Nursing Do's and Don'ts
The field of medicine is always changing, and there's always more to learn. As nurses gain experience, we should always be updating our practices.
Here are some practical nursing do's and don'ts to level up your practice.
Don't: Assume a Respiratory Rate
You laugh — but I'm serious. It's become far too common for nurses and aides to "make it up." It's easy to do, and does the respiratory rate even matter? Yes!
The pulse ox shows oxygenation, whereas the respiratory rate shows work of breathing. A normal rate is 12–20 rpm. A patient with a pulse ox of 98% could be breathing 34. Without counting, you can miss this until the patient fatigues and the SpO2 finally drops. Respiratory rate is critical in several situations:
Don't Chart What You Didn't Obtain
The respiratory rate is an important vital sign, and simply assuming it's normal can be detrimental to the patient. It's also illegal to fraudulently chart a vital sign you didn't actually obtain.
Do: Learn to Give Great Report
Part of what makes a great nurse is the ability to communicate effectively — to patients, fellow nurses, ancillary staff, residents, attendings, and APPs. Hand-off report takes practice and isn't taught well in school. SBAR helps, but I never found it sufficient for nurse-to-nurse hand-off.
Something I use is IMSBAR — adding key patient information before the meat of the call. For a phone report to a provider:
Your name, title, where you're calling from, and who you're calling about — including the patient's name and room number.
Relevant and "big" past history (diabetes, hypertension, CAD with stents, AFib on Xarelto, etc.), including history relevant to the current admission.
Why are you calling? Does the patient need a medication? Is there a change in status or a critical lab result?
Elaborate. If asking for pain medication: where's the pain, is it new or changed, when was the last dose, did it help? Do the preliminary work to help the provider decide.
A quick, focused assessment. If short of breath, what do the lungs sound like? What are the current vitals?
Any recommendations you think might help the patient.
This also adapts to a clear, concise patient hand-off — Introduction (patient and room), Medical History (more detail if inpatient), Situation (why admitted / what's being treated), Background (what's happened since admission, pending tests), Assessment (abnormalities, vital and lab trends), and Recommendations (anticipations and pertinent info). Read more in Calling the Doctor.
Do: Update Your Patients!
Speaking of communication — communicate with your patients and families. Some nurses are great at this; others need work. Especially in the ER, keeping patients updated makes a huge difference in satisfaction. Most patients become impatient waiting hours for any update, and let's be real — many providers aren't great at it either.
Let the patient know what the holdup is. Are they waiting on imaging because there's a line? Waiting for a repeat troponin before discharge? I explain the workup from the get-go, and even how long it may take — but never speak in absolutes, because things rarely go exactly as planned in the hospital.
Do: Update Your Resources!
There are some great apps and references to use as a medical professional. We shouldn't be resorting to Google or WebMD to care for patients when so many evidence-based resources exist.
Do: Update Your Knowledge!
Medicine is always changing, so we always need to stay updated. Nursing school teaches the basics, but it's on you to take initiative and keep learning. I recommend taking online courses to build the knowledge and skills you want to be comfortable with — cardiac, new-nurse, ICU, and IV courses are all great places to deepen your practice.
Don't: Neglect Yourself!
As nurses, it's too easy to neglect our own health while focused on patients and then our families at home. The field is tough — stressful, long hours, high-stress environments, and constant blame for things outside your control. Nursing burnout is a huge deal that happens to so many of us, myself included. Make yourself a priority:
It’s kind of concerning that respiratory rate is glossed over and not taken seriously – obviously this isn’t true for a lot of nurses, but if it’s true for just one then that’s a gateway into medical errors and future lapses in judgment. If caregivers are fabricating respiratory rates, what else are they making up? Nothing taught in professional school, at least related to a physical exam and history, is meaningless, especially not respiratory rate, so it should certainly be acknowledged as is done here.
I completely agree! We should never be fabricating numbers within the medical record. This is a fraud – not to mention dangerous! I think the issue is that if the patient “seemed to be breathing normally”, then they just estimate a normal rate. This will lead to errors and misses, and should definitely be avoided. Unfortunately, this is more common within nursing than you’d think.