Advice for the new nurse entering Med-Surg - page 6

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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    Quote from nursing04
    6. Be prepared- if you go the hospital to prep the day before, go in and introduce yourself to the pt, and do a history- it's much easier then trying to read the MD's handwriting, and/or ask the nurse caring for them.
    Wow, such simple advice and I don't know why I didn't think of it! I can't tell you how much time I spent (wasted!) trying to extract information from the patient's chart that I either couldn't read, was incomplete, or had conflicting info from page-to-page. Thanks, I'll have an easier time of it on my advanced med-surg next semester. SG

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    PYXEDUHST5282,Good advice! And oh so true ,of a minority I might add. Give it back at an appropriate time and you will be surprised at the support you will have from others.
    Last edit by Hopalong on Sep 13, '05
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    Quote from RNPATL
    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 .....
    If a nurse is absolutely serious about making nursing a life long career then med/surg is definately the place to start. Several years on med/surg will provide you more experience than you can imagine. Good Luck.
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    First of all--keep calm. Dont let yourself get overwhelmed. Med-surg is just that, med-surg. Alot of information to gather and learn. You will experience patients with a wide variety of problems and scopes of health issues and post ops. Possibly may have some with nausea/vomiting, pneumonia, CHF, COPD, cancer, GI bleeds, fx. legs, hips, gallbladder, appendix, tonsils, wrists, ankles, etc., some with weakness, dizzyness, syncope, high blood pressure, low blood pressure, and, yes, even electrolyte imbalances, some on telemetry, and a host of others. Just remember that there is no way you can learn everything there is to know overnight. It will take many months and then you will still realize everyday is a learning day. Keep up with nursing journals and read-read-read-read-study-study-study. But if your like me you love challenges and that is what med-surg is all about. Been doing this for 20 years and I still love it. I would get bored really quickly if I just had to learn one thing and just do that everytime I worked. Hopefully you will find a seasoned nurse that will befriend you and respect the fact that your starting out and she will remember how it felt for her. The rewards from your patients will be all the rewards you will need. I highly recommend taking ACLS, PALS, BLS and a telemetry class. Two words--fastpaced and multitasking. Dont take to heart words said in the heat of a moment. Watch and take notes--OBSERVE AND LEARN!!! There is no "stupid question"!!!!!! LOTS OF LUCK AND GLAD TO HAVE YOU
    arobins72, mitral, mhickenbottom1, and 4 others like this.
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    Great advice and thanks alot because I am a new grad start tomorrow on a Telemetry Unit and I am scared, excited and nervous at the same time but I think with your tips I will be a bit more relaxed

    Quote from mjlrn97
    Oh, I can think of a million things that I wish I'd known when I was a brand-new

    1) Whatever you do, don't, I repeat, DON'T freak out! Panic never solves anything, and indeed may make it worse. Even if your confused elderly patient just yanked out his triple lumen and is wandering around the floor bleeding.......or if you realize you've just discharged a patient without a doctor's order........or if your 30-something patient codes during an iron-dextran least pretend to keep your cool. You can fall apart when the crisis is over.

    2) All bleeding/vomiting/diarrhea/coughing stops....eventually.

    3) Learn to prioritize. No matter how insistent a patient is about having her pillow fluffed RIGHT NOW, your post-op's pain meds are much more important. Also, watch the experienced nurses and to see how they prioritize tasks of equal importance.......that happens more often than not.

    4) The best way to encourage some patients to get up and pee is to wave a catheter under their nose and tell them: "If you don't 'go' within the next hour, I'm going to have to put this in".

    5) Documentation: No matter how ingenious your interventions, if you didn't chart didn't do it. Give yourself credit for your hard work!

    6) It's OK to cry.

    7) It's OK to laugh.......A lot of what we deal with every day is just plain funny!

    8) It's even OK to get mad.....people do some incredibly stupid/dangerous/foolish things, and you'd hardly be human if it didn't **** you off sometimes. (You cannot, however, tell the patient they are stupid/dangerous/foolish.)

    9) You will have good days and bad days.......unfortunately, the bad days are the ones that always seem to come in groups.

    10) IV starts: The more you do, the quicker you'll get good at it.

    11) Be flexible. This prevents you from getting bent out of shape.

    12) Above all: Med/surg nursing is the toughest job you'll ever love, and if you don't love it, leave it! There are already too many nurses in this field who are doing it only because they need the money, or because they're just marking time until they can retire, or because it's all they know and they're too tired and burned-out to learn another area of nursing. Our patients deserve the best care possible; only those who truly enjoy med/surg nursing are able to give it.

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    Thanks for the advice on setting limits because that happens to be one of my weaknesses, I do not know how to say no and I end up wearing myself out. also, helping your coworkers when you have a down time is a good idea because you can then learn new things.

    Quote from lady_jezebel
    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!
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    Thanks for the wonderful advice!! I am doing my clinicals in Med/Surg and it is most difficult. I feel overwhelmed quite often. It gives me encouragement to know that I am not alone!! Thanks again.
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    This is very helpful. I only worked 4 weekends in PICU and ran as fast and far as I could (this was 11 years ago), because I had no orientation at all, nurses who did not want to help a new nurse and a nurse manager who was only there a few hours a week due to an illness, but who was not understanding at all about my sick child. I am now starting over in med/surg and all of the advise here has made me think that maybe I can do this after all. I also will get 3 months of orientation this time, yea!!!
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    Quote from RNPATL
    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 .....
    No where else will you get a good basis for clinical practice than on a med/surg unit. Sometimes med/surg units are not the first choice by new grads because you have to really work hard and know what you're doing. You don't just take care of a speciality disease or machines, you take care of patients that multiple co-morbities, are very complicated and require great orginazational skills. If you can master the care of patients on a med/surg unit, believe me, you can learn anything and work anywhere.
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    I have a question regarding Medical surgical nursing, what is the diffrence you probably think this is a strange question but let me enlighten you.
    I work in a mainly medical area (we feel like the dumping ground of the hospital) if a patient is confused, too hard to handle, looks like staying longer than necessary they get sent to us, yet as medical nurses we administer antibiotics, put in Intravenous cannulas, attend to wound dressings, do post operative observations, communicate with doctors and family members, console the relative of a dying patient and many more things, yet the surgical nurses always think they are more superior and harder working and we medical nurses just can't do anything why are we not equal can someone please explain
    king regards Lynne.

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