New to the field

Specialties Med-Surg

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Hi,

I'm a new grad embarking upon my first journey into the world of nursing.

I've got a job on a Med/Surg unit, but won't be starting till November.

I'd like to do some reading/courses/anything in the interim, as preparation for my entry into the "RN role".

Any advice, referrals would be greatly appreciated.

EM

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AS AN EDUCATOR, MAKE SURE YOU GET AN ADEQUATE ORIENTATION ONCE YOU START AND DON'T BE AFRAID TO ASK QUESTIONS. NO QUESTION IS STUPID, AND WE WERE ALL NEW GRADS AT ONE TIME. PERFORM A THOROUGH ASSESSMENT OF EACH PT AT THE BEGINNING OF YOUR SHIFT, DON'T RELY ON PREVIOUS SHIFTS'

ASSESS. DATA. IT'S YOUR LICENSE!!! THEN CONTINUALLY REASSESS AND GO THRU THE NSG PROC. THEN DOCUMENT, DOCUMENT, DOCUMENT!!!

REMEMBER, LEGALLY, IF IT ISN'T DOCUMENTED, IT WASN'T DONE. ALSO, IF YOUR "GUT" TELLS YOU SOMETHING IS WRONG, DON'T IGNORE IT: THERE PROBABLY IS. DON'T WORRY ABOUT CALLING PHYSICIANS, BOTHERING, THEM, ETC...

IT'S YOUR JOB TO ACT ON YOUR PT'S BEHALF. IN THE MEANTIME, JUST REVIEW MED-SURG LITERATURE, POPULAR JOURNALS SUCH AS NURSING 98, AJN, ETC... MAY BE MOST HELPFUL IN PREPARING YOU AT ENTRY LEVEL. GOOD LUCK AND LET ME HERE FROM YOU. CIFELLIOF5@MINDSPRING. COM

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AS AN EDUCATOR, MAKE SURE YOU GET AN ADEQUATE ORIENTATION ONCE YOU START AND DON'T BE AFRAID TO ASK QUESTIONS. NO QUESTION IS STUPID, AND WE WERE ALL NEW GRADS AT ONE TIME. PERFORM A THOROUGH ASSESSMENT OF EACH PT AT THE BEGINNING OF YOUR SHIFT, DON'T RELY ON PREVIOUS SHIFTS'

ASSESS. DATA. IT'S YOUR LICENSE!!! THEN CONTINUALLY REASSESS AND GO THRU THE NSG PROC. THEN DOCUMENT, DOCUMENT, DOCUMENT!!!

REMEMBER, LEGALLY, IF IT ISN'T DOCUMENTED, IT WASN'T DONE. ALSO, IF YOUR "GUT" TELLS YOU SOMETHING IS WRONG, DON'T IGNORE IT: THERE PROBABLY IS. DON'T WORRY ABOUT CALLING PHYSICIANS, BOTHERING, THEM, ETC...

IT'S YOUR JOB TO ACT ON YOUR PT'S BEHALF. IN THE MEANTIME, JUST REVIEW MED-SURG LITERATURE, POPULAR JOURNALS SUCH AS NURSING 98, AJN, ETC... MAY BE MOST HELPFUL IN PREPARING YOU AT ENTRY LEVEL. GOOD LUCK AND LET ME HERE FROM YOU. CIFELLIOF5@MINDSPRING. COM

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Just as you should not be afraid to ask as many questions as you need to ask, do not be afraid to speak up for yourself or your patients. When I was a new grad I learned a lot by floating to other areas of the hospital. I always made sure that every one knew that I was a new grad and what my strengths and weaknesses were. Expect to be overwhelmed at times. There were days when I just knew that I had made a big mistake in joining this field. There will also be days when things go right or you have done a small thing that really made a difference to a patient. Lots of luck and welcome to the field.

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Reccommend: Focus on body systems.ie-immune, FI,neuro, etc.Always read prior days progress notes of MROService, specialties and nursing.Sometimes RN's focus on the basics in report and forget to give you a small detail in report that may have been insignificant to them at that time. Sometimes that thread of information becomes a clue to a bigger problem important to diagnosis and developing problems in other body systems. Nursing notes focus on patient needs, response to therapy. ALSO, read,read read. Get on all of the continuing education mailing lists. A book I bought about documentation is helpful. Don't get stuck in med surg forever. Being on the internet already is a godsend to you. You are ahead of a lot of RN's already. I've been an RN 2 years and this is my first day on a nursing web sit. I'm, not even on-line. But I'm learning. That's the name of the game baby. Don't be afraid to speak up , but keep you career moves to yourself and your mentors unless speaking in general terms to coworkers. Don't bash other people. Word gets around. It's OK to make a presence and have opinions and a reputation. Learn to relate to doctors and learn how to work them for your patient needs. Of course they are good for networking also. OK, I went overboard, but it's a lifestyle and I love it, what can I say. Just think of the big picture, don't get run down with the daily grind and you will blossom. Good luck.

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Dont be afraid to ask any question no matter how stupid or embarrassed you might feel. Also remember you are there for your patients so if you have to wake up a tired cranky physician who has a reputation for chewing up nurses who call him at 3am and spitting them out, keep this thought in mind. Dont ever let them intimidate you-I find this happening with most new Rns. Also find that big black policy and procedure book on your unit, study it and use it. And check out all the great sites for nurses on the web. Also go to any conferences offered in your area that your hospital will pay for. They are a great way of keeping up with the most current issues nurses are facing. And continue your education- go for certification or start work towards your BSN or masters. Good luck and take one day at a time.

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First, congratulations on becoming a nurse. It is definately one of the most rewarding careers one can have. You will see the best humanity can offer-and (unfortunately) some of the worst.

I don't want to repeat what has already been stated in the earlier posts. This is more a comment on one of the earlier posts. If you do end up working night shift, and you might being 'the new kid on the block', you may find that you LOVE it. I have been working nights for 19 years and won't even consider working another shift.

Yes, you are there for the patient. But you also have to work with the doctors. DON'T CALL IN THE MIDDLE OF THE NIGHT FOR EVERY LITTLE THING! You will quickly get on the doc's hate list. If you ask him for anything, he will just say 'no' to spite you. There are 3 times to contact the doctor-

1. immediately

2. call him before the end of your shift

3. pass the information to days and hope they carry through, and/or leave a note on the front of the chart. (I prefer leaving a note, 'cuase sometimes the day nurse may not even see the doctor on his rounds.)

Your own gut feelings and experience will help. If in doubt, ask another nurse for her opinion, or your nurse manager/night shift nursing manager. If still in doubt-call. Better to be safe than sorry.

I have often times called for a vital sign that is out of whack, only to find out from the doctor, this is the patient's normal. Ask the doctor for some parameters, then so you and others will know when to call, and he is not called needlessly. They are usually good about doing this if they know this will get them some more sleep.

If a patient asks for something you don't have an order for, like a sleeping pill, you really don't have much choice but to call.

If something is out-of-whatck, try to eliinate some possibilities before calling the doctor. If your patients suddenly seems confused to you, is sun=downer's syndrome a possibility, hypoxia (most places now have non-invasive digital oxygen saturation monitors to use), if diabetic, take a fingerstick blood sugar and see if it is low. The doctory will appreciate what you can do to help eliminate the possibilities before calling.

When you DO make that call in the middle of the night, the doctor will be more cooperative (usually) in giving you what you want. And if you don't call in the middle of the night for every little thing, they will also respect your decision on making that call. I have called a doctor in the middle of the night just on gut-feelings when everything appears normal and be acted upon.

And if you find something that legally impells you to make that call but if not for your own license wouldn't make the call, I have then even told the doctor that this is a C-Y-A call.

And if for some reason night shift itself does not work for you, let your superior know. My hospital is real good about getting some one off nights as quick as they can if working night shift causes family strife, or you just CAN NOT sleep more than a few hourse a day, even after several days of seriously trying to adjust.

And remember there are 2 basic types of doctors. The ones who think they are gods and would love it for all to worship the ground they walk on. And second, those doctors who see themselves as a collaborator with nurses for the patient's health. This doctor may even ask for your opinion when you call him in the middle of the night. And don't be afraid to give it.

I realize this reply bacame much longer than I even thought it would be. But I felt compelled to comment about calling the doctor at 3 in the morning every morning for your patient. You do this and the doctor may question your judgement and may not act at a critical time when something really needs to be done.

To moderator=feel free to shorten this as much as needs to be shortened.

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Another reply! I too have been in nursing for 20 years. I started in Med-surg, and I think it's a great way to begin and maybe spend your career. It is by far the most difficult place in the health system to work. You will get to know about a vast array of disease/surgical enitities and will be well-prepared to branch off if you desire. . . One thing I can say now that I wish I had been consciously aware of 20 years ago, is to BE with and for the patient. Their illness is not all there is to them; and you will be more effective a nurse if you're facilitating THEIR goals towards health from their viewpoint (Erickson calls it modeling their world). . . rather than pushing your own idea of how they should be, etc. You know what I'm talking about. . . Follow your gut instincts, always, and they will get better and bette with experience (and there is NO substitute for experience). . . hang in there, welcome, and good luck!

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