Advice for the new nurse entering Med-Surg - page 10
Here is your chance to give some advice and counsel to new RN's and LPN's entering their first clinical job as a nurse. What advice would you give them? I am going to make this a sticky so that... Read More
2Jun 11, '07 by Jade005Quote from sunneeRNProbably the MOST Important advice! You are so right. You can't think straight if you need to Pee. I am not a new nurse 18yrs as an LPN and now a Grad Nurse (NCLEX in 16 days). I Began working Med/Tele last march, I feel like a brand new nurse I think my biggest issue is learning to prioritize. I watch the experienced nurses do this automatically and wonder how long it will take me to master this art! I am working 7p-7a and feel like a dunce, time management has improved tremendously and the charting (medTech) is pretty old hat for me. IV's make me nervous because I don't trust my skills at spotting infiltration although starting them is something I do well. I might mention I have done mostly psych and home health, nursing homes briefly, couldn't handle the frustration and staffing issues there. I am what the younger(age) nurses call "old school". I prefer to give meds as scheduled rather than giving 8,9,10's all at 1930. I have had 3 preceptors and they each do things differently told by one to only assess for admit dx, which I think could be dangerous and underlying problems could be missed. Learned this from 1st hand exp. Finally, I had a really bad noc last week: I had a very confused Pt (Aids Encephalopathy) in a room right next to the Nursing Station. My preceptor and an exceptionally LOUD Nurse were laughing and talking Loudly all night long while sitting at the nursing station. (neither of which, moved from their perches to lift a finger to help me when the pt got out of bed, foley still attached to bed on one side and IV engaged with pump on the other side of the bed.) I had been walking past, with meds for a pt down the hall running a heparin drip(and hadn't even sat down for 6 hrs) when I spotted him. I asked for help and they both looked at me like I was crazy and carried on with their obviously entertaining conversation. I managed to get the patient back in bed and taught myself the protocol for the heparin drip. At 0500 the preceptor asked me why I hadn't made more than one entry on my charting for the night? DUH!!! I explained that I was just a little busy and that I had not had time. I called my manager the next morning and told her how the night had gone. Needless to say, I am now treated with pure contempt. After 18 yrs as an LPN I feel I have paid my dues and don't feel that anyone deserves to be treated like this. But ya know I still like this job and I am not going anywhere. I can make a difference here, nursing IS MY CALLING and I am digging in! Whew! Sorry for the rant. Thanks for listening!I've been an RN for almost 2 years now. I was the most insecure nurse you'd ever meet at first (sometimes still am!), so here is my advice.
1. Trust your assessment. If family is in the room, ask them to step out for a moment so that you don't feel the need to hurry. Assess your patient, head to toe. Ask them questions. Tell them the plan for the shift (if you know). ex. "Today, will will help you wash at the sink, physical therapy will see you, and you have a scheduled MRI." That way, when the time comes for that MRI, they aren't asking you why the heck they are going!
2. IF you have downtime, even for 5 minutes, find another nurse to see if he/she has anything interesting going on with their patients, ex. inserting a foley, NG tube, starting a tube feed, etc.
3. When calling an MD, have information readily available. I always grab the bedside chart for most recent vitals, previous nurse's notes, their I/O sheet, and their chart. That way, the doctor isn't on hold while you are running to find info. They appreciate this and it helps you to gather your thoughts.
4. Find a nurse that you can trust with anything. When you are feeling overwhelmed and maybe insecure, talk with that one person. I still go to one particular nurse for ANYTHING and she loves that I trust her and she has helped me a great deal over the past 2 years.
5. Don't be afraid to ask questions. I still ask a ton of questions, and I find that some questions that I ask, even seasoned nurses do not know...so we we look up the info together.
6. When receiving report, have a system that is individual to you and use it every time. For example, I take report with a black pen and I highlight in pink things that need to be done first. Anything that happens on my shift that is new, (new orders, changes in physical assessment, etc) I write in red so that when I give report, I know this is a change and can pass it along.
7. Something that I started doing when I was brand new was having a space on my report sheet called "my assessment." and I find this EXTREMELY helpful. I have my report sheet in chart form, so I have the basic info first. Name, MD, hosptial day since admission, diagnosis, Past medial history, allergies, IV fluids, PCA settings, Diet/Activity, VS, I/O, Accu checks, labwork. Then, I have a box for "report" where I write down info that the previous nurse gives me, and the next box is entitled "My assessment." After leaving a pt's room, I dont always have time to chart, so I jot down my assessment on my repor sheet..i only write things that are abnormal so that when I chart, i know everything else was normal. for example i jot down, crackles at left base, abd inc with steris, pain 8/10 in LLQ and i will write med. with 2 perc at 2130. That makes charting so much easier later. Also remember, that if your facility charts by exception, then CHART BY EXCEPTION! You are taught to write a full note in school, but charting by exception will save loads of time, especially when you still have paper charting. They made it that way for a reason. That doesn't mean that you didn't do a full assessment. If you check off respiratory, that means that you assessed respiratory and it was within normal limits.
8. Finally, prioritizing is key but it TAKES TIME! I remember wanting to complete as many tasks as possible at first. Constantly running in and out of rooms wastes time. Before you start running off your behind, think ahead. Say to yourself "I have to give room 311 meds at 9. When I go in, I will take all the supplies for the 11 pm dressing change." That will save time later.
My biggest advice, though, to a new nurse is this. If you have to go to the bathroom, GO! If you are thirsty and parched, get a drink! Take care of yourself. You don't want to hurry through administering medications because you can't hold your urine for another second...it is dangerous for you and for the patient. Take those 2 minutes for yourself. Even when I am so busy that I can't stop for a second, I take the time to pee....the 2 seconds away from the nursing world is needed to just stop, relax, and relieve yourself!!!!!
1Jun 26, '07 by turtletymeThanks for all the great advise. I am a new nurse and have been working in med surge for a couple of months now. I am having trouble keeping myself organized. I need some suggestions. I start out organized then it goes downhill from there. I feel as slow as a turtle because I Do look things up and therefore I am thinking maybe this slows me down. Every time I work I run my legs off. Then before I know it, it is time to give report and I have not had the time to really look at the patient's history and be as thorough as I would like to be. Something else that is new for me is the computer charting. I did not learn this in school, so this has been kinda rough.I guess I feel new at too many things and it is frustrating me.Where do I start? I am on the nightshift and that is better, but people still get sick in the night as well as you get admissions too. Does anyone else have some suggestions?
0Jul 4, '07 by mdnurse1I agree with the take time to pee thread. As a nurse you learn to not have to run to the bathroom all the time, but oh my goodness don't go all 12 hours without taking a pee break. And if your facility has a phone that you have to carry around so everyone and their mother can get ahold of you, dont answer it during your pee time (even if you just walked into the bathroom). My favorite quote and everyone that I work with knows I will say it: "I refuse to answer the phone during my pee time, you dont want to talk mid-pee so neither do I" I have been a nurse for about a year. (resent new RN, just passed boards on 7/3/07 but was a LPN before that). Organizational skills are the most important thing a nurse can learn. I love working on the med-surg floor that I am on. I think med-surg is a great place to start even if you don't plan on staying there. Med-surg will give you great experience that you will take with you no matter where you go.
27Jul 4, '07 by deeDawntee1) See your sickest patient first or as soon as you can.
2) Have a routine you use when assessing patients and follow it when possible. Many people, go head to toe. I do it a slightly differently. When I go into the room, I just look at them first, see if I can connect with them, sometimes your intuition can tell you a lot, does anything seem wrong. I introduce myself while I'm doing this. Then I ask how they are doing, are they in any pain, as I talk with them, I check peripheral pulses and cap refill and edema. But the initial step is connection. It is our relationship that is important (and our roles). During this process you are also assessing affect, feelings, depression, or anxiety. Make sure they are breathing, that they are pain free (if possible) and that they feel cared about.
3)Then, I go head to toe, check pupils, basic neuros, unless they are a neuro patient, then do a whole set of neuro checks. Heart Sounds, any JVD, how does their mouth look (mucous membranes dry or wet), Lung sounds, are they coughing up anything. Bowel sounds, when was their last BM and voiding status. Check your lines.
Come up with a plan for the shift. Ask them if there is anything they need.
Be Systematic. Establish a routine for yourself. The more routine it becomes the less you have to think about it. Then of course you have the freedom to be spontaneous. Get mundane things done as quick as you can, like charting, you want to give yourself time for emergencies or unexpected events. Don't dawdle over little stuff, push yourself and get it done efficiently.
After doing this for a while, I have found that the connection is what is the sweetest part of the job, it is our relationship that heals. Try to connect with your patients every time you come to work. That way you will be filled up instead of being used up by being a nurse.
1Jul 5, '07 by luvBonjoviThat was a great post! I love the way you do your assessment!
0Jul 6, '07 by DoulaCindyI am starting on Med Surg on Monday as a new Staff Nurse. I took and passed the NCLEX one week ago! Wow, what a weight has been lifted off my shoulders!
Now for the hard part...I am an older nurse...44 to be exact. This is my second career. I chose nursing because I have always wanted to be a nurse....but physically, I wish I had started this 20 years ago. I am older, my feet and legs hurt more after 12 hour clinicals (our transition clinicals), etc. I am a little scared about starting...although I am starting on the unit where I did student nursing over the summer, so at least I have the advantage of knowing most of the staff.
Probably the best piece of advice I have been told is to eliminate the words I KNOW from your vocabulary. Even if you DO know how to do something...just listen, compare to what you know, and then add the info to your information bank :-) I consider my RN a license to learn :-) Just like when you earned your drivers license...most probably, you didn't really know how to drive very well...well, that is how I view my new nursing career.
Just my two cents worth!! And I would love to know more about how the nurses out there organize their patients' info....i.e., labs, vs, meds, treatments. We print out each patient's profile, fold them a certain way, and use the back of each paper to write report notes and vital information that occurs during our shift. Does anybody have a copy of any type of report form or shift form they use that has been really helpful in getting organized?
Cindy in Maryland
4Jul 7, '07 by Daytonitecindy. . .here is the file that contains the report sheet that i used for 5 patients. it was created on a word program so it can be chopped up into any number of patients within about 8, i believe, to fit on an 8-11 1/2 inch piece of paper. i've altered it for students who needed a report sheet for only 3 patients and what it does is give you more room to write notes on between all the fill-in items. hope you find it helpful to use. the actual one i used had extension numbers of hospital departments or doctors numbers that i had to call frequently on the top section so that i didn't have to stop to look them up all the time. i had to remove them for obvious reasons to post this on allnurses. in my early days of nursing i used to print out todo lists on the backs of my report sheets so i wouldn't forget all the things i needed to complete by the end of my shift. i would cross things off as i got them completed and reviewed this just before leaving for the day.
1Aug 30, '07 by Lucky#13My advice for a new nurse is to establish a routine on any Med-Surg unit because that will save her day. We all know that these units are busy ones, and the one I have worked on for 12 years is no exception...and I work 12 hr. days...every Fri, Sat & Sun.
I agree with deeDawntee about making a connection built on trust...that is important. But, my assessment may be slightly different. I don't do a head-to-toe on everyone...I do a focused assessment based on their admission diagnosis and history. So, by 8:30 am, if I'm not done w/assessments..I stop....and start med pass where I left off w/assessments...then I go chart...on the computer, which I like...because I can then check to see if the rest of my labs are up, or testings are transribed.
Just remember this....we all have good days and bad days...and one of the worst things I see happening today with nurses is not relying on each other. Some are so worried about being self-sufficient, that they become too embarassed to ask any questions. Find out who you can go to for help.
This part is for Daytonite...does that mean you are/were from Dayton,Ohio by chance?
0Aug 30, '07 by DaytoniteQuote from Lucky#13Yes. I lived in Centerville right across the street from the Dorothy Lane Market where I could go and get a Killer Brownie anytime I wanted!This part is for Daytonite...does that mean you are/were from Dayton,Ohio by chance?
0Sep 3, '07 by Lucky#13Quote from DaytoniteAHH!Yes. I lived in Centerville right across the street from the Dorothy Lane Market where I could go and get a Killer Brownie anytime I wanted!
I know the area... I live in Springboro now, but grew up in Dayton...and I have an uncle that still works at that DLM bagging groceries...and he's 84! Keeps him young, you know!
And God Bless Killer Brownies! We have a doc that brings a tray of assorted ones in to us occasionally...he's a OB/GYN.
Actually every time he has pts. on our floor..(we have alot of gyn surgeries)..he graces us a huge box of fresh doughnuts!! Says he likes his nurses "fluffy!" But it's actually because he is IDDM... so he wants to make us "happy". He will also bring us Cold Stone cakes..if you know what they are...my goodness...and stuff from Panera Bread....and did I mention how much we love him? LOL!
0Sep 3, '07 by DaytoniteLove Killer Brownies! German Chocolate are my favorite!
For people who don't know, these are triple layer brownies that you gotta eat with a fork because they are so big. My brother has a dozen of them sent to the office of their dispatcher (he's a truck driver) every Christmas.
Yes, I know Cold Stone cakes. What I miss, as well, is driving down to Jungle Jim's down in Fairfield (?) outside of Cincinnati. Oh, what a great place to shop for imported food. Out here in California we have Trader Joe's, but they are just not the same as Jungle Jim's.