Please help: new grad on tele floor

A preceptor is basically a teacher and mentor who will help you learn to work on your own. Learning to be a good nurse is only partly knowledge and the rest is experience, so it will help you to be able to have a good preceptor.

I always am sure to carry phone numbers with me -- the Charge nurse, the dietary department, the lab, and the Pharmacy are the ones I use the most.
I look up different meds on my PDA, but if I'm unfamiliar with them, I call and ask the Pharmacist.

Other than that, this thread is a wealth of information for the new nurse:

http://allnurses.com/forums/f224/tip...ng-109924.html

http://www.allheart.com/pm3309.html

Here is a clipboard with assessment info, etc. on it that I recommend to new nurses all the time. They love it!

Hi,
I graduated this past May. I have been working on a tele floor since June. I have lots of advice, but will try to be brief:
1. Know your telemetry: especially what the abnormals are, and what the dangerous rhythms are. If your hospital does not offer a class on interpretation, ask to spend time in the tele monitoring station. The tele monitors in my hospital quizzed me on rhythms.
2. know your basic heart drugs (action, dose, side effects, etc.), look up those you are not familiar with before you give them. If you are giving a B/P med for hypertension, ALWAYS check B/P and apical pulse before you give the med, even if your aide checked a B/P 20 minutes ago (I once gave Coreg based on my aides vitals and bottomed out a pt.).
3. Get an organizational system that works for you so you can give meds on time, do assessments, and procedures without feeling rushed.
4. Ask questions! Do not feel stupid for asking. I often would think a decision through, and then run it by someone to confirm that I was doing the right thing. Even nurses with years of experience do this.
5. I will frequently refer back to my textbooks for learning about a particular disease process, or use the internet at work.
6. If the attending Cardiologist is approachable, I try to ask them questions about a patients condition to learn from them what they are trying to accomplish (just dont' ask them if they seem busy or stressed), we have lots of MD's who like to teach, and get along well with the nurses.
7. Have confidence in your knowledge base...You know more than you think you do!
8. If you are not "Gelling" well with your preceptor, ask to be reassigned...You cannot learn if you don't get along with your mentors. It's not a reflection on you or them, just that you do not mesh well.
9. If a pt on your unit codes (even if it's not yours), and you can, go observe or help. My first code I forgot everything I ever learned, so observing really helped me learn what to do.
10. If you do not feel comfortable with a situation (that "gut feeling"), listen to your gut, and get help. Another opinion can really help you sometimes.
11. If you have to call a Dr., be prepared (again, I speak from experience) to give vitals, your assessment, labs, etc. and have the chart there to look things up.
It's definitely tough the first few weeks, but I can promise you that it gets easier, and if you have a good staff to help you, it makes all the difference.
Good luck! You will love it! I know I do.
Amy

I brought a whole briefcase full of what I thought would be useful references with me my first week and never opened it. I found the relevance, quality, and speed of retrieval of information gathered by watching and listening and asking easily beats searching references for most things, and for the rest, our floor is littered with computers so I google as needed.

al7139 pretty much nailed it, and I'm only five weeks into orientation, but I'd add (warning, may be obvious as all heck):

-Keep a little jot-down of all your patients' most recent labs, and their most recent vital signs as well. If anything is borderline-but-normal, jot down what the recent trend has been, and keep handy the pager number of whomever you'll have to call should they go abnormal. Keeping them on you will help if there's a code, as in that situation you'll be asked for them repeatedly. Haven't had a code myself yet, but this is second-hand advice.

-I like to explain meds to patients as I give them, provided of course that they are conversant enough for this. Helps me and them, and gets us both on the same team, or at least makes a good attempt at same.

-Someone else on this site (I forget - shame on me!) made a great recommendation, something to the effect of making three "passes" after getting report. Here's my modified version (the "m'am" system, since everything needs a silly acronym...):
-First: Meet and greet: checking in briefly, making sure they're breathing, swabbing and flushing all INTs & bringing water if allowable (kind of like a "peace offering", or like a waiter/waitress bringing something to the table first - makes waking them a nicer experience, and ensures that they have water for their pills)
-Second: Assess, and give insulin covereage as needed, if their glucose levels are available. Also, this is if their trays are in front of them, if they're getting Aspart.
-Third: Meds, with the BP/apical checks al7139 mentioned, including insulins not covered in the previous step.


It's a work in progress, and of course now that I said all this I'm bound to have a morning that throws all of this stuff off! But, it's not a bad idea to codify your own system in writing this way.

Oh, and try to keep a straight face when you're told you'll have nursing students working with you in your fifth week! I almost cracked up at that one!

-Kevin

I would also add knowing your chest pain protocol VERY well. Get a copy of it right away. Often Cardiologists like to get an EKG before nitro is given, if possible, find out if that is a policy at your facility. Develop for yourself a very organized method for managing chest pain, note exact time when you gave the first nitro, what the pt's pain level was, the blood pressure etc.... being very good at managing chest pain and documenting it and its interventions quickly will serve you well.

Get a copy of your Acute Coronary Syndrome order set and know why each of those orders are on there. Cardiac enzymes will be ordered, a beta blocker...etc.

Know where your code cart is and learn how to use your defibrillator, also know where the emergent intubation tray is kept, the temporary pacer and the emergent chest tube insertion kits are.

I am a new grad as well, and I have to say that creating a good report sheet is so helpful. It really helps to organize the day and makes things less stressful since everything you need to do and need to know is right on the sheet. I put things like the patient's doctor, vital signs, important labs, times that meds are due, tele checks, finger sticks, etc. I was on the floor a couple of weeks before I figured out what I needed on my sheet. Your floor will probably provide you with learning materials and tell you what you need to know. Let your preceptor guide you until you get into the routine of being the nurse! That's what they are there for! Good luck!

Be ready to be more physically and emotionally exhausted than you ever thought possible.