Advice for the new nurse entering Med-Surg - page 12

by RNPATL 199,154 Views | 228 Comments

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... Read More


  1. 0
    I am a new nurse going from LTC of one year to Med/Surg. I use to have 30 to 60 patients, and now I will only have 7. Are there any other differences that I should expect?
    Last edit by st4wb3rr33sh0rtc4k3 on Mar 11, '07
  2. 0
    my husband just started in med surg less than 6 months ago. He is already being asked to charge, and he feels unprepared for this. He has received no orientation to charge, and has no desire to do so. Can he refuse this assignment. Advise??? Thanks in advance.
  3. 0
    as a new grad, we are not allowed to be in charge of the ward. we need at least a year of post grad experience before we can be in charge of the ward. surgical nursing is not easy, patients coming bac from theatre require hrly obs and close monitoring for possible complications. most of them have drainage bag and iv fluids and on Iv antibiotics.

    I was in the same position a month ago when the NUM left me with two EN's one afternoon. I could not sleep the whole night. the following day, i approached the NUM calmly and assertively and stated my case. she got the message. my other colleagues were very supportive.
  4. 0
    I'm a new lpn and tuesday will be my first day on a med-surg unit work as a nurse, but I have ten years in the icu as a tech. I'm nervous is their certain things i should have with me when i start just in case noone wants to help? (you know that eat your young disease)
  5. 3
    ok.. i don't know if this has already been posted but i am going to post it anyway.. it is from a book called "training wheels for nurses"...
    i thought this was good advice.. the 4 S's....

    Shoes: Buy the most comfortable shoes you can afford to buy, and remember to replace them often..

    Stethescope: Listening to breath sounds is a skill, and having a good stethescope will help.

    Scrubs: Get a scrub jacket with lots of pockets.

    Scissors: A good pair of bandage scissors will last a lifetime.

    I agree that med-surg is a great place for a new nurse to gain a very broad spectrum of experience and become more proficient at many different skills.. It can also help you realize what sort of nursing might be the most rewarding for you.. I do PRN shifts on an Acute Med-Surg floor and I really enjoy it..
    marqc_rn, creativemom, and eznal like this.
  6. 1
    Quote from nghtfltguy
    ok.. i don't know if this has already been posted but i am going to post it anyway.. it is from a book called "training wheels for nurses"...
    i thought this was good advice.. the 4 S's....

    Shoes: Buy the most comfortable shoes you can afford to buy, and remember to replace them often..

    Stethescope: Listening to breath sounds is a skill, and having a good stethescope will help.

    Scrubs: Get a scrub jacket with lots of pockets.

    Scissors: A good pair of bandage scissors will last a lifetime.

    I agree that med-surg is a great place for a new nurse to gain a very broad spectrum of experience and become more proficient at many different skills.. It can also help you realize what sort of nursing might be the most rewarding for you.. I do PRN shifts on an Acute Med-Surg floor and I really enjoy it..
    Thank u for the advice I didnt even think about the scissors
    eznal likes this.
  7. 0
    great advice
  8. 0
    This is a GREAT thread! Thanks so much!
  9. 2
    Quote from sunneeRN
    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!!!!!
    Probably 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!
    mitral and marqc_rn like this.
  10. 0
    How did it go after 10 years? I am going back after 6 and am terrified


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