

On your days off – make sure you prioritize yourself and your mental health.

Take a 2-3 day vacation, travel somewhere fun, stay home and relax and read a book (a non-medical book), or go swimming with your dog.

Whatever it is – make sure you don’t devote all your time off to nursing as well.

Sure – continue to spend time learning and studying even with your time off, but make sure you also have plenty of non-nursing time as well!

20. Never feel pressured to work

Once you come off orientation, you will likely be eligible to work overtime.

Management will take advantage of this. Sure – extra money sounds fun, but is it always worth it?

If you don’t want to work OT and you are being pressured to come in to help the department, don’t.

You don’t owe management or your department your time off.

They are responsible for staffing appropriately, and the blame does not fall on you for your coworkers being short-staffed.

On the other hand – if you want to work the OT and get the extra money – go for it! Just don’t burn yourself out too hard!

Do you have any tips for new nurses?

Comment down below to let others know!!

How to Stay Organized as a New Nurse

Feb 3, 2021 | 0 comments

How to Stay Organized as a New Nurse

This post may contain affiliate links, which means I get a commission if you decide to purchase through my links, at no cost to you. Please read affiliate disclosure for more information

Learning how to stay organized as a nurse can be challenging, especially as a new nurse!

Use these 7 Nursing Tips on how to stay organized to help keep you organized and efficient!

How to Stay Organized as a Nurse

The learning curve as a new nurse is super high, and we could all use some tips on staying organized.

There is so much to remember when it comes to all of our patients, and we are expected to know all of their information and often have to recall it in high-pressure situations.

Organization as a nurse takes time and experience, but if you are diligent – you can become that organized nurse that you’ve always wanted to be!

1. Get There Early

On my first day as a nurse, I arrived at 6:50 am bright and early to my new Med-Surg unit – excited to make a good impression.

I walked over to my preceptor and she looked at me and said “you’re late. I’m already getting report. You’re expected to be here at 6:30 tomorrow”.

I had NO idea that I needed to get there so early? But why?

One major tip on how to stay organized as a nurse is to adequately prepare and “read up” on your patients. This takes time, which may mean needing to get there early.

This is especially important on Med-Surg units when you will be caring for multiple patients at once.

Most facilities will have some type of print-out with the patient’s medical information on it including their attending physician, allergies, diagnoses, and their medications.

Using these sheets, look through their medical record for information like:

Why they’re admitted and what they’re being admitted for (Look in the H&Ps)
Their vital sign trends
Their IV access (gauge and location)
Their active orders (diet, activity, code status, etc)
Any other information you deem to be important

If your facility doesn’t have these printouts, or if you prefer to use your own – bring your own!

I always made my own that I would use. You can sign up for my free patient organization sheets here.

Now when you get nursing report from the previous shift, you will have some baseline information to go off of.

Make sure to have space to write down important information that the previous shift’s nurse gives you.

I would say as a new nurse it is important to get there about 30 minutes early to start writing up on your patients. However, as you gain skills and become more proficient, 5-15 minutes early will likely suffice.

Also, understand that you are not getting paid for this time. Being so – it is not mandatory, but it will help your shift go more smoothly.

Quick note: What worked well for me was briefly reading up on my patients, looking at their vital sign trends, and their main admission diagnoses.
I would get report, assess each patient and pass meds, and then when I got time later on I would read more deeply into the H&Ps, writing down important information to pass along to the next shift.

2. Learn To Prioritize

Learning to prioritize is essential in figuring out how to stay organized as a nurse.

As nurses, we have so many tasks that we need to accomplish, and figuring out which order to do them is can mean the difference between life. That seems extreme, but sometimes can be true!

First, prioritize which patients you should see first.

A patient that has more unstable vital signs or more serious diagnoses should be bumped to the top of your list.

You should probably see the patient with CHF on Lasix and oxygen before you are seeing the patient with a broken hip who was recently medicated and is comfortable.

See those who are “more sick” before those who are “less sick”.

This is because those who have more serious diagnoses are more likely to decompensate.

Seeing them quicker can mean faster intervention and prevention of poor outcomes.

Also make sure you are prioritizing your tasks.

Sure – everyone needs to be charted on and their care plans completed, but making sure medications are administered in a timely manner is likely more important.

In the hospital – unexpected situations are inevitably going to occur.

Maybe you need to take a quick pause on your charting to go give pain medication to a patient who is requesting it.

Assessing a patient who is hypotensive takes precedence over giving your other patient their bedtime pills.

Learning to prioritize and being flexible will help you learn how to stay organized as a nurse, especially within the hospital.

3. Make Lists

In order to prioritize tasks, you actually need to know which tasks need to be performed.

As an experienced nurse – this can become second nature. However, as a new nurse – you are prone to forgetting or missing something.

Since it is so new, you need to write it down to make sure you do everything correctly.

I would always have checkboxes on each of my sheets for each patient. These checkmarks would include:

Assess
Chart
Medicate (with times ordered i.e. 9pm | 12am | 5am)
Care Plan
Rhythm Strip Interpretation

As a new nurse, you will inevitably be task-oriented. This is unavoidable and ensures that all of your tasks get done.

Once you gain experience, you will improve your critical thinking skills, and completing your tasks will become second nature.

4. Real-Time Chart

I know I said to prioritize medication passes and urgent assessments over charting – and that holds true!

But something that made me an efficient nurse is real-time charting!

Essentially this means right after I saw my patient and assessed them, I would park my computer-on-wheels right outside their door and quickly chart my assessment.

This only takes about 5 minutes while the assessment fresh your mind.

As a new nurse, you will forget to assess certain things that are important to assess! If you real-time chart, you can easily just walk back in and complete your assessment.

This does not take as much time as you think. If you have 6 patients, that’s only about a total of 30 minutes of charting.

Anecdotal Note: I would start assessing and charting my patients after getting report around 7:30, and move onto the next patient.

Once 8pm hit, I could medicate my patients for their night-time med pass. I would assess, medicate, and then chart.

Finally, I would double back on the initial patients to medicate them. This means all my patients would be assessed, medicated, and charted on by 10pm.

This leaves the rest of the night for any admissions, to hourly round on your patients, answer call bells, and perform the other tasks needed like care plans and reading up in their H&Ps.

Related Article: Top 6 Charting Tips for Newbie Nurses

5. Investigate Before Notifying

Another aspect of how to stay organized as a nurse is doing proper investigation before notifying a Provider.

This improves the communication and ensures the patient gets what they need. It can also help avoid a negative interaction with a Provider – which we all know can put a damper on the shift.

Learning to organize your thoughts and relay your concerns to the Provider is not inherently easy. The added pressure doesn’t help!

Make sure to investigate any anticipated questions they may ask. Some examples include:

If you are calling about high blood pressure, make sure you write down the BP trends, what they are taking for blood pressure, and if anything had needed to be given for high BP before.
If you are calling for additional pain medications, make sure you have an adequate assessment of the pain (new or chronic, location, radiation, etc), what they are currently getting for pain, any PRNs or previous medications given for pain, etc.

Make sure to include any recommendations you may have. Make sure to use a proper SBAR format.

“SBAR” always left me a bit confused and wanting more, so I made up an “IMSBAR” format which you can read all about here!

Related Articles:

6. Stock Up

Learning how to stay organized as a nurse also means always being prepared for whatever can happen. This means having the right equipment at the ready!

Important hospital equipment to stash in your pockets include:

10mL saline flushes
Alcohol wipes
Medical Tape
4×4 gauze

Important equipment that you should be bringing to work and have on you include:

It may be a good idea to also carry with you a bottle or two of lotion or barrier cream, so you’re not always needing to run to the clean utility room.

Having all this equipment will save you time and make you more efficient and keep you organized.

Related Article:

7. Know When You’re Actually Working

Knowing when you’re working is an important aspect of how to stay organized as a nurse.

I would be lying if I said I never got a call saying “where are you – you’re on the schedule for today”.

I use Nurse Grid to keep track of my schedule. This app is specifically for nurses. What I love is that you can see your colleague’s schedules as well and even request a shift-switch within the app itself.

It’s simple and yet functional. Whatever app or calendar you use – make sure you always know when you’re working!

Related Articles:

Hopefully, you found some of these tips helpful when searching how to stay organized as a nurse! Are there any other tips that have helped you? What other areas do you struggle with?

Let us know in the comments below!

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Nursing Do’s and DONT’s of 2021

Jan 18, 2021 | 2 comments

Nursing Do’s and DONT’s of 2021

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The field of medicine is always changing and there is always so much more to learn. As time passes and nurses gain more experience, we should always be updating our practices!

Check out these nursing Do’s and Don’ts for 2021!

Don’t: Assume a Respiratory Rate

You laugh – but I’m serious! It has become WAY too common for nurses and nursing assistants / PCTs to just “make up” the patient’s respiratory rate. It’s easy to do, and does the respiration rate even matter? Well… YES!

With COVID, the respiratory rate matters now more than ever. The pulse ox shows us a patient’s oxygenation, whereas the respiratory rate shows us their work of breathing.

A normal respiratory rate is 12-20 rpm. A patient with a pulse ox of 98% could have a respiratory rate of 34. Without realizing or counting, this can lead to improper treatment until the patient fatigues and the SPO2 actually drops.

We are seeing TONS of COVID patients come through the ER. We always check their pulse ox and their respiratory rate. If they are hypoxic or too tachypneic – these patients will likely need to stay within the hospital on oxygen.

Respiratory rate is also super important in people with potential cardiac or pulmonary disorders like asthma, COPD, or an active CHF exacerbation.

The respiratory rate is also important for accidental or intentional overdoses, as many medications like opioids can cause respiratory depression.

An increased respiratory rate can also be secondary to metabolic acidosis! The patient may be trying to breathe off extra CO2 to compensate for the acidosis – termed respiratory compensation.

Long story short – the respiratory rate is an important vital sign, and just assuming it is normal can be detrimental to the patient. This is dangerous, let alone illegal to fraudulently chart a vital sign that you did not actually obtain.

Related Articles:

Do: Learn to Give Great Report

Part of what makes a nurse a great nurse is their ability to communicate effectively. Nurses constantly need to communicate to their patients, but maybe more importantly to their fellow nurses, ancillary staff, resident and attending physicians, and APPs.

Learning to give a good hand-off report takes practice, and it can be difficult because nursing school doesn’t really teach you how to do it, at least not well. Sure – they talk about SBAR, but I never found it super helpful, especially when giving hand-off report to fellow nurses.

Something that I use myself I call IMSBAR. This is what I use for my phone report to physicians, but it can work well with modifications to giving patient hand-off as well!

IMSBAR essentially adds some important patient information before launching into the meat of the reason for calling. For use over the phone, this includes:

Introduction: Introduce your name, title, where you’re calling from, and who you’re calling about including their name and room number
Medical History: Relevant and “big” past medical history including diabetes, hypertension CAD with stents, Afib (on Xarelto), etc. Include history relevant to the current admission.
Situation: Why are you calling? Does the patient need a medication? Is there a change in their status? Is there a critical lab result?
Background: Elaborate on the background information regarding the situation. If you’re asking for pain medication, where is their pain, is it new or changed, when was their last pain medication, and did it help? Do the preliminary investigation work to help the Provider make a decision on the management of the patient.
Assessment: Give a quick focused assessment of the patient. If they’re short of breath, what do their lung sounds like? What are their current vital signs?
Recommendations: Do you have any recommendations that you think might help the patient?

This can also be modified to give a clear and concise patient hand-off report. This will obviously be different depending on which unit you are in, but as a basic guide:

Introduction: List the patient and room number you are reporting on
Medical History: List relevant medical history – can be more detailed if inpatient with a full list of history
Situation: Why was the patient admitted and what are they being treated for?
Background: What has occurred since their admission? Are they waiting on any tests?
Assessment: Any physical assessment abnormalities? Vital sign trends? Lab result trends?
Recommendations: Give any recommendations or anticipations that you may have regarding the patient, and include any other info that you find pertinent.

Related Articles:

Do: Update Your Patients!

And speaking of communication, start communicating with your patient and their families!

Some nurses are great at this, and others need some work.

At least within the ER, keeping your patient updated can make a HUGE difference in their satisfaction. Most patients become impatient when waiting for hours for any type of update.

And let’s be real – most physicians and APPs are not the best at keeping their patients updated either! This can be frustrating for patients and their family members.

Try to let the patient know what the holdup is for. Are they waiting for CT because there’s a line? Do they have to wait for a 3-hour troponin before they can be discharged?

I always try to explain from the get-go what the workup is going to be, and even how long it may take. But never speak in absolutes because as you know – things almost never work out like they’re supposed to in the hospital!

Do: Update Your iPhone!

Or Android… if you’re into that.

What I mean is – there are some GREAT apps out there to use as medical resources.

We are medical professionals – we should not be resorting to google or WebMD to help us take care of patients! There are so many evidence-based resources that we can actually use!

My all-time favorite is UpToDate. This is perfect for physicians and APPs, but I would argue that reading on UpToDate can help make you an excellent nurse.

You can look up specific information on drugs or medical conditions like clinical manifestations or treatments. UpToDate isn’t free though, but many institutions offer it free to their staff! You just need to login on your institution’s internet every 3 months or so!

WIKEM is a great quick reference for all things emergency medicine.

FP Notebook offers quick and comprehensive information as well, in bullet-style notes!

Another non-medical resource app that I LOVE is Nurse Grid! It helps me keep my schedule organized, is color-coded, and lets me see who else I am working with!

Related Articles:

Do: Update Your Knowledge!

As I always say – medicine is always changing, so we always need to stay updated! There is so much to learn.

Nursing school teaches you the basics, but it’s on YOU to take the initiative and keep learning!

I recommend taking digital courses online to help you with knowledge and skills that you want to be comfortable with!

Some of my favorite online courses are:

FYI: I have an ECG Rhythm course for nurses coming out in February! Be sure to sign up for the interest form so you can be notified when it drops!

Don’t: Neglect Yourself!

As nurses, it is TOO easy to neglect our own health and well-being as we are so focused on the health of our patients, and then on our families once we finally get home!

The nursing field is TOUGH – it’s stressful with long hours, high-stress environments, and you are constantly blamed for things that seem out of your control. AND add the pandemic to it all!

Nursing Burnout is a HUGE deal and happens to so many of us – myself included.

In 2021, make yourself a priority! Focus on your own health. Here are some ways you can focus on yourself:

Diet + Exercise: Make lifestyle modifications to your diet or exercise patterns (or lack thereof!). I’m doing KETO because it’s worked for me in the past, but do any diet or lifestyle change that you can stick to and is healthy!
Take Time Off: Use your PTO to relax and focus on yourself and your relationships! Take that trip to Disney (I’m obsessed), travel Europe, relax on the beach in the Bahamas, cruise the open sea!
Change your Mentality: Realize that money isn’t everything. Your quality of life is more important than any amount of money you can make. If you are breaking your back picking up overtime left and right – you will burn out! Sure, money is important and we all have bills (and giant amounts of student loans), but if you are miserable – make a change! I started working Part-time this month to focus on myself and so far – so SO good!
Pick up a new Hobby: Dive into an old hobby, or pick up a new one! There is so much more to the world than work, money, and medicine! Exercise the other side of the brain and get your creative juices flowing! No – drinking alcohol doesn’t count!
Stay off Facebook: Yeah… self-explanatory. Besides… all the cool kids are on TikTok nowadays 🙂

It’s not easy to admit, but at the end of the day, we’re all replaceable in the eyes of our employers. You need to put yourself first so that you can help your patients!

As Rupaul says “If you can’t love yourself, how in the heck are you going to love somebody else?” Now can I get an amen!? That love starts with self-care!

And those are the “insert title here” for 2021! Do you have any New Years Nursing resolutions? Drop them below in a comment!

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