“How can new nurses get to the top of their game?”

Shutterstock | wavebreakmedia

It probably comes as no surprise to you that we’re all about nurses helping nurses—from professional advice to emotional support to everything in between. 

That said, we understand that quality care is a team effort, and when members of that team communicate openly, honestly and constructively, you’ve got yourself a whole that’s greater than its parts.

Below, Kati Kleber capitalizes on the relationships she’s developed with mid-level providers and physicians in various roles to gather advice for new nurses that’s (here’s the kicker) not necessarily from other nurses. The goal? To pinpoint potential stumbling blocks and provide counsel that’s rooted in slightly different yet deeply interconnected perspectives. And also, no doubt, to demonstrate that staff-wide feedback isn’t just helpful—it can help build bridges, too. 

One of the things that I love about being someone’s nurse is that I’m in charge. I’m calling the shots (ha!), and other than the 10 minutes that the doctor is at the bedside, I’m the boss. Nurses have so much autonomy now. When your critical thinking skills are on point, you know all your resources and you feel confident in what you’re doing, you are…well, a rock star.

I love that there is so much I do and initiate because of my personal nursing judgment. I love when other nurses and physicians come and ask me, “So what do you think? What should we do?” Or when I catch something, call the doc and suggest something, and they’re like, “Hey, great idea!” or “Good catch!”—that is some serious job satisfaction right there.

So how do you get there? If you’re a brand-new nurse, getting to that point seems impossible. Well, it absolutely is not. You will get there. I believe something that’s important to becoming an awesome, safe and confident nurse with sharp critical thinking skills is knowing your weakness. I think we need to be aware of things we aren’t so hot at so we can…well, be hot. (Hee hee.)

I have a few mid-level provider and physician friends who work in different areas of the hospital. I highly value their opinions because not only are they great providers, but they’re also highly respected by the nursing staff. They know how tough our job is and know they need us on their team. Because of their keen understanding of nursing, I asked them the following questions:

What are some common mistakes that newer nurses typically make?

What do you wish all of your nurses knew?

I asked this because we, as nurses, can ask and answer these questions with each other and get similar answers, but I think it’s important to ask the same questions to people who are not nurses. We need to ask the non-nursing members of the healthcare team this question to ensure we are at the top of our game, because we work so closely with other departments and members of the healthcare team. Below, I have paraphrased their answers.

1. Using PRN medications incorrectly. For example, if Ativan is ordered and the indication is listed as “seizures” and the MD rounds to see what PRN meds they’ve received in the last 24 hours, and they got two doses of Ativan for agitation and they’re zonked, it’s not appropriate. So make sure to check your indication for the med before you use it. Also, legally speaking, you can’t use a med for something other than its indicated use. Just because it’s listed as a PRN doesn’t mean you can use it whenever you want. You must use it for its indicated use.

2. Giving a definitive time for when the doctor will round. As we know, lots of unpredictable things can occur during the day. The same is true for MDs. They may intend to round at 1400, but they’re also first call and have an emergent case and can’t round now until 1700. A good rule of thumb when you get that dreaded “When will the doctor be by?” question: Always let them know the general time they round and then add that “if an emergency occurs, it could be much later, so it’s difficult to predict.” That’ll cover both of you. I also say to the families that if for some reason they’re not there when the doc comes by, I’ll ask the doc to call a family member with an update.

3. Not painting the same picture as the MD. Death/dying/poor prognosis conversations are tough and you want to be consistent with the groundwork they’ve laid. I’ve screwed this up before and felt terrible.

Personal story from my first year: I got a stroke pt from the ED. The MD told the fam how dire the circumstances were. I didn’t read his note and I just went off of the small amount of info I knew about stroke recovery to educate the family. I gave too much hope after the doc had already worked really hard for them to understand their mother was essentially dying. I undid all of that. I gave this poor mourning daughter a tiny speck of hope that she clung to when I should have just said, “I’m so sorry” and comforted her.

I suggest reading notes if you can’t touch base with the doctor or if the previous RN is unsure about plan-of-care goals. You don’t want to undo work they’ve done or confuse the family. Also, if you disagree with the way the physician is handling it (which is totally okay and happens sometimes), talk to your manager and see what to do next.

4. Have mutual respect for the entire care team. If you’re a jerk to CNAs, transporters, pharmacy…everyone, including the doctors, notices that. It doesn’t make them think you’re a good nurse; it makes them respect and trust you less.

5. Maintain professionalism. Nurses and techs joke around a lot in the nursing station and it can get kinda dicey. Sometimes docs do, too, but know when to pump the brakes. Talking about needing personal scripts in front of a doctor who’s your coworker is an unwritten, never-ever-do-that rule. So if you need your ADHD med refilled or your PCP didn’t listen to you when you said you really needed something to relax, don’t vent about it in the nurses’ station within earshot of your physician coworkers or patients/families. It’s awkward and unprofessional, but that line can get easily blurred when everyone is having a good time.

Also, joking around is good because it does foster a fun work environment, but know when to get serious or do something quickly. If you’re having a laugh with a doc while they’re putting in orders for STAT labs, you need to stop joking and go get the labs. Patient care is always, always the priority, which can be easily forgotten when everyone’s having a good time. We’ve all been there; just notice when you need to get down to business.

Doctors, techs, non-nursing members of the healthcare team—what else would you want your newer nurses to know?

To read more, visit NurseEyeRoll.com.

Becoming Nursey: From Code Blues to Code Browns, How to Take Care of Your Patients and Yourself talks about how to realistically live as a nurse, both at home and at the bedside…with a little humor and some shenanigans along the way. Get ready: It’s about to get real, real nursey. You can get your own copy at NurseEyeRoll.com, Amazon or Goodreads (ebook).