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:
- 5 Vital Sign Errors to Avoid
- Arterial Blood Gas (ABG) Interpretation
- These 8 COVID nursing tips could save your life
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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It’s kind of concerning that respiratory rate is glossed over and not taken seriously – obviously this isn’t true for a lot of nurses, but if it’s true for just one then that’s a gateway into medical errors and future lapses in judgment. If caregivers are fabricating respiratory rates, what else are they making up? Nothing taught in professional school, at least related to a physical exam and history, is meaningless, especially not respiratory rate, so it should certainly be acknowledged as is done here.
I completely agree! We should never be fabricating numbers within the medical record. This is a fraud – not to mention dangerous! I think the issue is that if the patient “seemed to be breathing normally”, then they just estimate a normal rate. This will lead to errors and misses, and should definitely be avoided. Unfortunately, this is more common within nursing than you’d think.