to New Nurses (long, but, hopefully helpful)

  1. Hello to all the New Grad Nurses!
    I have noticed, as I read the posts, a lot of you are talking about being frustrated, overwhelmed and scared. Let me start by saying that it's normal to feel this way. I have been an LPN for 5 years and guess what, I sometimes feel the same! I know Nurses, both RN & LPN, with many more years than I have that have days like that too. So, take a deep breath and relax for a minute.
    The one thing that most Nursing schools don't tell you is that what you learn in class and what goes on in the "real" world are sometimes very different. Instructors never tell you about how many patients you will be assigned, the different levels of care each needs, the tons of paperwork needed to be done each shift (not counting the emergency, admission and discharge paperwork), the problems of giving meds to some pts (that can take forever to give) , the pts who call you constantly for little things they can actually do themselves, The pts who berate you, scream & threaten you, the ones who complain to management about everything you do (no matter how much you try to satisfy their needs). But, remember, they also do not tell you about the little wonders that happen each day. The confused pt who remembers who you are, the hugs you get from them for something so small you never even thought about it. The Thank You received from the pt & family for catching a problem before it got worse. Being singled out by a very difficult patient, only to have them thank you for your care and the time you gave to them despite their attitude towards staff. And last but not least, the feeling you get when you know you did your best & the patient is healing perfectly.
    Yes, you are overwhelmed, stressed, frustrated, scared, you question your decision to become a Nurse. You just graduated, you are learning, you feel like you should be quicker, know everything, maybe scared to ask too many questions. It will take 5 years for a Nurse to feel fully confident in her decisions and assessments. Seriously, 5 years! And even then, you will have moments where you question yourself. I was very lucky, I had a fantastic mentor!! She taught me many things, the most important things she taught me I will try to give to you;
    1. Never be afraid to ask questions - if you ask someone and they won't answer, ask someone else (I know that sometimes the experienced Nurse get irritated by your questioning and may snap at you, gently remind them that you are still learning and they have the knowledge you need and you appreciate their sharing it with you) And try to keep a notebook to jot down answers to questions, this gives you the ability to look something up and remind yourself of the answers.
    2. There are no stupid questions, only unasked ones
    3. Keep a "cheat sheet" on your assignment - jot down the little things you need to know about that pt
    -DX, treatments & times due
    - hard to give meds, crush meds & put in applesauce, jelly, a drink, ice cream, best time to give meds, wants juice, warm water or ice water with meds
    -BS, VS, Neuros, fall risk, specimens needed
    -DNR or Full Code
    -Allergies
    4. Trust your CNA's - they spend more time with the pts than you do, they know when something isn't quite right, let them know what you expect from them and what you will to do for them (help with a boost, answer a call bell, toilet pts) and it never hurts to thank them for the great job they did today (they are overworked & underpaid, appreciation goes a long way). Ask them to write down pt requests on a slip of paper & place it on your cart, you can then prioritize requests.
    5. When in doubt, call the DR, explain what the problem is (I have called them and told them VS are perfect, but, something isn't right, they usually believed me and ordered tests or asked me to continue watching. Though I have to say if you call the on-call at 2AM they will not be real happy with you, so keep watching and let the next shift know your concerns, as long as it's not life threatening).
    Remember the ABC's of Nursing, a Nurse once told me the following mantra (at least I use it as one): Air goes in & out, Blood stays in and goes round & round, any deviation from this is bad! Follow this simple pattern for your shift: Safety First, Meds second, Treatments third, everything else is last. When you leave work do not take it home with you, do not worry about whether you did something right or wrong, unless you put the pt in danger you'll be fine, again if in doubt about something ask someone. Take a moment to breath, clear your mind, and rely on the Family of Nurses to help you, each shift has their own jobs to do, but, in the end we are all working towards the same goal: healthy patients!
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  2. 16 Comments

  3. by   Forever Sunshine
    Also when you call the doctor. Have everything together. or your "ducks in a row" Fresh set of vitals, reason why you are calling, assessment info, chart, MARS/TARS, most recent labs if its pertaining that.

    I usually take a minute to "rehearse" not outloud, but to myself, what I'm going to tell the doctor. (I mess up during phone calls with everybody and I freeze up when I get an answering machine lol) and put all the things I want to tell the doctor in the SBAR format.

    You will want to cry before, during or after some shifts, you will stay late, you might not get to go eat dinner, or even pee.
  4. by   kakamegamama
    ....AND....you will have the satisfaction some days of knowing that you really did make a difference. In spite of all the craziness of a shift, you helped a patient get better or ease into dying (yes, that will probably happen at some point) and a family member find some peace that their loved one had good care in spite of all the craziness that the shift held. To the OP---thank YOU for taking the time to encourage and paint a good, realistic picture of "a day in the life of a nurse".
  5. by   herowneulogy
    Thank you! I hope more people chime in!


    Any specific advice for new grads interested in ER/ICU specialty?
  6. by   Forever Sunshine
    Quote from herowneulogy
    Thank you! I hope more people chime in!


    Any specific advice for new grads interested in ER/ICU specialty?

    This was posted in LTC forum. Maybe someone posted a similar thread in that forum.

    It is all worth it when the confused resident who has been combative all night and you get her in bed and you tuck her in and she says "thank you michelle.. good night".. (my name isnt michelle thats just what she calls me)
  7. by   badphish
    The ER is a Bar and The ICU is a library, even turkeys die. GOMERS go to ground, (ERcentric). The floor Nurse and ER nurse have totally different thoughts on priorities and what is or isn't stable. The more annoying the family member, the longer they stay, sick patients complain less, the amount of complaining by patients about wait times is a complicated formula dealing with length of wait, severity of illness, number of total patients waiting, relative ranking in queue of said patient and number of family members with patient. In short. The ones that should complain least about wait complain the mist and have largest group of supporters, most most most importantly don't forget the pillow
    Peace out,
    ( this has been a feeble attempt at humor, all characters portrayed are fictitious and no orcas were harmed during this posting)
  8. by   SeeTheMoon
    Reading posts like this reminds me of why I am enduring the stress!! of school to become a nurse. Thank you for sharing, and letting us "up and comers" know what it's like in the real world of nursing!
  9. by   JenniferSews
    Quote from dajulieness
    Also when you call the doctor. Have everything together. or your "ducks in a row" Fresh set of vitals, reason why you are calling, assessment info, chart, MARS/TARS, most recent labs if its pertaining that.

    I usually take a minute to "rehearse" not outloud, but to myself, what I'm going to tell the doctor. (I mess up during phone calls with everybody and I freeze up when I get an answering machine lol) and put all the things I want to tell the doctor in the SBAR format.
    I agree! I have had the experience where the doc asked to have ME put on the phone when I wasn't caring for the patient and the nurse calling had a lot more experience. Having the basics in front of me when I called had earned me the trust of the physicians and they listened to me instead of blowing us off.

    On the flip side think through your assessment and look through the chart. Then don't take it personally if the doc blows up at you over the phone. You did the right thing by calling them and presented the situation as best you can. Some are great teachers, and some just aren't. Keep the patient and their best interests at heart.

    As for trusting your CNA's, I agree 110%! If they come to you with a concern, assess the patient even if you don't see a need. That CNA will learn that you trust them and will come to you next time with some valuable information. And be kind, say thank you and give them credit for seeing those small changes. Everyone likes to know when they did a good job!
  10. by   WillowNMe
    Quote from dajulieness
    It is all worth it when the confused resident who has been combative all night and you get her in bed and you tuck her in and she says "thank you michelle.. good night".. (my name isnt michelle thats just what she calls me)
    I just put my two weeks in at a place that I have been at for a year and a half (since it opened)... one of the original residents in our MC, who has progressed quite a bit, was actually quite disturbed when he found out I was leaving. He doesn't necessarily remember me - my name, etc. - but he normally always has some sort of recognition. He asked why I was leaving ("To spread my care to others".. sort of an inside joke!) and he replied, "Well, if you don't like it over there, you just kill 'em, come back over here and we'll accept you!" I said, "Well... I may not kill them, but I will certainly come back and visit you!!" He seemed to be content with that

    It always never ceases to amaze me, either, the residents that might not know your correct name, but they have given you your own random name and remember to call you by it. Such as I have one resident who swears up and down that I am Emily -- we have no "Emilys" that work her, nor does she call anyone else Emily. I have a friend who stopped working here a few weeks ago, but still comes back to visit some residents every once in a while - one who has declined rather significantly still remembered our inside joke about calling my friend "Wilma".. Amazing how the mind works!!!
  11. by   gentlegiver
    Can some one please post the SBAR for this Thread, some may not know what it is. I had it once and can't remember how to word it. Thank You
  12. by   Forever Sunshine
    Quote from WillowNMe
    I just put my two weeks in at a place that I have been at for a year and a half (since it opened)... one of the original residents in our MC, who has progressed quite a bit, was actually quite disturbed when he found out I was leaving. He doesn't necessarily remember me - my name, etc. - but he normally always has some sort of recognition. He asked why I was leaving ("To spread my care to others".. sort of an inside joke!) and he replied, "Well, if you don't like it over there, you just kill 'em, come back over here and we'll accept you!" I said, "Well... I may not kill them, but I will certainly come back and visit you!!" He seemed to be content with that

    It always never ceases to amaze me, either, the residents that might not know your correct name, but they have given you your own random name and remember to call you by it. Such as I have one resident who swears up and down that I am Emily -- we have no "Emilys" that work her, nor does she call anyone else Emily. I have a friend who stopped working here a few weeks ago, but still comes back to visit some residents every once in a while - one who has declined rather significantly still remembered our inside joke about calling my friend "Wilma".. Amazing how the mind works!!!
    She thinks I'm her niece. I go along with it too, I call her "Aunt Mary"
  13. by   gentlegiver
    [FONT=Arial,Bold][FONT=Arial,Bold]
    I located the SBAR Worksheet, it showes you what information you need when contacting the Dr.

    SBAR report to physician about a critical situation
    [FONT=Georgia-Bold][FONT=Georgia-Bold]
    S
    [FONT=Arial,Bold][FONT=Arial,Bold]
    Situation
    I am calling about
    <patient name and location>.

    [FONT=Arial,Bold][FONT=Arial,Bold]
    The patient's code status is
    <code status>

    [FONT=Arial,Bold][FONT=Arial,Bold]
    The problem I am calling about is
    ____________________________.
    I am afraid the patient is going to arrest.

    [FONT=Arial,Bold][FONT=Arial,Bold]
    I have just assessed the patient personally:
    Vital signs are
    : Blood pressure _____/_____, Pulse ______, Respiration_____ and temperature ______

    [FONT=Arial,Bold][FONT=Arial,Bold]
    I am concerned about the:
    Blood pressure because it is over 200 or less than 100 or 30 mmHg below usual
    Pulse because it is over 140 or less than 50
    Respiration because it is less than 5 or over 40.
    Temperature because it is less than 96 or over 104.
    [FONT=Georgia-Bold][FONT=Georgia-Bold]
    B
    [FONT=Arial,Bold][FONT=Arial,Bold]
    Background
    The patient's mental status is:
    Alert and oriented to person place and time.
    Confused and cooperative or non-cooperative
    Agitated or combative
    Lethargic but conversant and able to swallow
    Stuporous and not talking clearly and possibly not able to swallow
    Comatose. Eyes closed. Not responding to stimulation.
    [FONT=Arial,Bold][FONT=Arial,Bold]
    The skin is:
    Warm and dry
    Pale
    Mottled
    Diaphoretic
    Extremities are cold
    Extremities are warm
    [FONT=Arial,Bold][FONT=Arial,Bold]
    The patient is not or is on oxygen.
    The patient has been on ________ (l/min) or (%) oxygen for ______ minutes (hours)
    The oximeter is reading _______%
    The oximeter does not detect a good pulse and is giving erratic readings.
    [FONT=Georgia-Bold][FONT=Georgia-Bold]
    A
    [FONT=Arial,Bold][FONT=Arial,Bold]
    Assessment
    This is what I think the problem is:
    <say what you think is the problem>

    [FONT=Arial,Bold][FONT=Arial,Bold]
    The problem seems to be cardiac infection neurologic respiratory _____
    I am not sure what the problem is but the patient is deteriorating.
    The patient seems to be unstable and may get worse, we need to do something.
    [FONT=Georgia-Bold][FONT=Georgia-Bold]
    R
    [FONT=Arial,Bold][FONT=Arial,Bold]
    Recommendation
    I suggest or request that you
    <say what you would like to see done>.
    transfer the patient to critical care
    come to see the patient at this time.
    Talk to the patient or family about code status.
    Ask the on-call family practice resident to see the patient now.
    Ask for a consultant to see the patient now.

    [FONT=Arial,Bold][FONT=Arial,Bold]
    Are any tests needed:
    Do you need any tests like CXR, ABG, EKG, CBC, or BMP?
    Others?
    [FONT=Arial,Bold][FONT=Arial,Bold]
    If a change in treatment is ordered then ask:
    How often do you want vital signs?
    How long to you expect this problem will last?
    If the patient does not get better when would you want us to call again?
  14. by   Forever Sunshine
    This I found on wikipedia. I feel it gives a more.. general...example of SBAR that can be used in any situation. The one above I wouldn't use. I doubt any of our MDs would be coming in to see the resident at 10:30pm. lol

    Situation-

    Identify yourself, employee of Interim Healthcare and the Site you are calling from
    Identify the patient by name, DOB, Age, Sex reason for report
    Describe reason for phone call

    Background-
    Give the patient's Presenting Complaint
    Give the patient's relevant Past Medical History
    Brief summary of background

    (if the MD is familiar with the resident.. I just say the complaint)

    Assessment-

    Vital Signs - HR, RR, O2sats, BP, Temp,
    List if any VS are outside of parameters
    Severity of Patient, additional concern
    (don't forget abdomen(is it distended, tender etc), and bowel sounds if calling for a GI issue such as painful abdominal cramps for example)

    Recommendations-
    Explanation of what you require, how urgent and when action needs to be taken
    Make suggestions of what action is to be taken
    Clarify what action you expect to be taken

    (Theres some MDs who ask for your input, and theres some who don't, so take this one carefully.. but always when taking a telephone order .. don't forget to read it back.. and when you write your note.. "read back and confirmed"

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