Advice For The New Nurse Entering Med-Surg

Iheartadvice · May 20, 2009

This 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..

nurse_becks6 · May 22, 2009

Thank you so much for the wonderful advice. I just graduated a week ago from my ADN program, I did my final transition in a small rural hospital Med Surg and LOVED it. I got an interview this past Monday and was offered the job yesterday...I'm so thrilled but nervous at the same time. Everyone's words of encouragement make me WAY less scared and I hope to shine once I'm there. I did 8 shifts in the past month and learned a lot in those 8 shifts. I never saw myself as a med surg nurse when I started nursing school but I've found that I love the diversity and fast pace. Thanks again for your words, I still have several pages of threads to read but wanted to say kudos to those that posted....even from 2004:nuke:

On another funny note.....since starting nursing school I've found that I can't use my initials BM as I've done in the past...hehe...all my fellow classmates found lots of humor in that:nurse: Becky is my nickname so now I have to use my given name for all nursing related papers....for obvious reasons:lol2:

orangepink, NP · Jun 5, 2009

Hi! I'm at my 3rd and last month of new grad training. My preceptor is worried because according to her standards, I'm still not ready. The thing is ---- I asked a lot of other new grads in our unit and they told me that it took them 6 - 7 months of work before they became totally comfortable and confident in their work. Another nurse told me that he felt that his life was just crazy and hopeless for a year and then, after that, things got better.

As for me, I feel that yes, there are so many things that I still have to learn but I have found my routine and I'm gradually learning time management and prioritization.

For example, my patient was scheduled for ct scan and I forgot to call the technician first before sending the patient down to radiology. Kudos to me though cuz at least I remembered to send along the patient's signed consent form, unlike the last time.

what do you guys think? how long did you become completely comfortable at your job?

i'm just a little stressed out because she kept saying that i'm not ready and maybe, she's right but then, sometimes, I think she's just a perfectionist. Do people expect new grads to be perfect afther 3 months of training?

ilovenana · Jun 6, 2009

I feel the same way I'm going on my 3rd and last month.and I do not feel ready... not even with my routine. My preceptor doesn't really tell me I'm not ready, I'm the one who tells her I'm not ready. I don't think that 3 months of training on a Med-Surg floor for a new grad is enough. I feel stressed everyday. I feel like I try my hardest to do my best...but I still need my preceptor to help me out because I end up getting behinde. I have alot of trouble just carrying out the orders in a timely manner... and when I know I have an admission coming it throws me off. I really hope and pray I can get through this because I just feel like it is alot to learn in so little time.

orangepink, NP · Jun 6, 2009

I feel the same way I'm going on my 3rd and last month.and I do not feel ready... not even with my routine. My preceptor doesn't really tell me I'm not ready, I'm the one who tells her I'm not ready. I don't think that 3 months of training on a Med-Surg floor for a new grad is enough. I feel stressed everyday. I feel like I try my hardest to do my best...but I still need my preceptor to help me out because I end up getting behinde. I have alot of trouble just carrying out the orders in a timely manner... and when I know I have an admission coming it throws me off. I really hope and pray I can get through this because I just feel like it is alot to learn in so little time.

i understand exactly how you feel. in my case, i'm comfortable with my routine. and i do get stressed if a new order / an admission pops up but most of the time, i can catch up with my work by the time my shift ends. my concern is that i only hope that people in my unit are willing to answer my questions. that is all i can ask from my co-workers.

karenrussell_rn · Jun 6, 2009

At 3 months on the floor, it is perfectly normal to feel as if you are not ready to be out on your own. It is virtually impossible to be exposed to everything in your orientation that will equip you for the remainder of your first year of nursing. Unfortunately, most facilities are experiencing critical nursing shortages and pretty much rush new grads onto the floor for ratios; if you are able, ask for an extension in orientation.

HoosierMale · Jun 7, 2009

Well I have been on floor as a new grad for a little over two months and was told among many other barbs that I should be running, not figuratively mind you, but literally. I would not be permitted to ask any questions but in the event that I dared, I should think long and hard about those questions carefully and in advance so as not to make myself seem incompetent and that I was taking beyond what was considered an appropriate orientation time. After all, I had graduated from nursing school and passed the NCLEX intimating i suppose that I was just lucky to have passed them... but an attack on my alma mater was a little hard to swallow but I just sat there determined to only listen. I certainly did not want to be disrespectful but I suspect the manager might have had a bad night or something so I decided to turn the other cheek and I actually sat there and said a silent prayer for her and I both as she continued to tear into me over my "not getting all" it in the 2 months. I received very high marks on all of my med surg clinicals, some of the highest in my class and was inducted into 2 honor societies not to brag but only to to assert that I am not bad at learning or following orders or direction if they are given clearly I will absolutely carry them out. I am beginning to think that maybe it is like being a prospect in a motorcycle club where you are just insulted and condescended just to see if you will crack and how much you will take without becoming what could be deemed as insubordinate. I am, I must admit, quite surprised that our experiences are somewhat similar and would encourage you all to just hang in there. I do not plan to quit or give up as that is not in my nature and probably not in yours as you would have got this far either.

We should just continue to write to each other about our experieces and then one of us should sit down and write an article for AJN or Nursing and from the perspective with the ordeal behind us and to offer our pain as insight for those following us into the field. I find it is easier to pray when I feel persecuted that to respond with any malice or resentment and try to think of everything I am grateful for rather than complain about. It is hard for me to do this, believe me, but it has always worked for me.

Good luck to us all and God bless us all!

orangepink, NP · Jun 8, 2009

I would not be permitted to ask any questions but in the event that I dared, I should think long and hard about those questions carefully and in advance so as not to make myself seem incompetent
...
After all, I had graduated from nursing school and passed the NCLEX intimating i suppose that I was just lucky to have passed them... but an attack on my alma mater was a little hard to swallow but I just sat there determined to only listen. I certainly did not want to be disrespectful but I suspect the manager might have had a bad night or something so I decided to turn the other cheek and I actually sat there and said a silent prayer for her and I both as she continued to tear into me over my "not getting all" it in the 2 months. I received very high marks on all of my med surg clinicals, some of the highest in my class and was inducted into 2 honor societies not to brag but only to to assert that I am not bad at learning or following orders or direction if they are given clearly I will absolutely carry them out. I am beginning to think that maybe it is like being a prospect in a motorcycle club where you are just insulted and condescended just to see if you will crack and how much you will take without becoming what could be deemed as insubordinate. I am, I must admit, quite surprised that our experiences are somewhat similar and would encourage you all to just hang in there. I do not plan to quit or give up as that is not in my nature and probably not in yours as you would have got this far either.

this happened to me too! the older RNs would make snide comments about my clinical training to the point that i feel like i'm really stupid but i know i'm not. i've always been a good, smart, hardworking student. thank you so much for sharing your experience. i thought it was just me.

it really is true when they say that nurses eat their young.

ruralgirl08 · Jun 11, 2009

Just a thought....has nursing always ate their young? Why do you think that is? Is it too many females in one profession? Is it a kind of bullying that has moved through the generation of nurses?

Or is it related to a difference in training...toady vs. a decade ago vs. years ago.

I was told when I was a new grad by an older nurse, that it wasn't my fault I had trouble adjusting at first. They had alot more hospital training in the old nursing programs (diploma and hospital trained,) compared to the new BScN programs. Or is it a not so nice way, to toughen us up?

I really don't know the answer, so I am throwing it out there, why do you think nurses eat their young?

Btw, I took me a good year to get comfortable as a nurse, but I also had to adjust to two new positions in my first year at two different hospitals. This is my third new job in just over a year with all the layoffs (plus I wanted permanent full-time.) I have just transitioned to a new position on a new floor in a new hospital, and it was so much easier then when I first started as a new grad. You gain alot more confidence and strength through the new grad struggles, and that can definately be drawn on when things get tough on the job.

MedSurgeMess · Jul 7, 2009

Not all nurses eat their young. But unfortunately some do. I think low self esteem makes them that way....

Just ask questions, look up any dx, tx, or med that you don't understand. Learn time management from your experienced coworkers. Find a mentor, and listen to what they say. Remember that they aren't perfect either, but will be able to guide you to right resources, and will be a shoulder to cry on when things go wrong. Hang in there, it does get better, even if it seems daunting now. We were all the new kid at one time, so keep that in mind. And go to any inservices that you can, they are learning experiences.

Editorial Team / Admin · Jul 8, 2009

a good site for information:

http://www.bostonscientific.com/procedure/indexofproceduresaction.bsci/,,/navrelid/1000.1002/seo.serve cardiac, kidney, urology, vascular, lung/airway, gyn, digestive disorders, cancer, brain conditions, chronic pain

MissLouda · Jul 30, 2009

I have an interview for a medical floor, which I am very excited about. I have read everyone's advice and they are great!!! I know that if I end up getting the job and working I will definitely freak out... but I know it takes time to feel completely comfortable. I love nursing and can't wait to start my career. :yeah: