Do You Dislike Nursing? | Nursing Hacks # 19

Do you or someone you know dislike the nursing profession, system, or culture? There is a difference, and people sometimes clump them all together. So, let's talk about this whole situation and get some clarity.

I want you to think of the nursing profession on a global level, the whole kit and caboodle, and all of its moving and changing parts. Disliking nursing means that you prefer to avoid caring for or assisting individuals with their medical conditions or illnesses, directly or indirectly. That is not your thing. When someone does not like nursing, they do not want to care for or support someone under any circumstances. If you are there or have been there, that is fine. As humans, we sometimes grow beyond a role or profession, and our needs change. Change is normal and okay.

Now, think of the nursing system on a national level. The nursing system involves leadership and how initiatives and objectives are created and reinforced. Do you have enough nurses to care for the patients? Is the administration focusing on the right things? Does leadership understand the issues you are currently facing? All that upper-level, c-suite goodiness. Are those who don't wear scrubs supporting and meeting your professional needs? Can you make safe choices, given the options you have? Is leadership listening to those who provide direct care? If there are issues, you have a system issue, not necessarily a dislike of the nursing profession.

Lastly, think of nursing culture on a state level. Disliking the nursing culture focuses on your local experience. Culture has to do with your work environment, your unit, your team members, and their behaviors. It focuses on your interpersonal relationships and support group. Do you feel supported in the day-to-day operations? Do you have what you need to do your job each shift (medication, team members, medical supplies, safety measures)? Is there workplace bullying or favoritism? If there is, disliking the situation makes sense. As you might feel, you are set up for failure. The work culture can make or break a job. It's that important. 

When someone says they don't like nursing, don't judge them. If you have a relationship with them, ask why. Inquire about the actual reason because the nursing shortage is NOT due to nurses not "liking" nursing anymore. It is much deeper than that. Simplifying things only diminishes the true issues. We don't work that hard to simply walk away because we lost interest. There is more there, and I find it insulting when people pretend we stopped caring when in reality, it is more complicated than that.

What Is Happening? | Nursing Hacks # 18

We went from the world loving us and calling us 'healthcare heroes' to them physically assaulting us in public and saying we are in the Illuminati. These past three years have been quite a ride. Now granted, I live in Florida, and it's been umm, more colorful here. But, when I turn on the news, I'm forever seeing a nurse on the news for doing something outrageous or a nursing program disbursing fake degrees or stealing students' money. I am, indeed, feeling some type of way about nursing right now, haha. Nursing is the most trusted profession, but it doesn't feel that way lately. If it isn't hospitals nationwide facing retention issues, unsafe ratios, or abysmal compensation, the nursing field seems like trap after trap. A trap to harm yourself, a trap to hurt others, a trap to compromise your morals or a trap to get you stuck. It's okay not to like the circumstances of something and still strive for better and hope for improvement. 

We, as a profession, need to talk about so many things. These unresolved topics, over time, can erode our passion. It can make us not trust our colleagues and hesitate to continue progressing within the profession. Where is nursing going? Where will I be in 6 months? Questions with varying responses. But when you think about those things, understand we all have different pathways and needs. In the shitshow of 2023, don't lose who you are. It's okay not to know what you want but know exactly what you don't want. Allow yourself the space and time to see what you want and need. Pretending everything is fine and acting as if nothing requires reexamination is dense. The profession is in transition, and it's okay to admit that you see some significant issues that must be addressed. We don't need to have all the answers. We need to be open to the conversation that what's happening isn't working for some of us. The shenanigans barometer is on shitshow right now, and we all need to just sit down and process everything and sit in the uncomfortable. Let's take it back to the practicum days and allow reflection on the sheer experience of what we have gone through without judging where we are in the process. Collect your thoughts, process your responses, and acknowledge your space. Once we understand our feelings and reactions, we can direct our efforts to improve our spaces. This isn't a sprint. It's a marathon. Get to stretching.

What Does Complete Look Like? | Nursing Hacks # 17

I recently finished my ARNP critical care orientation. I started with an ASN, got my BSN, and now my MSN. With each pathway, I found a common issue in the learning process. Many people would ask me to complete a task. I would attempt to complete the task, but there would always be some missing piece I never completed. The more this occurred, the more frustrated I began. I recently read the book, Dare to Lead by Brene Brown. This book is fantastic and opened my eyes to clear communication.

One aspect of the book that drew me in was the concept of completion. When I would be asked to complete a task, the instruction would be somewhat vague, and I never truly knew what finished looked like. For example, I was asked to complete the admission forms for a new admission. I'd complete the required forms, but there would special things I didn't do that everyone "knew to do" with new admissions. No one discussed this with me, but I was expected know it.

I would perform the task to the best of my knowledge. But there was always something missing or half-done in the eyes of my preceptor or attending. As you learn, you get feedback and corrective measures. That process can be overwhelming and honestly frustrating at times. But what was more frustrating was the lack of understanding regarding what "complete" looked like. After reading this section of the book, I now approach tasks differently. After I'm given a task, I always follow up with these questions:

C - 1. What does complete look like?
What checkboxes are your reviewing in your head? What do you expect to be done?

T - 2. Expected time frame to complete things?
How long do I have? Are you under any time constraints?

A - 3. Any additional things I need to know about?
Are there any special caveats I need to know before starting?

The frustration comes in a lack of overall understanding. The funny thing about communication is that one person can think it's happened, while the other person is completely clueless and lost. Just because words are spoken and someone nods their head, doesn't mean he or she properly understands the scope of the task. I've seen preceptors give nursing students a simple instruction. The nursing student then performs the task but misses a key element. This is often due to a lack of understanding regarding what "complete" looks like.

If all this sounds annoying, over the top or "too much," then you are probably a person who has to clarify instructions multiple times. You might often find yourself disappointed in the actions of others. Take the time to explain what you need. Don't assume people know the intricacies of your request. Explain what you want, and be clear the first time. Learning is a frustrating process. Someone who doesn't have the time or patience to explain what they want really doesn't help.

Uncomfortably Learning | Nursing Hacks # 16

Learning has a certain level of uncomfortableness to it that can deter some individuals. Trust me, I've wanted to quit many things after either being reprimanded or after performing an outright inappropriate action. I remember being a nurse technician (as a nursing student) and giving a patent a Pepsi after he requested one. I thought I was helpful. But what I didn't know was that the patient was a diabetic. The unit manager had a discussion with me and explained the error and the increase in the patient's blood glucose as a result. Now, I could have taken that moment in time as a sign that nursing wasn't for me. Granted, I did mess up. But we must understand that learning is messing up. It is the only moment in time where you are expected to make some mistakes. When you are learning, you are below a novice. You are at the beginning of the video game, where you are only learning what the controller buttons do, you are not even at level one.

The goal isn't to mess up, but you must be aware of the capacity for error when you are learning something new. You always see nursing graduation photos online, and registered nurses talking about the complexes of the profession, but I wish more people would discuss the struggle. The times were you weren't sure if you were going to be successful because those are the defining moments. The moments that will determine if you stay with this profession or not. It's not the NCLEX or certifications. It is your determination to keep getting up and to keep going. No exam will give you this trait or mindset, you must trust the process and know you will get there when the time is right.

No one graduates from nursing school and then immediately passes the CCRN. Critical thinking is developed over time. Allow yourself time to grow and develop. Education and knowledge aren't instant, no matter what Instagram or Facebook makes you believe. We all started at the same place, and you will get where you need to be when the time is right. Rushing will only cause anxiety because you can't control this aspect of your development. Deciding to be a nurse isn't a big, defining moment. It's a series of micro-decisions over a long time frame that will get you to the finish line. Every day, wake up and decide you are still in it and will try your hardest to be the best version of yourself. That's all you have control over in life.

The frustration of learning comes in one's inability to control outcomes and the stress of believing in the future. It can be scary. Hell, trying is scary. But learning is supposed to be uncomfortable. Learning is filled with growing pain you can't escape. Everyone who is learning something new is uncomfortable. Some just have better poker faces than others. Be secure in knowing we are all unconfident and uncomfortable together.

Custom Learning Tools | Nursing Hacks # 15

Learning is a beautiful process, but boy can it be annoying as hell sometimes. Those moments where things aren't clicking, and you forget the same things over and over can be disheartening. And in nursing, there are so many elements to remember. I know, it's a process and blah blah blah, I get that part. The part I struggle with is the in-between. The in-between is a phase where you've been there for a few weeks, you "should" know certain things but they just aren't sticking. When you're brand new, folks will let you get away with not knowing most things. But as time goes on, I feel people internally evaluate your knowledge base. They love answering tons and tons of questions for about a month. But after that month mark hits, I think some people get annoyed if you haven't picked up the "basics" or things they find to be concrete concepts. There is so much to learn in the beginning. I feel as though some people don't grasp just how overwhelming it can be in the early months. It seems like the timelines get shorter and shorter, and institutions want you to learn at lightning speed.  With my experiences, I've found that creating a learning tool has helped me, and I recommend all learners create one.

I carry around a notebook, a little one. Each day, I write down the answers to my questions. It requires commitment but helps tremendously. Once I'm home, I add and modify my learning tool based on what I learned that day.  It's an ongoing project. The goal is that the number of questions will lessen because I have created an aid for myself. Asking questions isn't a bad thing. The tool simply helps you retain the information by reinforcement. Seeing it in print does something in my brain, I can't explain it. But within a few days, concepts stick and become second nature. You might ask, how do I know what is important? I ask my colleagues and managers for guidance. I never want to assume what my role should be. I ask directly, and I ask for specific examples. Many conflicts involve communication or lack thereof. I want to understand clearly and wholeheartedly what I should be doing and what I need to know. This tool has kept me organized and provides me with a printed roadmap. I've used this type of tool throughout my entire nursing career. From nursing student to RN to APRN. It keeps my thoughts together and allows me to see patterns. You have no idea how many times someone has asked me something and bam, the answer was on my paper. I print the same page (twice), on one page and fold it down the middle - great compact resource. This method will allow you to have two patients on one page.

Download Medical ICU Template @ http://bit.ly/2XoXkmb
Download CT Surgery ICU Template @ http://bit.ly/2KUpEWQ

Note: This tool is a road map and will require updating throughout your shift. With time, you probably won't need such a detailed and extensive form (like the ones shown below). Sometimes, I carry the form around to simply remember things. It doesn't have to be filled out to assist you. I'm an APRN, this form works for me. Each position and floor is different. Make the form your own, you don't have to use it exactly as is. The goal is to help you learn, each journey is different. More tools @ http://bit.ly/1jn9L1f

Metacognition & Learning | Nursing Hacks # 14

Metacognition is a concept that concentrates on thinking about your thinking. Seems confusing, I know, but it focuses on processes concerning monitoring, assesses, and evaluating your understanding and performance. Metacognition is a new trend in nursing school education, and I'm very excited to see it is finally being put to use. It goes beyond nursing concepts and focuses on the learner's actual ability to learn and comprehend content. As an individual either interested or currently in the nursing profession, I know that metacognition will improve your knowledge capabilities. Metacognition makes you aware of your strengths and weaknesses in a variety of topics. It provides the learner the ability to be proactive, and not solely reactive to the learning process. The fundamental component of metacognition is the recognition of one's limitations regarding knowledge and performance. Once the deficiencies are known, one can focus on filling those gaps and expanding knowledge and performance roots. You don't know what you don't know unless you explore your perspectives toward learning. As humans, we tend to be blissfully oblivious of our incompetence, and lack insight about our deficiencies. We are our perspective, and every encounter is viewed through our own lens. To allow true education to take place, we must asses our viewpoint towards educational fundamentals. In order to understand the disease process of COPD, you must first understand the concept of gas exchange. Knowing the symptoms is not learning, it is memorization and unhelpful. Hence nursing schools moving toward nursing concept learning models.

 What can we do about this?

# 1: Examine Current Thinking
- What are your current feelings or ideas about the topic?
- What experiences have influenced your opinion about the topic?
- What are you learning & why are you learning it?

# 2: Identifying Confusion
- What element is confusing to you?
- What are you having issues grasping?
- What foundations do you feel you are lacking?

... research the gaps found, educate & evolve your thinking ... 

# 3: Recognize Change
- How has your thinking changed?
- What concrete concepts remained?

# 4: Reflection
- Do you feel you have expanded your knowledge?
- What gaps remain? What other questions do you have?

Avoiding Learned Helplessness | Nursing Hacks # 13

As new learners, we require support. We lack experience and therefore, we need others to guide us towards the proper efforts necessary to be safe and successful in a particular position or task. A certification doesn't qualify an individual, nor does it quantify intelligence. An individual's hard work, dedication, and efforts are what qualifies them. Exams merely open doors, they are professional pillars. Training is the journey and the real determinate of expertise. I've worked with many people who had a long list of credentials, yer they couldn't perform some novice level tasks. Experience and education go hand and hand.

As a new learner, we have the foundations, but the practice is what we lack. Preceptors are there to guide us in filling in those gaps. In the first few weeks of training, you depend on your preceptor. You will have deficits in your knowledge base, and your preceptor will fill those voids. These voids occur when real-life doesn't quite match up to textbook knowledge. For example, you have a patient with acute on chronic congestive heart failure. As there are layers to this disease process, you might need assistance in creating the proper nursing diagnose and care plan. Complex management is where most voids will occur as a new learner and rightfully so. You've never been in these professional situations, and you want to make sure you are providing safe, efficient medical care.

As training progresses, something happens to some individuals. Instead of them investing in their learning journey and studying to fill more and more voids, they merely ask more and more questions for instant answers. This form of inactive learning is called passive education. Passive education occurs when someone sits back and expects to be taught without any input on their end. For example, sitting at a desk and listening to a lecture is a form of passive education. You sit and absorb all the information you can. You are not a participant. You are an observer. This is appropriate in college. It is not suitable for on-the-job training. When you are learning as a new nurse at the bedside, you need to be active in the learning process - going home and researching concepts and taking notes. Your goal as a learner is to consider newly discovered professional voids and work on them by investing in yourself (by studying or creating personalized resources). You should be working towards understanding complex processes, and not merely waiting for someone to prompt you to perform a command. This idle, educational-waiting is called learned helplessness.

Learned helplessness occurs when preceptors provide all the answers throughout the entire training process. The learners are never required to procure knowledge independently (from trusted resources) or find said resources. Therefore, these learners wait for answers. They see a problem and don't work toward resolving things or seeking help. They sit and wait for commands. Once these learners are on their own, they drown. Without explicit instructions, these learners fall apart because they have never had to function with minimal to no assistance. Throughout their learning process, they had maximum aid. And now, their brains are hardwired to wait for instructions. They are dependent on someone telling them what needs to be done and when. Once training has been completed, these learners can't make the conversion from dependent to independent processes. Why would they? It's never been needed before.

Don't fall into the trap of learned helplessness. When you get home from a long shift and your ears are smoking, still take the time to read up on topics that you had to ask about frequently during your clinical experience. The at-home education will allow you to expand your thought processes more than you imagined possible. I know, training can be intense. But if you want this, you're going to need to invest off-the-clock also. Studying and training at the bedside cannot occur concurrently. You have two to six patients. You will likely be too busy to sit down and read up to vasopressors and their possible adverse effects at work. Take charge of your education and don't simply allow the process to be passive. Don't simply wait for commands, you are not a robot. Present your preceptor with nursing recommendations, do the appropriate research, and be ready for all possible outcomes. Be the amazing nurse you are. Use the knowledge acquired in your nursing program and grow.

Toxic People Management | Nursing Hacks # 12

You. You are on a unique, personal journey in life. No one else has been in your shoes and doesn't know your background. The background that brought you to the nursing profession. The background that shaped you and made you the person you are today - the person who is now drawn to helping others in your community. The journey was a long one, but you are here, stand tall. Please, please do not allow some random ass person in your life (professor, instructor, co-worker, friend, family member) to shake your foundation and core values. Don't let one individual disrupt your learning process. No one can tell you what your potential is or will be. They have no idea if you will be a "good" nurse or a "smart" student. They can't predict failure. There is no trait in failure. Failure is an event. It does not describe an action or an individual. I've failed nursing exams and courses before. I've experienced taking two steps forward and three steps back. The nursing journey can be emotionally exhausting. That emotional state has nothing to do with your academic or professional potential, nor does it determine your future success. Don't allow a random person to shake your confidence.

Do you ever wonder why people discourage and create an atmosphere of impossibilities? It's because they dislike their lives and must lash out at others. Their self-loathing projects itself outwardly. It isn't about you or the actual topic at hand. These people are toxic, and their negativity seeps into your skin and spread within you. Their words bore into your mind causing insecurity and stress. To these individuals, their advice is factual, solid and certain. When in reality, opinions are based on our life experiences and exposure. Opinions are paper thin, wavering and unstable. These negative people are unhealthy to your overall wellbeing. If it's a professor, learn what you can and move on quickly. You are paying to learn, so do that. Your goal is nursing, your endpoint is graduation. Get there and don't look back. My nursing fundamentals professor told me I'd never pass the NCLEX-RN exam. He told me I was inept... well, well, well look who was wrong!

If it's a co-worker or family member, sit down and evaluate the relationship. Who you surround yourself with determines your perspective and emotional health. I don't care about someone's intelligence when it comes to being within my support system. I need positive, well-rounded individuals who understand that life is complicated. No one has the answers. We are all merely doing the best we can. We are individuals attempting to improve the health and wellbeing of people in our community. You are enough. You have nothing to prove. Advice is great, but in the wrong hands, it can stop us from wanting more. It can prevent us from taking those needed steps. Always listen to your heart, block out the rest. You have to make a conscious effort to ignore the bullshit around you. It's all bullshit, it doesn't matter. It doesn't play a key role unless you allow it. Focus on what you want, how you want to grow and how you want to impact the world. You think Florence Nightingale was pressed on what others thought about her and her professional choices? Nah. People making history and causing true impact don't allow toxic people to deter their progress.

Professional Growth: I'm Still Drowning | Nursing Hacks # 11

I've been receiving tons of messages from nurses starting the profession (graduate nurses) or nurses transitioning to a new position (for example: from medical-surgical to the intensive care setting) with questions regarding professional growth. When you start a new post, regardless of history, there will always be a time of adjustment. A time where you are asking a ton of questions and feeling uneasy about your ability to perform your role. It can be stressful because you don't know what you don't know, and you're learning as you go. Understand every nurse experiences this. Your professional growth will vary from your counterparts so, do not compare your tracks or personal goals. In my personal opinion, it will take around SIX MONTHS to acclimate to a new setting. And by acclimating, I'm referring to the ability to perform the job with minimal to no assistance and to independently locate the resources needed to complete the job. So what does all this mean? It means that from 0 to 180 days or so, you SHOULD be asking many questions and still be at a loss as to what to do in some moments. There might even be times where you need someone to walk you through what to do. Don't judge yourself or think you aren't getting it. Nursing involves many layers of care and knowledge. It's not meant to be grasped quickly. Healthcare requires you to be continually evolving and it is a changing environment. It's a complex, dynamic profession. Which means it will take months to become proficient and safe. Let's understand why and help you in this time of anxiety.

Alright, let's dive deep into why this extended time frame is necessary. As a nurse, I've been trained as a graduate nurse on a progressive care floor, then from progressive care to intensive care, and then from private-sector to government-sector nursing. Each time, I gave myself six months to get my act together. I didn't judge myself because nursing is unapologetically changing and morphing into what communities need it to be. Each shift, you are given patients who are critically ill. These patients require your attention and critical thinking abilities. Each disease process is presented differently, with each patient reacting uniquely to ordered therapies. This profession isn't like opening a register and giving someone money, it's complicated and involved. You won't be comfortable until you've managed a fair amount of patients, which is why I recommend the six-month mark. By six months, you should have seen most of your patient population. Six months is an appropriate amount of time to assess your skill level and critical thinking abilities. I know it seems like a long time, but it isn't. You must be emersed in your patient population to accurately assess your level of competence and to properly evaluate your job performance. If this process is rushed, it could result in your leaving a position you would have been great at given the appropriate amount of time to discover your strengths. You got this, all day! Lean into the learning process and understand how complicated your job truly is. Give it time, allow yourself time to absorb things. It took me six to seven months to get "comfortable" at my job. And by "comfortable" I mean, not freaking out all the time due to fear, and being more independent. Nursing isn't a professional you will ever be entirely comfortable in, things change second to second. Understand the environment and do the best you can, but please don't judge or compare yourself to others. We all learn at our own pace. Take a deep breath and take it one day at a time, allow yourself to adapt to the new setting. You will find your stride soon enough.

If by the sixth month, you see no growth, and you still see yourself struggling to grasp nursing concepts, I recommend you speak to your manager or unit educator. There is a disconnect somewhere and getting them involved might assist you in finding where or what it is. We can't always see our flaws or areas we need to work on. Getting others involved in your educational plan is a great idea. Remember, this isn't a contest. You aren't competing with anyone. The goal is to learn and grow. Before I was a nurse, I worked in retail. My learning curve is enormous. I didn't think I could do this in month three. I kept messing up. I kept forgetting things, important things. But by the fifth month, I was just fine. Time is crucial to change. You will get there.

Trusting The Process | Nursing Hacks # 10

I've trained many new nurses, ranging in age and nursing experience, and I've seen some individuals have issues with trusting the learning process. As people, we think we know what our strengths and weaknesses are. We believe we know what we need to learn and what we know to be true. I'm here to tell you this isn't true, not even close. We are blind to certain aspects of our educational journey, and we need a third-party to assist us in seeing the full picture. I got this notion from my husband, as he was having trouble in his Jiu-Jitsu course and felt he needed one thing and was getting another. After a conversation with his instructor, he found that he was getting exactly what he wanted but in a different way. That is the key, communication. Instead of assuming you know better, thinking you "got it" already, communicate what you need but never close your mind to the process itself. The goal is to evaluate your overall performance and thinking process, and NOT give you what you think you need. You might think you know yourself, but guess what? We only see what we want to see. There is no way in hell you know what you lack, humans aren't built like that. We are emotional creatures. Allow your instructor the opportunity to explain the process to you. More often than not, you don't see your weakness, the areas you are struggling in. It isn't about perfection. It's about the learning process. If you knew everything, you wouldn't need training. Allow for professional growth and go with the process.

You think: I'm great at time management. I'm doing well. I'm only behind sometimes.
Reality: You are chronically behind in performing nursing duties, you are not doing well.

... it's not up to you to determine what is a major versus a minor concern. You don't have the required critical thinking skills (for this new position) to see that far along. This is why instructors are needed, to see the big picture, to evaluate the potential within you. If you are unwilling to adapt and change, there is only so much dialogue will achieve ...

I know, it's hard to let go of control, but please understand that you are learning new concepts. Understand the setting and soak up what you can, when you can. You're not insecure in realizing you don't know everything. You are smart in knowing your knowledge deficits. Because more often than not, your instructor is assisting you in developing your professional performance. If you don't allow this, these troublesome areas will follow you throughout your nursing career. When I was told I needed to verbalize my concerns more by my instructor, I got defensive. She didn't know me, what if my concerns were stupid? I didn't see it as a problem. It wasn't until an event happened, that I finally saw this issue as a true professional concern. My eagerness to avoid confrontation was a problem. It was causing problems. Ever since management spoke to me about this, I've changed my behavior. I finally understood what my instructor initially meant. Fear led to avoidance, which led to problems not being managed promptly. Now, I advocate, I stand up and I go home whole, happy, and knowing I did the right thing. But when I was in the learning process, I didn't see it as a big deal. I blew off my instructor's concerns as being dramatic. I regretted it for a long time and now, as an instructor myself, I see the value in recognizing different perspective and viewpoints. They are crucial for growth and development. If four people see the same issue in your performance, it is you, not them. They all saw the same behavior, they all came to the same conclusions. Stop trying to convince everyone what they saw was wrong and focus more on evaluating your behavior. Trust your instructors are trying to help you. The learning process isn't an "us versus them" situation. It's a journey. You should be planning to grow and to adapt, and not doing what you find or feel is important based on an arbitrary aim in your mind. That is not growth, that is not trust. That is insecurity, and it will come back to haunt you professionally.

Processing Emotions | Nursing Hacks # 9

So, you have an instructor, manager or preceptor you dislike, huh? Well, I've been there and I wanted to give some advice to those new nurses experiencing this currently or have in the past. Understand that nursing is based on relationship dynamics. Whether it's a patient's wife or your charge nurse, relationships are crucial in the nursing profession. The problem some new nurses face is their inability to see the forest for the trees. You want to mouth off, you want to act unprofessionally, that's fine. But trust me, nurses NEVER leave the profession. We grow, we progress and move upward. That manager you disrespected many times might have left your unit months ago. But now, he or she is the chief nursing officer at the hospital you're working at. And currently, you're at an interview, seeking a management position and guess who walks in? That manager from the past. They have been resurrected like a zombie, BAM! That's what I'm talking about. People come and people go, but they never go-go in nursing. Understanding how to remain professional even if you have strong emotions is essential. So when opportunities come up, your past transgressions or emotional episodes don't interfere. Nurses are humans, with histories and issues (like everyone else). And sadly, some nurses hold grudges. We might not have office politics like some professions, but we are humans with memories and what you have done in the past could impact what you want to do in the future. Some opportunities can be missed based on your past interactions.

Emotions run high when you being pulled in five different ways. I understand, I get where you're coming from but understand remaining professional doesn't require any additional actions. It just involves always understanding you are on. When I worked at Disney (everyone who lives in Orlando works at Disney for at least one summer, haha), they explained front-stage and back-stage attitude expectations. When you were in front-stage, meaning in the view of visitors, your attitude had to be per policy and on-point. When you were back-stage, the employee area, you didn't have these same rules. As you were on break and changing into costumes. The point of this example is to illustrate that each job has communication expectations. In nursing, you are always on, there is no backstage in relation to your emotions. You are expected to be professional to staff, patients and families. There is no discrimination or separation. You have to maintain your chill and emotional wellbeing up until you get into your car. Please don't explode on staff members and act unprofessionally in front to family members. Your job is stressful, yep we get it. You signed up for this, you wanted this. Here you go. Embrace and enjoy getting your dream job and stop giving reasons why you're allowed to act childish and unprofessionally. Nursing is a team effort. When you act unprofessionally and disrespect your teammates, you are less likely to get a team to work with you or support you. It's a lose-lose situation. Whether I like or dislike someone (on a personal level) isn't a factor at work. Helping each other and taking care of patients are the priorities. Stop with the high school shenanigans.

I have a rule. If I'm angry. I stop talking, wait an hour or call my husband (if I have time). My initial reaction is usually one of anger or hurt. I know this about myself, so I don't allow myself to reply immediately. Give yourself a time to process things BEFORE I act on them. I then sit down and write my feelings out on my laptop (or on a notepad), this act will dissipate some anger and allow me to get my thoughts together. By the final stage of actually discussing my feelings with the other party, I'm relatively calm. The two previous steps really slow things down and stop me from making big mistakes. Anger is like a hot stove, the processing turns the burner off. Being busy doesn't mean you get to be verbally abusive. Being stressed doesn't mean you get to be verbally abusive. Process and examine why you're really mad. Most of the time, there is more there. Take a deep breathe and don't allow your emotions to get the best of you or your career goals. You can apologize all day but you will never know why you didn't get that job. Was it based on past dynamics or emotional episodes? Who knows. It's hard controlling your emotions initially. But processing them in a healthy manner works. I've been doing this for years now. Just yesterday someone was screaming at me and I processed in the moment and remained calm. You will get to a point where you're the calm, professional one watching all these folks lose it over nonsense. You will see the power that being in control of your emotional well-being will give you. It brings the ability to see past the emotions and gets you to the real issue or problem. Now that's gold and works in professional and personal relationships.

When I process emotions, I ask myself...
1. Why am I feeling this way? Angry? Disappointed?
2. Am I mad about this current issue or past issues?
3. Is this hindering me from doing something?
4. Do I think this person deserves this? Why?
5. What will the anger accomplish? The value?
6. Is my ego hurt? Does this bother me? Why?
7. Do I think this is healthy? Professional?
8. Will I look back and regret my actions?
9. What points do I want to get across?
10. Is this really about this one thing?

... sounds long, huh? It isn't. I do this in about 2-3 minutes.

Listen, I'm not perfect. I have random freak-outs (serenity now, haha). It's a rarity but happens. I feel terrible when it occurs and I apologize a million times. Attempting to control your emotions and understanding your process is the first step. Working towards these goals is what matters. But you have to try, you have to want to work on yourself.

Difficulty Adapting To Real-World Nursing | Nursing Hacks # 8

As a current professor, bedside nurse and soon to be practicing nurse practitioner (oh yes! I got my dream job - cardiothoracic and critical care nurse practitioner in a hospital, freaking ICU! OMG, okay I'm calming down now), I've had many instances where I've felt out of my depth. It has nothing to be with intelligence, it has to do with adapting to a new role and getting settled in. I want to give nurses in transition some advice on how I make it work when my mind is telling me to run far and fast because I'm overwhelmed.

Fundamentals
Before you can jump to how things ARE done and what things NEED to be done, we must understand the fundamentals. For examples, some new nurses love critical care and loving titrating and managing vasopressors. But when asked about drug properties and expected medication outcomes, they have no idea. In order to get to the fun stuff, we must understand the fundamentals. The fundamentals are your foundations and will assist you when you're stuck or lost. I don't need to know everything about cardiothoracic surgery initially, that will come with time. But I do need to know the cardiovascular system, coronary blood flow, and possible surgical complications. Nursing schools rave about fundamentals being important because THEY ARE IMPORTANT. They aren't as sexy as clinicals or simulations, but they will be with you for your entire career. The cardiovascular system will never change. Knowing the basics will be my starting point. If you have a patient with COPD, you must understand the respiratory system to understand its abnormalities. You can't jump to disease if you have no idea what normal organ function should be. This background will assist you in constructing proper nursing diagnoses and care plans. When my patient has fluid overload (for example), I know the fundamentals and am able to articulate my findings in an appropriate manner. If I can't connect shortness of breath, crackles, and edema to fluid overload, my patient will continue to decompensate right in front of me.

Expectations
In order to meet expectations, you must know them first. Sit down and take the time to ask your preceptor what the weekly goals are and how much responsibility they would like you to take. Setting these upfront terms will leave no gaps or room for misunderstandings. Too often, nurses will say a new nurse is "lazy" when in reality, he or she is just afraid and doesn't want to get in the way. Don't let your emotions get the best of you. Take a deep breath and go talk to your preceptor. Talk to your preceptor about how he or she will be involved weekly and shift expectations. Try to agree on standards and fundamental approaches. The goal to be ACTIVE in your education and not simply REACTIVE. Explain what you think the ideal plan of action should be and then ask for his or her input. Collaborate on medical plans and be involved in the minute-to-minute activities. You are learning, you must be involved in every aspect of your patient's care. Don't assume your preceptor will "let" you know what's important. You will be on your own one day. Be ready and willing to do what is needed to be the primary point of contact. You should be talking to the charge nurse about concerns and you should be holding the phone and calling providers. It is up to you to show your preceptor that you comprehend the fundamentals and are trying to be the best nurse you can be.

Execution
Now that you have your fundamentals down, and are aware of the expectations, there is nothing left but to get going. This will be the hardest part, putting all the pieces together. This will take some time but learning to perform your job in the designated time frame is what makes or breaks nurses. Too often, we are staying late or getting to work an hour early. This is all due to the inability to manage our time properly. We all have those days where we must stay late, but if it becomes a pattern, there is a problem. Giving medications late is a problem, charting late entries over and over is a problem. You will start off like that, and that's okay. But as the weeks progress, you should acclimate and start to thrive knowing what is needed of you. Nothing feels better than knowing what you're doing and being able to execute it within the appropriate time frame. When I've done my job successfully, I drive home with a smile and my heart full. When I was a new nurse, it took me 35 minutes to pass my medications. Now, I knock it out in 10 minutes. Speediness comes with time, but don't focus on that initially. Focus on getting as close as you can to the time frames needed to do your job successfully. It might be overwhelming at first but know that comfort and ease will come with TIME. Give it time! This is a new job, and with anything new, it will take time. You're not a failure, you are learning, and again, that takes time.

Note: Learning is a process, which means you should be demonstrating growth at certain set points. If you are weeks in and there is no growth, that should be a red flag. A red flag that you need to talk to your educator about your current position and perhaps a growth plan needs to be initiated.

Being Efficient While Being Busy | Nursing Hacks # 7

I've been a bedside nurse for a while now and lately, I've been training new nurses more than usual. Everyone is different, but there was a general complaint that most new nurses have had and I wanted to comment on it. Regardless of the level of care (I get floated all over the hospital... medical-surgical, progressive care, intermediate care, inpatient psych, even PACU), all nurses understand being busy. Busy is a way of life for us. We are presented with enormous to-do lists, and we complete each every task while somehow making it home on time. We thrive in being busy. It's our home. But, some new nurses don't quite understand the importance of being comfortable in chaos and finding your focus nevertheless. Now, I'm not saying ALL new nurses have this problem. It's just something I see some new nurses struggle with understanding and I wanted to give some advice.

There are going to be many instances when you, as a new nurse, are faced with a task list that seems impossible. Instead of freaking out and getting flustered, you need to focus on what's important and work outward. Your unstable patient's condition is more important than you getting an unimportant form printed for something that won't happen for another eight hours. You must be able to determine what is stat, urgent, important and routine. You can't handle every task as critical. You are a nurse. You are capable of evaluation and classification. You need to sit down and prioritize what tasks need to be completed in which of the following levels:

- STAT: What needs to be done within 5 minutes
- URGENT: What needs to be done within 30 minutes 
- IMPORTANT: What needs to be done within 2 hours
- ROUTINE: What needs to be done BEFORE you leave

Some things can't wait, while some can. Don't allow stress to get the best of you. You are only one person, you have to prioritize things. You must learn to work effectively in chaos. A hospital is a place of organized chaos. Sick people are being routed to the proper medical settings for treatment, and things are happening rather quickly. This will not change, and this is the environment you have decided to work within. I tell new nurses that, "If you wanted all smiles and hugs, you probably should have gone to a pediatric outpatient office. Multisystem ICU is not smiles and hugs (normally). These people are sick, and their families are stressed. Understand your environment and find the good in what you do. You must be productive regardless."

Being a nurse in the hospital setting is intense. You chose this job role, and now it's time to find your groove and get moving. Don't stress about what you don't know. Training will get you there. But you can't teach someone emotional intelligence or the capacity to control their emotions in times of stress. You chose to do this, and now you're here. Take a deep breath and ask your preceptor how he or she successfully juggles tasks. I love my job, but I know it can be overwhelming for some. The key is to learn from people who are successfully balancing the job's demands. Focus on perfecting your performance and less on complaining about something you signed up for. You got this, but you have to get past the complaining about stuff phase. Your patients deserve better and so do you.

Note: There will be tasks that can wait for the next shift to perform or things you physically can't perform within your 12-hour shift. And that's fine too. Just make sure your choices are in your and your patient's best interest. You can't do everything always, I understand that. But the goal is to use your time wisely and focus.

Real-Time Charting | Nursing Hacks # 6

A year and some change ago, I precepted and trained my girl, Ashley. She is now my co-host on The Working Nurse Podcast (click here to listen). After training, our friendship grew, and I now consider her one of my best friends. Back then (during training - the first two weeks), Ashley and I would get into tiffs over her charting. She would do this thing where she would perform tasks and then afterward, sit down and "catch up" on her charting. That was a pet peeve of mine, and one day we sat down and I explained why.

Charting is to be done in real-time, and most facilities require nursing staff to chart in this manner. When Ashley would perform her assessments, I would have her chart the entire evaluation while in the room (using the room's laptop). I didn't allow her to step out, sit down and get distracted by other things (Hey, I'm not evil. I have my reasons, let me explain). At first, she was annoyed and irritated at the request. Oh, yes she would shoot me daggers while in the room, haha. But with this action, her charting was always real-time and completed right then. She never needed to "catch up" on anything. As a preceptor, this was great because I could promptly review her charting, and we could discuss any needed changes immediately. I remember being a new nurse and nothing irritated me more than the shift ending and my preceptor making me fix my charting SIX times (per mistake) because I made the same mistake each entry (ICU nurses chart assessments every two hours [where I work] - 19:00, 21:00, 23:00, 01:00, 03:00, and 05:00). If we had talked about my errors during the shift, I wouldn't have copied the same mistakes over and over again.

Ashley usually never had late entries or delays (98% of the time - come on now, nursing is still nursing. Nothing is 100%). We never had to stay late for her to "catch up" on her charting and she never had to skip lunch to chart either (now that statement is 100%. I don't stay late, EVER). The first day of training I told Ashley, "I've been a nurse for five years. I've never stayed later than 7:35 AM (for night shift) or 7:35 PM (for day shift). I will not with you, so let's sit down and let me explain my expectations." I don't stay late. And I don't allow people I train to chart or stay late either. Charting is meant to be done in real-time. When you chart late-entries, it doesn't look good. Are you going to go to jail? No, but let's think this through. For example, you're three hours behind on your charting and your patient codes and sadly, passes away. Now, you have to chart all the pre-code vital signs and assessments, the code blue event itself (along with the given medications), perform postmortem care and chart the deceased patient checklist and security forms. Charting late ONLY delays the inevitable. And as more time passes, the to-do list gets bigger and bigger. Oh, and what if the doctor (during the code blue) wants the last set of vital signs and assessment before the patient coded? Would you know that information? Would you remember it at a time of total chaos? I usually have my patient's electronic chart open during the code for this very reason. But if you have no data, you are screwed.

The more time that goes by without you charting, the more things you must chart. Don't kid yourself. Sit down and chart right then, right when the event takes place. I know, you have 100 things to do. But charting is time-stamped. So, when you chart the 19:30 assessment at 23:15 (and you change the entry time to 19:30), those actions are logged. Does it make you an evil person or a liar? Of course not, but it doesn't look good. If a lawyer looks at it, let's just say you might have some problems. Start good habits, and begin with your charting tactics. Ashley probably hated my guts when I was training her but now, she's a graduate nurse who went straight into the ICU setting, and she is flourishing. She manages to chart real-time even in the critical care chaos. And sometimes I look over, and I still see her charting in the room, haha. Now, this is advice is for new nurses but all nurses can use this one. I have even seen nurses with 20+ years of experience chart their ENTIRE SHIFT's tasks and assessments at the very end of their shift. Yeah, not good!

Listen, I'm not saying there won't be situations where your charting is delayed. What I'm saying is if you find reasons to delay things, they will pile up and be waiting for you. Documentation doesn't disappear, and it doesn't get done by your assistant. It's all on your shoulders. Be proactive and not reactive in your documentation goals.

Notification Documentation | Nursing Hacks # 5

I've had many new nurses write me and mention situations that involved a verbal conversation with a provider. Either the patient deteriorated, or a serious event occurred and there as a problem with the communication trail or lack thereof. I've experienced this before and this is why I document ALL verbal conversations and provider interactions that take place during my shift. Sounds annoying, right? Of course, it does. But understand, when a patient codes or has had sustained issues your entire shift and nothing was done, the finger pointing begins. I love the providers I work with, but I also understand human nature. It's not personal, but if someone is going to get in trouble, they will attempt to deflect and use "gray zones." Gray zones are what I call undocumented conversations. I've had a patient with a sustained heart rate of 140-165 beats per minute for FOUR hours, and a provider tried to tell his medical director, "nursing never notified him." Luckily, I had many timed events regarding the phone calls to his service line (and I documented the operator who paged him each and every time). I worked my butt off to get my nursing license. I won't have my reputation sullied with inaccurate information. Okay, so let's take the previous situation above. My patient has sustained sinus tachycardia at the beginning of my shift. Here is my documentation trail:

Initial Notification
19:30: Cardiology (Dr. Ramon's Office) called regarding sustained heart rate of 140-155 BPM (sinus tachycardia). The patient is asymptomatic. BP 120/45, O2 100% (RA), Pain 0/10, RR 13, T 98.4. Nursing called after-hours service and left a message with the operator (Ruby). Nursing waiting for return call and will continue to monitor.

Second Chance
20:00: Nursing requested unit secretary send second call-out to cardiology (Dr. Ramon's Office) regarding sustained sinus tachycardia, all other VSS. The unit secretary left a second message with after-hours service, spoke to the operator (Ruby). Secretary notified Ruby this was the second request. Nursing waiting for return call and will continue to monitor.

Nursing Escalation
21:00: Charge nurse notified of sustained sinus tachycardia and cardiology (Dr. Ramon's Office) being notified twice. Nursing requested unit secretary send third call-out to cardiology regarding sustained sinus tachycardia, all other VSS. The unit secretary left a third message with after-hours service, spoke to the operator (Ruby). Secretary notified Ruby this was the third request. Nursing waiting for return call and will continue to monitor.

Provider Escalation
22:00: Nursing contacted critical care (face to face conversation - Amy) regarding sustained sinus tachycardia and repeated calls to cardiology (Dr. Ramon's Office). Critical care wants nursing to continue to monitor and wait for cardiology to return call. The patient remains asymptomatic and nursing will continue to monitor.

Condition Update
23:00: Nursing called critical care (phone conversation - Amy) regarding sustained sinus tachycardia condition update, all other VSS. Orders were given for metoprolol and 12-lead EKG. Nursing will continue to monitor.

The point of writing this novel is to show your hard work in you attempting to get this issue resolved. ALL NURSES DO THIS, we just don't document our hard work and follow through. The key is documentation. I could say all day I called and called. Documentation leaves nothing open or "gray." If I'm asked about this a month later, I don't need to guess or infer what my actions were. The documentation is there for all parties to read and track the series of events. Now, this doesn't happen often. But when it does, make sure you take the proper steps in protecting your license and properly presenting your actions step by step. What if this patient has a massive MI and dies? His loved one later sues the hospital, and their lawyer sees these CLEARLY dangerous vital signs for hours and hours? It looks bad. You look bad. Your only saving grace is your notification documentation and escalation steps.

Where Is The Tube? | Nursing Hacks # 4

As a critical care transition nurse (from PCU to ICU), my preceptor trained me to check diagnostics and progress notes for tube confirmations BEFORE continuing use during my shift. There have been times where I've entered a situation unaware of changes in a tube's location, and the change subsequently caused significant issues. For example, a patient was intubated yesterday, and the endotracheal tube was confirmed 2 cm above the carina, positioned 24 cm at the lip via CXR. When I go to perform my initial assessment and lean over to see that endotracheal tube, it better be at the 24 cm mark, or we have a problem. If it's not, I call the respiratory therapist and confirm the discrepancy. A combative patient can dislodge or advance an endotracheal tube without the nurse knowing. This isn't a competency issue. People are moving parts, they are not static. When I receive bedside report, I write down the details, but I make sure to confirm with diagnostics and visuals. Here is another example. The morning nurse placed a nasoduodenal feeding tube. The tube was confirmed as post-pyloric at the 85 cm mark via KUB XR. Upon your initial assessment, you find the feeding tube at 55 cm. The tube feeding pump is going as planned, no alarms will sound but obviously, the tube has been moved. It probably isn't post-pyloric anymore, you're probably feeding gastrically.

When I receive bedside report, I assume everything is messed up until I confirm it's not. Nothing personal, just nursing. Communication is complex and interruptions are plentiful. Inaccurate information isn't intentional. But it's your license and inheriting problems is common. Tubes slide, things move, don't be the last person to find an error 10 hours into your shift. Nothing beats good old eye-balling and research. These tubes are in people, don't assume they will remain in place. Oh, and by confirming placement, I mean reading the impression section of the diagnostic report. Don't over think it, scroll down and read. You don't have to be a radiologist to read two sentences. Remember, if you are using a line or tube, continued use is confirmation you're 100% aware of its location and trust the destination is appropriate. If you have reservations about the final destination of the device or product, you probably shouldn't be using it. You can't continue to use something and say, "Oh, I assumed it was right. I never checked." If you don't know, find out.

How To Develop Critical Thinking Skills | Nursing Hacks # 3

Experienced nurses often complain about new nurses lacking critical thinking skills. But as an observer, I've noticed many flaws in how some graduate nurses are being trained. When it comes to critical thinking, it's a trait built over time and needs to be nurtured. As a preceptor, you must cultivate and assist the trainee in finding their critical thinking abilities. It doesn't come naturally and will require development and reinforcement. Some nursing trainees need structure and lack a game plan for building critical thinking skills. This is where the preceptor must step in. As a new nurse, the expectation shouldn't be that he or she will disclose their weaknesses. Until told otherwise, assume all nursing trainees need help in this department. I'm in the process of obtaining my business degree, and I read an article in the Harvard Business Review titled, Mangement Time: Who's Got The Monkey? It is an excellent article that breaks down five levels of initiation. This same concept can be applied to critical thinking.

 5 Levels of Initiation
1. Wait until told what to do. 
2. Ask what to do, implement quickly.
3. Recommend an action, then with approval, implement. 
4. Take independent action, and advise preceptor at once.
5. Take independent action, and update preceptor as needed. 

As the weeks go by, the graduate nurse should use number one and number two less and less. After a few months, the preceptor shouldn't allow numbers one and two for problem-solving. With proper education and training, a four-month graduate nurse shouldn't be waiting for instruction. The goal is to nourish independent thinking and assist your trainee is building their critical thinking skills. Yes, it can be a nerve-racking process, but the goal as a preceptor is to develop individuals. Being afraid to allow a person to independently think is a problem and usually involves a preceptor who doesn't want to give up power. The preceptor-trainee relationship isn't based on power, it should be based education and trust. With using the five levels of initiation, you are developing and not merely telling a trainee what to do. Because once they are off training, they won't have a crutch (you) and will spiral-down and become indecisive. The key to training is to develop, not demand. This critical thinking strategy will assist you in this process.

Low Blood Pressure | Nursing Hacks # 2

You walk into your patient's room to perform your initial head to toe assessment. Your patient has an arterial blood pressure line (also called an a-line). You were told during bedside report that the mean arterial pressure (MAP) goal for the patient was equal to or greater than 65. Currently, the blood pressure is reading 80/30 (46), there are alarms going off, and everyone on the floor is giving you "worried" eyes. What should your next action be? Now, most people would have a knee-jerk reaction and started increasing vasopressors or giving a bolus. But you must slow it down. Start with the patient and work your way out. What do I always say? Assess then act. Blah, blah, blah, I know it's annoying. But that foundation will never change. Don't let dramatic folks provoke you into acting before you properly assess the situation.

First ask yourself, "Is this number real?" Meaning, is it accurate? Here is quick checklist...

• Is the arterial waveform appropriate? 
• Has the arterial line been correctly zeroed?
• Do you see blood backing up in the circuit?
• Is the transducer at the phlebostatic axis? 
• Is the pressure bag inflated to 300 mmHg?
• Are there any loose tubing connections?

There are so many things that can alter your blood pressure reading. You MUST assess that equipment first, before making decisions. There have been many times in my career when I found the transducer on the floor or taped to the bed, the line wasn't zeroed in the last 96 hours, or the catheter was kinked because the patient was agitated and moving. There are simply too many variables for you to react without seeing what is going on with your patient or the equipment.

This same concept applies to blood pressure cuff readings. You walk into your patient's room to perform your initial head to toe assessment and you see your patient's blood pressure cuff reading is 70/15. When I worked on a medical-surgical floor, this happened constantly. I'd arrive and as stated above, I'd assess my patient. For a blood pressure cuff reading to be accurate, it has to be the right size, under the right conditions. In most cases, the cuffs were too small/large, which caused inaccurate results. On top of that, most people are eating during the blood pressure readings, which also caused problems. A provider told me this awesome clinical pearl once and it's helped me from making unnecessary calls related to inaccurate vital signs. He told me to, "Check the blood pressure using another extremity first, at least 5 minutes apart from each other." You might get a low reading once but usually, the next one is normal. I personally follow-up 30 minutes later with another reading just to make sure. The goal isn't to avoid calling. If the blood pressure is definitely low, please call! The aim is to avoid unnecessary interventions being initiated based on false information. Vasopressors have many adverse effects, so do administering multiple fluid boluses.

Check Your Pumps | Nursing Hacks # 1

This is a new series of quick little reads on things I've learned throughout the years.

Check Your Pumps

When I receive bedside report, I write down the information I'm given, and I immediately confirm the drip rates and make sure the concentrations match from bag to pump. I scan the infusion pumps quickly so the outgoing nurse can leave. But, I make sure I've laid eyes on the drips BEFORE he or she leaves. Too often, I'm told one thing, and see another when I assess the pump configurations. Mistakes happen, numbers could be inverted, and wrong medications programmed. It is too easy to input the false information. Once I accept the responsibility of a patient, I make sure the infusing drugs are accurate, and the order in the chart matches the drug infusing. Yes, it sounds crazy but I've had many instances where a drug was hanging without an order. If a provider walks by your patient's room and sees this on your shift, you will definitely have problems.

Here is an example:
The patient weighs 135 lbs.
Information given during report: Neosynephrine concentration of 50mg/250mL is infusing at 1 mcg/kg/min
Infusion found at bedside: Neosynephrine concentration of 100mg/250mL is ACTUALLY infusing at 1 mcg/kg/min
The drug concentration programmed into the infusion pump: 50mg/250mL

Problem: Double concentrated medication infusing at the wrong rate

The patient should receive 18.41 mL/hr (1 mcg/kg/min) if receiving 50mg/250mL bag
The patient should receive 9.20 mL/hr (1 mcg/kg/min) if receiving 100mg/250mL bag
(Need math help? I always do, check this out... https://bit.ly/2IPSvGY)

See the difference there? You are infusing double the dose. And what does your pressure look like? Is it 290/150? Oh, I wonder why. This is why I say always inspect, it takes a second but can save you from inheriting a problem or being accused of something.

Now, this isn't your fault, but if you find the discrepancy at 1 PM (and you started work at 7 AM), that's six hours the drug was infusing on your shift. That is your fault, 100% for sure. I love my co-workers and value them, but I always confirm drips because mistakes are easy and interruptions are plentiful. Computers are great, but they require accurate information.

Don't even get me started on wrong drugs being hung! You told me insulin, why do I see a heparin bag hanging?! Yeah, check your drips, it can get confusing but label and confirm everything. It's your license. Once you accept responsibility, it's on you, and you will be at fault if you accept a problem and find it later. I've seen it. I surely wouldn't believe you if it's been five hours and you start blaming the previous shift... sounds shady. You might be telling the truth, but it doesn't look right.