First RN job M/S Intermediate Care/Step Down

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    Hi! I am finishing up my last semester of nursing school and have been lucky enough to be offered a job on a busy M/S Intermediate Care/Step Down floor at a large teaching hospital. The ratio is 1:3 for step down patients and 1:4(5 if they are having to double up in some of the rooms or if they are short a RN). I will share a CNA with two other RNs if they are not short that will get VS/blood sugars for me. I am not sure what I want to do with my nursing career except I'm kind of interested in ICU someday and the CNS or Infection Control positions look appealing for way down the road if I wanted to get away from bedside. The patient population can be from total care long term trachs/vents to monitored/non-monitored ambulatory patients (pulmonary problems seem to be common) or psych patients. Right now, my biggest fear is time management and catching someone going downhill/having available resources around when they do. The vast majority of my clinical time in nursing school was spent on cardiac/CV intermediate care floors. What do you suggest I do (after finishing school and passing NCLEX) to prepare myself for this patient population? And do you have any tips/advice for a new grad working with this population? Thanks!
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  3. 2 Comments so far...

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    Does your facility have monitor techs? If so, always check your patients' strips and don't take for granted that the tech will always notify you if something happens that you need to know about. The monitor techs where I work are very good, and I have never had a problem with any of them doing their job, but I still go into the monitor room at the beginning of my shift and review each of my patients trends with the tech. They don't mind (and they shouldn't, since they know that a competent nurse wants to know first hand what is going on with his/her patients), and I always feel better knowing that I can chart what I saw first hand. Some of the nurses that I work with have the "no news is good news" attitude about it and assume that the tech will let them know what is going on with their patients, but ultimately it is the nurse's responsibility if a patient goes south because the nurse wasn't aware that their rhythm or rate had changed. You can never be too careful. If you don't have monitor techs, then you will be checking your own strips anyway so no problem.
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    I actually start orientation on an Intermediate/ Step Down Unit May 15th. I am a new grad as well, I've worked as a PCA for 2 years all while in nursing school. But is there a book I can purchase to prepare for being a nurse on the floor? I am very nervous. I have the book smarts but I feel like I know nothing. Thank you for any help, anyone can provide.


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