Nursing Skills


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.


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.


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

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