Tag Archives: new grad

Dealing with difficult docs using SBAR

SBAR

Before I start an “us” vs. “them” war, let me start off by saying that I cannot imagine the pressure that physicians are under these days. They go for long stretches with no days off, work very long hours, have tremendous responsibility and, basically, have a job that I would never ever ever want. So, with that said, it is understandable that you will, at times, deal with a difficult or demanding physician. These tips about SBAR and effective communication should help!

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Managing intracranial pressure (ICP)

ICP

Taking care of patients with neurological injury means managing their intracranial pressure, or as it’s commonly called, ICP. And when we say neurological injury, keep in mind that we’re not just talking about people getting bonked on the head with a 2 x 4. We’re talking about space-occupying lesions, hydrocephalus, intracranial hemorrhage, subdural/epidural hematoma, even severe hyponatremia…basically anything that’s a key player in (drum roll please….) the Monro-Kellie doctrine.

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Surviving Night Shift

Night Shift

If you’re like me, your 4th semester preceptorship is on night shift and you have no idea how you are going to survive. Even if you snagged a fabulous day shift precept spot, chances are you’ll be a night shift nurse as a new-grad anyway….and knowing how to survive could mean the difference between loving your job and absolutely dreading it. With these tips, you’ll be rocking night shift like a pro!

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Idiot-Proof your Patient

One of the most useful skills you will utilize as an RN is organization. In fact, if assessment is your King-Daddy skill, then organization is a close second. An organized, orderly room is a much safer (and more pleasant) place to be than a chaotic mess. One of the things I like to do is something I call “idiot-proofing” my patient. This has nothing to do with the intellectual capacity of my patient, but more to do with setting things up so that anyone (ANYONE) could walk into my room and know what’s what. Here are a few things I do to make sure that if someone walked into my room while I was away, they would know what they need to know:

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The Metaphor of Illness

This is Marda*
I had been a nurse in the ICU for about two years when I received report on a patient with end-stage metastatic lung cancer.  She was approximately 25 years old, married, and the mother of three young children.  The patient, referred to by the alias Marda*, had come into the emergency room the day prior complaining of shortness of breath.  At the time of this writing, I do not recall if the cancer diagnosis was new, but my impression of the day’s events is that this woman and her family were blindsided by the news that there was nothing more that could be done.  The damage to her lungs was extensive, and the cancer had spread to her liver, brain, and lymph nodes.

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My ultimate “to-do” list

For the past couple of years I’ve used post-it notes to write out my daily to-do list…but then I bought a laminator and decided to make something reusable and stylish! So, without further ado, here is my new and improved (and reusable) to-do list for the ICU. I’ll use a wet-erase marker and it won’t smudge and will come clean easily at the end of the day. Plus, the chevron pattern is just too darling…if nothing else, it will make me smile in the middle of my 12-hour day 🙂

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