Advice For The New Nurse Entering Med-Surg

RNinRubySlippers, BSN, RN · May 17, 2005

Hey everyone. I am on summer break between my 3rd and 4th year and have been given the opportunity to work as a Undergraduate Nurse in my local Hospital. I will be working on a acute medical unit/palliative ward and couldnt be more excited (and nervous). Can you give me some tips on how to be efficent and assertive when calling docs re: orders for meds ect. Just a bit of a dialogue would be great! I think that is what I am most nervous about, that and any skills that will come up I have not had the opportunity to do more than once (foley insertions on oth male and female pts!).

Thanks all for your time and guidance, it is MUCH appreciated!

nursing04 · May 18, 2005

Hey everyone. I am on summer break between my 3rd and 4th year and have been given the opportunity to work as a Undergraduate Nurse in my local Hospital. I will be working on a acute medical unit/palliative ward and couldnt be more excited (and nervous). Can you give me some tips on how to be efficent and assertive when calling docs re: orders for meds ect. Just a bit of a dialogue would be great! I think that is what I am most nervous about, that and any skills that will come up I have not had the opportunity to do more than once (foley insertions on oth male and female pts!).
Thanks all for your time and guidance, it is MUCH appreciated!

Calling docs as a new nurse was also one of those things I was fearful of. But, then I realized right away that they are interns and they are learning too. I found it amazing when they ask me which medicine to prescribe. It's very intimidating but also great that they respect our opinion. But, when calling the doc make sure you are calling the right person in the chain of command, also have pertinent info available. For example if you are calling b/c the pt has a fever, also have a full set of vital signs ready. If a pt is c/o nausea, ask the pt if anything imparticular worked before, then request this med- otherwise the MD may prescribe a med that the pt may not want. Also trust your instincts, if something doesn't feel right then go to a colleague or tell the doctor. Ex. on orientation, the MD ordered an antipsychotic med with pretty severe side effects and withdrawal symptoms if they stop it suddenly, the pt had not had a psych consult nor were they aware of this med- so I talked to my charge nurse about it then called the MD to ask why they were putting her on it- and he said that the renal MD had requested it and he wasn't sure why- well, that was sufficient so I told the MD that I wasn't going to give it and if he wants her to take it he needed to explain it to the pt and give it. Remember that your the pts advocate- they trust you. And, if you don't know why something is being done then you need to f/o why for your pts safety. Also, your ultimately responcible.

As far as tasks- foley insertions- take another nurse with you. I am not good at female foley insertions- grab another nurse so they can hold the labia open while you insert- it's so much easier.

Anymore questions let me know. Good luck!

RNinRubySlippers, BSN, RN · May 18, 2005

Thanks so much for your responce NUrsing04! Much appreciated! I will let you know how things go my first week!

Bexx

duncanRN · Jun 10, 2005

I agree with you totally! I initially liked nursing, then hated it, now I'm fine with it and definitely feel more competent (I have been a nurse for one year). Great advice!

My experience:
I was thrilled to start working as an RN & initially loved my job, though I felt overwhelmed. Then I recognized all the communication problems within a hospital & started to feel a little depressed. Next I hated my job with a passion, and longed to leave nursing & do something else. By the 6 month mark I started feeling more relaxed & competent, and I began to enjoy it again. Now I'm at the year mark, feel MUCH more competent/capable as an RN, and am ready to move on to another area of nursing (such as ICU or research).
My advice would be to STICK WITH IT for at LEAST a year. You will feel overwhelmed, bored & frustrated at various points, but the amount of learning you do in your first year is tremendous. I'm convinced that at least a year of med-surg is invaluable experience for any nurse, no matter what area you eventually decided to go into. You will not know if you like med-surg, or even nursing, until a year has passed.
I agree with everything the previous poster already said. Very well-spoken. I'd agree that you should do all the blood draws & IV sticks you possibly can, ask questions if you don't understand something, write down anything new learned (so that you don't repeatedly ask the same questions over and over), keep a list of important phone numbers/lab values/facts that you will need to know (ie. stay organized), and offer to help out your co-workers whenever you have a free moment (be helpful and flexible). And above all, maintain your sense of humor! A good laugh will get you through some really tough moments...
Oh -- would especially emphasize: 1) to stay calm/collected no matter what happens. You can't think rationally if you're in a panic, and the patients/families & your co-workers rely on you for your strength. Pretend to be confident when you're doing your first blood draws, IVs and catheters, too. 2) set limits with demanding patients. You have to prioritize every moment. If you can't adjust the bedding or get jello for a pt at that moment, it's OK to say "I have several patients and need to prioritize my work right now. I have an urgent matter down the hall. Once I'm through with that however, I'll come back & do X". Also, if a patient is particularly needy, emphasize that part of their recovery is to be able to do things for themselves. Tell them you would like to help them in becoming more independent. Finally, if someone is on their call-bell constantly, contract with them -- go through the priority speech again, but agree to return to their room in an hour (& then be there @ the time you set). You are not a slave or a waitress. Remember that!

NurseMay · Jun 17, 2005

I just graduated with a BSN and got a job at a Neurology dept. I just wanted a Med-Surg position, not knowing what specialty or dept was best to work at. I finally had been deciding between Neuro (nights and rotating shifts) and a Surgery floor position (day shift). After having my heart set on the Surgery floor (the nurse mgr had unofficially offered the position but HR had to "officially" offer it to me), I didn't end up getting it and took the Neuro position. I'm now a little nervous about my decision. Any thoughts/advice on the Neuro dept? How about nights and rotating shifts? I had worked 7 weeks during school on nights and hated it, but isn't that probably the best shift to start as a new grad nurse? I think I'll rotate into day shifts every few months too and that'll give me more well-rounded experience. Should I have looked around and waited for better opportunities? Thanks for any thoughts!

duncanRN · Jun 17, 2005

If you don't feel right about the position, don't take it. However, don't be discouraged about the job if it is just the night shift situation. You will probably learn alot on this unit. Have a good attitude about working nights, and it will all be okay. Many of my friends prefer to work nights. You may like it, just give it a chance.

I just graduated with a BSN and got a job at a Neurology dept. I just wanted a Med-Surg position, not knowing what specialty or dept was best to work at. I finally had been deciding between Neuro (nights and rotating shifts) and a Surgery floor position (day shift). After having my heart set on the Surgery floor (the nurse mgr had unofficially offered the position but HR had to "officially" offer it to me), I didn't end up getting it and took the Neuro position. I'm now a little nervous about my decision. Any thoughts/advice on the Neuro dept? How about nights and rotating shifts? I had worked 7 weeks during school on nights and hated it, but isn't that probably the best shift to start as a new grad nurse? I think I'll rotate into day shifts every few months too and that'll give me more well-rounded experience. Should I have looked around and waited for better opportunities? Thanks for any thoughts!

christvs, DNP, RN, NP · Jul 20, 2005

This has been my favorite thread to read so far! I am a new RN who just graduated in May & on Monday I will be starting my orientation on a med/surg/tele floor. (I already did the classroom orientation part). I am so excited & nervous to start. Thanks for all the really good advice on this thread! I have one question-how long did it take you all to really feel like you are a nurse? It feels so weird & strange to say I'm an RN! Also, how hard was it for you when you were brand new,to delegate to nursing assistants? I worked as one during nursing school & so I've never ever delegated to anyone before. I'm used to others delegating TO me, so this will be very different for me! I know exactly what I can & cannot delegate, but know I'll feel strange in this new role. Do you know what I mean? I also wonder how long it will take me to get competent in things like interpreting tele strips & inserting IVs. Thinking about that makes me nervous! :uhoh3:

-Christine

Stella-Ohio · Jul 27, 2005

Thanks for your thoughtful response with the list of things I have permission to do (laugh,cry, be upset etc).

I just finished my first week of orientation on a med/surg floor (with renal and telemetry patients also)

I tihnk I experienced just about all of those emotions in my first 48 hours as a nurse.

Tomorrow I get to go to our Same Day Surgery Unit to put in their IV's (lots of experience in a short time frame).

All the experience on the forums is great, I'm glad that the 'older' nurses are still so engaged in their profession that they visit here.

Please don't take offense to my 'older' reference as it has nothing to do with physical age (I myself probably have many of you beat there).

pie123 · Aug 5, 2005

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 it is always available on the top of the forum for our newer nurses to see right from the start. Looking forward to seeing some of the great advice that our experienced nurses can lend to the newer nurses ..... :balloons:

Thank you so much for doing this! I am a new nurse (4th of 5 days of general orientation). I start on the Medical Surgical unit on Monday. I was just about to post a question about advice for new nurses on Med. Surg. Thanks again! Now I shall begin reading :)

mandrews · Aug 5, 2005

1. Only you can choose to find new opportunitys to grow.

2. When the med nurse ask you to witness Insulin don't take her word for it, LOOK at the sliding scale, bs amount, and the medication. We've had 5 errors this month. LANTUS CAN NOT BE GIVEN IV.

3. The cna can be your bestfriend or worst enemy.

4. On night shift check on your patients. Don't let your patient be found in rigor mortis.

5. The unit secretary is not your boss. She may just think she is. ( sorry you just have to meet mine)

6. Don't get pulled into office gossip. I'm a people watcher. If you watch long enough you will learn who you can confide in and who will put you on the spot.

lorilou · Aug 17, 2005

I will be starting in Sept on a med-surg unit. I am wondering what "supplies" I should have as a new nurse - RN. Is it worth it for me to get the Breathsounds made easy and Cardio made easy books. I am awful at listening and being able to document "breathsounds deminished bilaterally", etc. Honestly, that is what scares me the most. I don't really know the difference when I listen to lungs.

Also, as a new nurse, what should I keep with me while on the floor. I usually carried a clipboard during clinicals - but, should I buy a PDA? I don't really know what the PDA will be good for except helping with the drugs. Anything else?? I am really looking forward to this new experience and am determined to go into this with a positive attitude. Afterall, I spent the last 3 years working for it!! This is a great thread!!

Ruby Vee, BSN · Aug 18, 2005

i will be starting in sept on a med-surg unit. i am wondering what "supplies" i should have as a new nurse - rn. is it worth it for me to get the breathsounds made easy and cardio made easy books. i am awful at listening and being able to document "breathsounds deminished bilaterally", etc. honestly, that is what scares me the most. i don't really know the difference when i listen to lungs.
also, as a new nurse, what should i keep with me while on the floor. i usually carried a clipboard during clinicals - but, should i buy a pda? i don't really know what the pda will be good for except helping with the drugs. anything else?? i am really looking forward to this new experience and am determined to go into this with a positive attitude. afterall, i spent the last 3 years working for it!! this is a great thread!!

the first thing you need is a decent stethescope if you don't already have one. you'd be amazed at how much easier it is to distinguish breath sounds with a good stethesceope. a pda is definitely a worthwhile investment. i keep those all-important phone numbers: blood bank, pharmacy, social work, etc. my schedule, including any inservices that i want to attend. policies and procedures: the procedures at this hospital are somewhat different than my last one, so i can just scan them in to the computer (or download them from the hospital's website) and put them on my pda via documents 2 go. then i can consult them whenever i need to without the hassel of hunting for our unit's procedure book. drugs, of course. there are some drip calculation programs -- check out freewarepalm.com. also, aacn's site has some great palm programs -- you don't have to join to download. their programs tend to be pricey, though.

i also have games (for when i'm sitting in traffic or waiting at the doctor's office), splash id to keep track of all the various log-ons and passwords, email addresses, credit card numbers, etc. i have my pictures on my pda, a program to keep track of the calories i'm eating, keep track of my expenses, and a translator program for my upcoming trip to europe. i'd definitely advise getting a pda -- the longer you have it, the more uses you find for it!

ruby