Advice for the new nurse entering Med-Surg - page 13
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
0Jan 31, '09 by outside_child, ADNto lucky#13; thanks for this time management for the beginning of the shift..."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." i start off with the focused assess. too but still do head to toe also. i have been in ltc for 20 years and avoided hospital jobs, but lived to regret it. now i will start work in hosp. on surgical floor and will stick it out. i tried 2 other times and was traumatized because not all nurses are helpful, and the hospital orientation program was not very good. i have learned a lot each time but felt intimidated. i took acls class for continuing education and was proud i passed even though can't use in ltc, but i was proud that i passed it. if i can learn that, i feel i can learn anything now and my new manager is impressed (because i have basically no recent hosp. experience). i had slow responses to being hired for hospital work, but this one i believe/hope will be a good fit because all the staff i met that day was very receptive and majority worked there for 10-20 years on the same unit. that speaks volumes to me.
Last edit by outside_child on Jan 31, '09 : Reason: needed to add something
1Feb 4, '09 by LongieSo many great posts on here--also don't forget all the members of your interdisciplinary team--respiratory/cardiopulmonary, PT/OT/ST, dietary, unit secretary, even housekeeping! All of these people are folks who can help your days/nights go smoother and most of them have something that you can learn from them--yes, even housekeeping, I've had one who stopped while going down the hall and kept one of my patients from climbing over the side of the bed I've transferred to another area recently and a lot of these same people rotate through there and believe me, it has made an impression (favorable) on my new coworkers (and my supervisor as far as I can tell) who don't know me from Adam that they all smile, laugh and communicate well with me and I've caught one or two telling a few coworkers that I am a "great addition" to their area. Don't ever take an attitude that you are superior--'cause you're not!!!! We're all in this together and it takes all of us to make it work in this crazy place:spin:
0Feb 8, '09 by YendisHey Guys!!!
This is such a great thread!!! I'm also a new grad and just accepted a position on a Progressive Care Unit with a patient ration of 1:5, starting March 2009!!! Any advice regarding this type of unit would be so helpful!!!
0Feb 9, '09 by jpRN84always do the best job you can. If you don't know something, ask for help. always try to stay on top of current medical topics, even though I work primarily in psych, I always try to stay up on medical topics as well. Also, if you aren't sure of something never be afraid to call on the MD/PA/CRNP...that's what they are there for. I wish you all the best of luck. :-)
1Feb 9, '09 by jan ChristianMed Surg is a great experience for me,first it will freak you out because it seems a new life for you, you will say how am I going to do this and that?time management will be your first problem next your patients and next how you will cope up with all of the work and relationship with staff and folks,then the next time your on the unit,you're already embracing it. as time goes by you will learn from your work a lot of knowledge,skills and attitude.So embrace nursing as we embrace our patient with love and service.
0Feb 23, '09 by frankyfern22, APRN, NPWell, I didn't quite know where to put this but I'll put it here for now.
I am going to graduate in May and have no speciality or true desire to work in ICU, ER, Neuro, etc., and so far, desire to work in Med Surg. I feel this is a good place to start as a new nurse, get exposed to everything and get the skills down! Does this sound like a good plan as a new nurse rather than starting in another specialty?
Great posts by the way! Very encouraging )
THANKS FOR THE HELP! Im so lost hahaha.
0WOw... this is very good advice. I am a month into nursing on the Med-Surg floor and I'm greatful I had the chance to read all the advice given by all you nurses. I hope and pray I am a great and competent nurse.
0that is exactly how I feel. I am a new grad on the med-surg floor. and i feel like I'm not getting certain things. especially time management. is there any other advice you can give? thank you so much.
0Hello, I am also a new grad, working nights. and I feel the same way. However, they started me on days for the first 2 months then I will transition to nights. I heard it is good for a new grad to work nights. have you started working nights yet? if so, can you give me advice? how do you like it so far on the med-surg floor?
0Apr 27, '09 by orangepink, NPHi! I'm also a new grad RN in a med surg floor. Unlike my other classmates, I specifically chose med surg because although there's a lot of workload at least it's not so critical. Plus, all the experienced RNs I've talked to recommended that I start there.
Anyway, it's been a month since I started working and yes, I do feel overwhelmed most of the times but I don't let it get to me. My concerns are #1, there's just not enough time to do everything. maybe it's just me being a new grad and that i have to learn more organizational and prioritization skills but time just flies by so fast! at the end of the day, i reevaluate what went wrong and what could i have done better but somehow, i just don't get it. so if any of you experienced RNs have tips, i'd greatly appreciate.
my 2nd concern is what else can i do to improve myself as a new grad RN? right now, i'm reviewing a list of common IV push medications and i'm reviewing what to do for all kinds of procedures like which ones need the consent form or the procedure forms, etc
i would greatly appreciate any tips or personal stories that way i can find ways to better myself as a RN.
0May 14, '09 by HoosierMaleHello, I am also a new RN on a med surg floor. I went through 4 weeks of classroom orientation and then was sent to the floor. I was told that The first week was to acclimate and turned out to be one day as I had to watch some training tapes. The second week I was given one patient on day 1, 2 patients on day 2 of the second week and 3 patients on the last day (all with a preceptor to help. Now I have three patients with the preceptor after the thrid week and am supposed to start with 4 this next week and am told that should be it for the preceptor. I am barely able to take care of three and that is with lots of help and now the pressure is on to take 4 next week and the preceptor is supposed to only act as my assistant. I am told they can extend my training to 5 weeks on the floor but they would prefer to not. Is 4 or 5 weeks of preceptorship the norm as I feel as I am really being pressured to accept the 4 weeks and sign off that I understand everything and do not need a preceptor any longer? They tell me I can always ask someone else for help even if I am off of training but I see how busy all the other nurses are and so i was just wondering if this is the norm for preceptorship. Thanks!
0May 14, '09 by classicdameNever be afraid to ask for help.
Never assume you learned it the ONLY right way in school. Some things have more than one way.
Never assume your education stopped on graduation day.
Always value your unlicensed co-worker, unless you want to mop floors, do laundry and cook for your patients as well as all the other duties you perform. Learn their names and be cordial to everyone. You might be surprised how they can help you make your job easier!
6May 20, '09 by IheartadviceThis is long... but its so nice to be here with other nurses of all experience levels getting value from this site like me...
I've been on the tele step down med/surg floor as an RN for almost a year now... about to hit my anniversary and I still have those nights, rest/take care of yourself. I work weekend nights with increased differential, which was offered to me because I had worked part time/prn on the floor as a PCA/Student Extern my second year in school. I remember I felt so confident on orientation and was doing well because my preceptor was there if I needed her... I really felt like I was thrown to the wolves when my first night off orientation was my second night after orienting on day shift. Oh and 5 patients, all unstable and all getting really scary drugs. I've come so far now... I've always had notes from patients and caring stuff... but the best thing I did to build my confidence were the classes offered through each hospital's education department. We have core module classes of each system... It was the best experience for me, for example the renal class, the dialysis manager for our hospital also came and talked to us. I learned we had been doing stuff we didn't need to for prep, I learned what meds to give prior... and which one not to, which the sheet is in my locker and accessed daily by someone. Its a good refresher and its a lot more practical to the patient care. It also helps you explain chronic illness/PURPOSE of procedures to patients who are scared and start to trust you know what you're doing, then your work is easy... I love when I've had the time my first shift to build trust and talk to them about what all was going on... Telling them what the night will be like, "ill be in every hour to check in on you, every other hour while asleep, and addressing pain/getting up the bathroom/wound care/iv sticks... they are so much easier when the patient is working towards helping you.
My best and most satisfying nights are when I'm done early because I didn't take that extra 20 min to ***** about our manager or that demanding patient, I can be proud of that, then help the nurse who's behind or my tech taking vitals, always go in with the tech and offer yourself, give them a brief report of what they need to know right after you get report, and be respectful... I bring my PCAs my notes from school, since a couple are starting... I ask them to help me with a foley or what not so they can see it... or if a patient is turning bad, you're catching it bc youre not falling asleep over the chart or caught up in some story... Your doing what you're there to do. Patients can turn quick, always have a routine with getting report... instead of asking the off coming nurse, I'm done earlier and know what I should get as data anyways... labs, tests, etc. I never not look at labs/vitals for a diabetic, cardiac/chf patient, copd pat or dialysis patient... scan the chart, labs, orders, heart rhythm/changes and plan of care... I've seen so many nurses not do this, and it really makes a difference to have a clear understanding of what we're doing for them tonight before you go in... and definitely do focused on assessments, which will come with experience... even just a little and you're asking the right questions. Then at 4a when the patient's sugar is 500 OR they are sob with chest pain you'll be organized... everyone appreciates it! We've had several preventable codes the team talked to us about on our floor. Chart right when stuff happens and get your charting done early... I try to get it all done before midnight then I can defluff and focus on details/learning about the patho/dx... Patients first, that's why I'm here, but second for me is lifetime learning. I am certified in tele which was a requirement and I think if you can, at about six months get into an Advanced Cardiac Life Support Certification class. Its an intense two days, but that class made me stop hyperventilating about if I was going to correctly do chest compressions! I wasn't required to get my ACLS, but I think we should be, it will make you able to see the signs of "impending doom"... the other nurses laughed at me when I got all worked up about a patient's swollen leg that was not there last night.... or yelled at by a doctor when I call with info on a patient's status changing, then call again when they keep deteriorating... I'm annoying and persistent, but very polite and thorough... I always say I've been working with them for multiple nights if I have, and tell them, yeah, now their lungs are full of fluid... oh.. had a bout of v-tach... hm. why. And I'll ask the person I know who is the strongest on our floor w/ tele or surgical or experience or skin care... each have their strengths... watch a good nurse start an IV asking them how they were so good.. then answer a patient's bell and get their patient something instead of telling them that so-in-so's pump is beeping, now you got a good RN to go to for an IV for future... I have my patho/sx rn who wants to be an MD that I'm good at helping him catch up bc he's slower with care... i barter a lot haha, but it works. I agree with quick head to toe but also add a room check mentioned earlier... ok, alert/oriented, heart/lungs/belly, pulses/swelling. o2 on/cough, eat today/hungry/thirsty/last bm, foley draining, pain, IV fluids/need anything? I still miss some stuff but these are easy checks to do while you're doing first walking in... Do that as soon as someone is admitted and you'll be proactive not reactive. Don't bother your coworkers with labs and simple med questions/orders... the pharmacists don't mind at all when i ask them...I used to just ask the closest person I knew for whatever I needed in our computer system/supply/assessment abnorm/order/etc... bad mistake to make at first and looking back I'm sure I was so irritating my first few weeks off orientation I never feel like a pest when I actually think through the best person to ask this question to. I know my resources and I'm always polite/professional/thankful/helpful with them. Some coworkers I ask nothing of... they are the ones complaining, etc... negative attitudes will spread quickly... I've utilized the RRT nurses more for status changes instead of calling mds at 0300 with half of my ducks in a row. RRT loves that I'm utilizing them... they like to teach and feel valued. I tell them they made my night... and you know what, they're offering to come back in an hour and see how we're doing... And that same RRT nurse has also taught me some of my most invaluable info during a patient transfer... and I save them a lot of work. That gut feeling surprised me the first time I felt it... you see one little thing, then next thing you've got is a clot and stroke that you caught.. being able to tell them that data you collected early on, or atleast knowing their name and last vitals and dx... its better than the average nurse I think. They a lot of times get left alone with no background. Team work and planning... it will come, and I've learned every bit of this stuff by trial and error. I've had a few horrible nights recently, but I talked to my best friend on the floor after leaving... and you'd be surprised at how quickly you'll start to think, hey I did that, and I'm a good nurse.
I love writing, and obviously rambling on and on... about how passionate I am about patient care and being their advocate. I'm really proud that I had three emergency ICU transfers in two months... preventable codes. Med surg floor is full of them... Be careful and always ask for help. I'm hoping that I'll just get it all soon, haha, but I feel so stupid some days when I am mispronouncing a disease or drug... but always laugh at yourself! Something that really helps with my most stressful nights when we're all busting tail to get that patient's BP up that hadn't been checked on by their nurse!!! We can all sigh together sometimes with just one person smiling or goofy face, everyone's spirits are lifted that I would ask for help.
I just wish everyone felt this way... and I really appreciate this thread too... I've read over these blogs, especially of seasoned advice since nursing school... it doesn't really click until 6 months, then read it again, and this has been so helpful, so thanks a ton!! I think we all have to freak out and worry we're going to kill someone... otherwise we wouldn't be conscientious nurses. Expect at a year you'll still have to double check that simple procedure and you'll still miss an IV every now and then..