This Wasn't in the Nursing Textbook.
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Hey guys, welcome back to Friends Anonymous. My name's Lindsay. I am your host and your guest today. That is right. Be nice to me because I don't have anyone else to talk to. Literally my dog's in the other seat, but he doesn't feel like wearing the headphones or speaking into the mic today. So unfortunately you just got me, but I figured we should do a fun little episode where I tell you nursing tips that you won't find in a textbook.

So I'm just going to dive right into it. There's quite a few of these. We'll see if I need to make this a one part one or part two, but for now we're just going through it. I'm going to try to rapid fire them, but these are things that I've come to find out on my own. Some of these are things that you guys have told me from Instagram and some of them are things I found on the internet that I thought deserved a spot on this list. So I won't let you, I won't make you wait any longer.

Without further ado, here we go. You won't find this in a nursing textbook. These might bring in some controversial opinions, but I'm just the messenger, so be nice. Don't be mean, be nice.

Number one, prioritizing yourself makes you a better nurse. I talk about this with almost every single guest that I have. I ask them like, what are ways that you combat burnout or compassion fatigue, or just what are things you do to make you feel better? And everyone talks about this. You have to prioritize yourself in nursing. Nursing and healthcare in general takes so much from you. It will take so much from you that you will give every single...

piece of your being to it and feel left empty. You have to remember to take care of yourself outside of work. The moment you start doing things for others when you haven't taken care of yourself, AKA the hospital or your patients is when you start to feel burnout and you will experience it. If you aren't filling your own cup, you can't fill others period.

Do something for yourself outside of work. I don't care if it's taking a damn nap, walking the dogs, going to the shelter, volunteering with the shelter, reading a book, exercising. Do something for yourself that fills your cup. We're all different, so we're going to have different hobbies and things that we like, but you know you best. Do something for yourself.

Number two is learn to say no. I don't know why this is such... I do know why this is such an issue. I feel like our society has taught us to say yes to everything so much. And in the hospital, I feel like we are kind of...

taught to say yes to even like our managers, every single thing they ask. Like if they're coming up to you and asking, oh, you know, we're going to be short staffed tomorrow. Are you able to pick up? You need to take a deep dive into yourself before you just say yes. One of my favorite things to say is I'm not sure if I can be that person for you tomorrow. Let me check my schedule and get back to you because it's,

All of us, for the most part, are very quick to jump to yes and very slow to jump to no. And we should kind of flip that, especially in healthcare. Once again, if you're not taking care of yourself, do not say yes to these things. Example, I put an example on here, like your manager asks you to pick up because they really need people. You feel awkward in the moment and blur yes before you have a moment to decide if you want to do that. Practice saying no.

Number three, practice standing up for yourself. You don't need to be a people pleaser. You are an employee. This is not your family. The more you practice this, the easier it will get. On the same line of saying no, practice standing up for yourself. If someone is degrading you, belittling you, talking down to you in your place of profession, absolutely not. Are we going to tolerate that? It's not okay. We should be firm and professional.

be professional, but we should be firm in who we are, knowing who we are. And I understand that even like a lot of new adults are still trying to figure out who they are in life and whatnot. So it can be really scary to stand up for yourself when you're unsure of yourself. But the truth is, the more you do, the better you'll get at it. And also, I feel like when you are known for standing up for yourself, it's less likely that someone's going to be

coming after you or trying you in any way, shape, or form. Befriend your nursing supervisors and rapid response team. Someone wrote this in. I did not write this because honestly, I've never befriended them before, but I wouldn't say it's a bad idea.

I would like to add to this and say that we should befriend or have a rapport with RT, OT, PT, lab, pharmacy, tech, CT, techs, MRI, et cetera. You never know when you're going to need something from them and they can be the most helpful. However, if you start by treating them poorly, then I highly doubt you'll be treated kindly in response. Seriously, why in healthcare are we so hateful to each other right off the bat?

I don't understand it. I always say like, I am not hateful unless you give me a reason to be hateful. But even so, I understand that these are people I'm dealing with. And like, who knows what happened at home before they came in? And like, you can look at this two ways. There's things that happen at home in my personal life that don't make me the happiest person ever. And I'm not coming to work and being a total shithead to everyone. And then on the flip side, I also know that not everyone can...

Um, like prioritize their feelings and emotions, but you should be working on it and trying, you should stop. We should really stop like coming after each other from like different specialties. I noticed it happens a lot from nurses to so-and-so.

but a lot of people have really bad experiences with nurses that they work with. And that makes me sad because it kind of gives us a bad rap. Like we should be befriending each other and like by befriending, I don't mean you have to like tell them your whole life, but being kind to each other. To me, it's more fun to go to work with knowing my friends are there like friends. If I see people that I like on the roster, I already know it's going to be a better shift. So

Let's practice being kind to each other and being friendly. I don't find anything wrong with that personally.

Someone said, but what about grumpy coworkers? There are a few things you can do with this. Kill them with kindness is a tactic I like to use. I feel like any tactic I give, it's not 100% for every person. It depends on the person, depends on the situation. So you can kill them with kindness because eventually most people come around or you can confront them head on. Every time I try to be nice, like something like quote, every time I try to be nice to you, it seems like it leads us nowhere or you can ignore it.

There's several ways to go about it, but I just feel like you need to remember that everyone's different and trial and error with these things can show you the best form of action. Or you can ignore it. It's up to you, but I would try everything in my power to not let their attitude change mine personally. So I like to teach that to my new grads or nursing students or whoever's asking me. I try to

First, I tried to kill it with kindness and then I tried the other tactics. But a lot of times I just treat other people how I would want to be treated. And it seems to work out.

Ask questions. The scariest nurses are the ones who pretend to know it all and refuse to ask questions even when their gut nudges them to do so. If you are unsure in the slightest, ask somebody. If they respond poorly, making you feel dumb, it says more about them than you and stop allowing others to dictate who you are. I feel like

New grads are scared into not asking questions, which can make you a dangerous nurse. When you stop asking questions, everything changes. You're putting your patient's life on the line when you stop asking questions. Anytime you have any form of confusion, you need to be asking questions.

Um, these are all over the place, by the way. Like some of them are like really sweet and talking about asking questions or how to be nice to your coworkers. This one is paraphimosis. Know what paraphimosis is. If you don't know, you're about to get a huge lesson in paraphimosis. Um, you are going to deal with people of all types of bodies and body types and their anatomy doesn't always fit the book. Um,

Some men have a foreskin. If you didn't know, now you know. Some men have a foreskin. And when we are dealing with like adult men is who I'm talking about, not children. I don't know how you treat children. So ask somebody that knows. I'm talking about adult men because that's what I work with. If I have someone with a foreskin, I put it back how I found it, which is back over the shminus.

When you're dealing with the foreskin, there's so many times that I have come into a room, assess my patient and realize their foreskin is not where it should be. And the head of their shmenus, the corona of their shmenus is so swollen that it looks like it's going to burst. When you don't put a foreskin back, something called paraphimosis can happen. And it is where the corona of the penis swells, like I said, and it's not where it should be.

And it can be dangerous. Sometimes they can lose their shminus because of this. It is a very real thing. And you guys need to be paying attention to this. If you have a patient that already has paraphimosis developed, something you can do, and I would suggest this to the provider. I wouldn't just go do this willy-nilly only because certain hospital policies, this could get you in trouble. Sugar packets or dextrose soaked paper towel.

Yes, you heard that correctly. Can help shrink the swelling. It just works like with osmosis and the sugar pulls out the extra fluid, hopefully making the corona of the penis smaller so that you can put the foreskin back how it was. That was a lot. Hopefully, hopefully you got that. Same thing.

vein, rectal prolapse. If you have a patient with a rectal prolapse, sugar packets can help in the same manner or Coca-Cola could even help by resolving the swelling. And again, it's the sugar and the Coca-Cola and the sugar and the sugar granules that will pull out the extra fluid and hopefully resolve in some swelling going away. I always, like I said, I always suggest these to the physician first before I go off willy nilly, but you do you.

Um, speaking of Coca-Cola, usually it can help clear a peg tube that's clogged as well. Once again, I usually suggest this if it's happened, I haven't had this happen in a long time, but if you get those peg tubes that get like grimy, sticky inside of them and they get clogged, sometimes you can kind of, um, push some Coca-Cola or other type of carbonated sugary beverage in and out of the peg tube to get the clot to kind of like disintegrate. Number 10.

Putting a bedpan underneath your patient, line it with a Chucks first for easy cleanup. This goes for bedside commodes as well. I feel like sometimes when you haven't seen it before, you don't know of a better way to do things. But if you are putting a bedpan under your patient, why not line it with a Chucks first? The moment you take it out, you literally just throw the Chucks away. You don't have to clean it. You don't have to wipe it. You don't have to accidentally spray yourself with that freaking sprayer that's over the toilet.

Listen to me and put a chucks there first. If you have a patient with diarrhea in the bed, that's going everywhere, grab the yonker and suction it up. Yes, you heard that right. It might make you a little queasy because the noises are quite strange, but you are going to save yourself a large mess that could end up on the floor. Just trust me.

If you place the NG tube in the freezer for an hour or so before placing it, it creates a numbing effect. Somebody wrote that in. I've never thought about that in my life, but I don't see any harm in it. Putting an NG tube in the freezer before you place it, it would just be really cold. I feel like that would be very much more pleasant than a room temperature one. If you have a bubble in the syringe of your saline,

Barely twist the cap off and push the air out. There's no mess. If you're like me, you'll just twist the cap off and spray it right behind you. And if someone's there, they're there, but it's fine. Also, I had a nurse write in, a new grad write in and say that she got yelled at by her preceptor for not pushing the bubble of air out of the syringe before she used it.

Something else to keep in mind is when you turn your syringe downwards, the bubble that was now at the tip typically migrates back up to the top because gravity. So if that happens, you can just give the medication and don't push all the way through and you won't push the bubble into their IV. Several ways to do that. If you have a sedated patient,

still speak to them. I know you're probably like, obviously, Lindsay. No, seriously, go into the room, introduce yourself, tell them what you're doing, talk them through whatever you're doing. You never know what someone can hear. And there's lots of studies and stories showing that patients still remember hearing someone in the room, that they remember conversations had about them in the room. And people were talking about them as if they weren't there.

Go into the room and assume your patient can hear you at all times. It is still something I tell family too, because family will come in the room and be really quiet and they'll feel really awkward. I'll say, you can talk to them. They'll say, well, they can't hear me. Actually, there's several studies that show that patients can hear you under sedation. So it's okay to talk to them. And a lot of times it helps give family closure too when having a conversation with their loved one.

Number 15, don't be afraid to go up the chain of command and document when you do.

What does the documentation look like? I made this mistake early on when I was having problems at my workplace and I was going through the right course of actions, going up the chain of command, but I wasn't following up with an email summary to the person I spoke with and then BCCing my personal email. So I have a copy of this outside of work. You never want to assume that you're going to have access to your work email in a legal way.

um, action. You want to BCC yourself because it pretty much hides that you, it's like a secret way to send yourself the emails as well. Um, but you want to summarize what you just did or went through or spoke with or spoke about with that person. So an example, um,

Let's say you go to your manager about a workplace bully and it seems that she's going to resolve it. You are going to leave, go to your computer, write out an email summary of who you are, what you did in the room, what you guys spoke about, if you remember any quotes that

put them in quotations and send it to your manager. So you both have copy of it because if you do need to escalate further, you now have proof of documentation that you did. So unfortunately, typically proof of documentation on your phone, like a little note on your phone will not be enough. You need to email it to the person and email yourself a copy.

Um, apparently this is number 16. Someone wrote this in, um, for small splinters, thorns and stickers. You can spread a thin amount of Elmer's glue on top, let it dry and peel it away. And the sprint, the splinter will come off too. I've never tried that one, but I want to try it. So I low key want someone to come in with a splinter.

If you have a dementia or highly confused patient, bring them unfolded laundry and try out your acting skills and tell them that you're super behind and need their help. So anyone, anyone that works in healthcare has probably had a confused patient of some kind. And what do they try to do? They try to get out of bed because they don't know where they're at. They don't know what's going on. And no matter how many times you try to reorient them, it's not going to work.

Bring in some unfolded laundry and literally be like, oh my gosh, I'm so behind with my work. I would really appreciate it. Do you think you could help me? Nine times out of 10, these people help you. And in fact, they'll help you for hours with this laundry until they finally get sick of it. Also, if your unit has any form of like a baby doll, you can ask them to take care of the baby while you're gone. It gives them something to do and focus on and it distracts them from their anxiety.

Going along with demented patients, you don't always have to reorient agitated or demented patients. I think sometimes I see this a lot with in the ICU, I have a patient who's confused and their adult child will be in there with them like, no, mom, we're at the hospital. And you can tell she's just exasperated. She's said this a million times and it's not getting through. In those situations where it's not helping,

I like to see what the patients talk. What are they fixated on? Oh, they have a flight they're about to miss. No, ma'am. Did you know we act? They actually pushed your flight out or no, man. Did you must've forgot? We're actually at the airport right now. This is your bed. You can go along with their antics. It's,

usually easier to go along with it because at the baseline, your patient wants to feel heard, seen and safe. And sometimes going along with their lying, it's called theoretical fibbing or something like that. I can't think of the term for it, but there's some type, something fibbing where you're fibbing in it's for the best of the patient.

It doesn't always work, but I try to teach new grads this because I think sometimes they're not taught that. 19, they tell you not to milk tubes in nursing school, but one tube I've had to do this a lot with is a duo tube. Hold it firmly in place, squeeze and run your fingers down the tube toward the opening away from the patient.

In nursing school, they've taught us a lot not to milk tubes. And there are certain tubes you won't milk. Like I would be careful with like chest tubes unless someone has told you to do so. But typically with any type of OG or NG tube, it's going to get clogged. And sometimes you have to milk it. You need to hold it in place, milk it away from the patient. And usually it helps. If you need to clean up a patient with dried blood, apply some lube on them and wait a few minutes. It'll wipe right off.

If you have shit caked to your patient's booty and don't want to scrub their skin raw, see if your unit or call MedSurge or who's the people that holds all the supplies? Call them and ask if they have shaving cream. Whenever you use shaving cream on crusty shit on someone's ass, it softens it up and you can easily wipe it away. These are some great hacks.

When doing bedside report or first assessing your patient, make a mental note of things that are missing in the room that you might need. Look around. Is there any tubing you're going to be needing? Suction, fluids, medications that are about to run dry if you're in the ICU. Take mental note the first time you go see your patient. That way you're not having to come in and out of the room multiple times.

If you don't see the wink when placing a Foley, aim up. Always aim up. If you can't see it, but you can see a hole for the opening of something else, aim. Not every patient is book perfect. There is always an exception to the rule. That's one of my favorite things to teach new grads. I think we get really fixated as new grads that...

Well, the book said this, well, my instructor said this, the truth is there is always an exception to the rule. So keep that in mind when things aren't going as planned.

If you can't twist something off like the power cap at the end of your pick line, grab an IV tourniquet. The rubber will help provide friction and gives you some extra help. I've had to do this multiple times where I'm cleaning or replacing something on a pick line and I need to replace those caps and they are so tight. The rubber tubing, the tourniquet helps every single time.

Chart like you're going to court, but also chart in a way that paints a picture for the oncoming shift. If you forget something in report, they should be able to find what they're missing in your charting. So chart in a way that you're telling the whole story of the patient. Charting can be really difficult, especially as a new grad or if you've transferred to a new unit, but it is something that eventually becomes muscle memory. So really get to practicing very good charting.

Some patients will piss you off and you will still have to take care of them. Get over it. I am not speaking about any type of assault when I'm saying this. Sometimes you have to remember that this is the worst day of your patient's life. I know it's hard. Sometimes it's hard to keep that in mind. But the truth is, if you can't keep that in mind, you might be developing some type of compassion fatigue because you should be able to professionally move on from a situation with your patient.

Again, not talking about any form of assault. I'm just saying sometimes people are shitty and we deal with shitty people. You don't want to take that stuff home with you.

Set boundaries with your patients. Be firm with them. Like a teacher speaking to a child. That is my favorite way to explain it to people when they're like, oh, but I feel mean. I like to think of it as how would a teacher instruct a child to act or do something? Sometimes you have to do that with your patients. And again, the more you practice setting boundaries with your patients, the easier and quicker you'll be at it.

Let's say your patient is on Lasix or you got busy elsewhere and you come back to find their Foley bag is full. If you don't want to make three trips to MC with this graduated cylinder, grab a basin and pour them in one by one. Then make your one trip to the toilet.

So she's just saying the little cylinder that we have whenever you empty it from the Foley, if you notice your bag is full and you're going to be going back and forth, grab a basin. It saves you time in the long run. Just because your unit has a nurse tech or some kind of CNA tech, PCT aid, doesn't mean you can't help them.

If you are less busy than them and have a moment to grab the ice water your patient wants, do it. We are not above doing CNA tasks. A lot of nurses I work with, I can tell when a nurse has never been a CNA and I can tell when they have.

Basic respect goes a long way. Your CNAs and techs have a list of their own that they have to do. Beyond the tasks you're adding to their plate, they already have a set schedule of things they have to do for their shift. Keep that in mind.

Alcohol swabs or peppermint essential oil in your mask for nausea also can use this for your patients. So when I was a new grad, I did not know that sometimes the pharmacy or sorry, sometimes the pharmacy carries essential oils.

I thought that was so crazy. I was like, what? And it's for things like nausea. If your hospital doesn't have essential oils, I find that a simple alcohol swab in your mask. And if it's too strong, you can double your masks and put it in between. That can help with nausea. It can also help with really bad smells.

Um, if it's just for bad smells, sometimes the toothpaste from the supply closet works just as well. And I've also started carrying stink bomb with me. It's a product. It's a nurse made product. It's a small business and it's literally in the shape of a chapstick that I keep on my badge reel and I just wipe it underneath my nose. It's in lavender scent. She has a million cents. It's a fantastic way to keep those bad smells out of your face.

Triple check the clamp on the secondary you just hung. Even I am guilty of this. Even when the pump is telling me, did you check your secondary? And I'm just like, yes, shut up. It's done. It's fine. And I'll come back an hour later and my antibiotic is sitting there like ain't nothing ever happened. How many times have I done that? Triple check the clamp. It's probably fucking clamped. Honestly, just assume it is. Assume it is and get into the habit of making sure it's not.

When opening a bag of Ted hose, oh my God, this is one of my favorites. When opening a bag of Ted hose, use the plastic bag as a sock on the patient's foot. It makes it easier to slide the Ted hose on their leg.

People's feet are hot and sweaty. If you try to put the Ted hose on something hot and sweaty, it's going to be 10 times harder. If you use that plastic bag, it came in like a sock. It creates a slick, easy, smooth transition for the Ted hose to go from the foot to the leg. If you have a patient that is combative or going through a mental health crisis, ask them, quote, would you like me to work in silence or verbalize step-by-step what I'm doing?

Sometimes people need silence because they're overstimulated. And sometimes they need to be informed on what's happening because they're scared. Again, I think if you work in a way of remembering that your patients are typically, they don't feel heard. They don't feel like people listen to them and you give them the option to be heard and listened to, they're going to be so much happier with you. I

I've had so many psych patients that, um, you know, I go in and I assume that they want me to tell them everything I'm doing and really I'm just overwhelming them. So I've gotten in the habit of asking them that, would you like me to work in silence while I'm in your room? Or would you like me to verbalize step-by-step what I'm doing to ease your worries? Simple as that.

Use the medical air on the wall. Usually it's the yellow one, not the oxygen to pre-fill your bags for your A-lines. This is for my ICU people. Sometimes our hands get cramped pumping that sucker up. If it takes you forever to pump that bag up for your A-line, you can literally hook it up to the medical air on the wall, not the oxygen, and it fills it up in no time.

And damn, we're already down to the last one. I don't know why I thought this would take like two episodes. But the last one I wrote is believe patients when they say they're going to die. This is something that...

I learned so fast as a new grad. It was kind of terrifying. My first patient that told me that they were going to die, I was like, that was weird. Casually told my preceptor and she was like, we need to keep an eye on them. They ended up passing that same day, which is crazy to think about. But you need to believe your patients when they say they're going to die. Look for signs of unstable vitals, et cetera. If something feels off, ask someone who's more experienced than you and tell them what happened.

A lot of times our bodies know when we're about to leave this earth, which is kind of a cool thing, but also a terrifying thing when you're in charge of someone's life. So if your patient tells you that, or they're feeling a sense of doom, a sense of dread, a sense of leaving this earth, believe them every single time. There's so many stories and studies about this that it's creepy in a way, but it's also very telling and it can give you a heads up on what's to come.

That was a really short and sweet episode. I wanted to try something different with you guys because I love getting you guys involved in my episodes. And I asked you guys on Instagram what you wanted to hear next. And you guys said something like this. So we put this together. If you liked this, let me know. And I want to do more solo episodes. So if you guys want to give me some themes and topics, I will start working on those. But until next time, guys, bye.

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