Top 5 Mistakes New Nurses Make

Luca Bertolli/123RF.com

Being a new nurse is hard – hard enough that 1 in 5 newly licensed nurses quit within a year, according to one national study. Heavy patient loads, the stress of being faced with critical decisions daily, and the seemingly endless documentation required is enough to make even the toughest new grad want to throw in the towel. After all, in a lot of ways, nursing school mostly prepares you to take the NCLEX. Being an actual nurse is the all about on the job training. New nurses are particularly susceptible to making some common mistakes that can affect their patients’ well being and the nurse’s job satisfaction. Here are some tips to avoiding some common newbie mistakes.

Look it up

You won’t know every medication; there’s no way to do so. That’s why for the early weeks and months of a nursing career, keep a drug book handy by your pyxis or a medication app on your phone, because if you give a medication that is contraindicated for your particular patient at this particular time – even if the doctor just ordered it -- the consequences land squarely on your shoulders. Know what test you are getting and why, what medication you are giving, and what the risks are.

One nurse’s story is a powerful reminder of what can happen when we are neglectful. “I was a new nurse, and I was caring for a patient post-carotid surgery with severe hypertension. The intern ordered apresoline iv push stat to drop her pressure to safer levels, to avoid rupturing her carotid, and to repeat it every five minutes until her pressure was under control. It wasn't a familiar medication to me, but I went and got it out of the drawer and gave the first dose, the intern at my side. Five minutes later, pressure was still too high. The intern ordered me to give it again, so I did. Same thing five minutes later, and then twenty minutes later. Her blood pressure crashed; she bottomed out and had a stroke. If I had known the medication can take 30 minutes to reach peak effect, I would never have given that much. I still see that woman in my dreams, and it’s been 40 years.”

Giving incomplete shift reports

It’s nearing the end of night shift, and the nurse realizes her patient has a sleep-deprived EEG scheduled in just two hours. The problem? That patient had slept like a baby all night, and now the test had to be rescheduled, costing the patient another night’s stay, and more importantly, a delay in diagnosing her condition. The evening shift nurse had forgotten to pass the test information along in report.

You might have practiced in nursing school, but giving report on multiple patients in an efficient manner takes practice. Effective hand off communication is a life or death matter at times, and a complete nursing report needs to include the patient’s allergies, code status, assessment, vitals/lab results, pathology, treatments and future care plan, and relevant medical team members. You can add more, as needed. Watch and learn from veteran nurses as they give their reports. If your health care facility doesn’t use a template, look online for samples or make your own cheat sheet.

Caught Unprepared

If you haven’t been yelled at by a physician for not having all the necessary information on a patient, you haven’t been a nurse for very long. Inevitably, you will need to call for admitting or other orders, and you will glance through the chart, sure that you know everything you need to know as you page the doc. Sure enough, she starts asking you questions, and now you have to scramble to find the answers quickly. We often have to provide patient information to medical team members, and they depend on us to do so quickly and accurately. Take the time to review labs, admitting notes, H&P, vital sign trends, and relevant key data for your unit.

What do I do first?

The IV pump in room 1 is beeping, the patient in room 2 is complaining of chest pain, bed 3 has to sign a surgery consent form, and bed 4 is a total care and just soiled himself. There is charting to be done, AM meds to pass, and you don’t have any idea which patient to address first. In nursing school, you may have had 2-3 patients at a time. Now that you are on the floor, you may have as many as six. On some specialized units, such as psychiatric care, you may have up to 20 patients. Watch and learn from veteran nurses to see how to prioritize each patient's care and then efficiently multitask so you can appropriately meet each patient's needs

You will be confronted with situations you have no idea how to handle, equipment you have no idea how to use, and situations complicated enough to make you miss the comfort of nursing school. Use your preceptor and your manager as resources. Look for senior nurses who are kind and pick their brains. Ask lots of questions, take lots of notes, and before you know it, you’ll be heading into year two with a brand new confidence!

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