7 Nursing Interventions You Do Every Single Shift | NURSING.com

When you’re making care plans in nursing school, they seem so formal. It’s hard to imagine actually doing them and they seem like such empty words.

But honestly, you will routinely do a lot of the nursing interventions listed in that trusty old NIC book (Nursing Intervention Classification). Here is the highlight reel of nursing interventions…

(SIDE NOTE: if you are struggling with Nursing Care Plans please read our MASTER POST on writing them here)

1. Active listening

This is something that hopefully you will do with each and every patient. While active listening is typically covered in a mental and behavioral health course, it is essential to do with every patient and their support system. This facilitates trust and rapport.

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2. Prevent falls

Fall prevention should be on your mind for all patients. Some patients are at a higher risk than others, but throughout the shift, it is important to do what you can to prevent your patient from hitting the deck. These ways you’ll prevent falls will be using a bed alarm, making sure they have a call bell within reach, using non-skid socks whenever they’re walking around, and checking on people that are of higher risk more frequently. We’re so worried about falls because patients in the hospital, even if they’re in decent health otherwise, for a variety of reasons.

Patients are in pain

medications, confused, feel terrible, are suffering from sleep deprivation, and are in a totally different environment than their homes. People you wouldn’t think could ever fall end up doing so. That’s why we really need to be hyper-vigilant in preventing falls for all patients, paying particular attention to the higher-risk patients.

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3. Control pain

Many patients suffer from pain. Not all have pain medications ordered, but many – if not most – are incredibly uncomfortable. Surgeries, broken bones, and various disease processes combined with a lot of time in bed and not at home is a recipe for pain and discomfort. Therefore, controlling pain will be something you are going to do frequently.

You’ll do things like dim the lights, time pain medications before activity, reposition patients, provide pillow support, figure out which pain meds work best and at what times, and decrease stimuli.

4. Cluster care

Clustering care is a vital part of every shift, not only for the patient but for you as the nurse as well. It is tough being in the hospital, having someone walk into the room every 20 minutes is utterly exhausting. You get no time to rest or have time to yourself. Someone always needs you to do something.

But, if you have the health care team member clusters their care and consolidate trips into the room, more gets done at once and therefore takes less time, therefore allowing the patient to rest longer. It truly is a win-win situation.

5. Turn every two hours / promote position changes

Like falls, many hospitalized patients are at risk of developing skin issues. Maybe they can’t move around in bed as well, or at all, causing pressure on bony prominences and therefore breakdown. Maybe they’re sweating a lot. Maybe they’re malnourished.

Maybe they just had major surgery and have some serious incisions. Or maybe whatever disease process that’s afflicting them right now is causing skin breakdown. There are many reasons why a patient’s skin might be compromised. This is such a common issue in hospitalized patients, that you will most likely be addressing it every single shift.

6. Promote adequate oral intake

Many patients will be dehydrated and have a fluid volume deficit. We are frequently trying to promote oral intake so that we can decrease and then discontinue their IV fluids. If patients have adequate oral intake and their volume status is optimized, it facilitates healing and getting the heck outta the hospital. Unless all of your patients are NPO, you’ll likely be promoting getting your patient(s) to drink enough fluids.

7. Promote self-care

Sometimes patients aren’t always too excited about doing things for themselves. Whether things cause them pain or fatigue, or if they wrongly assumed that being in the hospital meant their nurse would do every little thing for them, many patients need encouragement to do as much for themselves as possible.

I frequently find myself giving the, “I”m here to help you do things that you cannot do yourself” speech when the perfectly capable patient wants me to feed or wipe them. The sooner patients can take care of themselves, the sooner they can be at home, being as independent as possible. While there will be some patients that are completely dependent on the staff for routine care, many are able to do at least something for themselves. Maximizing what the patient can do for themselves will facilitate their care plan and you spend a lot of time every shift doing this!

Conclusion

So that was the nursing intervention highlight reel. We promise, you actually will use care plans while providing patient care as a practicing nurse. While they may not use the exact term in your NIC book, most nurses will control their patient’s pain, prevent falls, prevent pressure ulcers, encourage them to do as much for themselves as possible, promote fluids, listen to their patients and cluster their care.

3 Stories from My Early Nursing Career

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AMA: Nursing Student Q&A Panel

A nursing student AMA we did at our live event in 2019.  Needing some motivation for nursing school?  Give this a listen.

From Nursing School Grad to First Job (navigating the transition)

The transition from student to graduate nurse. This is a really difficult time for a lot of, new grads. It’s this whole transition from sitting at a desk and learning to actually practicing all those things that you’ve learned.  Listen to the podcast for a couple of tips and a couple of tricks for making that transition successful.

The Joy of Nursing with Juliana Adams RN, MSN, MA

To say that Juliana has done a lot with her nursing career would be a serious understatement.  In her 50 years of healthcare experience, Juliana has worked in several countries, being an author, filmmaker, ICU and ED nurse, and entrepreneur . . . all as a nurse.

In her latest adventure, Juliana has written the book: The Joy of Nursing which you can view here.

The book recounts many of her experiences as a nurse and provides encouragement and hope for the profession of nursing as a whole.

To learn more about Juliana visit her website here.

Podcast Transcriptions

(3 Stories from My Early Nursing Career):

I want to share with you guys three stories of kind of my first few weeks, first few months, maybe working as a nurse. Now I graduated from nursing school in Illinois, and then my wife and I moved down to Texas where I took a job at a large trauma, hospital in the neuro ICU in Dallas. So I took this job and I didn’t really know anything or have really a desire to work in neuro. It was just the ICU job that I was able to take.

And I really wanted to work in ICU because I wanted to get that experience as I was planning on going to CRNs school or getting a master’s or something like that. I didn’t know exactly what I wanted to do, but I wanted to get some critical care experience in that seemed more exciting to me than med-surge. So I took this job in the neuro ICU. And when you take a job in a neuro ICU or in an ICU, or hopefully any hospital, you do a preceptorship, which is kind of the first part of working as a nurse. And in the case of the hospital that I worked at, I did about a 13-week preceptorship with an experienced nurse who kind of showed me the ropes, showed me how to charge, show me how to assess taught me about everything that was, uh, the different conditions and that doctor and the physicians and providers we’d work with. And so that was a really great experience.

Her name was Vanessa and she really trained me really, really, really well on how to kind of helped me develop my own theory and philosophy and kind of practice as a nurse. And so it was a really great experience and I really enjoyed working with her, but all good things come to an end. And so I remember, you know, actually, well, first of all, let me tell this quick side note. I remember my very first shift. Um, I lived in North Dallas and the hospital was kind of downtown Dallas.

And so I had to drive to work and I worked night shifts. So I was kinda driving during rush hour traffic. And I thought the drive would be much faster, you know, but it ended up taking me well over an hour and a half and ended up being like 10 or 15 minutes late for my first shift as a nurse, with my new preceptor who I hadn’t met yet. And I was just so stressed. I ran up the stairs, you know, just huffing and puffing. Didn’t know where to set anything that hadn’t clocked in. Didn’t know how, um, and I run to Vanessa. I said, Oh my gosh, I’m so late. I’m so sorry. Like, I don’t know what’s going on. I thought, you know, they’re going to fire me, you know, first shift, what, uh, what a great way to start as a nurse. And Vanessa just said, slow down, take a minute, go put your lunch away, take some deep breaths. It’s going to be okay.

And so that really set the tone, like yes, taking care of these patients is critical, but as important is taking care of myself and taking care of ourselves, it’s a lot like flying on an airplane. You know, they say before you help another passenger with their oxygen, make sure you put yours on. And if we don’t take care of ourselves emotionally, physically, he physically, is that aware physically or otherwise, we can’t take care of our patients. Yeah. It can be a massively draining job working as a nurse and being a nursing student. But you must take those moments, take that time to take care of yourself. If you don’t do that, you’re very little used to your patients because a lot of them are going through a lot of emotional struggles right now, and a lot of emotional pain as they’re in the hospital and working with their families and et cetera.

So make sure you take the time to take care of yourself because without doing that, you can’t be the help that you need for your patients. So after that preceptorship, after the 13 weeks or so, that ended. And I remember my very first shift all on my own. I drove to work. I’m freaking out, right. I used to listen to like metal music or like heavy music in the car to like try to get myself pumped up and psyched up. So I remember driving down there and I took the elevator up to the fifth floor.

And as I was coming off the elevator, the charge nurse for the day shift came on elevator. Cause she was going to go home and her name was Jennifer. And so I, the doors open on the fifth floor and I’m walking off and she’s walking on. I’m like, Jennifer, do you think I’m ready for this? Like, do you think I’m ready to be all alone? And I swear to God, this is all she said to me. She goes, you better push the button, the doors closed. And she left.

And uh, I think that the lesson from that you know is to take advantage of every moment that you have to learn, to prepare and to ask the questions that you need to ask because someday you will be all on your own and it will be scary regardless of how much you prepare. It will feel a little bit scary to be all on your own practicing as a real nurse quote unquote.

So take this time while you’re in school, take this time. When you get to start a preceptorship just learn and ask and, and try new things. And even as you start practicing on your own, you’re not expected to be perfect. Uh, you won’t be perfect. You’ll make mistakes. So continue to ask questions and continue to learn and grow as you become a nurse. Another story I want to tell you guys is this came to a couple, maybe two weeks. Sure.

So after the first story or two weeks after finishing my clinic, right? Preceptorship, whatever it’s called, sorry. So two weeks into being like a real nurse all on my own, I show up for work, and uh, I find I’m going to be taking care of a patient who they’re planning on withdrawing care from now. He’s a younger guy who had an ischemic stroke and withdrawing care means we basically turn up all the machines, turn off the ventilator and let the patient expire pass away. And this was my first time ever doing this all on my own. Had done it a couple of times with my preceptor, but I have never done it on my own. This is incredibly involved work. It requires coordinating with the chaplain respiratory therapy, the provider, um, filling out forms for the coroner, all kinds of work. And I had never done all this on my own.

So I’m really nervous.

I get my assignment. I walked down the hall and, you know, outside his room, all the families gathered. So there’s, you know, 10, 15 people all there because they know, you know, what’s coming. And I walk in there and I try to be as competent as I can. I said, Hey, I’m John. I’m going to be your nurse tonight. And, uh, and they start asking questions and I, I give them the answers the best I can. And like I said, he’s a young guy, maybe in his mid-fifties or so, who had a big ischemic stroke and had been in the hospital for a couple of weeks.

And they’re now, you know, withdrawing care on him. So The time comes to turn off the ventilator, turn off all the machines and everything, and all of his family’s there. Like I said, his mom is this little old lady, a little tiny old lady. And she kind of stands there next to her son. We turn off the ventilator, pull out the breathing tube, turn off the medications. And he actually had a pacemaker. So we had to get this magnet and put it on the pacemaker to deactivate it. That’s how you deactivate pacemakers. So we deactivate the pacemaker and after about 10 minutes he passed. Okay. So we get the family time.

I shut the blinds. I cleaned the body a little bit, um, and closed the door and kind of give the family some time to say goodbye to their brother, to their son, to their friend. And the last person in the room is his mom, this little tiny lady. And I kind of go outside the door and just kind of stand at the door. I give her some privacy and then she comes out and she shuts the door and she leans into me immediately and gives me this big hug. And she says, thank you, John, thank you for taking care of my son. I will never forget you. Now in that moment, you know, in the lesson to get from this is that she, she wasn’t talking to me, Jon, because in that moment for her, I represented every nurse who had ever taken care of her son. I represented the hospital. I represented the healthcare team and I represented to you who are going to be nurses.

I want you guys to remember that, that you will be that nurse.

And at that moment she was leaving her son to me. And the next time she would see him would be at a funeral. You will be that nurse one day. And I want you to be that nurse that takes care of patients and takes care of patients’ families.

Because one day you’re going to represent me. And that’s an incredible responsibility and incredible role that we play in humanity is being the nurses who are there with people in their most difficult times in their best times. It’s such an incredible, powerful experience to have.

And that’s the thought, that’s what I want you guys to kind of keep it in your minds. As you continue to go forward and learn and grow. And as you become incredible nurses, cause you’re going to be, and I know that now I know you’re dealing with something incredibly difficult. Now, you know, online nursing school is something that in COVID is something that none of us prepared for or expected to come. And I can’t even imagine the difficulty of navigating clinical, virtual classes and all your home and family responsibilities.

And then that fear of thinking, am I ever going to be enough? And so while you feel alone right now, I want you to know that you are not alone. You are one of the nurses who are going to change the world while you can’t change the circumstances that you’re in right now. I do not want you to give up on your goals. You can do this and we are here to help. That’s what we’re here for. You’re part of this nursing family. nursing.com is a supplemental online learning platform. And it’s for nursing students. It’s to help you cut the clutter with clear and concise visual lessons, cheat sheets, and practice questions. And it’s all taught by world-class nursing educators. We love you guys. We want you to succeed. You will succeed now, go out and be your best self today. Happy nursing.

From Nursing School Grad to First Job (navigating the transition)

Welcome to the nursing.com podcast. You heard that right? The nursing.com podcast last month, the beginning of January we changed our name, we changed our company name, we changed all of that from in our S and G to nursing.com and we’re really excited about this as a, it was a huge change. Um, and we’re really excited to be now, uh, offering education and offering products and services for people across their entire journey as a nurse. So welcome to the nursing.com podcast. My name is Jon Haws RN. I’m the founder of nursing.com and I’m excited to talk with you guys a little bit today about the transition from student to graduate nurse. This is a really difficult time for a lot of, uh, new grads. It’s this whole transition from sitting in a desk and learning to actually practicing all those things that you’ve learned. And so we’re going to talk about that and a couple of tips and a couple of tricks for making that transition successful.

First of all, did you guys know that 30% of new nurses leave their first job within a year? This, while the demands of nursing are growing and growing and growing, while we’re, we’re expected to reach this shortage of about 600,000 nurses by 2024 and 30% of new nurses are leaving their first job within a year of starting it. You guys, the demands of nursing are unlike any career holding a patient’s hand while they take their last breath and then putting on a smile so you can go home and play with your kids or take care of other patients. You just don’t see that in other career fields. And so understanding how to approach this transition is incredibly important. There are all the technical things of how to start IVs and how to chart the emotional side of everything. But what I’m going to do today is I’m going to

break it down into a couple of musts, a couple of things that you absolutely must figure out, and give you some tips on how to figure those things out and a couple of things that are helpful so that you can find that success. So if you’re walking or if you’re sitting down or something, listening to this podcast, grab a sheet of paper if you’re just jogging or driving or whatever, save this episode for later and listen to it again so you can kind of remember these things. First of all, let’s talk about the musts. There are three musts that you need as you transition from being a student nurse to being a new graduate nurse. Those musts are competence, humility, and passionate curiosity. All right, so let’s talk about each of those individually. First of all, you need confidence.

And I know that even by telling you that you need confidence that a lot of you are probably feeling like, but I don’t have that confidence. So it almost attacks your confidence even more. But let me tell you guys that you belong here. Uh, those of you who are graduating, those of you who are beginning new jobs, those of you who are applying for new jobs, you belong where you are right now. And your patients deserve to feel like they’re in good hands. You’ve done all the work required. You graduated nursing school, you pass the inklings, you applied for a job, you got a job, you belong exactly where you are and you deserve to be there. So try to embrace that acceptance of yourself and acceptance of where you have arrived and where you have been and where you are now. And just have that confidence and demonstrate that to your patients so that they can feel that confidence coming from you. The next thing you guys need is, is humility. Be willing to ask questions and admit fault. Okay. Find nurses that you can trust and who embraced this idea of the patient first. And put yourself around those nurses and be willing to ask them questions and be willing to admit when you’ve made mistakes or when you can learn and, and, and understand things differently. When you are unsure. Be sure that you ask for help. It’s better to go into your patient’s room with confidence.

[inaudible]

when you don’t know what to do. Be sure you ask for help. It’s so much better to get that help and to ask questions of the right people, knowing the answer and knowing what you should do than to just guess and uh, and take actions without, uh, investigating first. So be humble. Admit your mistakes, admit your faults and admit when you know that you need to learn. The last must guys is passionate curiosity. As you begin working in a new field, you’re going to be learning things that you were never even exposed to in nursing school. My first job was in a neuro ICU and I was seeing things and saw patient populations and contraptions and procedures that I had no clue even existed. And so what I had to do was find the best books on neuro ICU, nursing, and on neuro in general.

And you need to devour every book to every article, attend every webinar, buy uh, equipment companies or, or by your hospital. Read everything that you can and understand everything that you can volunteer to take difficult patients and difficult cases, especially during those first few weeks when you have a preceptor volunteer for the most complex, most difficult patients because that’s the best time to learn when you’re brand new and to be exposed to as much as you can. So really ask every question that you can find at respiratory therapists who love to teach and ask them every question. Find physicians and providers who love to teach and ask them questions, and devour the best books. One thing that I would do, and one reason I liked working the night shift is that there was a little bit of time for me to sit back and investigate and learn more about the disease processes that my patients were having.

And one thing that I did is I actually read the ICU book front to back during my shifts as there was downtime, sometimes during the evenings. And I also studied for the CCRN and I studied for the GRE all during the night shift during downtime. So make sure that you’re finding those times, uh, to study. You’re finding the right things to study and you’re taking advantage of those things. So the three musts as you transition from student to graduate nurse are confidence, humility and curiosity. Now let’s talk about a few things that are helpful. These are things that are helpful for you to develop. They aren’t necessarily going to be as helpful as you get on the floor, but they’re going to be very helpful in your, in your life. Uh, personally, aside from nursing. The first would be budgeting. Get a budget in line before that first paycheck comes in.

I’ve seen so many new nurses after they graduate, the first thing they do is they buy a brand new car and then I find out they’re also $30,000 in debt. So understand what budgeting is. Get a budget in place and prepare to start paying off your debts before you even get that first paycheck. All right? That will help you tremendously. You can use, uh, different tools like why NAB, it’s called you need a budget. You can use, um, meant a lot of these tools are free and you can start budgeting immediately. Another thing is scheduling. Learn how to develop a schedule and learn how to keep a schedule. Even something as simple as Google calendar on your phone to keep track of your days and your nights. Um, because your schedule can be very fluid and very sporadic as you’re working as a new nurse and talk with your family and loved ones.

Help them understand why you can’t go to every party and why you have to miss this thing or that thing or why you have to sleep. And so they can understand what’s going on. And that takes me onto the next thing that’s very helpful is sleep. This must be your number one, especially if you’re working nights. Some things that I would do is I would use really dark curtains. Um, and in fact it got to the point that I ended up, we ended up creating this little place for me to sleep inside our bedroom closet because it was completely silent and dark and we had the kids home. And so for me to be able to sleep, I was able to go into that dark space where it was quiet and actually get the sleep that I needed. Um, don’t overextend yourself and think, well my, but my friend has this party, or there’s this thing going on, or my family has this birthday thing and I really have to be there.

Don’t try to overextend yourself, uh, with that, with trying to be everywhere with everyone, but also don’t overextend yourself with your working schedule. They’re gonna pop up these bonus shifts and they’re going to pop up extra hours. Uh, don’t overextend yourself, especially as you’re starting out. Um, kind of understand what you can physically do as a brand new nurse, um, and make sure that you take care of yourself first. Um, there’s that whole saying, you know, um, and this takes me into the next one, which is health. Uh, make sure that you’re putting yourself first. You can’t put oxygen on someone when you can’t breathe. Right? That’s what they always say in, um, on the airplanes before you take off. They say, make sure you adjust your oxygen before you take care of somebody else. And that’s the same with nursing. It’s hard to be there emotionally, physically, um, and mentally with your patients when you’re not in a good place.

And so really find balance. Um, whether that’s diet, exercise, yoga or meditation, find what motivates you to be healthy and, and implement some of those things that are sustainable so that you can take care of yourself and you can take care of your patients. And lastly, guys, I want to talk about relationships. Prioritize the relationships that foster your goals. One of my favorite quotes is that you are the average of the five people you spend the most time with. Those people that you spend your time with, those people that you spend your energy on, those are the people that are going to develop who you become. And so prioritize those relationships of people who help you become better. Um, talk with your spouse, stuck with your significant other and get them in an in your corner. Be transparent about your schedule and the demands of balancing work life and kids and all these things and find ways, um, to, to help each other out and to balance each other out and really finding these healthy, good relationships that help you be a better person, uh, as you, uh, make this transition because it truly is incredibly difficult.

Now, nursing.com we’ve developed a whole Academy around this. We developed a new nurse or a new grad Academy where we have multiple courses on some of the skills, uh, the assessment skills, the IVs, those types of things as well as some of these soft skills of how to find this balance. And so in our new grad Academy over on nursing.com we’ve uncovered all this for you with experienced nurses to help you guys because this is an incredibly difficult transition and we want to see you guys be successful in that. So if you guys need help with that, please head over there, please check it out. And we really want to see you succeed. We don’t need 30% of nurses leaving the field. We need more nurses. And you guys have made it. You’ve done some of the hardest parts of this, which is getting into school, getting out of school and getting a job. Let’s help you get through it. So let’s touch base on those one more time. We have some musts and we have some helpful habits. The musts are confidence, humility, and passionate curiosity. The helpful ones are budgeting, scheduling, sleep, health, and relationships. I know you guys can do this. I know you can be successful. We love you guys. Now go out and be your best selves. Happy nursing.

The Joy of Nursing with Juliana Adams RN, MSN, MA