The Beginner Nurse

CHAPTER 1 PREPARATION TO THE JOB A. Transition from beginner to Professional Before a nurse can become effective as a health care provider he or she should be psychologically and physically prepared for the job. Psychological preparedness means that the mental set and emotional state of the nurse must be ready for the everyday routines and stressors in the job. Psychological preparedness requires assessment of the self or awareness of the self. The nurse should know own strengths and limitations as a beginner. The nurse strengths include the academic theories and trainings in the BSN degree. This will require the new nurse to refresh self about those principles, fundamentals, and theories learned from the study. Limitations include lack of expert skills and dexterity (speed and efficiency in the use of hands) of nursing procedures as hospital trainings as a BSN student were not enough to encounter those specific procedures. Expert nurses in the workplace shall serve as source of the skills not encountered in academic trainings. Proper and appropriate attitude must be adopted in adjusting into working with colleagues who had earned skills and knowledge by their tenure in their job and the environment they are used to. The beginner nurse must use therapeutic self to gain confidence and trust with existing staff in the hospital. B. Hospital Policies The beginner nurse, if not given the opportunity to have job orientation, should strive to know the existing policies of the hospital. Policies which pertains to absences, tardiness, documentations, and safety of the clients should be given due attention. The beginner nurse cannot put the safety of the patient by sudden absence or tardiness from the job. The nurse should put to mind that the welfare and safety of the patients are his or her main concerns. C. Personal matters A beginner nurse and until such time he or she had become a professional should never allow personal matters to interfere in their responsibilities in the work. This is part of the emotional preparedness of the nurse in order to maintain therapeutic use of the self. CHAPTER 2 THE ROUTINE WORK OF A GENERAL NURSE PRACTITIONER There are areas in the hospitals that have common routines. Routines are nature of works or responsibilities that are normally done and repeated throughout succeeding shifts of the work. The routine works in departments like Surgical, Medical, Pediatrics, Isolation, and some critical care units such as the ICU and CCU may have some similarities. But special areas like Operating Theater, Delivery Room, OPD, Emergency, and ambulatory units may have their own unique routines. Routines in the special areas in the hospital are not taken into consideration in this handbook but individual items may be applicable to such areas. A. First Endorsement of the Shift First endorsement is defined as an endorsement of an outgoing nurse in a shift to an incoming nurse. The main purpose of this endorsement is to ensure continuity of care and avoid errors as well as missing vital interventions to the patient such as medications and special instructions. Endorsement will also safeguard personal safety of the incoming nurse of cases that are infectious that deserves special infection precautions. Below is the table for chronological items for endorsement. Table 1. Relevant Chronological Data for Patient Endorsement Patient’s name and Bed Number Diagnosis (medical) Attending Physician Age of the patient Medications Special InstructionsOngoing Interventions Laboratories and Diagnostics Special Needs of the Patient Latest Vital Signs THE PATIENT’S NAME and BED NUMBER Knowing your patient is an indispensible part of safety of care. This is to avoid mix up in the identification and documentation of the right patient. Though merely knowing the name of the patient is not enough this has to be validated by the incoming nurse when the nurse performs his or her own rounds. The endorsement shall give the name and the bed number of the patient. DIAGNOSIS Knowledge of the diagnosis or diagnoses are both for the safety of the nurse and the client as well. What is endorsed is the medical diagnosis as determined by the attending physician. With knowledge of the medical diagnosis, a nurse can immediately provide appropriate independent and dependent interventions per clinical judgment as he or she performs the nurse rounds. ATTENDING PHYSICIAN Endorsing the name of the attending physician will alert the nurse who to immediately refer to in the event of emergency or urgent situation arises. There should be an established system of how to reach attending physician or an alternate physician in case of emergent situation. One such system is the permanent list of telephone number to which the physician can be reached. If there is special consultant/s assigned to the patient it might as well be included too in the endorsement. AGE OF THE PATIENT Age of the patient is necessary for endorsement information so that the incoming nurse can anticipate what nursing approach to implement. MEDICATIONS As a matter of principle, errors in medication are never tolerated. However, no matter we desire for perfection, the chance and occurrence of an error may always be present. Errors in medication have different aspects. See Table 2 for types of medication errors. Wrong medication administered once absorbed by the body may have from nil to serious effects. We cannot afford to wait for a serious incident before becoming conscious of the proper medication. Table 2. Some Types of Medication Error 1. Failure to properly document medication. 2. Missing to carry out medication advice such as new prescription, modification of medicine, and discontinuance of medicine. 3. Mistake in the correct name, dosage, route, and timing of the medication. 4. Missed or interrupted medication. 5. Failure to observe Rights to Medication 6. Failure to maintain asepsis in medication administration. 7. Failure to validate doubts to medication. 8. Inappropriate nursing assessment of the client prior to medication administration. SPECIAL INSTRUCTIONS Special instructions are instructions coming the principal care provider of the patient such his or her attending physician, specialist, consultant, or from a senior house officer (SNO) Table 3. Some Lists of Special Instructions 1. Complete bed rest without bathroom privileges (CBR w/o BP) 2. On NPO 3. On clear or liquid diet only 4. No dark colored diet5. Gluten free diet 6. Turn to side q certain hours 7. Instructions to known allergies of the patient such as aspirin or a kind of antibiotic 8. For breath retraining Note: the nurse should also exercise clinical judgment to implement independent nursing intervention without the instruction of professional advice. Table 4. Some List of Independent Nursing Interventions 1. Nursing assessment 2. Turning the patient 3. Deep breathing and coughing 4. Checking of gag or swallowing reflex 5. Vital signs as PRN or stat 6. Referral to head and physician 7. Infection control and safety 8. Splinting of abdominal surgery9. ROM exercise 10. Providing comfort and massage 11. TSB 12. Early safe ambulation 13. Oxygen therapy 14. Positioning of HOB or head of bed 15. Oral suctioning 16. Termination of infiltrated IV access ONGOING and TO BE- CARRIED-OUT INTERVENTION Ongoing intervention is a nursing implementation of an advice that is currently being administered and is attached to the patient when the nurse who initiated it is to leave from work or bound for home. The safety of the client is primary purpose of the importance of this endorsement; secondly to avoid miscommunication or confusion to the ingoing process on the patient; and finally to ensure continuity of care. It is best to include in this aspect of endorsement relevant data to obtain accurate fluid intake and output monitoring such as the present volume of current IV, all volumes of catheter bags, level of serous fluids in water seal bottles, level of fluids in drainage bag, syringe pump, and all other similar procedures. Ongoing lood transfusion endorsement shall include the number of bags required, the current number of bag, number of remaining bag, date and time started, blood and Rh type, Serial number, and date of expiration. It is important that pending or to be-carried- out advice such as diagnostics and laboratory studies and fluid therapy be included as well. Missing out the advice and costly redundancy will be avoided through this way. Important attention should be given to blood transfusion advice. To be carried-out blood transfusion or BT should have result of cross-matching before implementation. Blood and Rh type for the right patient should be checked three 3 times with the last time to be confirmed by another staff. Table below lists some common intervention that may be having medium or long term intervention. Table 5. Some Medium and Long-Term Interventions 1. IVF therapy 2. Blood transfusion 3. Bladder irrigation 4. CTT with water seal bottle 5. Machine Ventilator 6. Lavage 7. Central Venous catheter 8. Urinary catheterization9. Phototherapy 10. Wound drainage 11. Hemovac 12. Skin or skeletal traction 13. Infusion pump 14. Syringe pump 15. Antithrombotic device By Dennis D. Monte, University of Sirte, Libya