49. There are very few legitimate contraindications to getting a patient OOB.
48. Physical therapists: What do they do, exactly?
47. You will know C. diff when you smell it. No need to wait for those lab results.
46. No matter how busy or tired you are, never let your patient sit in shit. Don’t be “that nurse.”
45. You are not above fetching coffee for grieving family members … but don’t do it for the doctors. If they can thread a catheter through a patient’s right atrium, then they can brew a pot of Maxwell House.
44. Substance abuse and alcoholism are ubiquitous among health care workers. This goes for nurses and doctors alike. Be watchful of your drinking and partying.
43. Need a respiratory therapist? Try the break room.
42. Be a night shift hero. Bring in a large drum of communal Folger’s.
41. A little bit of gentle gossip is good for workplace morale, but avoid nasty cattiness.
40. To care for an open heart, or a double lung transplant, or a premature infant, is literally to take a life in your hands. The level of stress and responsibility is terrifying and inexpressible.
39. A nurse with twenty years of service under her belt has seen more dead bodies than all of our active military combined. Bet on it.
38. Revealing your “next move” as a nurse — before being ready to put those plans in motion — is a surefire strategy for getting the worst patient assignments.
37. When you do decide it’s time to move on from your unit, tell your unit director immediately. She will understand. Nurses grow, we get bored, we seek new challenges. It’s what we do. It’s a privilege of the profession. Just be sure to give plenty of notice — one month, if possible.
36. Find the helpers. Befriend your kindest coworkers. But remember that there is a political aspect to this profession as well. Play the game, at least a little. Or risk getting burned. It’s a wolf’s den.
35. Hearing call lights and monitor alarms as you drift off to sleep — the nurse’s lullaby.
34. It’s not V-Tach — it’s artifact.
33. Snow over grass, smoke over fire, and mud in the middle: Lead Placement 101.
32. Basic fluid dynamics is one of the most challenging aspects of medicine to grasp — for nurses and doctors both.
31. Understanding ventilator settings is all good and fine, but none of it will matter if you don’t do regular mouth care.
30. Fitted sheets never fit.
29. A “good tuck” is a perfectly valid thing to be proud of.
28. No one should ever graduate nursing school without (a) seeing a baby born, and (b) helping a patient die.
27. Some of the very best, most successful nurses fail the NCLEX on their first try.
26. The NCLEX is bullshit. Who cares about eosinophils???
25. The key to avoiding nurse burnout is to Always Be Learning.
24. You can save yourself a lot of grief by thinking of a dialysis machine as a giant Fisher-Price toy.
23. It’s impossible to work three years in this field without saving at least one life.
22. Two rubber gloves, tied together by their middle fingers, make a perfectly serviceable tourniquet.
21. Pain is whatever the patient tells you it is. You are far more likely to undermanage pain than to overmedicate a patient.
20. On the other hand: When a patient tells you he “only” drinks a certain number of beers per day … you can safely multiply that number by three.
19. Removing an indwelling catheter when Lasix is due is a good way to piss off the nurse who follows you.
18. We all have MRSA.
17. Hydralazine never works. Why do we give it?
16. An experienced Level-1 trauma nurse can hear helicopter blades at frequencies undetectable to most humans, like Radar from M.A.S.H.
15. Eliminate the phrase: “He/she is going to be okay” from your vocabulary. Replace it with: “We’ll take good care of him/her.”
14. Call out nurses who “eat their young.” It’s morally indefensible, and stupid as shit.
13. Take care of your own needs first. A tired, hungry nurse does her patients no favors.
12. Eyeball your patients before getting report. Make sure they’re breathing. Remember the basics.
11. It’s never OK to assault a nurse (should probably go without saying).
10. Memorize the number to Security. You’re gonna need it.
9. One of the biggest myths in health care is that there is a “right way” to deal with the grieving. There isn’t, and if there is, you won’t always find it in the moment. (I once told a family to “have a nice day” as they walked off the unit after their loved one passed away.) Forgive yourself for these blunders. Know where your heart is.
8. Oh, you thought you were going to lunch? Very funny. You’re getting a new admission.
7. And your other patient needs to use the bedpan.
6. Whoever invented call lights can roast in hell.
5. How we fail our patients is not by delivering poor care, or the wrong plan of care, but by treating that which should never be treated. Speak up to physicians about patients who have clearly entered the dying process, and demand their mercy.
4. You will always feel awkward, clumsy, frustrated, stupid, ineffectual, unappreciated, underpaid, etc. Embrace it. Own it. Learn to laugh at the uniquely absurd difficulties of this profession.
3. If you don’t go to work every day expecting to learn something new and to laugh out loud with your coworkers, then you’re doing it wrong.
2. You will sometimes hate nursing, but you will always love having nursed.
1. Good health is the greatest gift of all.