Nursing Lyfe 101

Elevating Nursing through Effective Collaboration

• Nursing Lyfe 101 • Season 1 • Episode 7

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Discover the key to mastering respectful relationships in nursing teams and revolutionize your healthcare environment! Promise yourself a shift towards better collaboration as we explore the invaluable roles of Patient Care Technicians (PCTs), Certified Nursing Assistants (CNAs), and nurses. Learn how establishing rapport at the beginning of shifts and maintaining fair workloads can transform the working atmosphere into one of mutual support and efficiency, benefiting both staff and patients alike.

Find out how effective communication and delegation can make or break a nursing team. We highlight the often-overlooked training gaps in nursing schools and stress the need for practical skills in communication and delegation. Through real-life examples, we illustrate the importance of respectful dialogue and shared plans for patient care, ensuring that every team member feels valued and capable of providing the best care possible.

Reflecting on personal experiences and the journey from CNA to nurse, we delve into the challenges and triumphs of building a cohesive team. Highlighting the critical role of familiar colleagues and the difference they make, especially during unpredictable emergencies, we emphasize the power of teamwork. By setting a positive tone and embracing the support of techs as the backbone of hospital operations, we uncover strategies for cultivating a work environment where humor and camaraderie thrive, elevating both patient care and job satisfaction.

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Christopher:

Welcome to Nursing Lyfe 101, the most important nursing class you never got to take in nursing school. We will be traversing different objectives, like interviewing what to do in nursing school, boundaries burnout and so much more, if this interests you. I hope you are taking good notes because class is now in session.

Colby:

Hello and welcome to Nursing Lyfe 101. We're so excited to have you here with us as we dive into the world of nursing, sharing our experiences, insights and a little bit of fun along the way. I'm Colby, but I couldn't be happier to introduce my co-host.

Christopher:

What's up, guys? My name's Christopher. Together, we'll be bringing you real stories, practical tips and discussions about all things nursing, whether you're a fellow nurse or just curious about the life behind the scrubs, we're thrilled to have you join us.

Colby:

All right, so today's topic.

Christopher:

Today's topic is an interesting one relationships between PCTs, CNAs and nurses.

Colby:

And nurses. Yeah, so to start a PCT or a CNA are basically the same thing with a few nuances.

Christopher:

Right.

Colby:

But what you could summarize, it is like your nursing assistant.

Christopher:

Yeah, yeah, yeah.

Colby:

So, depending on the hospital or certification, they have a range of skills that are within their scope of practice, but generally they're there as the nurse's assistant to the patient.

Christopher:

And really and truly.

Christopher:

They probably see a patient a lot more than a nurse does, because they're the ones that do a lot of the bathing, a lot of the toileting, the feeding all those various things that nurses tend to not have as much time to be able to do because we have other things that we have to prioritize.

Colby:

Yes, um. So basically anything that nurses can delegate um to below them not below them isn't really a good term, but um as far as like degree. I guess um is what a nurse's aid or assistant tech will do.

Christopher:

Yep, what would you say? Or what do you think PCTs say about you?

Colby:

Oh, I think

Christopher:

To your face and then, I guess, behind your back.

Colby:

Okay, I think generally I have really good relationships with my techs, nurses, aides, whatever, what have you but I also feel like that's because they respect me in the sense of like, if I need help, I'm going to ask them to help me, but if I'm not busy, I'm going to do the things that technically are like in the scope of their practice.

Christopher:

Right.

Colby:

Like, for instance, like if a patient rings and they want a cup of ice and I'm not doing anything, I'm going to bring them a cup of ice. I'm not gonna say, okay, we'll send your tech in and then go look for the tech and say, can you bring them a cup of ice?

Colby:

And then continue on like talking or whatever.

Christopher:

yeah, and that's interesting because that leads on to various things. On like how do you think in terms of like, gaining that respect, for example, like you as a nurse, you can't when you're new, you can't just say yes to all of it.

Christopher:

You can't.

Colby:

Yeah, you've got to find a balance.

Christopher:

Right.

Christopher:

But like, how do you gain that respect? Because you do. You want to say, yes, I'm there and available.

Colby:

Yeah.

Christopher:

But like you can't just.

Colby:

I think it's really important to establish like a good report in the beginning of your shift. I mean, generally, unless you're in like a float pool situation, you're gonna be working with these staff members pretty consistently, true, and you want to, you want to grow healthy and good working relationships with all of your co-workers. I like to get report and then I go find my tech and say like hey, here's what I've got for these patients today. Like I'm going to do this and this or, and at this time I'm going to need like help with this point. Or, like you know, try to come up with a game plan together. I think you know that's gonna build a trusting working relationship. Um, you've established, like from the beginning of your shift, like this is the help that I know I'm gonna need right now, like what this patient's gonna need today from both of us. Or like maybe you could take this for me and blah, blah, blah, I think probably behind my back. No, I think it's probably much of the same. I think you, you know you cultivate these relationships. I think I don't know.

Colby:

I feel like my my as a charge nurse, like my nurses and my techs know that. I try to make everything very as fair as possible and I am very equitable when it comes to like assignment making. So, like when I'm on the floor and I'm taking care of patients, I'm very equitable and, like the amount of work that I'm asking for them to do, I'm taking on, you know, an equal responsibility as well, right, so I hope that, like, even behind my back, that that's my reputation, um is, you know it might not be fun, but it's fair. You know I want to, I want you know, I want them to feel like I check in and be like hey, how are you doing? Can I help you with anything? Um, I want to make sure that they get their break.

Colby:

You know, like that sort of thing, um, even with like I, I mean, we're talking about techs, but like, sometimes our techs end up like sitting with a patient who's confused and needs a companion and our staff cant, our staffing office, can't provide one. Like, right, I have gone and sat and like covered their lunch break and sat with the patient and even, and then also traditionally, if we do get a companion, a lot of times the techs are asked to break the companion or like the one-to-one sitter and instead of asking the tech to do that, I, as the nurse, is like hey, I have 30 minutes, my other patients are all tucked away. I can cover this person's break so that you can continue helping the rest of the floor.

Christopher:

Right Now. So what, in those situations where you do kind of alleviate some of that pressure in terms of like workload and that PCT just like sits and does nothing, how do you feel?

Colby:

oh, obviously that's frustrating.

Christopher:

Oh, I am.

Colby:

Yeah,

Christopher:

Yeah

Colby:

But I also don't let people get away with that like. I just don't like if I'm busy and I'm busting my, my tail end to get things done and I notice someone sitting on their phone at the nurse's station.

Colby:

Like I'll delegate, like I'll like. The thing about me is that, like I like, as a new grad, you have to figure out the balance of, like, what you should delegate and what you shouldn't. Um, and I do think there's a learning curve there for a lot of people, um, myself included. I like I like to be in charge of everything and do as much as I can. So that's probably another reason why my techs like me is because I do do a lot of stuff and they're like and that's why,

Christopher:

Colby's got it.

Colby:

Yeah, well but that.

Colby:

But like you said, that could become dangerous because then they just expect you to do things.

Christopher:

Right and and then they get upset if you don't.

Colby:

Yeah, yeah, but that's like a precedence that you've set.

Colby:

So, like for me, if I this is a learning curve that I had to figure out is like when I realize I can't do everything, as to when you can delegate the things that are delegatable to the people who can do them, and if I see someone sitting in the nurse's station on their phone or chit-chatting and I have like three sets of vitals I need to get and someone needs to go to the bathroom, I'm going to delegate something. I'm going to be like, hey, I need you to go and do blah, blah, blah, please, thank you. Oh, here's a question for you and I would love to know how you feel about this. There was conversation at some point about our health system, somebody in I don't know where it was, but the conversation came about where it's like you don't have to say please and thank you, it's their job, and I was like you don't have to be rude either.

Colby:

I was like I don't think that's a teamwork environment, but okay.

Christopher:

Yes, it is our job to do certain things, nurses included, but you, I've been reading Nine and a Half Things Disney, or Nine and a Half Things Disney Does Different Than the Hospital, or something like that. I can't think of the actual title at the very moment, but it it's. It talks about building a culture of teamwork and camaraderie, and that is not how you do it.

Colby:

No.

Christopher:

That is not how you do it.

Colby:

It's a quick way to set a fire.

Christopher:

Torch the place down.

Colby:

Yeah, well, that's what I said when someone came back from one of those things and said that. I said, ooh, don't use that language here, they're gonna burn you, they're gonna burn the whole place. Yeah, I mean, I'll say this I've seen nurses do it the wrong way.

Christopher:

Yeah.

Colby:

And I've seen people do it the right way, and you will too. And if you think and here's another sign If the techs aren't nice to you,

Christopher:

oh, you probably aren't doing it the right way.

Colby:

You probably are not doing it the right way.

Christopher:

It's true.

Colby:

That's a surefire sign

Christopher:

100%.

Colby:

But yeah, I mean someone's listening to this and they're like hate listening and they're like I hate Colby and she's the worst. She's the worst nurse she gives. She gives me a ton of just garbage to do

Christopher:

Go ahead and write it down in the comments.

Colby:

We yeah, call me out. I'm really not terrible, honestly. I truly, I truly do still do so much when I'm on the floor and I won't ask for help unless I really need it. And if there was something that we as far as our techs in nursing assistants, they do have specific tasks that are that they're supposed to do. Like on our unit we get everyone gets a morning vital signs at 8 am and then either Q4 or Q8 from that point on. So, like our techs do that.

Colby:

Our techs know that Our techs get blood sugars before mealtimes. That's something that they do. And then what is something else that they like automatically do? I mean they'll help settle the patient for an admission. So they'll get the vital signs, EKG, like in assistant with as an assistance to the nurse, like they're both in there doing it. Our our techs will run the QCs on our blood glucose machines, like. So there are some things that are just like automatically delegated and a part of their daily routine.

Colby:

Now there are other things that, like, they do throughout the day that it's like a conversation with the nurse, like I said at the beginning of the shift, like here's what I'm gonna need help from you at this point. Like this is what we're gonna do together, this is what I'm gonna need. I'll do that kind of thing. Um, for example, like when we're giving certain medications, um, like Ticasin or Sodalol, and it's a loading dose, someone's come to the hospital have this medication. Yeah, when someone comes to the hospital to do that, um, we give the medication, and two hours after that medication is given, we need to get an EKG. And so usually I'll have a conversation with my tech, like immediately in the morning, and say hey, this patient is on Ticasin, I'm planning on giving the dose at nine. They'll be due for an EKG at 11. I'll let you know after I give the dose to confirm what time the ekg is done right if, for whatever reason, if you're tied up around, then just let me know.

Colby:

I'll go get the EKG. But like, if not, like, can you please? And so, like that's a conversation, I like like, let's plan our day together, you know.

Christopher:

It really and truly you know.

Christopher:

So something that nursing school does not teach you is that, yes, they kind of give you a decent little break of what the non-licensed professional, I think, nlp non-licensed professional, I think that's what they usually refer to them as in terms of NCLEX world.

Christopher:

They give you kind of like a breakdown of what they can do, right, but they don't teach you how to actually communicate to someone and delegate. That is something that, at least in my nursing school, was never actually taught. I mean, you know, they say you should delegate, you should do this, but they never actually say what you should do.

Colby:

Yeah.

Christopher:

And it really does. It starts out, you know, as someone who was a CNA before becoming a nurse. I absolutely hated my nurses, hated them because they didn't do anything. They just sat at the computer and charted. Take that for what you will, but there were and you know, in terms of CNAs in the nursing home that I used to work for, there were only really and truly two really good ones that would be helpful to me.

Christopher:

Like I was, I graduated high school and immediately started working as a CNA. Yes, I had a whole semester of like actual work and I was working for that, that actual health system or that rehab facility, and I got to know the residents and the people. But when you, I mean this was like a big boy job for myself and I mean I didn't know what I was doing. So, like it was those two like pillars of CNAs, those two people. There was two older ladies, they had been there for years, they knew what they were doing, they could, they could tell you a resident back forward sideways.

Colby:

Yeah.

Christopher:

You know all kinds of different ways, but it was those people that really drove me into because, like honestly, legitimately, this just in I was like I'm not going into health care.

Colby:

Yeah.

Christopher:

Like even in I knew I was gonna be a doctor and I was like I don't even want to do that.

Colby:

Yeah.

Christopher:

I'm like if it's anything like this.

Christopher:

Yeah.

Christopher:

If it's anything like this.

Colby:

Yeah, I'm out.

Colby:

Yeah.

Christopher:

I'm out.

Colby:

Yeah.

Christopher:

And it wasn't until I really kind of honed in onto those two that I was like, okay, there is saving grace and you're going to have to be that for other people yeah Right.

Colby:

You have to set the tone.

Christopher:

You do, yeah, and so bringing all that story back together. So just one thing is that I one thing that I absolutely noticed in terms of just the communication between the two CNAs.

Christopher:

It was, it was solid yeah and they they could talk to each other and they could say things and it would they. They got it. But then they could also just do things and just know that it would be done. You know, like it was just kind of a that weird look. You know you've given people that like yo don't talk to them, look, and you know it would, it would be done. They did that, except with like actual tasks that CNAs did and it was. It was insane. They worked like a machine. I've never seen um but

Colby:

that's amazing.

Christopher:

Yeah, it was really cool. But going back to, I'm making my way back, I promise, is that what Colby's saying in terms of delegating? It's all about communication and it starts at 7.01.

Colby:

Yeah.

Christopher:

It really does. And we're in a health system where both I know our techs stagger our start time. Y'all don't.

Colby:

Yeah, our techs come in a half hour before our nurses.

Christopher:

Right. So that's a vital and also this also shows your commitment to the tech work as well. Your license covers everything the tech does, so don't ever think that you are not allowed to do any of that stuff, because you are trained to wipe butts, you are trained to feed, you are trained to walk people, you are trained to make sure they go to the bathroom. You are trained to do that, and so that 30 minute, like staggered time, is your ability to show the tech that you will do the work.

Colby:

Yeah, for sure, I think. Well, yes, I think that's so true of our techs. While they're in report, like our, if the call bell goes off, like our, we call them hospital unit coordinators, but they're like the secretary, um, they know that like the techs are in report and the nurse, like, will have to respond to this call balance, so they'll go to the nurse and say like hey, this person needs this. So then, like it's on the nurses to find a partner, if it's a two-person job, like another nurse to go in and do it. Like those techs are getting reports, so that way, when the nurse is going to report half an hour later, the techs are, you know, are there?

Colby:

Yeah, yeah yeah, exactly.

Christopher:

And really and truly that, like last 30 minutes, is a good time for you to make sure that pain medicines are addressed, making sure any other type of medicine is addressed any. I'd like to call them my bleeding and not or excuse me, not bleeding and shoot. What do I actually call it breathing and not bleeding rounds.

Colby:

Breathing and not bleeding rounds.

Colby:

I like that.

Colby:

Yeah, um, because the last half hour.

Christopher:

Yeah like

Colby:

Because how many times have you finished a shift and it's like 6.30, you go in to do your last round and it's automatically like we call them MET calls but like a medical emergency team. Like all the time at the end of shift because you haven't seen the patient. It's been busy the last two hours. You go in and you're like doing your final check and you're like something's wrong yeah, something's wrong.

Colby:

Oh stroke alert, oh like blood pressure suddenly tanked. There's always it's just the luck of your end of shift that everything goes down the drain.

Christopher:

It always hits the fan.

Colby:

Yeah.

Christopher:

Always.

Christopher:

Just be prepared.

Colby:

Just be prepared. But yeah, I think it goes back, like you said, to communication.

Colby:

If you're not talking about what your plans are and sharing that with each other, like you know, and also they're not your personal tech, that tech might have four other nurses that they're helping out that day, like you may think, like, oh, I'm gonna sit down and I'm gonna make this plan with them, and they're like I can't do that because I've got this going on with this patient. Like to have that conversation, that two way street, like then you understand, like what they have on their task list, and then you can see like, oh, ok, well, I can do this one. But if you can do that, like you can trade off it's like it's just so vital the communication, because otherwise, if you don't, then you're making an assumption that they're doing something, and then they made an assumption that you're doing it and then it doesn't get done.

Colby:

And at whose expense is that the?

Colby:

patient's. Well, that's a patient's expense but also yours.

Christopher:

because but it's your license that falls on them. Yes, yes, Like this is your license. Yes, they do not have a license.

Christopher:

That's why they're non-licensed professionals. You delegate those things and you assume that they or you, they have gone through the list of getting checked off, so you know that they're able to do it. So then you, you've got to circle back and ensure that it's got. It gets done, yeah, but to so nursing? Nursing is like you've got to communicate techs and, excuse me, nurses, you also know that they have they could have, depending on the health system between 9 and 12 patients.

Colby:

Or even more.

Colby:

I've worked on units where there's one tech and like 20 patients. Technically they're all. They're all they know.

Colby:

They're the tech for all those patients, which is obviously, obviously on those.

Colby:

I won't say obviously, because hospital, every hospital is different. I'm sure there's some hospitals that just are not well not splitting up workload very well, but I mean we would. That's what that's an example of, like how nurses took on workload.

Colby:

Uh, you know, like you know, not that it's extra, but like obviously, if we don't have enough techs, then there there will be more on our plates to do and when we had one tech at a hospital that was a traveler at like, nurses would get the end ofshift vitals and the start-of-shift vitals, and that was because that was when the most common labs were due, and these techs also were phlebotomists.

Colby:

They didn't have a phlebotomy team.

Christopher:

Yeah, yeah, yeah.

Colby:

So they got the middle-of-the-night vital signs and then were there to help answer all the call bells and toiling and everything with the nurses. But the vital signs in the morning and in the night of, like the two other, ones were done by the nurses and the weights were done by the nurses. That way the tech couldn't go around and get all the labs.

Christopher:

And see, that's the thing.

Christopher:

That's the thing our health system is very cush.

Colby:

Yeah, oh, it's a very cushy place to work.

Christopher:

And you know you might be listening and you're like man, they have, they always have two techs, or at least have two techs, and you know plenty of nurses Like that happens.

Colby:

But to the we often have one tech on my unit at least but we have a floor rule or a specialty rule that they don't take more than 10 patients. So you could have one tech, but they're only taking 10 patients. So then that means the rest of them are technically quote-unquote nurse-covered. As far as tech responsibility,

Christopher:

Right, and we do.

Christopher:

We try our best to respect that, and that's just something that I think, overall, is something that should be done. Yeah, but, techs, when you hear that nurses only have three or four patients or five, who knows it doesn't mean that we have more time.

Christopher:

Yeah it doesn't I. I know it sounds like it. You're like there's the, but take it from me, who has been a CNA and who had done 13, 14, 15 patients at a time. I get it, I it makes. It makes no sense in your mind, but when I became a nurse, I was like it makes no sense in your mind. But when I became a nurse, I was like I feel like I'm taking care of 15, 16, 17 patients. Yeah. And it didn't change, though I actually did decrease in natural patient load. Yeah.

Christopher:

And I would love to tell you that it's because I don't know, I can't even really start to kind of quantify what is the real reason behind why it's so heavy. It's a different, I think it's just different.

Colby:

It's just like fully different tasks. It is. The reason why a non-licensed person can do the things that a tech can is because like not to like discriminate against a tech or a nurse's assistant but like anybody can do those things right what the responsibility of a nurse with each patient is. It takes the degrees that we have to do it and it's just like task.

Christopher:

The tasks that we do are way more involved yeah, there's, and it's not just physical, it's a lot more mental, yeah, than what a tech does. And there's there's a lot of thinking and and not theorizing.

Colby:

But just it's like critical thinking, like you know, like they're like, oh, you're just giving meds.

Colby:

It's like, oh, I'm not just like scanning and handing them meds like I have to think like what this med is, what it's gonna do, how is it gonna affect the patient, what is their vital signs? Right now, if I give this med, how is it gonna affect their vital signs? Like you have to think about that for each individual patient, for each individual medication. You have to look at lab work like we're. We're as nurses. We have way more like critical thinking involved than we do in a tech role.

Christopher:

Yeah.

Colby:

Yeah, not to say that what the techs do is not vital.

Colby:

I mean, like you said earlier, a lot of times they may be spending more one-on-one time with the patient than the nurse gets to, and they might be the first person to recognize, like hey, their blood pressure at eight o'clock this morning was 140 over 70. And now it's 80 over like 40. Like that's a big change. Like they're the first one to see that they're getting the vital signs. They're coming to the nurse and saying, hey, something's up, that's important. Like important work too.

Christopher:

It is, and and that's why you are so important as a CNA, PCT, PCA, NA, all the acronyms. Acronyms is because you do have so much information that you can give a nurse that sometimes we as nurses are thinking about another patient and we just don't know. So, like when you see that a blood pressure has changed that drastically, you're probably going to be the one to see it and you've got to let us know.

Colby:

Yeah.

Christopher:

If a patient doesn't pee within like four hours of the shift, like we want to know, like these are. These are important things.

Colby:

Yeah, if you're getting a blood sugar before a meal and someone's 50, like it's so important, like for them to like let you know so that you can act fast. And you know some techs that have been around long enough know that 50 is critical.

Colby:

And they'll go get an orange juice and tell you on the way, like I'm grabbing an orange juice, 12 sugars, 50, and then like you're like, all right, I'm right behind you like it is that having that assist, having that second pair of eyes, having that second pair of hands, is so important and it's so important for you to cultivate, like good working relationships with your PCAs, PCTs, with your nursing assistants, so that, like it again, it all comes back to the patient. Like you want to provide the best patient care and working with this individual in a team, in sync, like having a plan, is what is how the best care is going to be delivered to the patient.

Christopher:

Yeah, and so like all of that involves all types of communication. But let's kind of bridge a little bit further into the delegation part, like we briefly kind of touched on it. But like how can you tell when is it too much and when when is it not enough?

Colby:

When is it too much and when is it not enough. We kind of talked about it a little bit when we said, like you know too, when you're not delegating enough, when you're feeling frazzled and you're noticing like the tech is chilling, that is like a very like baseline, like very easy way to tell. When you're delegating too much, like if you're not doing anything, there's no reason for you to not do a task.

Christopher:

Right.

Colby:

That like if you were let otherwise, if you were busy, you would delegate.

Colby:

Like that gets under my skin so bad. Like, okay, how about when I've seen this happen so many times and I've called people out on it you walk out of a room.

Christopher:

And I believe that one.

Colby:

I've seen a nurse walk out of a room that she was they I'll just say they, because it could be a she or he but I've seen nurses walk out of a room that they were in for maybe 30 minutes and then they go up to the tech and they're like can you get their vital signs?

Colby:

Why didn't you get the vital signs while you were in there? You were there for 30 minutes. Why would you leave the room and then go ask them to get the vital signs? If you didn't have the Dynamap or the B450 or whatever kind of monitor you have with the to check the blood pressure? Then you left the room anyways, you might as well just went and got it and go right back and get them real quick, like, unless there's something that's like so crazy that you have to go to the next patient. You're like, hey, this is going on. Like, can you, can you go back in there and get those vital signs for me real quick? I need to go check on this patient. Like, unless there's like an extenuating circumstance, just get them while you're in there, and it's very rare that that extenuating circumstance is actually happening.

Colby:

Yeah, no, exactly that's why I'm saying that's when it's too much delegation. Yeah.

Christopher:

And I mean I think there's a very fine line in that, because there are times where you're like I see the PCT there, like they could easily do it. When I have, you know, timely meds that I still have to give, like I get it. But like you you said you were in there for 30 minutes you could. The blood, the blood pressure cuff is automatic, so it runs by itself.

Colby:

Yeah, it's not like you're doing a lot of heavy lifting.

Christopher:

So like you know.

Christopher:

and then you, your pulse ox is automatic, so you don't have to do much, for I mean you can't do anything manual for the O2, but you don't have to count the pulse.

Colby:

Yeah, the only thing you have to count is respirations.

Christopher:

Respirations.

Colby:

Everything else is digital.

Christopher:

I'll tell you so like five minutes at most.

Colby:

Yeah, it really shouldn't be that long.

Christopher:

It takes me a little longer, but you know it's been a while.

Colby:

It does not take you more than five minutes to get a set of vital signs. Um, I think that's another thing, like why techs can take on more than a nurse, because the tasks that they do have can be done quickly. Yeah, like generally, it should not take more than five minutes to do vital signs. No, maybe if you're having a lot of conversation, the patient asks you to go get a water in the middle of it, like that kind of thing. Sure, but they don't take their tests, don't take as long.

Colby:

But

Christopher:

Well, if if you know anything about patient satisfaction scores and one of the like major patient satisfaction companies for hospitals is Press Ganey and one of the questions that is Press Ganey and then another one is Gallop g-a-l-l-o-p? Um the one of the other, one of the questions actually both of them ask, is anticipating your patient's needs yeah as nurses. I just remembered I always brought a cup of water.

Colby:

Yeah, you pull your meds, you get a cup of water.

Christopher:

You got a cup of water.

Colby:

I think, and some of our techs that I've experienced, some of my techs are also like that, like when they come through in the morning. Well, it's tricky on my floor because we have heavy heart failure.

Colby:

So you have to make sure, like and that sort of thing. But like, if there isn't a fluid restriction on a patient, like a lot of my texts are really good about. Just like getting a water going and getting vital signs getting a water going and getting vital signs, like it's just, it just becomes like secondhand practice, like you just got to anticipate it. And also like toileting in advance, being like, hey, while I'm here, do you need to go to the bathroom? Like that's another thing. Like, if you're I hate that.

Colby:

Like you're as a nurse, hate that, like you're as a nurse they walk out and they're like hey, this patient needs to go to the bathroom oh okay, you were just there, just there welcome to the bathroom please like I just can't, like, I can't wrap my head around that one and I've seen people do it and I'm always like shocked every time. Like what? And I again I think like it is in the, in the scope of responsibility for Charge Nurse to I don't want to say call out, but like call out behaviors like that. And on both sides

Christopher:

Right

Colby:

A lot of times.

Christopher:

You're maintaining a culture. You're not calling it out, you're just maintaining the culture.

Colby:

Maintaining a positive yeah, a positive work environment.

Colby:

And. To let nurses get away with that kind of behavior is not like going to provide you with a, with a patient positive experience like that's.

Christopher:

A patient positive experience or a employee or teammate positive experience.

Colby:

Yeah, either one.

Christopher:

I mean I don't want. I have to catch myself at times because I'm like, hey, can you do this? Because I need to go back to the office. I mean I have an RN behind my name, I have not lost my license, I just renewed it this past year. Like, I still am able to do those things and I have to remember that. You know, sometimes I should do it.

Christopher:

I mean it's just.

Colby:

Yeah, I think, and, like I said, it goes both ways too. Like, if you notice like there might be some beef between a tech and a nurse and you're in that charge nurse role, you have to a lot of times, like try to resolve that between the two. Like I hear you need to listen to both sides, you need to, you know, say like hey, I hear what you're saying this is, and then like try to get them to get on the same page and then remind everybody that ultimately, it's not about it's not about one or the other, it's about again I'm gonna say, it's about the patient making sure that they get the care that they need. And I think a lot of times people take situations like this. Again it becomes, if it's a bad situation with, like, a nurse and a tech, or beefing, it's a personal thing. Yeah, and we need to remember to leave, like like we can handle personal things, but right now we have to get this work done for the patient.

Colby:

We need to put that to the side, Like when we walk through this door threshold into the patient room. It's about the patient. It is.

Colby:

And that should be our first priority.

Christopher:

What do you do when a PCT like shows favoritism?

Colby:

This is completely off script. Yeah, this is off script. Yeah, what do you mean like shows favoritism?

Christopher:

So I I remember a particular tech on my floor when I was an actual nurse on the floor, um, I mean, it was kind of like ensure that all the things were done for me, but I mean like to a T but, but it was kind of like whatever yeah. For everybody else.

Colby:

I mean again.

Christopher:

I appreciated it.

Colby:

Thank you. I mean I think that goes back to like your. You have a working relationship with that, with that tech. You know like you and not to say that that's the right thing, but it kind of just shows that like you're a better example of a nurse and what everyone else should strive to be, if that tech likes you so much that they did everything to a T and then they were just kind of blasé about everyone else. What's going on there? There's a bigger question and that's more for management.

Colby:

But also in the moment. Are you asking me, I'm a charge nurse or I'm one of the nurses that's getting neglected?

Christopher:

I'm saying charge

Colby:

okay, well, I mean either way, I mean personally, but as charge. I mean, if I see it and it's blatant, I don't know. I feel like here's the thing. I feel like a lot of times it's charged. I might not notice something like that it's like, as long as they're working and they're not just, like you know I'm not going to notice that they did everything like you know, and then like left some things to the side unless it gets brought to my attention, um, but let's say it does get brought to my attention.

Colby:

I mean I have to address it and that's like a critical and awkward conversation, but it has to be done. I mean you want to just like say, hey, like what's going on, like it's been brought to my attention that like you're not doing x, y and z for these three nurses, like did something happen? Like what's, like was there a conversation? Like you need to get to the bottom of it and figure it out, I mean, and then just go from there.

Christopher:

No, that's fair.

Colby:

It's not a comfortable conversation but when you're, when you're in a leadership role, you have to have uncomfortable conversations quite frequently, unfortunately.

Christopher:

Yeah, I'm learning that very quickly actually. Yeah, it's not fun at all. But I mean and it another like excerpt very much to your point. You can't just make a blanket statement at huddle, you have to target that person. And it's not targeting in terms of like aggressive or mean or malicious.

Christopher:

It's targeting to understand you know it's like hey, I...

Colby:

I mean it's just getting to the source. Like, if you know that it's not a blanket issue, why would you give a blanket statement. Like, if it's not all of the techs doing something or all of the nurses doing something, why would you just say like, hey, everyone, because one that's going to create more animosity. Because I will say personally, when that does get done, because for some reason, there is a leadership style like that where, like, something bad happened well.

Christopher:

It's because it's easier to do.

Colby:

And there's it it is, but it doesn't make you a good leader and I'll say that unless it's a consistent I would say this unless it's a consistent issue, unless it's a blanket problem, right it like. If it's a blanket problem, then it warrants a blanket response yeah if you know who's doing something, it needs to be directly like intervened right yeah, like otherwise, what's the point?

Colby:

because, as someone who knows like, I don't know why they're saying this right now I did all the a, b, c, a, one, two, three tasks and I do it every shift.

Colby:

Yeah, and I do it every shift. Why are they saying this? There's like probably six other people that have that same thought and then they get angry. They're like you know I get upset At least I'm like I always do that. Why are they saying that? But really they're talking to like one or two people and you're like, just talk to those two people. So they said that's gone off track a little bit. But I just think like, yeah, if you know specifically that it's one or two people, you need to talk to those one or two people to figure out what's going on. Sometimes somebody just needs to be heard, or you, you hear what's going on. You're like oh, you're frustrated because of this, this and this. Okay, let's see what we can do to mitigate and like fix the problem so that we can all get back on track.

Christopher:

Yeah, all right, it's time for Pop Quiz. In this segment, we're diving into one or two NCLEX style questions to test our knowledge and see how we stack up. Colby and I will each take a shot at answering the question and then I'll break it down with the correct answer. We'll also chat about how realistic, or sometimes unrealistic, these questions can be in the real world. Let's see how we do.

Colby:

Okay, I'll read the first question to you because, this is kind of like in my wheelhouse, so I already knew the answer earlier.

Christopher:

Well, you say that I do deal with kidneys.

Colby:

You do, but like come on.

Christopher:

Oh wow, okay.

Colby:

This question was made for me.

Christopher:

Yeah it was, so I'm gonna read it.

Colby:

Oh, accident, it was really by happenstance. All right. Question number one a nurse is caring for a client. I hate that they use client now by the way sidebar. Yeah, I hate that.

Colby:

They're patients, come on.

Christopher:

So so okay'm going to continue on this sidebar. Interestingly enough, the reason why Walt Disney calls their...

Colby:

Patreons.

Christopher:

Yeah, the people that come to the, they call them guests, yeah because they're guests in their amusement park. Yeah, yeah, yeah, but like it's, it's all about patient satisfaction.

Colby:

I know and that I feel like I get it. But also there needs to be a line of like patient satisfaction, but also like let's remind you that you're sick and we're providing life-saving care.

Christopher:

Okay, that's okay.

Colby:

There's like I feel like there's a fine line.

Christopher:

Client, doesn't work like that?

Colby:

No, because they need to be reminded that they're a patient. I'm not working for them.

Colby:

Like it's a different mindset. You know what I mean.

Colby:

Yeah, like if I have a client like I'm working for them, I'm investing their money.

Colby:

I'm doing blah, blah, blah.

Colby:

I'm saving your life, and it's a little bit more.

Christopher:

It's a little bit different than working for you.

Colby:

I'm working for you, I'm to keep you alive. Yeah, sorry this is way off topic, but I would love for you to keep this actually in the podcast, okay, okay, anyway, don't edit that out.

Christopher:

I won't.

Colby:

Back to the segment break. Question number one a nurse is caring for a client with heart failure who has been prescribed Furosemide, also known as Lasix. Which of the following assessment findings should the nurse report to the healthcare provider immediately? A. A blood pressure of 102 over 68. B. Potassium level of 2.8. C. Urine output of 250 milliliters over eight hours or D. Heart rate of 82 beats per minute.

Christopher:

So I mean blood pressure, it's okay.

Colby:

Yeah, you know, it's fine For a heart failure patient. Sounds about right.

Christopher:

Yeah, luckily I have delved into your world before. Yeah, urine output is fine. Yeah, and then the heart rate is good, super soft. I'm not worried about Lasix dropping any type of heart rate anytime soon, right? So I mean, I think I'm going to go with B potassium level of 2.8 because of it being low and Lasix lowers potassium.

Colby:

Yes, yep.

Christopher:

Look at me.

Colby:

So B potassium level of 2.8 is the correct answer. Um. So for anyone that's not familiar with diuretics, um, there's a few different kinds but furosemide or lasix. That's actually a loop diuretic and that causes the body to lose potassium. Um, a potassium level of 2.8 is critically low. Um, normal range is 3.5 to 5. But in our world we really like to see our potassium Like in cardiology we really love to see potassium at least 4. So whenever it drops below 4, our providers are ordering potassium repletion. When the potassium does get low, it has a higher chance of causing lethal rhythms, lethal cardiac arrhythmia. So we want to keep those potassium within a good normal range.

Christopher:

You be dead.

Colby:

Because we don't want to have to save your life

Christopher:

We want to stop you before.

Colby:

Right. And then when Christopher went through all the other options and why they weren't the right answer, those are all legitimate. Blood pressure's fine, the urine output was fine and the heart rate was absolutely normal.

Christopher:

And so, interestingly enough, when I learned in nursing school, potassium is a wimp. It is a wimp of an electrolyte it moves the fastest away yeah. It does all kinds of stuff weird to the body.

Colby:

Yeah.

Christopher:

It's just a wimp.

Colby:

Yeah, potassium sucks.

Christopher:

It does, and it's the biggest dang pill to actually use.

Colby:

Oh my God, they're like horse pills.

Colby:

Yeah, they're massive.

Colby:

Patients hate them and then like ou can't cut them because they're like enteric coated you can't smoosh them up, the big white ones.

Colby:

You can't squish them. Yeah, that's what I'm gonna squish them up, yeah. And then the powders taste disgusting and then the iv version burns the shit out of your veins. So potassium's not fun to replete, it's not fun to lose, it's not fun to mess with it. It's not fun to lose, it's not fun to mess with. It's also not fun when it's elevated, like if you're above five, we have to do like hyperkalemia protocols to get it back down. It's just.

Colby:

Potassium is a rascal.

Christopher:

It's a rascal. It's the one that's easily hemolyzed. It's just a rascal.

Christopher:

Yeah. So a nurse is caring for a client with type 1 diabetes who reports nausea and abdominal pain. The client's blood glucose level is 350 mg per deciliter and ketones are present in the urine. Which of the following interventions should the nurse perform first A. Administer regular insulin intravenously. B Start an IV infusion of normal saline. C Administer an anti-emetic as prescribed, or. D Notify the healthcare provider.

Colby:

Okay, so this is a classic NCLEX question situation where you're like there's multiple right answers here. Yes, and the first time that we went through this question I said D notify the healthcare provider, because I was like, yeah, I think we're going to do that first, but unfortunately that's not the right, that is not the right answer.

Christopher:

It's actually starting an iv infusion of normal saline and here's why the client is exhibiting signs of diabetic ketoacidosis, also known as dka, a life-threatening condition characterized by hyperglycemia, ketonuria and dehydration. So rehydration with normal saline is a priority intervention to restore circulating blood volume and improve perfusion. Once rehydration has begun, other interventions can follow. With a wonderful key NCLEX tip in DKA always prioritize your ABCs, your airway, breathing and circulation. I'm sure you've heard it many times in nursing school. So those principles. Rehydration addresses the critical issue of circulation and takes precedence over other interventions.

Colby:

Yes, so that is, like I said, a classic NCLEX question, where it's like very easy to get caught up and I fell in the trap because my I go straight to like my, my actual practice brain where I'm like, well, I wouldn't. Just while I know starting normal saline makes sense and I can anticipate that the doctor would do that. If I'm suspicious of DKA, I'm going to page the doctor first. What I thought that the answer was going to be.

Colby:

My second guess was like administer the anti-emetic as prescribed, because they said that they were nauseous and there's already an order for it. So, with the answer actually being the saline, I was kind of surprised because it didn't say that there was already a standing order for it or something. So it's just a tricky NCLEX question, classic, exactly what you'll see in the actual board test. You're going to run into those ones where you're like there's multiple things right here. You have to figure out which one's the most right. So while I knew instantly the answer to the first one, without even having to take a a second to think about it, the second one, even after 10 years experience NCLEX style question, got me tripped up

Christopher:

Well and that's the thing right, like in in nursing world and you're in nursing school, you're taught the s-bar right situation.

Christopher:

So here's the situation. The situation is there's type 1 diabetes patient who reports nausea and abdominal pain, has a glucose of 350, ketones are present in the urine. Background is probably the type 1 diabetes part. Assessment is the ketones in the urine part and the recommendation is starting the. Iv of normal saline.

Christopher:

So you're notifying the healthcare provider. That's what we do in the actual health system. Is the starting the IV of normal saline? So you're notifying the healthcare provider. That's what we do in the actual health system. And it's so unfortunate because I mean I somewhat guessed my answer.

Christopher:

I mean I did, I was like oh

Colby:

yeah, christopher got it right immediately and I was like oh, that's probably right, I was like I was. Like I was like it's DKA.

Christopher:

But yeah, but you know and that's the thing you kind of have to think about what the patient is actually going through. But you do this on a daily basis. Yeah, you do it, and you would not start IV fluids before notifying the provider. You won't. The only time you'll do it maybe is if you're in the ICU Excuse me Sorry, maybe, and even then it's yeah.

Colby:

I mean, usually when you're in the ICU, your providers are right there so you're just kind of being like working together we're doing.

Christopher:

I'm moving my, I'm moving my face away from the mic. I don't know if y'all heard me pop your head in. It was like, hey, I'm just doing this, is that okay?

Colby:

yeah yeah, yeah, yeah. And they're like oh, yeah, yeah, yeah, I'm putting the order in right now. So, like you're working simultaneously in the ICUs Cool.

Christopher:

Well, great job. If you feel like you would want to hear more NCLEX questions, just let us know. And also, if you thought these were pretty tough and are terrified NCLEX now it's okay. Yeah, you have time and you might not ever get this question.

Colby:

Yeah, or maybe you just passed your boards and you're like, oh, listen to this question that I got. That is going to haunt me.

Colby:

For the rest, of my life, yeah.

Colby:

And then I looked it up after I walked out of the test.

Christopher:

Do you have one?

Colby:

No, I don't, honestly, that was such a traumatic experience, I literally blacked out. So I passed, but I blacked out.

Christopher:

That's good, I'm glad.

Colby:

But if there are any that haunted you, send anyone else to like. If you want to share, let us know. Do you have any that haunt you?

Christopher:

No, I don't remember.

Colby:

Yeah, I feel like a lot of people's shared experience would be like. I don't remember, but if there is one, share it with us.

Christopher:

I remember the drive home.

Colby:

I don't Wow, it was such a long time, good, so I want to go back to journaling.

Colby:

So I don't have a good memory for small things like that.

Colby:

I remember afterwards I was walking around a mall and I was on the phone with my mom and I was like I don't know what just happened.

Colby:

I was like I'm shocked, I'm in shock

Colby:

oh god

Christopher:

Do you feel a good relationship can drastically change your shift?

Colby:

Oh for sure.

Colby:

yeah, I mean I definitely think like the difference between working with a tech that normally works on my floor and working with a tech who got floated to my floor Definitely two different experiences. Like when I'm working with people that I have known for a while and I have a good relationship with, like someone you can like not that you can't share a laugh or joke around with someone you don't know,a Like you can, but some people are very serious um, a nd you know it's the difference between like making it through your shift and being like all right, it was fine, it was a good shift, I survived, we all survived.

Colby:

and then like having a good time and like right cutting it up with your friends and like yeah like getting the work done, but also being like I'm wiping poop from this person while they're holding the leg and like we're just like making eyes, like sometimes you can like do that silent giggle like I cannot believe that just happened. Like you know, it's like different when you're working with your friends versus working with, like, someone you don't know, but they're a colleague, whatever

Christopher:

Yeah, no for sure, and you know you talked about how there are times where nurses do not have text covered.

Christopher:

Tech coverage do you? What does it make you feel in terms of having techs when you don't have tech coverage? Um it's kind of a different question than what's actually written down yeah, so you're.

Colby:

My brain kind of like skipped, though. So, like you're asking, like when we have techs but they're not covered for all your patients, right, how does it feel? Like when you're I mean, listen, I think, if you're working well as a team, even if the tech isn't assigned to your patient, and you have a good relationship and like everyone's tied up and the tech happens to be sitting there, like you have a good relationship, like hey, can you just help me turn this patient real quick? Yeah.

Colby:

Like it's not going to be a big deal or a big ask. You can. I mean you can ask anybody that you know. It doesn't. You don't have to ask like the tech. Obviously, if they're not assigned, you don't have to ask them. You can. It shouldn't be a big deal to have a turn. But everybody that works on the floor, it should like. We used to have this saying on our unit. We don't use it quite often, but it's just kind of like a culture of like it's all, it's all 28, and 28 was the amount of patients that we had on our floor. So all 28, like it's not. Oh, I have four patients and I'm not going to help you. Or.

Colby:

I have like or I'm a tech. I have these 10 and I'm not helping you with the rest.

Colby:

Like we're here for all of them and like if I'm free, I'm going to help you. So it's like never fun when you're short-staffed, it's never going to be like the best day you've ever had. But that's just not going to happen. Like there's going to be a point in the shift where you're like you're like Jesus, I can't be in six places at once. Like give me a break. But if you're working with, with good people and everybody has that teamwork mindset, like it's not, it's not going to be the worst shift, either You'll get through it.

Colby:

Yeah.

Christopher:

Yeah, yeah, yeah. I think and I'm really just kind of coming back from when I was on the floor I know that I really appreciated the days that we were fully staffed.

Colby:

Oh yeah.

Christopher:

It was like oh wow. But then it was like when the tech was like hey, I'm busy, I'm like you know what I get it. Yeah. You know, like, okay, like.

Colby:

Yeah, no problem.

Christopher:

No problem, no big deal.

Colby:

That happened today.

Colby:

I mean today we had if we have three techs, technically that I mean I think technically our unit, when our unit's full, we qualify for four techs, which is that hasn't happened in years, I'd say.

Christopher:

Because if we have four techs, that is a unicorn I've yet to see.

Colby:

Yeah, I was like if we have four techs that are scheduled in the same day, they're pulling them to help, like, cover other units. So we never have more than three on the floor in the last few years. But when we have three, that means all of our patients are covered by a tech with, as well as, obviously, our nurses. The day goes by so much easier with, as well as, obviously, our nurses. The day goes by so much easier and like literally today I had a LIP reach out to me and said hey, I went to go message the nurse, but they're on, do not disturb. I didn't want to bother them. If they were on lunch, do you mind going to recheck a blood pressure? I was in the charge role so I was like no problem, we'll get it done. So I reached out to the tech because the NP didn't know who the tech was.

Colby:

So I was like I reached out to the tech. I said, hey, can you recheck this patient's blood pressure? And she, the tech, replied back to me she's like I'm on lunch but I'll do it afterwards. And I said, oh poo, don't worry about it, I'll go down there and get it, no problem. Like I was, like I let her have her lunch, like it's not a big deal, like I can go get it. I have a second.

Colby:

Like no NBD, but like NBD NBD no big deal, like I will go and get that. Like it's just like you just appreciate having having them. When you actually get them, it's just a different vibe for your whole shift, like you just less worries, less stress, like they're probably they're the backbone of the hospital, truly so.

Colby:

When you actually have like a fully staff ship, it's like oh amazing it's so great yeah, like the angels are like

Christopher:

um, and we talked about this, uh, in, actually I think was it the first or second episode? It was earlier. But being a CNA before being a nurse, was it the first episode? I really we definitely.

Colby:

Yeah, we talked about this before. Yeah, definitely gives you an advantage.

Christopher:

Yeah, 100%.

Colby:

Yeah, we were going to. And again, I'm sure other people would agree that it definitely gives you an advantage of being a CNA, makes you better nurse and you can speak to that because you did that as well.

Christopher:

Yeah, but I mean I can't tell if I'm a better nurse or not. I can't say that. That would be very conceited of me. I think it does, though I think it does, though oh no, I mean, I have seen other people and I do. I think it does make them a better nurse. They're just more aware and they're easier to delegate things, but they are also easier to be overwhelmed by not delegating things.

Colby:

True, yeah, I could see that as well, because they know how it feels to be like. They know what feels to feel like they've been over delegated, being like why don't you lazy nurses do something? So then they want to like try and do more than what they probably should. Yeah, yeah, I can. I've seen it both ways. I've seen them. I've also seen a former CNA that's become a nurse be like now you can do all my stuff and just like be kicking back. And I've been like okay, that's not remember how you felt when that was done to you, like come on redirect.

Christopher:

I can't imagine. Yeah, it's like uh.

Colby:

but I think for the majority, though, I would say yes, it definitely makes a difference on the positive side of things, to come in with that experience before nursing. Fair. Does that wrap it up? I think so. I think that wraps it up.

Christopher:

Class dismissed. That's a wrap for today's session of Nursing Lyfe 101. We hope you found some useful takeaways to bring back to the floor. Remember, nursing is a lifelong learning journey and we're here with you.

Colby:

If you want to connect, find us on Twitter at NurseLyfe101, or on Facebook at NursingLyfe101. And don't forget to subscribe and share with fellow nurses. Until next time, take care of yourselves, which is what I need to do. Clearly, I have a cold.

Christopher:

100%.

Colby:

And keep making a difference out there.

People on this episode

Contributor

Christopher Henderson

Co-host
Contributor

Colby Daniel

Co-host