Nursing now days has so many formal rules. Here's a list of thoughts and informal rules of thumbs that I've picked up in my short time as an ICU nurse:
- A good nurse lacks shame, an ego, and a conscience but has heart, soul, and the determination to never stop smiling. Even during codes.
- There's nothing to be nervous about; you're not the one that's gonna die.
- You have to laugh at inappropriate things.
- Be and island of calm in a sea of chaos.
- Primum non nocere. Do no harm. Addendum: Primum non nocere sans documentum. Do no harm without proper documentation.
- The IV access catheter is quite possible the most important invention ever created for the medical profession. Without an IV access, I am useless.
- Revatio rhymes with fellatio.
- All the crap learned in nursing school about patient advocacy and doing "what's right" and "by the book": out the window. Patient advocacy is all good, but protect your job and license first.
- Work when you're sick. Call in sick when you're not.
- Scrubs: Pockets are your friend. The more the better. ADDENDUM: As my experience in ICU progresses, I find that I have a need for fewer and fewer pockets, because I carry fewer things. And probably because I'm tired of finding crumpled up alcohol wipes in the dryer.
- Invest in comfortable shoes, even if they're ugly. You'll be standing on them for 12+ hours.
- You should chart and document like how girls should pick clothes: just enough to cover your ass; sometimes less is more.
- Turn on the lights in the patients room or you might miss something on your assessment. Turn off your lights in your patients rooms so they go to sleep and stop bugging you.
- Learn to prioritize: take things one step at a time, accomplish the small and simple tasks first and get them out of the way. It leaves you time to tackle the bigger issues, like the drsg change on the sacrum of your 600 lbs patient.
- There's always going to be that lingering thought that you forgot administer this, fax or document that, or call so and so for whatever reason. You are human and can only do so much; endose that shit to the next shift. Leave work at work; when you get home, the scrubs come off.
- A good nurse takes good care of their patients. A great nurse takes good care of their patients but does great documenting.
- Nursing will never be easy or stress-free; you will never be comfortable in your element. If you ever get to that point, you're not doing it right.
- Reorientate and negotiation doesn't work. Restrain your patients for, you know, their safety. Addendum: It's ok for med-surg patients to walk around.
- If 90 year old dementia grandma says she's going to buy you a pie, sometimes she's serious.
- Best idea over: Obesity differential. You should get an extra dime an hour for every 10 lbs over ideal body weight if your patient is morbidly obese, and an extra quarter an hour more if they're immobile.
- Adventitious heart and lung sounds? No symptoms, no problems.
- Got gas? Best place to release is to go crop dust in your comatose, intubated, C-diff+ patient's room.
- The worst part about C-diff isn't the smell or the isolation procedures. It's getting bleach on your scrubs.
- The speed at which ER brings your admission is direct proportional to how stable the patient is. Severe sepsis with a suspected ruptured AAA on 3 vasopressors? Patient rolls through door while you're on the phone for report. Suicidal patient that just needs ICU for 1:1? Arrives at change of shift.
- You wouldn't donate blood if you knew some of the patients who would be receiving it.
- Your gut instincts is just as important as your physical assessment skills.
- If you work night shift, which inevitably you will, your phone's "do not disturb" mode is your best friend. Your manager WILL call you at 3PM after you just finally fell asleep to ask you to come in early to do overtime.
