Things I Learned As A New Grad Nurse (Part 2)

This is part 2 to my first tips for new grad nurses. I know healthcare can be both exciting but also stressful. To help those that are new to the field, here are my tips.

01 IV insertion Before inserting an IV, get everything set up. Open/spike your fluids, make sure cap is untightened, make sure bandage/securement device is easily accessible.

02 IV Insertion When inserting an IV, make sure to anchor down vein with other hand so you’re not “chasing it” and digging.

03 IV Insertion If all of the patient’s veins are curved/squiggly, you can stretch the vein and straighten it out prior to IV insertion. Keep tension until the catheter is inserted. The IV catheter will then maintain lumen and direction of the vein.

04 Dialysis Patient Tip Sometimes we have a patient admitted in the hospital who also has to go to dialysis. Don’t be alarmed if their BP is lower after dialysis and all of the fluid “taken off.” They may also have labored breathing due to this.

05 Nasogastric Tubes (NG) NG tubes are used with patients who have a small bowel obstruction. This helps heal the bowel as there is nothing going through it plus helps with nausea. Even if a patient is NPO, the stomach still produces bile, this is where intermittent wall suction and the NG comes into play to give the full rest.

06 NG Tube These are almost always placed on low wall intermittent suction (LWIS). And you must ALWAYS assess the site for placement/placement at the nare. Patients are oblivious to the movement of this 9.5 times out of 10. You must get this number in report. Some people are not good at charting this or reporting this off. And you HAVE to know as is this moved, the patient is at risk for aspiration.

07 NG Tube Placement When inserting an NG, have the patient drink some water. Coughing can help as well but coughing can also “cough it up” and into their mouth as well. Once this is inserted, obtain a CXR right away for placement in stomach.

08 Tube Feedings You really do need to pause the feed when laying the patient down. Story time: I had a pt who needed subglottal suctioning who also had tube feedings. My assumption is someone had helped him without pausing the feed which caused the suctioning and breath sounds to be significantly worse the rest of the day. This can happen quickly and the effects can be pretty bad! **I recommend putting a sign above the headboard indicating specific instructions such as no HOB below 30 degrees without nurse present**

09 Heart Rhythm Here’s a fun fact, if a patient is in SVT what do you do? Tell the patient to bear down because this is the Valsalva Maneuver. Oh, and of course you should mention this to the physician!

10 More IV insertion You can’t let them “get in your head” ever. Sometimes you’re the best person in the building and sometimes you feel like an imbecile.

11 IV Insertion Tips Until you get good at them, don’t ask the patient where they want it. I recommend you put the tourniquet on and look at ALL of your options. Think about the angles and how your body will have to be in relation to this IV stick.

12 IV Insertion Tips Okay, now that I have you overthinking it a bit, don’t overthink it (lol I’m sorry). But you have this! You’re a nurse, a badass and YOU HAVE GOT THIS!

13 IV Insertion Tips Do, listen to the patient! They know their body just as you know yours, but also take it with a grain of salt as well as YOU are the trained professional doing the act. Do what YOU are comfortable with especially when you are new. When they say that everyone sticks me “here” or “it always works in the left arm” I suggest you look. There’s no pressure but maybe they are right and there is a massive juicer (AKA a large vein) with your name on it!

14 Surgical Nurses When helping a patient with a back fracture/surgery/issue, you must worry about urinary retention/pressure.

15 Oxygen Nasal cannula goes up to 5L then we switch to a non-rebreather. You can only be on a non-rebreather for about 6 hours or so because it is not a long term fix.

16 Oxygen If a patient is in respiratory distress or if simply you cannot get their O2 sats to be above 90%. It may be due to the patient talking too much. Look at environment: do family members need to leave, does patient need to purely rest to catch their breath. First sit them up, intervene as needed, call RT if needed. And they just may need a CPAP/rest/no stimuli.

17 An Older Nurse Once Told Me Now I don’t know how far you want to take this but an older nurse once told me “If you have a sinking ship, sink the whole ship.” Story time: When she told me this, I had 5 patients, one of which had been in respiratory distress all day. The family would not leave or stop talking to him. The wife was constantly outside of the room and asking me “will he die?” However, would not (truly) listen to any of my answers to her. Later, a physician was called who was also new and inexperienced as well. What ended up happening was the wife’s emotions all day were bottling up and finally exploded at the end of the shift. I took the brunt of it even though I did my job well. And this old nurse tells me this sinking ship quote. What she meant by it all was….we are all here together on this ship. Use your resources and your team. I think as newgrads and nurses in general, we like to do everything ourselves. I’m still not against this mentality as I despise the opposite, but I will also say to use those resources even if they are busy too. And ask your other nurses to help. Trust me, you will return the favor someday.