New Grad Med Surg Nurse Freaking Out!

r2d2az · Jul 6, 2013

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!

Summers_Off · Jul 18, 2013

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!

nursejami · Jul 18, 2013

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. :)

pumpkinspice555 · Jul 19, 2013

Thank you so much for this great great advise

r2d2az!

gigglestarsRN · Jul 20, 2013

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.

bubbasmom · Aug 13, 2013

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...

bubbasmom · Aug 13, 2013

Dont be too hard on urself! It gets better..i had 1 bad day n 2 good days just last week

c.kelly20 · Aug 13, 2013

I am also a new med surg and starting my job next week. I have the worry that I will be the same way! I was hesitant to take a medsurg position because of the patient load, but I'm hoping it will improve my organization skills. I've read a lot that any job takes about 6-12 months before we really feel "comfortable". Just do your best and always ASK if you're unsure- it's safer that way. I'd rather look like a putz for a few minutes than harm a patient because I didn't ask. But you can do it!!! Hang in there and know that you're not alone!!:)

sourapril · Aug 13, 2013

Sometimes I think hospital nurses work in a battlefield. Good luck. Don't get discouraged. Learn as much and as fast as you can, but also take a good care of yourself.

LisaHanson · Sep 11, 2015

I know this is an old post, but I love it! I am graduating in May '16... God willing. And i just decided that I will be looking for new nurse grad Med-surg positions. I feel like this will be my BEST learning opportunity, and make me more marketable for any future potential job change. Your organizational pointers are great. It's what I do now for clinical (on Med-surg floor). And my clinical instructor has told me that my documentation is spot on. I know it will take some time fore to feel comfortable. I know the key is a good preceptor. I'm becoming more afraid of not getting a good one.. been reading stories of nurse-nurse bullying. Pretty scary stuff. That's no way to build someone's confidence!

Idk if you'll even see this... but I wanted to thank you for this post. It was a good read, and I appreciate you being so open and positive. :)

gemmi999 · Sep 19, 2015

I just recently started my New Grad position in the ER. My first day, when I was still shadowing my preceptor, there were two codes. I'd never been involved in a code before and suddenly I was being told to push EPI! I felt (and still feel, at times) completely over my head. It took me a month solid to feel comfortably handling two patients, and just when I got there my patient load was bumped up to 4. What I've found that works best for me is to

a) never put something off that can be done now, even if it's charting vitals. Yeah, I don't need to chart them for another hour, but who knows if I'll get busy. If I chart now that buys me two hours before I need to rechart/recheck (unless it's an unstable patient).

b) If you have a patient that is SUPER needy, let your charge nurse know and your support staff! Make sure to bundle care and set limits with the patient right away--I can only stay here for a few minutes, I have to talk to X person at this time. But, I can answer a couple questions now and then come back later when I have more time.

c) Ask for help! If one of your patient's is more unstable and needs you attention, ask your resource or charge RN to make a pain medication pass for you. That way you can focus on your unstable patient but your stable patient doesn't start yelling or threatening to pull out her IV because she's pissed off.

d) Know that some days are just gonna be rough, and you won't finish everything you needed to finish. Apologize to night shift and say what still needs to be done, and then offer to grab them a coffee from the cafeteria.

Smile! You made it!

Tay56 · Sep 23, 2015

I, too, am upset. I am in my 8^th week into my preceptorship. I have about 4 more weeks and I'm nervous about that coming. Also a bit excited; who knows what will happen? Anyway. I think the main thing is to go easy on yourself. You can't beat yourself for what happened; it already happened. You got to remember you are human and love yourself. It's still a process I struggle with every day after I get off work. I cried at the end of a shift because I got so frustrated with a pt taking off her oxygen and pulling out her IVs that during report to the night shift I said because SOMEONE kept taking off her oxygen even though I keep telling her to keep it on.â€ That was awful of me. I understand she was human too, and maybe I am able to find a different method for her to keep her NC on. Still. Beating yourself up for the little things does no one any good. You got to love yourself like you love your patients; sure you might not be perfect or do what you need/want to do, but to accept that human part of you. Good luck to all of us new grads out there. I want it to get better now, too.