becomingrn's Posts

Why isn’t this taught in the nursing textbooks? Where is the skills test for this in nursing school? Making good coffee as a nurse is that important. We’re talking patient safety here!

I ditched my automatic drip coffee maker years ago and traded it in for the pour over method. The equipment involved never fails (ceramic or glass dripper, electric kettle, and a grinder). And with just a little practice, it takes the same amount of time AND tastes 100 times better. I am not kidding.

Try it for yourself and ditch the Folgers!

  1. Determine the type of roast that you prefer and purchase whole bean coffee. Light roasts retain the most coffee flavor and the most caffeine. It is my favorite roast, but can be too acidic for some taste buds. Dark roasts are roasted for a longer period of time and have the least amount of caffeine. Dark roasts usually bring out the flavor of the roast rather than the bean, and they tend to taste smokey, bitter, or even burnt. Medium roasts strike a balance between the two, which appeals to many coffee drinkers.
  2. Grind beans immediately before brewing. Beans contain oils that will go rancid once they are exposed to air. For the freshest tasting coffee, grind immediately before you brew!
  3. Use enough coffee. A general rule of thumb is to use two heaping tablespoons of ground coffee for each six ounces of water. Measure it out the first time and you’ll get a good feel for how to eyeball it in the future.
  4. Add a pinch of salt. I’m serious. Salt brings out the flavors of whatever you are making. If you want your hot chocolate to taste more chocolatey, add a pinch of salt! Want a more savory chicken noodle soup? Add a pinch of salt. Same for coffee! It won’t taste salty, I promise!
  5. Set up your equipment. Place a filter in the dripper. Add the grounds and salt, and place the dripper over a carafe.
  6. Use an electric kettle to heat the water. This is important because you want the water to be at just the right temperature. If it’s too hot (boiling), it will burn the coffee. If it’s not hot enough, it won’t extract the beans properly. Best way to ensure the appropriate temperature is reached is to use an electric kettle and turn it off when you hear the water quiet down just before the boil.
  7. Pour the water. Take 15 seconds to pour just enough water to cover and saturate the beans. When the water drops to the bottom of the filter, pour more water over the beans. Repeat until you’ve used up your water.
  8. Enjoy! And kick that next shift in the butt!
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Airway, ventilator, trach, OH MY! Mechanical ventilation seems scary, am I right?! You’re working with the “A” of the ABC’s, so yeah, it’s normal to have a little extra adrenaline running through your veins. That’s okay! I’m going to walk you through the basics to ease that fear a bit.

I’ve worked with patients on ventilators for a little over a year now. The patients I see are ventilator dependent due to a number of different conditions including muscular dystrophy, cerebral palsy, post-polio syndrome, spinal cord injury, and COPD. When I first started working with these patients, I felt overwhelmed with the ventilator settings and knowing what to do if a problem arose. I now feel like I could handle most situations that come my way.

Here are the three key things every single nurse should know when working with a ventilator dependent patient.

  1. Locate that ambu bag immediately! Before it is needed. You do not want to be the nurse that is frantically looking for the ambu bag while your patient is rapidly de-sating. Your eyes won’t work when you’re in a frenzy, so locate the ambu bag at the beginning of your shift so that if the need arises, you can grab it quickly!
  2. High pressure alarm = blockage. You could also think of a kinked garden hose. If you have a kink in the hose (circuit or airway), the water (air) won’t get through! It could be a complete blockage where no air is getting through, or it could mean that the patient is coughing and there is a temporary blockage of air that will resolve on its own. Most of the time, it will indicate that there are some secretions in the airway that need to be cleared. Get that suction kit ready, and get the job done!
  3. Low pressure alarm = disconnect or leak. This alarm will sound when the circuit has disconnected somewhere along the line, there is a hole in the circuit somewhere, or the circuit connections are loose but not completely disconnected. Run your eyes down the circuit from the trach to the ventilator and see if you can quickly spot the problem. If you are having trouble spotting the disconnect, call respiratory therapy and/or get the ambu bag ready and connect the patient to the back-up ventilator.

Don’t get me wrong, mechanical ventilation is way more complicated than that. I could go on and on about assist control and pressure support and PIP and PEEP and MAP and…on and on.

If you are in the acute care setting, most nurses will not have to know details about ventilator settings because respiratory therapists are circulating the floor to assist the patient and address your concerns.

For most nurses, the three pieces above will be more than enough to begin caring for a patient on a ventilator!

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…GIRL!

Yep, that’s right! We’re expecting our second child, a girl, in August! We are terribly excited to meet this little one! If I’m completely honest though, I’m dreading the sleep deprivation that is just around the corner!

We are trying to help Patrick get acquainted with the idea of a baby sister. He likes to pull up my shirt and say, “baby,” but he also does the same to Grant. I think we are confusing him more than anything!

We can’t wait to meet our little sweetie. In the meantime, we’ll be working on developing some big brother skills with Patrick and praying really hard that Baby Girl is a rock star sleeper from the get-go!

Sending my love to all of you!

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I recently just finished up obtaining my required continuing education credits, and I did them all for free! I have to admit, I look forward to the day when I can earn CE credits at a fancy nursing conference, but I just don’t have the time or money to do that at this point.

Here is what I found for free. Share links of your favorite free CE courses in the comment section.

  • Centers for Disease Control and Prevention
    • Once you create an account, you can search the available courses. I took courses on infection control, working night shift, and obstetric hemorrhage.
  • 3M Health Care Academy
    • A well organized hub for so many different continuing education topics (professional development, infection prevention, edema management, IV site care, skin care, and wound care)
  • Medscape Nursing
    • Requires free registration in order to obtain continuing education credits.
  • NurseCEU.com
    • This website is a database of continuing education courses from multiple course providers.
  • Don’t forget to print continuing education certificates for the classes you take at work. Most of these count, too!
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I am definitely one of those nurses that replays her shift on the way home from work, while I’m cleaning the grime off of me in the shower, while I’m eating my supper, and then again while I’m lying in bed. What I worry about the most is whether I reported the important information so that the next nurse has a successful shift and the patients are well cared for as a result.

Report plays a huge role in providing quality patient care. I’m definitely still learning the process, but here is what I’ve picked up on so far while working in a transitional care facility.

Report the Basics.

Reporting the basics should be the first part of the report. It gives the nurse a brief picture of the patient that can be built upon during the remainder of the report. Include the admitting diagnosis, pertinent secondary diagnoses, code status, and mental status.

Report the Abnormal.

Is the patient NPO? Is there an abnormal heart rhythm? Elevated temp? How about mobility issues? Hearing or visual deficits? The oncoming nurse will need to know these things.

In order to be thorough and efficient, move in a head-to-toe fashion by body system. After practicing this a few times, you will develop a rhythm and get through this portion of report in less than a minute.

Anticipate What the Oncoming Nurse Will Need to Know.

I am always tempted to tell the oncoming nurse what happened during my shift because it’s what I know, but it’s actually more helpful to the oncoming nurse to keep the focus of report on the anticipated needs of each patient. This may be a little tricky. As an evening shift nurse, you might not be aware of what the night shift looks like on your unit (take the time and ask!).

Here are a few time-sensitive things I find helpful to receive in report before beginning my shift:

  • PRN pain medication schedule
  • Scheduled appointments/procedures
  • Tube feeding/IV completion schedule
  • Blood sugar checks and whether or not the patient takes insulin
  • Patients who haven’t had a bowel movement in three days and what actions have been taken so far (remember, I work in transitional care so patients stay an average of 18 days)

Of course the content of this list will depend on your facility/unit and the shift you are working. Also, the oncoming nurse should never rely solely on report and should consult the MAR before acting on any of these time-sensitive issues. But having this information will help the oncoming nurse anticipate needs, and that’s huge for time management.

Keep it brief.

It’s best to keep report as brief as possible while making sure all of the important info is shared. I hate to put a time limit on report because every unit/scenario is going to be a little different, but I imagine that a 5-10 minute report would be sufficient in most situations.

What do y’all think? What has your experience been with end-of-shift report?

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virtruvian man

When you have 10 patients each day (yes, I said 10!), you start brainstorming how to make the most out of every minute you have and every assessment you make. As you can imagine, I don’t have a lot of extra time to dawdle. But the head-to-toe assessment is something I don’t want to miss out on, and here’s why.

The Initial Head-to-Toe Assessment Saves Time in the Long Run.

I know that it’s hard to believe that it’ll save time in the long run when you are rushing to get through your morning med pass on time, but assessing your patients within the first hour of your shift will make the rest of your shift more manageable.

At the facility I work at, we have certain assessments that we need to complete on patients, including a bowel and bladder, pain, range of motion, skin, and hydration assessments. Some of these assessments are rather lengthy. Instead of taking time out of my afternoon to go back into the patient’s room to ask a bunch of additional questions, I can complete the assessment form based off my initial head-to-toe from the morning. Bing. Bang. Boom. Done.

It Allows You to Do a Better Focused Assessment.

Once you have a baseline assessment of your patient, you are able to hone in on one or two potential problem areas to reassess as the day progresses. For example, if your patient is recovering from hip replacement surgery, a focused assessment may involve asking the patient about pain and looking at or even replacing the wound dressing.

If you are in a healthcare setting where you see the same patients every day (such as long-term care), you might be able to forgo the full head-to-toe on subsequent days with the patient. I would limit the full head-to-toe to once a week unless they were recently admitted to your facility or had a recent change in condition. If you are in an acute care setting, complete a head-to-toe every single shift.

It May Just Save Your Patient’s Life.

I know that sounds dramatic, but we have to remember that there is a reason the patient is in our care. I have been a nurse for less than a year, and I have already sent two patients to the hospital based on findings in my initial head-to-toe assessment. If our patients were well, they would not be in our care. We need to keep a close eye on any potential complications that might be popping up, and this starts with the initial head-to-toe!

And knowing the results from initial and focused assessments as well as admitting and secondary diagnoses will make you a better nurse. You’ll be able to pick up on subtle changes in your patient’s condition that may prevent a major complication from occurring in the first place!

In what ways have you found the head-to-toe assessment to be helpful for you and your patients? Leave your stories in the comment section below!

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I had my precious baby Patrick on November 20th of last year, and was on maternity leave until the beginning of February. That is a looooooooong time to go without practicing my new nursing skills. I was no longer changing central line dressings, inserting catheters, caring for wounds, maintaining G/J-tubes, and giving medications around the clock. I was, however, becoming rather proficient in swaddling, diaper changing, laundry doing, tip-toeing, and lullabying.

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As the end of my maternity leave was approaching, the anxiety about going back and remembering how to do my job was increasing exponentially. I only had five months from the time I became a nurse until Patrick was born to perform the skills I learned in nursing school. Was it going to come back to me? Or was I going to embarrass myself in front of the patient by sticking the urinary catheter in the wrong hole? Believe me, I had plenty of nightmares where things went horribly wrong.

Whenever I experience anxiety about something that is under my control, I always make a plan. Once I have a plan, my anxiety seems to subside. Here’s what I did and what you can do if you are in need of a little skills refresher.

1. Make a list of all of the skills you need to freshen up on. My list included central line dressing change, PICC removal, TPN administration, urinary catheter insertion, G/J-tube management, and wound care. I work in a transitional care facility and see patients recovering from knee and hip fractures and surgeries, COPD exacerbations, strokes, and things of that nature. If you are in the hospital, nursing home, or working in home care, your list might look different from mine.

I've been using Google Keep on my phone and laptop for all of my to-do lists.

I’ve been using Google Keep on my phone and laptop for all of my to-do lists.

2. Gather all of your resources. I used YouTube A LOT! Click here for a playlist of nursing skills videos. Videos are not always 100% by the book, so check your nursing fundamentals book to make sure you’re following the proper procedure.

3. Practice like you did in nursing school…on your friends and family! I saved my lab kit from nursing school, so I took out my supplies and walked through each of the skills I needed to practice. I didn’t have central line dressing change kit anymore, so I just followed along with the YouTube video and put my hands through the motions so I could gain some muscle memory.

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Alright my friends, tell me about the skill you are going to brush up on today! Trach care anyone?!

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