hey it's kathy
and i know it's been a while since i put
out a video with
some tips for you guys just some tips in
general
as you're getting started on your
nursing career so i thought of a couple
today that i wanted to share with you
the first
is not to automatically follow
the charting that came before you so
this sometimes the charting before you
can be
completely wrong sometimes so i know as
a new grad when i would go do
my patient assessment and i would like
not hear crackles like the
nurses before me would chart crackles or
something else
and i wouldn't hear it and i would like
double check
and i sometimes would second guess
myself like well i'm a new nurse maybe
i'm just not hearing right i'm sure
they're probably right
maybe i should chart crackles too but i
would really warn you against doing that
so i
in the end i would not do it but i'd
always second guess
myself but i've been working long enough
now
to see that people chart some crazy
things or things that are just not true
or just copy the charting that happened
before them so let me give you an
example so
as a wound nurse i do audits um every
monday wednesday and friday
on pressure ulcer charting so
um when i'm looking there i had a
patient who had i think a stage
two pressure injury on their coccyx
right so on their backside and a nurse
like a couple days ago started charting
that she put an
ace bandage on the pressure injury
which is not going to work out at all
like an ace wrap
on a pressure injury and then a couple
other nurses
like copied that same charting after her
so
three different chefs of nurses um
put that they were putting an ace wrap
on somebody's pressure injury
which makes no sense at all so
i'm warning you that don't just copy the
stuff
ahead of you do your own independent
assessment
and don't second-guess yourself um
it's good to see what has been charted
but always put
your assessment your charting as you see
and as you hear it
in the chart okay because sometimes
there's mistakes
and um you don't want to just be
following up with those same mistakes
so that is that's one really important
piece of advice because i think
every new grad nurse i know has always
felt like
oh they put this before me i should
probably do that
but that's really not the case um and
then speaking of charting i wanted to
give you some advice
on where you should or shouldn't cut
corners so
as a nurse in a perfect world we would
have
time um to do like super thorough
charting and to get
everything like perfect with our charts
but
what you'll find or which maybe you've
already seen is that
a lot of times you're fighting fires and
just trying to keep your head above
water
when you're on the floor and there's not
a lot of extra time if you had a patient
who had a rapid response somebody's
going down for surgery
somebody's potassium level is super low
so you had to like hang
four bags of potassium it just gets
crazy
so you wanna do the really important
charting
and as much charge you can but i'm here
to tell you that
you don't want to cut corners in a in a
couple of key areas so
one is pressure ulcers or pressure
injuries
so when and i say that because i
actually do the audits and when
um nurses miss their pressure injury
charting
i actually have to notify their
supervisors and charge nurses
uh and let them know this is because
when the state or
jayco comes in to do their inspections
and assessments
they look at this charting if patients
are
have gotten a pressure injury while
they're in the hospital
that's hospital choir that's a really
big deal right so
um we don't get paid for their care
in trying to resolve this pressure
injury if they got it while they're in
the hospital
and if they came in with it it's really
important that we take pictures of it
and document it really really
clearly so if your patient has wounds
particularly pressure injuries you
definitely want to chart on those
because if you don't
someone will come find you probably your
manager or supervisor and let you know
and then you'll have to fix that
the other area that you never want to
cut corners on
is your pain assessment so you need to
make sure you're doing a pain assessment
on your patients every day and if they
are having pain and you're giving them
pain medication
you need to do a assessment prior to the
medication administration and then one
following up so if it's like an iv pain
medication that you've given them
then the follow-up's going to happen
pretty quickly after that like 10-15
minutes
um you know probably at 30 minutes on
the on the
long side you want to follow up and see
how they're feeling and what their pain
level is
if it's oral pain meds then that may
take more like an hour
before it would you know take full
effect and that's when you want to do
your reassessment but you definitely
want to have those pain assessments
documented
before and after pain medication and
even if you're
not giving any pain medication to a
patient you want to at least do one pain
assessment per shift um
and then the last thing is around
wounds actually so i'm a wound nurse i'm
always you know eager to give tips on
that
but i wanted to talk about how you
should go about removing tape or
adhesive
from a patient's skin so as patients get
older their skin is very very vulnerable
to being ripped and so i've seen it more
than once
where a nurse or somebody will will take
tape off
and the skin will come right with it
that top layer of skin
and now they have this gnarly skin tear
which is very very painful
so when you are removing a patient's
tape or adhesive i'd really recommend
trying to find an adhesive wipe
remover which should be in your supply
room
some people use alcohol swabs which are
um work pretty well
they're actually definitely better than
nothing but if you can find an adhesive
remover
um wipe then what you want to do is use
a
push pull technique so you kind of lift
the corner
and you want to push on the skin with
the adhesive remover wipe and kind of
wipe it back and forth
as you pull the tape back so you're
pushing on skin
while you're pulling the tape not just
pulling
because then the skin is going to rip in
all likelihood if they're older
so using a push-pull and adhesive
remover
and that takes away a lot of the pain
and prevents
injury to the patient's skin so those
are my tips of the day
i hope they've been helpful and good
luck with studying take care