Succeed as a New Med-Surg Nurse: Part 1

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    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 itís the only job in town. Being a Med-Surg nurse at heart, and having great mentors in school and after graduation, Iíve 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 Iíve learned have been from ED and ICU nurses. But Iím aiming at the ďbaby nursesĒ 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, itís understandably difficult to look at the million tasks for the shift and say to yourself, ďWhat do I do first? What can wait?Ē

    An important point to remember is you canít organize without prioritizing, and you canít prioritize without organizing. You can have a beautiful sheet of paper with checklist after checklist thatís brilliantly organized, but youíll barely have time to do everything you MUST do, much less time to do everything you want to do. So youíll have to prioritize. And you can know whatís most important for each of your patients, but fitting it all into a 12 hour shift wonít happen if you donít stay organized.

    For Part 1 of this series, Iím 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, ďWhy is the patient in the hospital TODAY?Ē 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, theyíre eating and drinking without nausea, and they go home. Whatís the worst outcome? If you said, ďDeath!Ē then Iíll give you bonus points, but letís 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, ďWhatís the most important thing I can do today to increase the chances of that good outcome?Ē And then, ďWhatís the most important thing I can do today to decrease the chances of a bad outcome?Ē

    So for this post-op patient, Iím thinking, ďGood pain/nausea control.Ē And then Iím thinking, ďGet their bootie out of bed and ambulate!Ē What has this done for me? Instead of a swirl of things to do and think about, Iíve 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 youíll still apply the same concepts. If my post-op appendectomy patient is 84 and has a history of COPD, Iím going to account for her lungs not working as well, and Iím going to focus even more on making sure they donít 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 weíll look at what we do once weíve located the forests amongst the trees.
    Last edit by Joe V on Apr 16, '12
    `NurseConnie33, NURSE_NECI, happyRN29, and 15 others like this.

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  2. About wooh

    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.

    From 'GA, US'; Joined Feb '04; Posts: 4,985; Likes: 20,646.

    Read more articles from wooh

    9 Comments so far...

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    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?
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    All 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 :-(
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    I 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!
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    Hi 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.
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    Hey 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!
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    Feeling 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.
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    Would love to hear more....great post!
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    Beneficial. This is going to help me have a better idea of what to write down for discharge rounds.
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    This 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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