New Grad Med Surg Nurse Freaking Out! - page 3

by shakedwnst924

22,279 Views | 32 Comments

Oh God, somebody please help me! I just started a job on the Med Surg floor and will have 6-7 patients per shift. I am working with a preceptor right now and having trouble juggling only 2 patients (I just finished up my 2nd week... Read More


  1. 0
    Hey, how did it work out for you? I Know this thread is old, but I'm in this spot right now!
    -K
  2. 1
    Wow 6-7 patients? I couldnt imagine that ratio, I am in a GN internship on a med-surg floor and our ratio is 1-4...very rarely is it 5 pts...this is my 3rd week on the floor on orientation and I am taking 3 out of the 4 of my preceptors patients. I very rarely have down-time but I get everything done including charting...I must admit I prefer for it to be busy, I like to stay active Hope everything worked out for you, I have found my internship very helpful so far (thank goodness for an AWESOME preceptor)...my internship is 3 months long and intern graduation is May 7! I feel ready already...it was also helpful that I did clinicals my last semester of nursing school this past fall before graduation so I was pretty familiar w/ the way things worked there. I find it helpful to get to work early and print out handoff reports and list all my pts meds by time 0900, 1100, 1300, etc and then as I pull them from the pixis i put a dot next to them and then when they are given to the pt I check them off and then I put a list of new orders at the end of each pts page and will mark those off as they are done. we also have computers at the bedside and so i chart right then and there as i am assessing the pt and chatting w/ them in the AM so that kind of helps.
    tsunade likes this.
  3. 1
    Quote from hawkfdc
    And if it doesn't go to night shift where its quiet.
    That has to be the funniest thing I've read all day!!!

    No matter what I did, it took me the better part of the first year to get mostly comfortable with the regular day to day things. Just in the last few months have the sudden out of the ordinary things not completely knocked me off my rocker. Keep plugging away and you'll get there!
    grandpaj likes this.
  4. 1
    I think we all feel this way. I had 2 weeks of classroom orientation, and am in week 8 now. I've had 6 weeks on the floor, roughly, and am taking 5 to 6 pts with the supervision of my preceptor. It seems like I never get my charting done!!!! I focus on my patients because they are most important. I strive to get it all done, but charting comes last, period, unless it is absolutely necessary that it be done at that moment.

    I'm on a surgical unit, we also take medical patients, and even the experienced RN's are having trouble getting it all done. That's the nature of the beast. So I say don't feel discouraged, just keep doing your best. We all suffer as newbies, you are not alone. You can do it!!

    I find it super easy to get bogged down with patients going to surgery (i.e. paperwork, consents, calling family), pt's who pass away (more paperwork, family, calling everyone), and patients who are high acuity and end up in the unit. For me, the downfall of nursing is the paperwork!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    To make things worse, we are short staffed on RN' and aides. So I spend most of my day taking pts to the bathroom because no one is allowed to get up by themselves. I have patients who have been in the hospital for 3 or 4 days with no bath. You can smell them from the hall I struggle with that because I want to help them clean up because I know they desperatley need to.

    It's a sad state of affairs in most hospitals, and with the new reimbursement plans it seems it will only get worse before it gets better, but we are all in it together I suppose, and all we can do is try our best. You are definately not alone.
    hakunamatataRN likes this.
  5. 4
    I am a new grad RN. I was just hired into a new grad program on a med surg fllor with a ration of 1:5 patients. I have advice based on my preceptorship on a med/surg floor. MAKE YOUR OWN shift report or brain sheet or whatever you want to call it. If you make your own it's much easier to organize your patients info quickly during shift report. A good start to the day makes the rest of the day go smoother. This was my work flow when I got to the unit in the morning:

    1) FInd out your pt's and rooms number - get stickers for each, arrange room number in sequential order
    2) If using an electronic medical record system open up each patietns chart so you can access each quickly
    3) Start with first patient: read H & P, write down admitting daignosis. Read their history - write down co-morbidities. Write down most recent vitals. Look at labs - write down the abnl lab values. Are they DNR or FC? write down IV sites, foleys, drains, tubes they may have - this way when you go into patients room you know what to look for. write down their Doctors name/ team name, or whatever. If your struggling with your beginning preparations ask your preceptor how they start out. everyone's different. Now during shift report you already know a lot about the patient and you'll have time to think about what questions you may have!! yay!

    4) Most important part** Look at the MAR or Mar summary. I write down PRN meds seperate from scheduled meds. Write down scheduled meds and when they are due - if you have time write down dose so when you go to the pixis/med removal machine you have more confidence.
    For the PRN's write down whether they are Q4/Q6/Q8 or whatever and when the last med was given - this way when your in the patients room and they say their pains a 7, you can look at your notes and see what pain med they can have when. Saves time!! I wirte down PRN meds in a different color ink so they stand out. Buy one of those pens that can switch from red,blue, black. Consider writing all patients scheduled meds on one page you can look at, that way you can look ahead and go ok and noon so and so, and so and so have meds due, so I should do this first. or whatever... you get the idea.

    5) Go meet the patient with the nurse that your relieving. Have them come into room with you. Introduce yourself and ask them if they need anything rt now and tell them you have to go see the rest of your patients, and that your still getting report and you'll be back soon. Look around the room where are there IV's? do they have a folley? see somehting you'll need to fix soon? are they in pain? write it down so when you come back after report your prepared!

    6) After reports down and you have all your patients data. med time! remember your 5 rights of med passing. dont rely soley on your notes you have to recheck MAR again. but you'll have more brain material from writing things down already. Makes it go smoother, and you'll feel more confident. Practice IV piggyback whenever you can, seems simple but unless you practice you wont have confidence. do everything. volunteer! ask other nurses if they have a skilll to do if you can do it. practice makes perfect and build confidence.

    7) If you have down time play with patients charts so you can familiarize yourself with where certain info is contained. Explore away! ask questions about new things you discover!

    8) Do a good assessment! look at dressings - don't chart on something you never asked about or looked at. if you forgot something go back to patients room - be bold - there's no shame in learning. Don't worry about what other ppl think - they probably arent even thinking about you. so relax take deep breaths and blow off anxiety. live and learn live and learn! woo!

    Thats all i can think of for now. good luck! oh and ask about pain - have them rate it and describe it... some nurses dont - but you have to chart that you asked these things - an dpt's can get copies of this - and they wont be happy when they see things you quoted them as saying that never happened.... shame!
    krazieklutz03, hazel_bite_, SamHill, and 1 other like this.
  6. 0
    Quote from r2d2az
    I am a new grad RN. I was just hired into a new grad program on a med surg fllor with a ration of 1:5 patients. I have advice based on my preceptorship on a med/surg floor. MAKE YOUR OWN shift report or brain sheet or whatever you want to call it. If you make your own it's much easier to organize your patients info quickly during shift report. A good start to the day makes the rest of the day go smoother. This was my work flow when I got to the unit in the morning:

    1) FInd out your pt's and rooms number - get stickers for each, arrange room number in sequential order
    2) If using an electronic medical record system open up each patietns chart so you can access each quickly
    3) Start with first patient: read H & P, write down admitting daignosis. Read their history - write down co-morbidities. Write down most recent vitals. Look at labs - write down the abnl lab values. Are they DNR or FC? write down IV sites, foleys, drains, tubes they may have - this way when you go into patients room you know what to look for. write down their Doctors name/ team name, or whatever. If your struggling with your beginning preparations ask your preceptor how they start out. everyone's different. Now during shift report you already know a lot about the patient and you'll have time to think about what questions you may have!! yay!

    4) Most important part** Look at the MAR or Mar summary. I write down PRN meds seperate from scheduled meds. Write down scheduled meds and when they are due - if you have time write down dose so when you go to the pixis/med removal machine you have more confidence.
    For the PRN's write down whether they are Q4/Q6/Q8 or whatever and when the last med was given - this way when your in the patients room and they say their pains a 7, you can look at your notes and see what pain med they can have when. Saves time!! I wirte down PRN meds in a different color ink so they stand out. Buy one of those pens that can switch from red,blue, black. Consider writing all patients scheduled meds on one page you can look at, that way you can look ahead and go ok and noon so and so, and so and so have meds due, so I should do this first. or whatever... you get the idea.

    5) Go meet the patient with the nurse that your relieving. Have them come into room with you. Introduce yourself and ask them if they need anything rt now and tell them you have to go see the rest of your patients, and that your still getting report and you'll be back soon. Look around the room where are there IV's? do they have a folley? see somehting you'll need to fix soon? are they in pain? write it down so when you come back after report your prepared!

    6) After reports down and you have all your patients data. med time! remember your 5 rights of med passing. dont rely soley on your notes you have to recheck MAR again. but you'll have more brain material from writing things down already. Makes it go smoother, and you'll feel more confident. Practice IV piggyback whenever you can, seems simple but unless you practice you wont have confidence. do everything. volunteer! ask other nurses if they have a skilll to do if you can do it. practice makes perfect and build confidence.

    7) If you have down time play with patients charts so you can familiarize yourself with where certain info is contained. Explore away! ask questions about new things you discover!

    8) Do a good assessment! look at dressings - don't chart on something you never asked about or looked at. if you forgot something go back to patients room - be bold - there's no shame in learning. Don't worry about what other ppl think - they probably arent even thinking about you. so relax take deep breaths and blow off anxiety. live and learn live and learn! woo!

    Thats all i can think of for now. good luck! oh and ask about pain - have them rate it and describe it... some nurses dont - but you have to chart that you asked these things - an dpt's can get copies of this - and they wont be happy when they see things you quoted them as saying that never happened.... shame!
    Wow, this is SO helpful!
  7. 0
    Also: take the opportunity to practice your skills whenever you can! I see so many nurses complain about being bad at IVs/NGs/etc. and then just ask charge to do it. You won't get good if you don't practice.
  8. 0
    Thank you so much for this great great advise r2d2az!
  9. 0
    Quote from r2d2az
    I am a new grad RN. I was just hired into a new grad program on a med surg fllor with a ration of 1:5 patients. I have advice based on my preceptorship on a med/surg floor. MAKE YOUR OWN shift report or brain sheet or whatever you want to call it. If you make your own it's much easier to organize your patients info quickly during shift report. A good start to the day makes the rest of the day go smoother. This was my work flow when I got to the unit in the morning:

    1) FInd out your pt's and rooms number - get stickers for each, arrange room number in sequential order
    2) If using an electronic medical record system open up each patietns chart so you can access each quickly
    3) Start with first patient: read H & P, write down admitting daignosis. Read their history - write down co-morbidities. Write down most recent vitals. Look at labs - write down the abnl lab values. Are they DNR or FC? write down IV sites, foleys, drains, tubes they may have - this way when you go into patients room you know what to look for. write down their Doctors name/ team name, or whatever. If your struggling with your beginning preparations ask your preceptor how they start out. everyone's different. Now during shift report you already know a lot about the patient and you'll have time to think about what questions you may have!! yay!

    4) Most important part** Look at the MAR or Mar summary. I write down PRN meds seperate from scheduled meds. Write down scheduled meds and when they are due - if you have time write down dose so when you go to the pixis/med removal machine you have more confidence.
    For the PRN's write down whether they are Q4/Q6/Q8 or whatever and when the last med was given - this way when your in the patients room and they say their pains a 7, you can look at your notes and see what pain med they can have when. Saves time!! I wirte down PRN meds in a different color ink so they stand out. Buy one of those pens that can switch from red,blue, black. Consider writing all patients scheduled meds on one page you can look at, that way you can look ahead and go ok and noon so and so, and so and so have meds due, so I should do this first. or whatever... you get the idea.

    5) Go meet the patient with the nurse that your relieving. Have them come into room with you. Introduce yourself and ask them if they need anything rt now and tell them you have to go see the rest of your patients, and that your still getting report and you'll be back soon. Look around the room where are there IV's? do they have a folley? see somehting you'll need to fix soon? are they in pain? write it down so when you come back after report your prepared!

    6) After reports down and you have all your patients data. med time! remember your 5 rights of med passing. dont rely soley on your notes you have to recheck MAR again. but you'll have more brain material from writing things down already. Makes it go smoother, and you'll feel more confident. Practice IV piggyback whenever you can, seems simple but unless you practice you wont have confidence. do everything. volunteer! ask other nurses if they have a skilll to do if you can do it. practice makes perfect and build confidence.

    7) If you have down time play with patients charts so you can familiarize yourself with where certain info is contained. Explore away! ask questions about new things you discover!

    8) Do a good assessment! look at dressings - don't chart on something you never asked about or looked at. if you forgot something go back to patients room - be bold - there's no shame in learning. Don't worry about what other ppl think - they probably arent even thinking about you. so relax take deep breaths and blow off anxiety. live and learn live and learn! woo!

    Thats all i can think of for now. good luck! oh and ask about pain - have them rate it and describe it... some nurses dont - but you have to chart that you asked these things - an dpt's can get copies of this - and they wont be happy when they see things you quoted them as saying that never happened.... shame!
    I couldn't agree more with this advice! I've been doing this since I started a year ago and it's a real great start to a shift. Anytime I skip parts or cut corners, which sometimes inevitably happens due to issues arising w pts right at shift change, I always regret it and end up feeling scattered. It really helps start the shift in the right foot and keeps my time management in line to be able to glance at my brain when I have a spare minute and see what meds are due. I also make a small list of " to dos" with check boxes next to them while getting report, like ambulate 3x, up to chair for meals, times for blood sugars and a blank spot for units given, order scds, Ptt at 8, 14, 20 as reminders to follow up, Etc- you get the idea- It's often a real life saver.
  10. 0
    I am a new med surg grad, and ive been doin it for almost a month...it gets easier as time goes on, when u call a dr have all dhe pts imp info together so if ur callin about removin an iv, check the mar n also ask about switchin any iv drugs to po so u dont have to call twice...


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