We are continually told that our patients are increasingly complicated in diagnoses and everyone is sicker than they used to be. And the reality of the nursing staff is that the amount of cumulative experience for a unit is decreasing by the push for nurses (new and old) to seek further education. I know we all have to start somewhere and I am thoroughly impressed with the education the new grads at our hospital system receive. Actually I’m incredibly envious of the amount of time and resources poured into preparing them to be critically thinking ICU nurses. Personally, I don’t think I am a very good orientee because I’m not always clear on what questions I should be asking so I often feel like I miss out on what I should/could be learning. I am not as intrinsically curious as others so I often don’t ask enough questions. I had wonderful, experienced nurses as preceptors but I was overwhelmed and unsure and afraid of looking stupid. So I didn’t ask enough questions and I didn’t push to get the sickest of the sick while I had a support person right there to catch me before I made a mistake. Now that I’m all on my own (and have been for over a year) I still feel inadequate as a critically thinking ICU nurse especially when I have a patient with some sort of device that I need to know and understand.
As I was thinking about this today I realized that there is a simple answer to how to handle this. So here is my simple strategy for upping your (and MY) nursing game.
The Three Rs of Nursing:
There are a few different things that you need to read in order to improve your nursing skills, knowledge and abilities.
- H&Ps – this is the first thing you should read on every patient. Make it a point to sit down early in the shift and read the H&P as well as a note from that day. This will give you a starting point and a reference point to where you are on this patient’s hospitalization journey.
- Nursing Publications – The AACN journals are fantastic places to start. You get insight into how practice is changing and the up and coming evidence based practice you will soon be seeing in your hospital. Plus this gives you great ideas on how to implement changes in your practice and maybe even your unit.
- Policies & Procedures – Every hospital has a manual (online or hard copy) of policies and procedures. These are key to help guide you to know how to act in various situations. If you are guided by principles, half of your decisions are already made. As a new nurse this is so, so, so important. Quite frankly, it takes a while to develop critical thinking skills so you need to be guided by something before your ability to think critically is like second nature.
If you have your BSN you definitely know that there’s an awful lot of writing for a science degree. I often hate writing papers because I don’t think I have a good scholastic writing style. This is why blogging is easier for me; it’s more conversational and less…science-y? Technical? Not sure which.
But I also write because it brings clarity. Great minds have taken time to think and to write. They write to solidify what they have learned and in order to teach others. So write. Find a journal or take on a project at work. Read the research and then write out how it is important for you, your staff, your hospital.
Also, for a good majority of people, the more you write stuff down the better you remember it. Which is probably why writing drug cards over and over is super beneficial for learning at any stage of nursing.
As for the numbers, know your common doses and understand the logic of your medications. Know your values for labs and vitals and what they mean for your patients. And your devices…understand or ask if there’s a number that you don’t understand.
Also, know your scores. Know what a RASS of -3 actually looks like or what the interval for adenosine is or what a narrowing pulse pressure means for your patients.
Making time for all of these will improve your practice and mine. Who knows, maybe they will even spur on curiosity and keep you an active, engaged learner (and nurse)!