[PurrRN]

Well, I graduated, passed the NCLEX, and got a job .

I start orientation on Monday and will be going to an Acute Rehab floor to begin my career.

My only experience has been through the clinicals I completed while in school and fully understand that I have a lot more learning to do with regards to nursing.

My question is two fold actually. First I wanted to know what more experienced first year nurses felt was most important (helpful) to concentrate on mastering first? What things helped you feel more at ease in your position?

Second, from preceptors- What do you like to see from your newbie nurses?


Any advice is welcomed. I'm just trying to prep a little before I start on Monday. I'm excited to finally be doing what I've been going to school for for sooooo long. At the same time it's a little scary knowing that there is so much more to being a nurse than just what I've been exposed to in the lecture/clinical setting.

Thanks to all that respond.

[Jed Row]

Well congratulations on the new job.

Time management and prioritizing patients are definitely the two biggest areas to focus on in your first year. It's expected that you won't know everything about your patients' pathologies and the operational culture at your job so don't get overwhelmed if you come up against something you've never seen before.

When I started out I was terrified that I was a) going to kill someone; and b) going to look incompetent doing it. What I learned is that if you rely on your colleagues and focus on your patient's needs you'll do just fine. Try to focus on what your patient needs for that day and how you're going to get it done as quickly and safely as possible. You're part of a team so don't be afraid to ask for help. In fact, if you try doing everything by yourself your first year nursing is also likely to be your first year as a patient. Skills take time to develop and anyone who expects you to be an expert on day one is delusional...or a physician <grin>

A practical word of advice for the start of your shifts:
1) Know who to yell for and where to go if you need help fast (i.e. my patient is the colour of her sheets)

2) Prioritize your patients based on the last shift's report. If something was off on someone go see them first.

3) Do a quick walk around before you actually start working on anything specific and say hi. It puts your patients at ease and verifies that they're all still breathing.

4) Something that's always helped me: tell your patients what the plan is for the day. It gives you instant credibility and involves people in their own recovery. It's a hell of a long day for a patient even if it flies by for you and people like to know they're important and being thought of.

If your facility is like mine you'll likely be too busy to properly review a chart and all of the details for any one person. But there will be time at some point to do this and you should take advantage of it. There's nothing worse than having to say to someone "I don't know very much about this person" when you're giving report or talking to the code team.

Have a blast, it really is a lot of fun, and good luck on Monday.

[PurrRN]

Thank you so much for your response. I'm will definitely add your suggestions to my plan.

I've read before that some new nurses like myself can get overwhelmed with time management and real world nursing and I just felt like I needed a focus beforehand.

I've started my to do list and I'll be adding your suggestions and any others that come my way.

Thanks again, Angela

[Mudwoman]

There will be so much to learn that I recommend that you get a small notebook that will fit in your pocket and you can jot things down to refer to later if needed. Example: what do you do for patients going to MRI? You can right down the process and then you don't have to worry about remembering everything. After a while, you will know things like this by heart, but at first you won't. I found a notebook at the local office supply store in the index card area. It is in a clear cover and the pages are thick enough to hold up.

Everyone has their way of working that works for them. You are going to have to find what works for you. However, most of the nurses I work with agree that you have to get that initial assessment done first thing or you find that things come up and it doesn't get done.

Have some kind of "brain" worksheet to keep you organized. You need to be able to look at a glance and see hour by hour what you need to get done.

As a preceptor, what I hate to see is a nurse that thinks the only thing that matters is how well you took care of the patient. This is important, don't get me wrong, but you have to be able to document your work as well. For example, if you give pain meds, you must reassess how well that pain med worked and document that within one hour of giving that pain med. This is easy to miss if you don't make a note on your worksheet. We have new nurses that just don't do this and think it is okay because the patient was okay. We have to change out the IV tubing twice weekly and some think that because they didn't get time to do this, it is okay. Or, they do it and don't chart it. I also hate to see new nurses not do certain procedures because they "don't know how". Problem is they don't search out someone to show them how and then it seems to become a convenient excuse to not have to do something. I can't tell you how many times I've come on shift and I'm told, this patient has to have a dubhoff placed or this patient has to have a port accessed, etc, because "I don't know how to do that".

Finally, I can't tell you how many times I have assessed a patient and then looked at the flow chart assessment done for days by other nurses and wondered if I had assessed a different patient. It is obvious that they were in a hurry and just wrote the same info as the last nurse to save time. Don't just follow what the others have done. Do your own assessment and chart your own findings and opinion. Find the time to do your job via time management.

Hope this helps.

Charlee

[PurrRN]

Thanks Charlee,

I appreciate your insight and advice because I want to be able to be great at my job and realize its ALL important. For the inexperienced, like myself, it can be the little things that experienced nurses don't have to think about anymore, that trip us up.

I've actually finished my first week in orientation with the hospital. Got my official name tag, took PBDS (yuck!!), etc. We have two more days of documentation training and then I'll finally be able to go to my own floor.

I'm going to do what you suggest and get my "brain sheet" together with all those reminders on board. Sounds like it will make the transition smoother than if I were just winging it.

Thanks again, Angela