Succeed as a New Med-Surg Nurse: Part 1
Succeeding as a new grad in Med-Surg requires learning to organize and prioritize. I'll share tips on HOW to gain these vital skills.
So many new grads start off on a Med-Surg floor. Either they want to, they think they should, someone else thinks they should, or it's the only job in town. Being a Med-Surg nurse at heart, and having great mentors in school and after graduation, I've become pretty good at Med-Surg, because I stick to a few basic rules. This series will be aimed at helping the new grad in Med-Surg (adult or pediatrics). I hope some it will prove useful to others as well, as some of the things I've learned have been from ED and ICU nurses. But I'm aiming at the "baby nurses" entering the big bad world of hospital floor nursing.
The two most important things a nurse in Med-Surg has to learn are PRIORITIZATION and ORGANIZATION. Nobody can organize like a Med-Surg nurse. Unfortunately, for the new grad, this is one of the hardest skills to develop. Being inexperienced, it's understandably difficult to look at the million tasks for the shift and say to yourself, "What do I do first? What can wait?"
An important point to remember is you can't organize without prioritizing, and you can't prioritize without organizing. You can have a beautiful sheet of paper with checklist after checklist that's brilliantly organized, but you'll barely have time to do everything you MUST do, much less time to do everything you want to do. So you'll have to prioritize. And you can know what's most important for each of your patients, but fitting it all into a 12 hour shift won't happen if you don't stay organized.
For Part 1 of this series, I'm going to share a few general ideas about that core concept of Prioritize and Organize.
First, you need to start the day figuring out what is most important for each patient. When you come in and get your patient information and get report, there will likely be a whirlwind of diagnoses and treatments and drugs. For each patient, step back from the trees to look at the forest. The trees are all the comorbidities and drugs and social issues. Step back and look at the forest, "Why is the patient in the hospital TODAY?" And with that thought in mind, look into the future and imagine the best outcome and imagine the worst outcome.
For example, you have an easy post-operative appendectomy. Best outcome? Pain is controlled on PO meds, they're eating and drinking without nausea, and they go home. What's the worst outcome? If you said, "Death!" then I'll give you bonus points, but let's think of the likely bad scenarios. For post-op patients, I always imagine post op ileus and some pneumonia.
So next is to think through, "What's the most important thing I can do today to increase the chances of that good outcome?" And then, "What's the most important thing I can do today to decrease the chances of a bad outcome?"
So for this post-op patient, I'm thinking, "Good pain/nausea control." And then I'm thinking, "Get their bootie out of bed and ambulate!" What has this done for me? Instead of a swirl of things to do and think about, I've now found what I need to focus on for that patient.
But wooh! None of my patients are a simple post-op! In this day and age of outpatient surgery, rarely will you have the easy post-op patient. But you'll still apply the same concepts. If my post-op appendectomy patient is 84 and has a history of COPD, I'm going to account for her lungs not working as well, and I'm going to focus even more on making sure they don't end up with pneumonia from inactivity caused atelectasis. The secret is to look at the big picture of the patient. Step back from the trees to see the forest.
It will take some practice at first, but soon it will become second nature. Next time we'll look at what we do once we've located the forests amongst the trees.Last edit by Joe V on Apr 16, '12
wooh started off as a CNA in a nursing home before being a tech and unit secretary on a medical surgical floor. After graduating, wooh has spent years in med-surg, previously adult and now pediatric. While willng to occasionally float to other areas, wooh is a happy (although sometimes jaded and bitter) floor nurse.
Joined Feb '04; Posts: 4,987; Likes: 20,773.Jan 9, '12[FONT=comic sans ms]Good article wooh. Question, let's take this from the perspective of the new RN who worked as an LPN previously. The LPN is more task oriented, yet still prioritizes in order to get things done. When transitioning from one to the other, how do you know what to prioritize from the RN perspective? Same as what you originally state correct?Jan 11, '12All great advice. I am a recent grad on my first job. It has not worked well for me, im on my second position within this facility and its just not happening. Im so over whelmed, time management is a issue. I fear i will be let go at the end of this week, its almost a relief to walk away from the stress. I feel perhaps hospital nursing my not for me, i truely need the time to get my legs under me before i take off running, there is NO WAY in that fast paced environment that this is goin to happen for me...i give up and will look for other avenues :-(Mar 31, '12I am about 7 months into my first nursing job which is on a small med-surg unit. I'm doing ok, but I feel more like I'm playing at being a nurse than actually being a nurse. This article has been really helpful, do you have a Part 2?
Thank you!Apr 16, '12Hi all! I've been neglecting this, sorry. I think Part 2 got eaten in the upgrade. I'll go looking for it and try to get a part 3 in about a month when school slows down for me a bit. Thanks for the positive feedback! And I'll try to answer the questions I've gotten in future articles. They're great questions and I want to put some real thought into answering them.Oct 1, '12Hey wooh,
I was just wondering if you were still going to post up part 2 and maybe part 3 of this guide. I and I think everyone else would really appreciate it. Thanks!Oct 2, '12Feeling so guilty! Sorry!!! I'm putting it on my to do list. Got the idea when I had some free time. Then I've more or less had no free time. But on my to do list. It will be a nice break from studying when I can afford a break from studying. Glad that Part One was helpful to you and I will use that as my kick in the pants to get to work on Part Two and then some.Oct 1, '13Beneficial. This is going to help me have a better idea of what to write down for discharge rounds.Oct 3, '13This is a great article! Going to be asking myself "whats the most important thing I can do today to increase the chances of a good outcome" every patient, every shift Such a great way to look at it!
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