For years, I’ve had the privilege of orienting new LPNs and RNs to our facility. We have a checklist that must be completed in the first month of their employment. The nurses who will work with them on the unit show the orientees’ how we give medications, perform treatments, write and take off medical orders and much more. Each time, as the nurse manager, I find I am teaching my new nurses in four different areas that I think are the most important areas all nurses need to focus on:
Area One: Assessment
Nurses learn about assessment in school. Once in practice, it is time to apply this knowledge. Nurses must know what questions to ask, the signs and symptoms of the most common illnesses and conditions in this specialty and how they are treated and what is abnormal and normal when performing a physical exam. LPNs and RNs must know how and what information to gather. RNs take this data and analyze it to form a nursing diagnosis. This means good critical thinking and problem solving. Easier said than done. Practice, learning from mistakes and working with more experienced nurses is key. Most nurses find it harder than they expected and end up making several common mistakes from missing obvious signs to jumping to conclusions without adequate data. (See my chapter on 10 common assessment mistakes nurses make in my book, “Catching Critical Changes: Six Essential Steps to Effective Nursing Assessment”)
Area Two: Pharmacology
Whether a nurse is a new graduate or not, new medications are difficult to keep up with. Side effects taught in school are not always the ones seen in practice. Pharmacology can be so overwhelming; it is difficult to know what to focus on. Looking up every medication that is unfamiliar is one of the best ways to learn about medications. What is important to know: diagnosis that the medication is being used for, how the medication works, the most common side effects, the correct administration of the medication, any interactions with food or other medications and the half life for porn medication.
Area Three: Communication
Whatever their specialty, nurses work with people. Whether dealing with patients, peers, supervisors, administrators or other health care professionals, nurses need to communicate what they want and need effectively. When giving directions or information, nurses must be clear. Then it is important to evaluate to see if what was said was heard and followed. Nurses must be aware of any feedback that indicates that what was communicated was not what was intended. Being a good communicator can make the next area of focus so much easier.
Area Four: Supervision and Leadership
LPNs and RNs supervise other nursing staff members. How they approach this responsibility can make the difference between a well functioning, effective team and a troubled, dysfunctional group. I have seen nurses in two opposite extremes: Those nurses who pretend they don’t have to supervise so ignore the rest of their team. Everyone just “does their own thing.” When there is a problem, it is ignored. Like a sore that does not heal, it might scab over, but fester underneath. Then there are the nurses who are constantly in their team members’ faces They micromanage. The happy medium is for nurses to develop mutual trust and respect with their team, delegate and lead by example. When there is a problem, these nurses don’t confront, they talk.
This is just an overview of the four areas I think new and experienced nurses need to perform well. My blogs have included many of these subjects, especially communication and conflict resolution. I have covered the process of assessment in my book, but not how to do specific exams. In the months to come, I will continue to discuss these subjects and how explain multiple aspects of pharmacology, discuss specific drugs, and talk more about how to supervise and lead a team.