Advice for the new nurse entering Med-Surg - page 13

by RNPATL

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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


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    Thanks 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?
    newrngrad likes this.
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    I 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.
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    1) 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.
    Rebekah1882, ahorton75, arobins72, and 22 others like this.
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    That was a great post! I love the way you do your assessment!
    deeDawntee likes this.
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    I 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?

    Thanks!!
    Cindy in Maryland
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    cindy. . .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.
    i worked in a variety of different kinds of med/surg units over the years. my best wishes to you as you start your new career. get yourself some good support hose and if you begin to have any problems at all with your feet do yourself a favor and see a podiatrist. they are not just for the elderly. they can help you. i've been wearing an arch support orthotic in my shoes for years to prevent getting plantar fasciitis.
    sunnybabe, MedSurgRNiowa, cfsleo812, and 1 other like this.
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    My 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?
    cfsleo812 likes this.
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    Quote from Lucky#13
    This part is for Daytonite...does that mean you are/were from Dayton,Ohio by chance?
    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!
  9. 0
    Quote from Daytonite
    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!
    AHH!
    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!
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    Love 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.


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