Tips for nurses in their first year of nursing

Nurses New Nurse

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Please share any tips you might have for our new nurses. Hopefully, this will become a great resource of nursing tips from all of our experienced nurses from around the globe.

After having my first year anniversary in nursing last week, my tips would be

1. Always listen to your gut instinct, if you think your patient looks well and is all right they probably are. If you have a little voice in your head telling you something is wrong, there IS!! Always listen to this little nagging voice!

2. Always listen to your patients..if they have pain, they will tell you (especially in paeds), likewise if they say they're gonna vomit...99.5% chance it's coming, run for the sick bowl!

3. If you don't know how to do something, or not sure, ALWAYS say! You're gonna look a lot more stupid doing someting wrong you're not competent to do, rather than saying "can I have some help?" before you start!

4. Never lie to patients/families..they prefer the truth than to be lied to/or not told anything, people need information and honesty. Listening and showing an interest in them will get you a long way too.

5. Always try to put your own health/life first, if you feel burned out, take a break if you need it...it's no good carrying on regardless, it doesn't do you, your colleagues or your patients any good. We all need a rest sometimes.

6. Learn to say "no"...if you can't/don't want to do a shift you're not rostered for, then don't! Nurses need a life too! There will be someone else to fill that gap.

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Specializes in Utilization Management.

I'll title this, "Things You Learn to Assess at a Glance." Each takes less than 3 seconds to check and all provide critical clues as to how your patient is doing.

1. Never trust an IV. You have to look at it every time you see the patient.

Corollary i: Never trust an IV pump. Always check the rate and volume of a pump and the amount of fluid in a bag, even as you pass the room to go to another room.

Corollary ii: For important drips like heparin, cardizem, and things that must go at a very controlled rate, LOCK the pump. But still, don't trust it. Patients and relatives have been known to figure out just enough to cause problems.

2. Never trust the O2 setting. Check the lines, the settings and the cannula itself (is it clogged with mucous, dried blood?) when you assess the patient, and do a brief visual check each time you see the patient.

Corollary i: Always believe the patient who says, "I'm having trouble breathing" even if you can't hear any adventitious sounds. Patients can go into respiratory failure very quickly and for no apparent reason. This is the patient you stay with until they are breathing better.Better to be safe than sorry. Reposition with HOB up and legs flat, check the O2 sat, check the line and the flow rate, call Respiratory--for a start.

3. Patient skin colors are important. Is your patient pale and pasty? Check the H&H. If the H&H is low, DO NOT LET THE PATIENT GET OOB. Make them use the bedpan, as these types are notorious for "vagaling out"---that is, passing out suddenly while using the bathroom due to vagal stimulation. If your patient cannot use the bedpan and must use the bedside commode, get help and stand by the patient at all times.

Is your patient pasty and slightly blue-tinged around the lips? color off, but you almost can't say how? (This one's subtle and takes some experience.) Check EKG, troponin, heart conditions, lung conditions. Take every complaint this patient has seriously. MI patients sometimes have this "funny" color.

4. What's the patient's urine look like to the Foley bag? No urine with IV fluids running? Is the Foley leaking? (Could be plugged or not placed correctly.) No? Check placement in a female. Unkink the line, check abdominal distention, do a bladder scan.

Corollary i: You have an older male patient who's up all night peeing. He goes 50, maybe 100 cc's or less each time. Do a post-void residual bladder scan. He may have an enlarged prostate and could be retaining urine. A Foley (if you can slide it past the prostate) might be in order for the poor fella so he can rest.

5. Skin temps are important. TAKE THOSE STUPID HOSPITAL SOCKS OFF and LOOK at the feet. Get a pedal pulse. One foot lots cooler, paler than another with weaker pulse? Doppler a pulse and call the doc for an arterial ultrasound. One leg have a pink or red, inflamed area that's warm? Think cellulitis or DVT and get a call out to the doc for a venous ultrasound.

Those are all things that don't take long to check and most of the time turn out to be just that--checks. But if there is a problem, you'll at least have a heads-up to correct it before it's a critical problem.

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Great info for a student nurse. THANKS!

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How on earth did you go through nursing school without giving many baths???????????? My only advice is to 1) do your baths when you do your assessment (you really get to see skin this way, plus turn and listen to lungs!), or 2) save it for when you have a code brown.

I did 3-11 shifts for clinicals in nursing school. Plus, I really don't think it was a very good school, clinicals wise.

They majored on writing papers, and passing the nclex. I made straight As but didn't feel confident at all in the practical area. Never would recommend that school to anyone.

Now just trying to figure it all out on my own.

Sad but true. :o

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Specializes in Critical Care, ER.

My Guide to Surviving Your First Year in the ICU:

1. Don't complain about anything. They don't want to hear it and you'll be labeled.

2. Know your unit's standards very well. You are accountable to these.

3. During report, check every line and every pump to make sure it's done right. Trust me on this one.

4. Verify that all the orders you expect for a certain pt type are actually in the chart (i.e. restraints, c-spine precautions, DNR, etc).

5. Spend at least 10 minutes at the beginning of your shift looking through the progress notes and history. Don't assume what you got in report is true. Do this even if it puts you behind in your vitals, etc.

6. If you are even 0.01% uncertain about a med or an IV med interaction, look it up or call the pharmacy before giving.

7. Your patient's family is not your enemy, a nuissance or an inconvenience. Your patient's family is a group of scared, powerless people who may or may not know how to react and behave in this environment. Remember this.

8. If you make a significant mistake, don't cover it up. That's not honorable.

9. All that glitters is not gold and all that smiles is not a friend. (sorry about the cynicism, y'all).

10. All of us have made the following mistakes at one point or other so don't feel bad when it happens to you, just correct it and try not to do it again:

* push too hard into a small bowel feeding tube with a syringe and splash all over ourselves and the patient.

* made a momentary stop cock error and let blood out of an artline or central line for a second.

* fail to assemble the correct equipment for a Swann placement (gloves, introducer, blah blah blah) and get yelled at by a doc.

* been caught feeling like an idiot when not able to answer a seemingly simple question.

* get yelled at for not being perfectly sterile in some dressing change or device insertion by a senior RN and then proceed to observe her doing the same within the next month.

* repeat something in report that you were told by the previous RN only to feel exposed when it turns out what you heard wasn't accurate.

* act like a diva the first time you give report to a floor nurse and proceed to get your a*s kicked.

11. Always have another RN watch you mix high risk IV bags such as vasoactives, not just sign it.

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Thanks guys, these were great. Gotta admit..they made me feel nervous and excited all at the same time!

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Ever have an "I wish I was told this" moment? Well, we all do as nurses regarding school. Here are some things I wish they told me nursing school (and some I wish they had emphasized more)----and what I told another new BSN nurse in a different thread (and it would be the same advice I would give any new nurse/grad):

You have achieved a great thing, graduating and earning your degree (BSN, ADN , LPN or Diploma). Now, the REAL learning begins......

Don't ever pretend to know what you don't. Be a sponge---watch and listen to what is going on around you. Take mental notes. Find mentors and emulate their good habits. Take note of the bad habits and avoid those.

Listen to your patients; they know their bodies better than you do.

Have integrity----be honest with yourself and others.

Stay out of the gossip game/circle. It goes nowhere and brings down morale, including your own.

Be on time! EVERYtime. When you are late, so am I. And I don't like to be late!

Stay organized as possible. Keep up on your charting and tasks as they come up. Dont' save it all for "later"---there may not be time, "later".

Do it right the first time, even if there IS "no time". Believe me, there is no time to "Do it over", either.

Plan for the worst; hope for the best.

Be someone they can rely on---and rely on yourself!

Take good care of yourself; eat well, exercise. It's the only body you got and you are gonna need it. Nurture the self. Nurses have a tendency to martyr themselves and neglect their own needs. Don't be one of them; it's a fast superhighway to burn-out.

Nourish the mind. Plan on spending a LOT of time investing in your continuing education as a nurse. The world of nursing/medicine is changing faster everyday. You are going to have to make a conscious and concerted effort to "stay abreast". It's more work than you imagine right now.....plan on it.

Learn assertiveness if you have not already. Lots of good books and conferences/seminars exist. Learn early-on you no are NO ONE's doormat. Also, know there is a difference between "assertion" and "aggression".

Work hard, yes, but don't forget to PLAY hard too! Have hobbies you enjoy. Your life is NOT your work, and while being a nurse is part of who you are, it need not *define* you.

Believe in your self and good instincts. Sometimes, "instinct" is what lets us know something is amiss or wrong with our patients. Never ignore that gut instinct. It's very often right! BELIEVE IN YOURSELF!!!!!

After 8 years in nursing, these things are things I have learned the "hard way"; hopefully you don't have to.

Warm, hearty congratulations to you and all new grads here. I wish you all good things in your new careers.

Thanks for the advice. It's been difficult since I got out of school. I have felt like I don't know what to do in some cases. But I have excellent nurses that I work with that have guided me and took me under their wings. I learn how to handle some cases and what I think they are doing is not right. Thanks again for the advice.

New Grad... graduated May 2005.

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i was wondering if there were any websites that maybe helpful to me, i'm awful at taking test and i feel if i can have a pre test so to speak i do a lot better.

thanks

penny

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Thanks all for your advice. I am about to graduate at the end of this year. So I'll take this information on board :)

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thanks for all the great advice. I am a new student in LPN program. Hopefully I will be able to look back at this advice once I get licensed.

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wow this was really helpful!

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Ok I'm about to start my night shifts here in New York as an ICU nurse. And i'm wondering how to lose weight (that i gained in school) and be up long hours?

I'm 52 yrs old and I'm about to join a local gym. But avoiding the extra food when I'm up the extra hours is going to be difficult......

Any tips on what to do that can help? Any tips on how to adjust to the night shift?

Thanks in advance........

Bryan RN, BSN

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