Tips for CNAs and New Nurses and Students (Oh My)

Starting clinicals soon? If you’re like me (I had never wiped a backside before nursing school), nursing school clinicals are coming up, and you’re about to get a rude but exciting awakening. If you’re a pro CNA or a new nurse or an advanced nursing student, I have some tips for you too. These are just tidbits I picked up along the way that I thought, “Aha. They should teach that in school,” or things that my students over the years have been excited about. From least to most complicated:

  • Cozy up to pull-up briefs. No, this is not below you. You will be tagged as a beginner if you ever try to pull a soiled brief off like underwear, so here’s tip 1: cut the sides, fold the top under TOWARD the patient, roll, remove. Bonus points: if you’re in a nursing home or anywhere where the pull-up–wearing person is wearing slacks, put a clean brief on by putting their foot through a leg hole and pulling the brief up through a pant leg.
  • Change a bed, do a bed bath, and change a patient’s brief, Chux, and gown all in one step while they are still lying in the bed. Amateur tag: roll the patient more than 6 times during a linen change. Key: collect supplies and think ahead in backward layers. You’re going to bathe the patient’s front side, whisk a clean gown over them, undo the diaper and do peri care from the front, then roll. Whisk off the soiled diaper, clean whole back of patient, and put the new diaper against them from the back. Pro tip: the tape goes right against the front of the hip. It won’t look right from the back but this will line it up. Do this first or an unplanned evacuation will prompt a second linen change. Next: undo the dirty linen and roll everything in one big bump toward the patient. Put the clean flat sheet down, add a draw sheet and Chux, and roll the other side of these OVER the bump you already made. Put the flat sheet on next to the the bedrail nearest you. Now: ROLL. From the other side, take out the dirty linen bump. Then you can easily grab the clean layers, smooth them out, tuck, and tidy. One last roll to center: fasten diaper, position patient to where they’re comfortable, fluff pillows, whisk top sheet over, add bedspread/blankets/bedside tray. YES, you can do this yourself, unless your patient is totally unable to help you. Practice this in your head, because a nurse who can’t do this is writing in the sky “I don’t know what I’m doing.”
  • Prime an IV piggyback bag without running it out the bottom of the line. Clean port on the carrier fluid line, pause everything, clamp the piggyback line, and hook up the piggyback line to the main line. Yes, you have a dry line hooked up.  Hold the piggyback bag BELOW the main fluid bag and unclamp the piggyback line. Gravity will take fluid from the other bag and run it up the line. When it reaches the chamber, hang the piggyback bag and commence. “It’s not that huge of a deal to prime a piggyback line.” No, but get back with me after a few drops of Rocephin have gotten in the room and everything smells like cat pee, and I’m guessing it will seem like a huge-er deal.
  • Put a stop to rolling veins. New IV starters quake in fear at “my veins roll.” First, everyone says this whether or not their veins roll. Second, even if they do roll, there’s a relatively consistent way to snag the devils. You can tell which veins are going to roll by putting the pad of your finger over the vein. If it slides to one side or the other, it will slide away from a needle, too. Forewarned is forearmed. Your plan is to let the vein roll ON to your needle. What? Yes. Pull the skin to where the vein is a little to the side of your needle. Insert the catheter just past the bevel and release the vein. Generally it will roll right on to the tip of the needle. Advance a little more, and you should have flash and be good to go.


About Megen Duffy

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Megen Duffy, RN, BA, BSN, CEN, is a practicing nurse, blogger, and contributing editor for the American Journal of Nursing. Megen has practiced in a variety of settings from emergency rooms to prisons.