Author: Renee Thompson

Safe Nursing Practice – Part 2

The article written by Sally Austin titled, “Safe Nursing Practice” provides tips for nurses that they can apply immediately into practice.  Last week we talked about strategies to make sure we are practicing safely – using the nursing process, administering medications properly, monitoring for and reporting deterioration, and communicating effectively.  This week we continue focusing on how we can practice safely.  Follow the next principles outlined in the article: 5.     Delegate responsibly – Nurses are notoriously known for not delegating.  We try to do everything ourselves either because we think we need to, don’t know how to delegate or because we are “too busy” to delegate.  However, to provide safe, effective care, we must learn when and what to delegate.  Unlicensed assistive personnel (UAL) are typically the nursing assistants working with you.  Utilizing their help is important but you need to ask understand the 5 rights of delegation – right person, right task, right circumstances, right direction and right supervision. 6.     Document in an accurate, timely manner – A few blogs ago (check it out) I talked about the importance of documentation.  I know we are so busy but we have to find a way to document what we do to protect patients.  It’s both a legal issue and a quality one.  Accurate, thorough nursing documentation can demonstrate the value we bring to patient care. 7.     Follow facility policies...

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Evidence Based Nursing Practice

This blog was written by Carol Adams, a fellow nurse.  Carol is a DNP student at Waynesburg University.  She is passionate about the role of the nurse in evidence based practice.  Thanks Carol!! Evidence based nursing (EBN) has its roots in the same foundations as medical evidence.  It is defined as “the practice of nursing in which the nurse makes clinical decisions on the basis of the best available evidence, his or her own clinical expertise, and the needs and preferences of the patient” As well as helping  to develop  a better understanding of a patients conditions and treatment methods. (The free medical dictionary, 2010). The process of EBN always begins with the desire to find the best answers available to meet the needs of our patients while providing the highest quality and most efficient nursing care possible.  However in order to actively practice EBN, as practitioners, you must first understand the concept of research, how to evaluate the research and apply it.  EBN can be broken down into five steps (aka “the five As”):    ASK:  Information needs identified from practice are converted into focused, structured questions through the use of the question building process known as PICO (the patient/problem, the intervention, the comparison and the outcome). ACQUIRE:  The focused questions are used as a basis for literature searching in order to identify relevant external evidence from research....

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Safe Nursing Practice

Safe Nursing Practice I read a great article in Nursing2008 Titled, “Safe Nursing Practice”.  This article details how to deliver care that conforms to the standards of practice.  I found it to be so simple even in today’s complex environments.  According to Sally Austin, 8 key principles can keep you and your patient’s safe: 1.     Follow the nursing practice – Assessment, diagnosis, planning, implementation, and evaluation.  Believe it or not, this is your roadmap to great nursing care.  Don’t take short cuts.  It’s the nursing process that is our gift to healthcare.  Use it.  Embrace it.  Own it! 2.     Administer medications properly – Every nurse I know, including myself, fears making a med error.  Understanding the medications you are giving, any labs you need to check before giving, why you are giving them and what you expect as a result is crucial for all nurses to consider.  Also, the number 1 reason for medication errors is distraction.  Don’t allow yourself to be distracted when preparing your meds. 3.     Monitor for and report deterioration – Do you know what your patient is at risk for and are you anticipating that risk?  How would you know if your patient was having that complication? Focus your assessments specifically on their risk.  Are you monitoring labs?  Remember, it’s not one lab value but rather the trending up or the trending down that provides valid information....

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Owning your practice

There is a difference between “owning” your practice and “renting” it.  How do you tell the difference?  The “renter” walks past a patient’s room with their call bell on and says, “Not my patient” as she walks away.  As professional nurses, we need to own our practice and take responsibility for the role we play in the delivery of healthcare.How do you own it?  Here are some tips:Take your role seriously Nursing isn’t easy.  It’s one of the only professions I know that it is NEVER about you.  You are always asked to sacrifice for the sake of your patients, your colleagues and your organization.  Owning your practice involves knowing that it is about your patients – not about you. Nurses are responsible for human lives – not machine parts, hamburgers, or even money but human lives.  Never forget that the decisions we make on a daily, hourly and moment-to-moment basis impact lives.  This demands a serious approach and a serious commitment to always be practicing according to quality and safety.       Be a part of the solution So often I hear nurses complain about what’s wrong with the system – they complain about pharmacy, other nurses, administration, physicians and even patients and their families at times.  Just think if all of that energy wasted on complaining was invested in coming up with solutions.  Nurses are in the...

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Weekly Tip for new nurses: Time Management

Greetings Here is your tip for the week: Time management: This is definitely a skill that can be learned if you work on it.  The most important aspect of time management is in planning.  Even in the unpredictable environment of healthcare, there are still things that you can plan.    Tips: After getting report, spend 5 – 10 minutes planning your day.  Ask yourself, “Who should I see first, second, third, etc?”. For each patient, think in terms of why are they here?  What are they at risk for?  How would I know?  What do I need to do to prevent complications?  Thinking this through as part of your plan for the day can really help you anticipate and prepare for issues. Get into habits (knowing that sometimes things change).  I always saw each patient, introduced myself, told them the plan for the day and asked if they had any issues that needed to be addressed immediately. Then I would start rounding.  I would start with the first patient and do all assessments, give meds – until I saw all patients, then document, check for orders, check labs etc.  Once done, I would start all over again with the first patient.  On my second rounds, I would do the little things that weren’t necessarily a priority at first – check for patent IV, redress messy IV site, wound care, pt education, etc. ...

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Making a great first impression

It takes 7 seconds for somebody to make an impression of you the first time you meet.  As a professional nurse, we are constantly meeting new people: patients, their families, new physicians, new nurses, ancillary staff, etc.  How you introduce yourself, what you wear, what you say and how you say it during those first few moments will determine their confidence in you as a professional nurse.  To make a good first impression, follow these 5 steps: 1.   Be on time – You will lose credibility immediately by arriving late for a meeting, appointment, or even when you tell a patient when you will return and you don’t.  It can build or destroy trust with your colleagues and your patients. 2.   Dress professionally – Are you inspiring confidence in your patients and the other members of the healthcare team but what you are wearing?  When working as a professional nurse, not only are you representing yourself but you are also representing the nursing profession.  Consider the following: a.     Uniforms should be clean and pressed (avoid cartoons and “hoodies”) b.     Hair conservative, clean and “normal color” c.     Make-up and jewelry minimal d.     Nails clean and reasonable length e.     Clean shoes 3.   Maintain good eye contact – Looking at the person you are talking with implies that you are interested in them.  It makes them feel important, projects openness and keeps their attention. By not...

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Weekly Tip: Nursing Documentation

Nursing Documentation: Whether you document electronically or on paper, documentation of patient care is a priority.  However, nurses constantly complain about spending too much time documenting and not enough time with their patients.  Let’s first look at the importance of documentation.  We’ve all heard the comments, “If it wasn’t documented, it wasn’t done”.  This is true but if you truly documented every single thing you did in a day, it would take you another whole day!  So the goal is to really prioritize your documentation.  What is a priority?: 1.  Assessment – A thorough assessment is the value nurses bring to patient care. It drives treatment, demonstrates patient improvements and identifies deterioration.  A thorough documentation of patient specific assessments is where you need to be spending most of your time.   2.  Follow-up issues – Any time you indicate a problem, it is critical that you document proper follow-up.  For example, you note that a patient is short of breath, pulse ox of 90%, resp rate of 24 and has crackles 1/2 up bilaterally.  You contact physician who gives you an order for Lasix 20mg IV and increases oxygen to 4 liters.  It is critical that you document (lung sounds, resp rate, pulse ox, urine output, etc) your follow-up assessment until you indicate that the patient is back to baseline.  Time saving tips for documentation: 1.  Chart in the room – Either with a computer on wheels or a paper chart,...

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Structural Empowerment

Structural Empowerment Structural empowerment is a term that refers factors in the environment that promote your ability to be effective:  Opportunity, information, resources and support. Knowing how challenging it can be to keep up with the demands of your role, find ways to identify each of these factors while at work.  Let’s start with support.  At the beginning of each shift, grab yourself a partner – another nurse that can partner with you throughout your shift when you both need extra help.  You can cover each other for breaks and lunch, help each other out when your assignment gets crazy, and tap into each others strengths.  For example, when I worked on a cardiac step-down unit, we drew our own blood gases and inserted IVs.  I was really, really good at both.  However, I always (and still do) struggled with chest tubes.  So, anytime a patient would need an IV or blood gases drawn, I would do them (helped my colleagues and it was better – more effecient for the patients).  And if I had a patient with a chest tube, one of the other nurses (it was her strength) would come in with me and do my assessment with me.  Win-win. How can you start to incorporate this type of partnerships with the nurses on your unit?  What can you differently that will move you towards structural...

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Celebrating Nursing

You just never know when paths will cross and you will meet an amazing human.  I met Judy Starr in a classroom at Waynesburg University located in Western Pennsylvania.  Judy was taking a Community Nursing course as part of her RN-BSN program.  I was her instructor.  A requirement of the course was to complete a service project in the community.  Judy and her husband decided to meet with mission leaders at a Spanish immersion school and were matched with Leonardo’s Home of Hope – an orphanage in Honduras.  They were looking for nurses and physicians to support their mission trips and as a couple, they decided to go. They joined the trip in Aug 2008 for the medical mission purpose, and met the children of the orphanage.  Being a pediatric nurse, Judy was more interested in the children of the orphanage than anything else. Their pure joy and happiness to meet new people came through their smiles.  Although she had met the requirement of the course, Judy and her husband continued their support of the orphanage.  The trips reinforced her desire to stay a ‘hands on’ nurse. She enjoys the interaction with patients and families (albeit not always pleasant) but part of bedside nursing. Judy’s mission experience has prompted her to pursue travel nursing as another way to spread her competence, care and compassion. The connection with the children...

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Today’s healthcare environment is very different from when I graduated over 20 years ago.  Back then we had time to do the little things that made us feel human – pm care, real patient education, and even an occasional “hanging out” with patients and their families. Now, nurses find themselves in a whirlwind of increasing demands, technology and patient acuity.  Not only is being competent in delegation more important than ever – it’s a matter of survival.  Yet it is a skill that most nursing professionals identify as our biggest weakness. So, what are we going to do about it?  We need to start learning the “skill” of delegation.  We will start looking at delegation and begin the steps to mastering this critical skill.  I invite you to share any tips that work for you – chances are, they will work for others. Delegating to nursing assistants:  Many nurses find it difficult to delegate to nursing assistants that are older than them or have been there for a longer period of time.  I know some of them can be intimidating but delegation is a skill that you need to master.  Most new graduate nurses and even seasoned ones struggle with this skill so you’re not alone. Here’s a tip:  Avoid using the phrase, “Can you do me a favor”.  It implies that it really isn’t their job and that they are just...

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Renee Thompson
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