Tips for nurses in their first year of nursing

Deb,
Thank you for the encouragement... and the reminder! A Spanish teacher who became my friend this year on a month-long class in Mexico said that to me all the time, and her spirit and personality inspired me very much.

I started my first nursing job as a GN the first week in June on a 40-bed Med/Surg unit in a small community hospital. I passed my boards about 3 weeks ago and am now an RN. A week after passing my boards, my nurse manager said she wanted to take me off of orientation. I gave it a try for a few days, and realized I wasn't ready yet. I asked her to put me back on orientation and she agreed to. She kept me on orientation for 7 more days, then took me off again. All together I have been on orientation about 6 weeks. I know the reason for wanting to get me off of orientation is monetary as it "costs the hospital a lot of money to orient a nurse." Somehow I don't feel I am ready to be 100% responsible for 7-8 patients after only 6 weeks of orientation. The hospital is very antiquated. There is no "PYXIS" for medications (they still use the little plastic drawer system), you can only fit 2 nurses in the med room at a time, and we have to mix and reconsistute all of our own meds (the pharmacy does not do it for us). The school I went to had us doing clinicals at a hospital that had modern, up-to-date equipment and a full-service pharmacy. This antiquated way of nursing takes so much time....some nights I never even get a chance to assess my patients other than to look at them and talk to them for a minute while delivering meds to them. I am always there late catching up on charting that I never had a chance to do before the end of my shift. I graduated in the top 10 of my nursing class and received an award at graduation as "Best Clinician" out of a class of 42 graduates. Someone tell me....is it me? Or is the hospital administration being unrealistic in their expectations of a new nurse right out of school? My preceptor never spent any time with me during orientation working directly with the patients. I was given 2 patients to care for my very first night with my preceptor, pretty much to care for on my own. I am considering leaving and finding a job elsewhere. Does anyone have any advice, suggestions, comments?

Just got a job at a new hospital. The pts will be total care.
Any tips on baths???? I have never done this (much).
i don't have an aversion to it just want some tips to be faster, or better at giving them. Thanks! Nurscee

wow that is great. I loved my Spanish classes and had an awesome Spanish professor "way back when"...

Thanks For All This Great Advice!!! This Makes Me Feel Sooo Much Better!!!! Now If I Could Only Have A Semi-perfect Day!!

God Bless You All,amartin1 From Sa,tx.

Welcome to allnurses, Amartin!

Kim - I think you have 2 options: you can give yourself a little bit of time to get in a routine and get more time-efficient (remember when you first started doing pt care in nursing school and how long it took you to do everything), or you can leave and go to another hospital where you may find yourself still swamped when you get out of orientation. If you got the "best clinician" award, the faculty at your school really thought that you excelled on the floor. Give yourself some time and I think you will find that you'll get it after a while. Remember that there were several "nursy" things that you could not do as a student (like writing orders, etc.) that you are having to learn how to do now. Don't be so hard on yourself! You can do it!

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.

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.

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.