By Diane Meagher, BSN, RN, CCRN
I have been a nurse for 30 years, 28 of those in critical care, and have been a preceptor to new critical care nurses for more than 20 years. I love direct patient care and teaching, so in my role as preceptor I have the opportunity to combine both of my passions in my work.
I feel I make a difference with my patients, their families and my preceptees every day — some big, some small. I have a handful of memories in which I know I alone made the difference between life and death for patients, but those are not the stories I wish to share now. Instead I would like to share a little wisdom and advice.
I want to encourage you, tomorrow’s nurses, to develop good nursing practice habits. I encourage you to be thorough in your assessments, cautious in your documentation and diligent when reviewing and reporting patient information and processing physicians’ orders. The electronic medical record has been developed to improve safety, but if not used properly and carefully, it can actually contribute to errors and omissions. We are surrounded by advanced equipment and technology, especially in critical care, but be sure to focus on patient care and safety. Always employ safety measures, which include basics such as verifying two patient identifiers before labeling a specimen, administering a medication, or performing a procedure. Use the safety measure we call STAR – Stop, Think, Act and Review. I find this tool especially helpful when I am very busy. When I titrate a vasoactive infusion, I stop and think about the change in dose I want to make, I make the change, then I review by waiting to watch the dose display on the infusion pump screen to verify that I made the change correctly.
Don’t hesitate to speak up whenever you have a question in any given situation, whether you question the appropriateness of an order or a provider’s technique during a procedure. Optimize patient care based on physician orders and your facility’s policies and procedures, but be sure to also incorporate best practices to prevent complications, such as pressure ulcers and healthcare-associated infections. Always employ proper isolation precautions to prevent the spread of multiple drug-resistant organisms and infections. Use skilled, effective and respectful communication techniques with all members of the healthcare team, including patients and families, to ensure the exchange of all pertinent information throughout your shift and at handoff, and to effectively advocate for your patients.
You can make the difference between life and death for patients by developing good practice habits and providing patient care that is cautious and deliberate.
And don’t forget the basic care activities that provide comfort to your patients, like repositioning and back rubs. Be sure to take the time to talk with your patients and their families; keep them updated on their condition and plan of care and allow them the time to express themselves. Little things mean a lot, and patients and families always will remember the little things you did to help comfort them during a difficult time in their lives.
Diane Meagher, BSN, RN, CCRN, is a staff nurse in the ICU at Winchester Hospital, Winchester, Mass.
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