Advice for new RNs, from a new RN
Being a new nurse is such an exciting new experience, but it can be extremely overwhelming. This is totally normal! I have come up with a few tips to help new RNs be more prepared to help save time and become more efficient.
I am by no means a seasoned nurse, but I have learned a few things during the beginning of my career that have saved me time and made my work more efficient. I work on a fast-paced MedSurg/Trauma/Orthopedic unit in an inner city teaching hospital. I hope that these tips can help some of you!
Being organized with patient’s medications, charts, to-do lists, etc., will make everything feel less chaotic. Find a way that works for you and stick to it.
MAKE A TO-DO LIST
My suggestion is if you cannot do something at the exact moment, write it down. It is so easy to forget that a patient requested pain medication, or a new pitcher of water, if you are in the middle of something else.
START YOUR DAY PREPARED
Glance through your patients’ charts and become familiar with their orders. Things especially important to pay attention to are code status, diet orders, PRN medication orders, and parameters when to call the physician.
ALWAYS HAVE A BASELINE ASSESSMENT
You need to have a focused assessment at the beginning of your shift to monitor for any changes throughout. I can’t stress enough the importance of this!
KEEP YOUR POCKETS STOCKED
Keep your pockets and your cart stocked with items is a HUGE time-saver. There is nothing worse than realizing you don’t have IV tubing when you are about to hang a med, and having to run across the floor to grab supplies.
Things I always have in my pockets are:
a. Alcohol swab (it can double as a piece of paper in a pinch)
b. Something to write on
c. Pen and pencil
d. Saline flushes
e. Tape (I keep around my stethoscope)
Things always in my cart:
a. Syringes (all sizes)
b. Gauze and Band-Aids
c. Cups, straws, spoons
d. IV tubing (primary and secondary)
e. A bag of normal saline and LR
f. Blood draw sets and IV kits
g. A suture removal kit (docs are always coming up to me asking me to grab them one!)
Anything else you reach for frequently!
DON’T BE AFRAID TO DELEGATE
At the beginning of my career, I was always scared to ask the aides or other nurses for help with small tasks because I didn't want to bother anyone. That said, do not abuse your aides or make them feel like they are doing all your “dirty work.” Don’t think that because you are an RN now, you are “too good” to put a patient on a bedpan or assist them to the bathroom. Work together and always thank your aides for their help. Don’t forget, they are a second pair of eyes and hands for you.
BE A TEAM PLAYER
If you have some free time (rare I know!) ask other nurses if they need help with anything. Even seasoned nurses can use an extra hand. The act of offering to assist others creates a positive work environment and hopefully others will return the favor.
BE PREPARED BEFORE YOU CALL THE DOCTOR
Think before you call and imagine how the conversation may go. Think about the important information you will be asked about. ALWAYS have a RECENT set of vitals!! Other important information includes pertinent lab values and medications, including PRNs. Have a piece of paper and a pen ready for new orders. Have your patients chart up and ready for quick glance. It definitely takes practice to effectively communicate with physicians, so rehearse in your head what you are going to say if you need to.
BE ON TOP OF WHEN THE NEXT DOSES IS FOR PRN PAIN MEDICATION
Patients who are in pain get very frustrated when having to wait for pain medication. Knowing when the next dose is due can keep you from feeling rushed and it will also keep your patients happy.
BUY A PULSE OXIMETER
It comes in handy in more instances than I could imagine! If you are in your patient’s room, and you find an opportunity to stick the pulse ox on them for a moment, do so.
PREPARE FOR NEXT SHIFT
If you see the fluid bag is going to run out soon, grab another bag to have ready to go. Don't leave an almost-empty bag for the next shift to have to change right away!
Also, always do a quick rounding within the hour before shift change to make sure your patients are comfortable, have everything they need, are medicated, and that the room is clutter free.
BE ON TOP OF THE NURSES AIDES
Some are great, and others are not. You will quickly learn the ones you can trust and the ones you cannot. Give them specific parameters to report to you if necessary. There have been times aides have not reported abnormal vital signs and complications were not caught right away. That said, always stay on top of your patient’s vital signs, especially if someone else is taking them.
AVOID MEDICATION ERRORS
As nurses, it feels like we are rushing and getting interrupted all day, but you need to be 150% focused when it comes to medication administration. Luckily with scanning technology, medication errors are less prevalent but they do happen. Do not put more than one patient’s medication in front of you at a time. Scan the medication, put it in a cup, and go directly into your patient’s room. If you get interrupted, start over and double check. Taking extra precaution to avoid an error is SO important for your patient’s safety as well as your job security, especially as a new nurse. Also, be extremely careful with narcotics and dosages.
QUICK GLANCE NOTES
I have one piece of computer paper with all my patient’s information including: diagnosis, IV fluids and rate, pain medication and dosing, abnormal or pertinent lab values, antibiotics, recent vitals, etc. (I find it is best to write when you are getting report from the previous shift RN.)
If a physician stops you in the hallway and asks you a question about the patient, having this information at a quick glance not only shows you are prepared, it is also a huge time-saver. It takes time and practice to know what the “important” information is that you will be asked about.
TAKE A MINUTE TO REGROUP
We have all had times where our heads are spinning, we are bombarded with things to do, a patient is angry, and you don't know where to start. Take a deep breath, regroup, and prioritize what needs to get done. Being a new nurse can be so overwhelming, and everything feels like it is an emergency. In due time, you will be able to figure out what really is the priority. The most important thing to due when you feel overwhelmed is to stay calm, regroup, and focus. Don't let the feeling of being overwhelmed send you into a panic. One step at a time!
DOCUMENT, DOCUMENT, DOCUMENT
Cover your butt. I know you learned this in nursing school, but it really is so important. If you report something abnormal to a physician, document it, especially if you get no new orders. If you have placed multiple calls to a physician, but have not received a callback, document it.
DON'T BEAT YOURSELF UP IF YOU HAVE TO STAY LATE TO CHART
As a new nurse, you may feel discouraged when your coworkers are leaving on time and you still have charting to do. This is normal, and your time management skills will improve.
SOCIAL MEDIA & DATING COWORKERS
Be very careful with who you decide to be friends with on social media. Also, as a new RN, there will be many new people you meet with opportunities to date. I am sure you are all smart enough to figure this one out, but be very careful!
Jul 17, '17Of note, keep in mind that some facilities do not allow flushes to be carried in pockets. Also tape is not recommended around the stethoscope due to infectious disease risks.Jul 17, '17I'm a new nurse and I do so much of this already and still feel really overwhelmed. I work cardiac Telemetry, and if nothing goes wrong (which a nearly perfect shift has only happened once for me), everything goes smoothly. But as soon as something happens...a rapid response, a serious dysrhythmia change with a symptomatic patient...my whole shift is shot straight to hell. And this happens so often. Then I end up getting to meds late, not having time to document until after my shift, getting frazzled and making stupid mistakes, and worst of all to me....I feel like I don't have time to assess everyone enough or to really dig through their charts and notes to get the full picture (unless I come early, which isn't paid). I make a cheat sheet for each patient. I make a schedule. I have all my facts in order before I call providers, and my pockets are fully stocked. I don't know what else to do to make my shifts smoother. Hopefully it'll just come with time? I do delegate when needed and I do ask lots of questions and ask my preceptor for input all the time. Still just feel blah.Jul 17, '17Quote from JadedCPNThe same goes for the pulse oximeter. Difficult to clean between patient uses and is not maintained by the hospital's biomed department.Of note, keep in mind that some facilities do not allow flushes to be carried in pockets. Also tape is not recommended around the stethoscope due to infectious disease risks.Jul 19, '17I was expecting like "top five most important things" and there was plenty more than five! But above all thanks for sharing. It is nice to hear from new RNs the struggles you guys go through a day.Jul 19, '17If you hear rumors that an employer is predatory against nurses, BELIEVE IT. Learn from my mistake.Jul 20, '17Thank you for your insight. This is really helpful and it lays a foundation for growth and development. Highly recommend reading it!
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