Taking the Next Steps...Planned Succession

The career handoff: Intentional sharing of knowledge and wisdom ​Chapter from The Career Handoff, an STTI book.

By Kathy Malloch and Tim Porter-O'Grady

This chapter from The Career Handoff: A Healthcare Leader's Guide to Knowledge & Wisdom Transfer Across Generations examines the critical components of successful communication, transition, handing off, and succession planning in the healthcare profession.   “Tell me and I forget, teach me and I may remember, involve me and I learn.” –Benjamin Franklin Every year, Tim and I schedule time for a retreat to plan what we are going to focus on in the next year. We select a special place where we can both think and play and do something special. At our latest retreat at the Ojai Valley Inn & Spa in California, we found ourselves wondering how many more revisions of our work we could do—and how much longer our ideas and strategies would be relevant for healthcare organizations. And then came the even tougher question: What would happen to our textbooks? Would Quantum Leadership just sail into the sunset? We humbly wanted the information that would be meaningful to future generations not to be lost; we did not want future generations to rediscover what we had already identified and shared. These questions got us to think about how to hand off our successful ideas to younger colleagues and selectively discard that which is no longer relevant. From that conversation, we began to strategize and learn about how to hand off knowledge and wisdom to younger generations, and this book is a result of those ideas.   We realized from our consulting practices that highly successful professionals are often reluctant to consider retirement, and many people avoid the thought of moving away from active engagement with colleagues in sharing knowledge and wisdom. It is even more challenging to figure out how to hand off or give one’s intellectual property to another colleague. As an unprecedented number of baby boomers move closer to retirement, there is much to share with succeeding generations. There is also some content or intellectual property that might not be applicable in future generations. We believe a formalized process for sharing and designating intellectual property and products would be helpful to not only our baby boomer colleagues but also to other generations of colleagues.   The Need for Generational Sharing Our professional consulting focus has been on the importance of leadership and in helping others to learn as much as possible about leadership—to embrace new ideas to become the most successful leaders possible. Our belief has always been that everyone is a leader, regardless of whether they have a formal leadership title. Whenever two individuals are together, one person begins the dialogue or movement in the simplest way, and leadership is evident. Each one of us has some special knowledge and expertise that future generations should or might want. Creating a culture as well as validating the science that assists others in handing off and nourishing our colleagues with our wisdom is important to both of us. Cultivating a culture of giving to others with minimal expectations of receiving something in return will allow future generations to grow and move on with what is vital to them. Our focus has shifted from figuring out what to give and how to instruct them to “love our stuff” to identifying interested colleagues and turning our work over to them to sort out and retain what is deemed valuable. It is also time for us to get out of the way of future leaders and shift from driving the boat to creating a safe space for others learning how to manage the boat’s journey!   Soon after our retreat, I was invited to keynote a leadership summit group; my focus was on this topic of generational sharing. Participants at this meeting included successful professionals from three generations, including chief executive officers, nurse executives, consultants, real estate executives, and physicians. As part of the keynote, I presented the plan Tim and I developed to hand off two of our books (see the feature that follows) and the discussion began to flow. Participants were highly interested in learning more and becoming involved in advancing the science of both giving and receiving intellectual property and the wisdom of ages.   Handing Off Our Publications After many years of writing books and revising those books, Tim and I wondered what would happen to our book content when we were really finished writing. So, after some thought, we decided to be proactive and formally pass on the writings. Over the course of our careers we had had many excellent students and colleagues; we selected two who we thought embraced our philosophy about innovation and leadership and had a track record for getting things done. We asked Dr. Dan Weberg and Dr. Sandra Davidson if they would be interested in taking on the work of combining our evidence-based practice (EBP) books with our Innovation Leadership book to make one “Innovation–Evidence Dynamic” book. They were extremely excited and ready to set up and pursue a plan to make this happen. Our next step was to contact the publisher and present our idea. The publisher developed a contract, and Tim and I reviewed and approved it. Then it went to Dan and Sandra as the new lead authors. For this new book, Dan and Sandra would be the lead authors while Tim and I followed them. In the next edition, only Dan and Sandra will be listed as authors, and Tim and I will be contributors as the new authors deem necessary. Dan and Sandra skillfully took the chapter content from both books, rearranged it, added new chapters, and deleted those they thought were less relevant in today’s healthcare world. Interestingly, this process seemed complicated when we began; however, with the highly professional new authors, the book has taken on a life of its own and is due to be published in the fall of 2015. We are excited to see the new book and know that Dan and Sandra will have exceeded our expectations. Reflecting on these ideas, we created a book proposal with the interested retreat participants. We now had a team of wisdom experts to join us on this journey and, most importantly, the authors represented three generations of interested professionals. We realized quickly that the importance of sharing generational wisdom was significant and that there was much interest from younger generations in learning more about our work and how to keep the useful knowledge alive and contemporary. Rather than seeing ourselves as the fading generation, it is time to see ourselves as a generation who now has much to share with the younger generations! We believe we created a talented team of wisdom managers to assist in this work. Further dialogue with the contributing authors provided clarification and enhancement of our ideas and solidified the importance of documenting and sharing generational wisdom, successes, and strategies that we would not repeat. We believe formalizing this process and providing guidelines for colleagues will be an important contribution to professional nursing practice. Each one of our authors has included specific discussion on what the handoff is, some practical tips for sharing knowledge, and exemplars to demonstrate personal experiences (and, of course, some irreverent humor; we all need to laugh and enjoy the nuances of our journey!). This book reflects our commitment to professional coaching, mentoring, and assuring that our young nurses are not chewed up by the system but are supported proactively. Mentoring is a vital professional behavior and an ethical obligation to our profession; we need to nourish our young rather than engage in the proverbial “eating our young.” In the next section, we share our personal and scholarly connections to the art and science of mentoring. Life Journey: Membership in the Profession Transitions and transformations are a fundamental part of the journey of life. Naturally, as we age and grow, we gather information, skill, insight, and wisdom that accumulate and aggregate in a way that becomes a part of our characters and personalities. As professionals, one of the most important considerations is the responsibility that membership in the nursing profession brings. Who we are and what we are become a part of our professional identity such that our person and profession become one and the same thing (Malloch & Porter-O’Grady, 2010). As we journey through our careers and our lives and are recognized as professional nurses, we essentially become the “person of the nurse.” As professionals, we integrate our work, our relationships, and our individual persona in a way that creates the frame for who we are and provides the substance of the image we present to the world. Consider a notice you might see in a newspaper about the appointment of a position to an administrative or public role—the writer acknowledges the relationship between the person and profession by identifying the particular individual as a “physician.” However, when a nurse is appointed in a similar fashion to an administrative or public role, he or she will more frequently be identified as a “former nurse.” For the physician the identity is singular; for the nurse the same identity is dual (a nurse is a job different from the administrative or public role and, therefore, cannot be identified in singular terms). Sage Insight Shared Across the Generations  We have had many opportunities to work with a number of organizations in helping to increase awareness of the many “sage” resources within those organizations. Often, the usual obligations of work overtake the value of reflection on past experiences, special skills, organizational tenure, insights, and wisdom gained from many years of providing healthcare services. In their haste to embrace contemporary challenges and opportunities for innovation, leaders often forget to access the tremendous acumens and talents of the more mature and long-tenured contributors in their midst. At the same time, those with gifts and wisdom to share need also to be available to their colleagues and new members of the professional staff in ways that are open, responsive, and engaging. A positive and renewing attitude that generates a sense of accomplishment and confidence provides a firm foundation out of which connections between a mentor and mentee can stimulate more positive relationships, meaningful interactions, and learning that can occur only between generations. Handing off knowledge to successive generations implies commitment and communication with those among us who have fresh ideas and different perspectives that need to be included in the dialogue among generations. As consultants with long tenure, we have been able to bring insights from outside the organization that may have already been available inside the organization, but leaders were often tied up with the challenges of the day in ways that didn’t make the same important insights easily visible to them. Taking advantage of these sage resources, leaders can fully access for the organization and for themselves the utility of the wisdom, insight, and history of those in the organization who have much to share. Often, a part of this scenario is the need to formally access and provide continuity to use of clinical and management leaders who have much of value to share. Sometimes decisions lacking sage information could lead to organizational challenge or failure. As consultants, we often communicate with more mature staff regarding long-term implications of a particular current crisis or challenge in a system. Often, what we have found is that the current critical issue has a direct or implied relationship to a continuum of decisions and actions predicated on a set of assumptions that could have been better informed had the key stakeholders been a part of the decision. Through the consultant’s lens, when leadership uses a succession or leadership handoff system that provides the right information, tools, and insights, many challenges and possible errors in leadership insight and strategy can be easily avoided. The trajectory of our experiences gives us information with regard to how complex systems work and represents the substance of our development. Along with our learning, our experience provides the platform for translating what we know and what we do in a way that has an impact on our own lives and on other people’s lives and experiences. At the same time, the experience and skills of colleagues and others that are significant in our lives have as much an impact on our development and growth, and those people do their part in influencing the course of our lives and the people we become. In our personal life journeys, there is a sort of developmental dance among our learning, our experiences, insights gained from others, and the relationships we share with people with whom we intersect (Patton, Zalon, & Ludwick, 2015). Each of these influences and the sum of them link within our persona to create a unique and individual life lens and insight related to our world and how we have lived in it.  “I am not a teacher, but an awakener.” –Robert Frost One of the joys of this life journey is the increased knowledge, insight, and skill we develop as we aggregate experiences and learning relationships. If we have had an open attitude in all these arenas, we have been available to the opportunities to deepen our insights and understandings and broaden our awareness in a way that helps us develop expertise that advances our talent as professionals. One of the urges this dynamic generates is the desire to share and to extend these insights and talents in a way that benefits others who are also eager for learning and personal development. This desire to share knowledge and skill is an outgrowth of our own openness and availability to learning and personal development. Those individuals who understand this dynamic also recognize that embedded in it is the give-and-take reflected in the interaction of all who share a commitment to growing, learning, and deepening their knowledge and understanding.

Poetry by Nurse Monique A. Shaw

Molestation, a sad plight

It's not enough to keep me up at night.

Projects, shelters, even evictions

Is that enough to make me lose my conviction?

The witness of a horrible stabbing,

Domestic abuse and a kidnapping.

She’s your mom! Yes, I know!

But the paperwork said she let me go!

All this before the age of ten

At what age will this tragedy end?

Brighter days must soon be near

Off to San Diego where the skies are clear.

Is it here that this will all end

Is my triumph about to begin?

No, not now I’ll have to wait

Let’s pile some more upon my plate.

ADDICTION! Why mom? Why did you choose

Drugs will surely make you lose.

Our home, our friends, our money, our things

You smoked them, you snorted and shot them up.

Walking the Downtown streets late at night

Nowhere to go, we spot a light.

Is that a sign? A vacancy?

Yale Hotel on F Street, our new home to be.

It is here where friends become family

And, of course, more tragedy.

NO! STOP IT! IT ISN'T SO! MY MOM DOES NOT HAVE HIV!

STOP TALKING! I'M NOT LISTENING! STOP LYING TO ME!

Off we move and leave our friends

The family that stays with me through thick and thin.

Now, In-Home Nurses and medication

I’m only in Junior High School, I need a vacation.

The drugs, they’re just too strong

She can’t let go and continues to succumb.

Now three little letters turn into four

AIDS came tapping at my mother’s door.

DEATH! Two times in a one year span

First dad now mom, it’s too much man!

Junior High, High School and College is the future for me

Constantly holding a 3.0 to a 3.33.

Life has many twists and turns and crooked paths

As we often learn.

Love provides an interruption

But abandoning college was never my solution.

Marriage at age twenty and a new place to call home

Military life in Illinois is where I'll roam.

Also Virginia and Mississippi

The love is now gone, there’s nothing here for me.

Back to San Diego from where I came.

Time to pack up and start again.

Now a single mother, I must go back to school

Go back to the path which I always knew was cool.

A Medical Assistant I’ll quickly become

To make decent money to try and move on.

Child, work and school that’s my daily routine

Working hard to fulfill my lifelong dream.

Along comes the news I’ve patiently waited for

Two long years or maybe more.

Monique, you’ve made it, your name has come up

Are you ready for Nursing School? Of course, there’s a but.

But I’m pregnant with another child, over ten years later.

Its OK, we’ll see you next year but not any greater.

The year came and went quick as a flash

Nursing School is here, time to attend class.

The toughest two years I really must say

But I remember my past and what I endured many days.

I persevered and progressed and completed the program

And walked across the stage with my kids looking on.

And knew that although life sometimes seemed bleak

That this was the TRIUMPH I always did seek.

So you may ask, “Do you think this scholarship can help you live your dream?”

Yes in many ways, one can only imagine

Higher education is the goal and is my passion.

From RN to BSN this is now my desire

This scholarship will help me live my dreams and aspire.

Monique A. Shaw, R.N.

 Monique is a registered nurse in the Southern California area. She is currently working on her BSN while balancing the busy life of work and mom.

Celebrating Nurses with the Top 10 Nurse Phrases

Top 10 phrases that nurses say most

by JournalofNursingJocularity • July 25, 2015

Shutterstock | racorn
We’ve conducted the World’s Most Unscientific Survey! It’s amazing: Our methodology was completely arbitrary. Little, if any, effort went into ensuring rigid scientific standards were observed. In fact, we thought, “Hmmm…isn’t there supposed to be a control group for this type of thing?”
No matter!
We’ve talked to approximately 37,034,686 nurses, give or take a few million, and we asked them: What is the single phrase you say most during the day? Now, some of the nurses gave us practical, useful answers, and we didn’t like those, so we threw those right out, as clear outliers.
Examining the remaining answers (approximately 65,023), we discovered that the following phrases cross nurses’ lips more frequently than any others:
10. “No problem! I’d be happy to change your TV station again. What else would I do with all of my free time?”
9. “Sorry, your insurance doesn’t cover the good Tylenol.”
8. “You won’t feel a thing.”
7. “You’ll have to ask your doctor that. And after he answers, could you clue me in?”
6. “This won’t hurt a bit. Trust me, all the times I’ve attended this procedure, I’ve never felt a thing!”
5. “Ring that call bell one more time and just see what happens.” (Generally not said very loudly.)
4. “No, I will not give you a sponge bath.”
3. “And how do you wipe your butt at home?”
2. “You’re going to feel a little prick…unless you don’t settle down, in which case it’s square needle time…those suckers hurt!”
And number one, always said with a big smile:
1. “I’m sorry to wake you, Doctor…”

Celebrating Nurses with a Little Bit of Poetry

IF MY STETHOSCOPE COULD TALK

by Kimberley Ensor, MSN, RN

If my stethoscope could talk what would it say about me today?

Would it say that I rushed through my assessment so I could scope out a place at the nurses’ station?

Would it say that I was thorough or going through the motions?

Did I just kill time until break? Lunch? End of my shift?

What would my stethoscope say?

If my stethoscope could talk how would my listening skills be evaluated?

Did I actually hear my patient?  When medications were refused or when the patient expressed they had enough, would I actually listen?

As my stethoscope moved across their body, did I notice a change that needed to be addressed in the plan of care or did I just do business as usual?

Was I listening to my patient and their family members’ concerns or did I just perform lip service as from a script.

What would my stethoscope say?

If my stethoscope could talk would it say that I had my eyes open as I took care of my patient?

Did I completely understand the physician’s orders?  When my patient addressed me did I provide eye contact or was I too busy looking at monitors and equipment?

Did I notice something and speak up as an advocate for my patient or did I leave it for the next shift to handle?

What would my stethoscope say?

If my stethoscope could talk would it say I half-heartedly gave education and explanations about medications?

Would what I speak actually come from a desire to be a help to my patient or just to look good as an authority figure?

Did I form my words to be culturally sensitive or did I disregard my patient’s views, beliefs and preferences?

When I spoke to colleagues or interacted with the multi-disciplinary staff was I a source of encouragement.

Did I include my unit assistants in the plan of care for the patient?  Did I recognize my charge nurse as a valuable resource?  Did I appreciate my unit clerk for their invaluable help?

What would my stethoscope say?

If my stethoscope could talk, would it say that I am an example of patient centered care?

Did my care come from my passion to be a nurse or am I just hanging around for a paycheck?

Did my body language speak I care about you or was I stand offish and couldn’t be bothered?

Was I first to the room when an IV or bed alarm sounded or did I say ‘that’s not my patient and turn a deaf ear and go about my day?

Did I make myself available to my colleagues, to my patient or was I nowhere to be found during busy periods?

Did I take a moment to step outside and let the sun touch my skin, reminding me of why I wanted to be a nurse in the first place?

What would my stethoscope say?

My stethoscope would say,

I bring my joy and positive spirit with me each time I step on the unit.

It would say I strive to listen with open ears and see with both eyes.

It would say I try to be an asset to my unit and an instrument of excellent care.

It would say I utilize evidence based practices when answering patient questions and use simple languages.

It would say I work daily to be an advocate, a hand to hold, and an empathetic ear.

My stethoscope would say I am a nurse and I put my heart into everything I do.

I wear my stethoscope with pride.

Celebrate Nurses by Mentoring

Follow These 10 Tips To Be A Great Mentor To Student Nurses

by Scrubs Staff • March 24, 2016

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Despite years of classes and studying, new nurses really have no idea what they are up against until they finally hit the floor on their own. That’s when reality strikes, and they realize exactly how much responsibility they really have.
You may have already forgotten those days, when you second-guessed every decision and feared the wrath of the more experienced nurses coming down on you. Now that you are in the more experienced pack, you have a great opportunity to mentor new nurses, show them the ropes, and set them on a course towards nursing excellence.
To be a good nurse mentor you need to be willing to work closely with new nurses. This is a time and energy investment that not only benefits the nurse you have under your wings, it will benefit the entire industry in the long run. If you are willing to take on that challenge, maximize the experience for both you and your student nurses by following these tips:

1. Be Willing to Share Your Expertise – A good nurse mentor cannot be greedy with the expertise they have obtained by their time in the field. Share the knowledge and skills that you have gained over the years freely, providing them with valuable information that will not only help them in their career, but that could help improve their quality of patient care.

2. Stay Positive – No one wants to be trained by someone who clearly is not happy in that role. Maintain a positive attitude with your mentee, even when they mess up a little. A good training rule to follow when you have to offer criticism is to cushion one negative remark with three positive. This type of feedback lets the new nurse know that you are just as aware of the good things you do as you are of the bad.

3. Hear What They Have to Say – When your mentee is talking, listen carefully. Not only to the words, but to how they are saying them. Read their body language for signs of nervousness or apprehension and gauge the tone of their voice. A new nurse may try and put up a brave front when faced with having to do something new, but if you can get a sense of how they really feel, you will be in a better position to guide them.

4. Make it Personal – The more you know about your nursing mentee, the easier it will be to instruct them. Don’t be shy about sharing personal anecdotes, and encourage them to do the same. This opens up the lines of communication to make them feel at ease in asking you anything. Have your lunch with them, or just share a cup of coffee at the start of the shift. You will learn a lot about the nursing student during these casual encounters that can help you to better instruct them.

5. Lighten Up – Yes, being a nurse is serious business, but try and lighten the mood when you can. Show your enthusiasm for the position and laugh during your shifts with your student nurse and they will soon learn to love working alongside you.

6. Accept That You Might Not Know Everything – While you have the experience under your belt, a newly graduated nurse has the book smarts at the forefront of her mind. Since it may have been a (long) while since you’ve picked up a nursing text book, accept that they may have learned a new trick or two that you don’t know.

7. Keep it Confidential – Practice the same privacy policies you have with your patients with a nurse in training. As much as you may want to share with your peers the mistakes of the day, remember, you at one point were making those same errors. If you lose the trust of your student nurse by sharing their trials and tribulations, you lose the chance to help make them a valuable member of our industry.

8. Walk the Walk – Nurses interact with dozens of people during one shift. From patients and family members to doctors and radiologists. Set a good example by consistently being respectful with everyone you come into contact with. You don’t want a new nurse to believe that it is acceptable to ridicule a patient behind their back or talk down to another staff member. Set the right tone now to avoid any problems in the future.

9. Be Available – Not on your off days of course, but when you are on shift, make sure that you are always accessible and responsive to your student nurses. Your experience has likely taught you that it only takes a split second for disaster to strike. To avoid having your mentee stuck in the middle of one alone, never let them go too far out of your reach.

10. Take a Break – Mentoring student nurses can be mentally exhausting, so if you feel like you need a break, ask for one. No one will blame you for wanting to work a shift once in a while without having to be responsible for teaching at the same time. Mentoring burn-out will only lead to bad mentoring, which will result in a negative experience for the student nurse.

If you are willing to invest the time it takes to mentor a student nurse, don’t take the role lightly. Make your expectations clear, yet attainable, while being a good role model and the student nurses under your charge will grow to become professionals that you will be proud to work with.

Celebrating Nurses with a Travel Through History

Historical Moments For African American Nurses

by Scrubs Editor • February 25, 2016

As a African-American registered nurse, I find it important to pay homage to those who paved the way by breaking down barriers and forcing out inequality. I attended the historically black college, Hampton University, formerly the Hampton Institute. This  college experience provided me with  a great education in nursing science and a rich education in African American History. I have the honor of being a part of an influential nursing magazine, so it is incumbent upon me  that I share some of the history that allowed me to work in the capacity that I do today..
                               African American Nursing History Timeline
1855-1856: Mary Grant Seacole is denied the opportunity to enlist Crimean War . She travels to Crimea herself and establishes  boarding houses where sick and wounded soldiers from both sides of the war can be treated.
1861 – 1865 Harriet Tubman served as a nurse during the American Civil War and used her knowledge of herbal medicine to treat wounded soldiers on the island of Port Royal off the coast of South Carolina. After the Civil War, Tubman helped found a home for the elderly.
1879: Mary Eliza Mahoney becomes the first black to graduate from an American nursing school. She is known as the first professional black nurse in America.
1881: The first school of record for black student nurses is established at Spelman Seminary (renamed Spelman College) in Atlanta, Georgia.
1891: The Kings Chapel Hospital for Colored and Indian Boys, Abbey Mae Infirmary, and the Hampton Training School for Nurses were started on the campus of Hampton Institute. Alice Bacon was instrumental in starting the Hampton Training School for Nurses. The school was commonly called Dixie Hospital, and its first graduate was Anna DeCosta Banks.
1891: Dr. Daniel Hale Williams establishes the Provident Hospital and Training School for Nurses, the first black-owned and first interracial hospital in the United States.
1908: The National Association of Colored Graduate Nurses (NACGN) is established.
1918: Eighteen black nurses admitted to the Army Nurse Corps after the armistice of World War I and assigned to Camp Sherman, Ohio, and Camp Grant, Illinois.
1932 : Chi Eta Phi Sorority, Inc (ΧΗΦ) is a professional association for registered professional nurses and student nurses. Chi Eta Phin is a sorority that both women and men may join. Chi was founded due to concerns of the  founder about the restrictions in employment of black nurses to segregated facilities and to positions where there was little or no chance of advancement
1941: Lieutenant Della Raney Jackson becomes the first black nurse to enter the military service during World War II.
1951 :NACGN- National Association of Colored Graduate Nurses  was dissolved when it’s members voted to merge with the American Nurses Association.
1967: Lawrence Washington became the first male ever to receive a regular commission in the U.S. Army Nurse Corps.
1971: National Black Nurses Association was founded by Lauranne Sams, former dean and professor of nursing at Tuskegee University
1979: Brig. Gen. Hazel W. Johnson-Brown becomes the first black woman in the Department of Defense to become a brigadier general and the first black to be chief of the Army Nurse Corps.
1991: Brig. Gen. Clara Adams-Ender becomes the first black woman and nurse to be appointed commander general of an Army post. As the highest-ranking woman in the Army, she commanded more than 20,000 nurses serving in the Persian Gulf War.
1992: State Senator Eddie Bernice Johnson (D-Texas) is elected to the U.S. House of Representatives—the first nurse, black or white, elected to Congress.

Celebrating Nurses with a little Blast from the Past!

10 Old-School Nursing Skills You Don’t See Anymore

by Scrubs Staff • March 23, 2016

Nursing, along with the rest of the medical field, is constantly evolving to ensure better patient outcomes. Nursing skills, in particular, have changed quite a bit over the last several decades. Some skills have even been discarded completely for the sake of safety or efficiency. Here are 10 interesting examples of old-school nursing skills that have either drastically changed or are no longer practiced:

1. Reusing syringes and urinary catheters

Believe it or not, new nurses, many of today’s disposable medical items, like urinary catheters and syringes, were made to be reused in the not-too-distant past. These items were sterilized between uses, a process that was eventually deemed too costly as disposable items became more common.

2. Charting patient care on paper

While it’s still possible to find rural and small-scale clinics that utilize paper charting, the majority of health-care facilities these days chart electronically. In addition to providing all members of the health-care team with easier access to patients’ charts, electronic charting is typically more efficient and more accurate.

3. Using urine dipsticks with sliding-scale insulin

Sliding-scale insulin has been in use longer than glucose meters. Before these meters were used to determine how much, if any, insulin to administer to a diabetic patient, nurses had to rely on urine dipsticks. Urine-dipstick results aren’t as accurate as those provided by glucose meters, so it’s no surprise that they aren’t used in this manner anymore.

4. Regulating IV fluids manually

Before infusion pumps were invented, it was necessary to manually regulate IV fluids. To do this, nurses had to count drops and calculate drip rates for each and every patient receiving IV fluids. Now, thanks to infusion pumps, administering IV fluids is easier, more accurate, and much faster.

5. Palpating for blood pressure

The vast majority of health-care facilities throughout the United States take patients’ blood-pressure measurements automatically, but this wasn’t always the case. Nurses used to rely on palpation to obtain blood-pressure measurements. To obtain a patient’s blood pressure in this manner, nurses would inflate and deflate a compression cuff while feeling for the disappearance and reemergence of the radial pulse.

6. Shaving patients prior to surgery

Up until fairly recently, hairy patients had their incision sites shaved prior to surgery. New evidence suggests that this leads to an increased risk of infection, and many hospitals have eliminated this practice. Now, instead of using a razor, nurses use clippers to cut away excessive hair as a part of their preoperative preparations.

7. Shaking mercury thermometers

Now that digital thermometers are used to obtain patients’ temperatures, the sight of a nurse shaking a mercury thermometer is extremely rare. In the past, however, nurses could be seen shaking mercury thermometers in hospitals on a daily basis. The reason that these old-school thermometers were shaken is that the mercury would often cling to the inner sides of the thermometer. Prior to taking a new temperature reading, bringing the majority of the mercury back down into the bulb by shaking the thermometer was the best way to ensure accuracy.

8. Cutting urinary catheters during removal

While cutting urinary catheters during removal is not recommended, some nurses and doctors still utilize this practice. It’s considered unsafe for two reasons primarily. Firstly, traction on the catheter could cause it to retract into the bladder if it’s cut. Secondly, the balloon might not deflate, which turns a simple catheter removal into something much more difficult and costly.

9. Irrigating NG tubes with Coca-Cola

Many old-school nurses swear by Coca-Cola for NG tube flushing. In theory, this is due to the coke’s acidity. Regardless of the reason behind this method’s supposed effectiveness, it’s not recommended as it can affect the plastic tubing. Before using coke, juice, or something similar to flush an NG tube, refer to your facility’s guidelines. More likely than not, using water when flushing an NG tube will be the preferred method.

10. Treating congestive heart failure (CHF) with rotating tourniquets

CHF patients used to be treated with rotating tourniquets. Essentially, these tourniquets were applied to the lower limbs to diminish venous return. These days, however, we have a wide variety of effective diuretics that can be used to help decrease the strain that excess fluid volume puts on the heart. Not only is this treatment more comfortable for patients than applying tourniquets, it’s much more effective.
Are there any old-school nurses working with you on your unit? If so, do they still practice a few of the skills mentioned in this article? Leave a comment below and let us know!