JulcaryRN 1,388 Views
Joined Jul 25, '10.
Posts: 9 (33% Liked)
I think the caseload is 25 max. And they do 2 or 3 visits a day. I don't work directly with our program, but they meet as a group monthly and have weekly one-to-one with the supervisor. I think that there is a lot of support for the nurses.
I do not work for Nurse Family Partnership but am a public health nurse in a similar program with a non-profit. Just wanted to say I love my job! I can't imagine doing anything else. I love getting to know my clients and to have enough time to really teach my clients what they need to know. I have a lot of autonomy with a great team that supports me and backs me up. If you decide to go for it, I hope you love it as much as I do.
Yeah, I totally stay over to finish up because I think the day shift nurse, who's been there longer than I'm alive, is incompetent to take care of my patient. Not at all because I've been berated in the past for, say, not calling report to a receiving hospital on a patient who is still on our floor when I walk out the door. Not because the younger (since someone else felt the need to make it about that) nurses on my floor are regularly left in tears during report over things left undone.
Why is it so damn impossible to have a vent thread on this board?
I am a new medsurg nurse and I really appreciate this thread!
Here is my advice (for whatever its worth )
1. Learn to be assertive. "No, you cannot go out to smoke because I just gave you a demerol push five minutes ago and you are on telemetry, and it is not safe for you to go out to smoke."
2. Prioritization and Organization are NECESSITIES.
3. Help your coworkers out when you can, they will return the favor.
4. Trust that little nagging feeling. (You ARE a nurse, they didn't give you your license on a fluke) I have had that feeling two times in a big way since I became a nurse. The first time I didn't follow through on it ("What do I know, I've only been a nurse since June...") and I have kicked myself ever since. The second time I acted on that little nagging feeling and I was VERY glad I did.
5. Keep in touch with friends from nsg school, find another nurse, someone in your field that you can talk to. I went through nursing school with four fabulous girls and we still talk. We talk about being overwhelmed and how much they don't tell you in school and how we are coping with it, things we love/hate about nursing. I still say that people who are not in nursing don't understand totally. I can tell my best friend about the terrible things I have experienced so far all day long (short staffing, bad docs, violent pt's, etc) and she will listen but she will tell you herself that she doesn't really GET what I am talking about. Find someone who you can talk to that KNOWS, somone whose BEEN THERE. Personally, I think that helps tremendously.
Stay strong, new nurses, we won't be new forever! (THANK GOD)
I am a student nurse about to enter my clinicals and I am sure that Med/Surg is where I want to be when I graduate. Not only do I want to learn and perfect my nursing skills, but I want to be exposed to everything I can in medicine. My future goals are either to work in the ED as a NP or become a certified nurse midwife. Either way, this advice you all have given serves all future nurses well in whatever they do.
Keep the nursing profession shining with your advice, guidance and dedication. That makes me want to be a nurse more than anything in this world.
I can't add much to the great posts above. But I will say that a sense of humor helps. And remember -- even if it doesn't seem funny NOW, it may be a great story to contribute to the "Poop" or "Grossest thing I've ever seen" threads in a few years!
Med surg is a great place to start in nursing -- you'll learn valuable skills that will serve you well throughout your career. There will be bad days -- so keep a sense of humor and stay flexible.
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!
Oh, I can think of a million things that I wish I'd known when I was a brand-new RN........like:
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 infusion......at 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 it.......you 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 piss 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.
Because most everyone has praised Denver Health, I just want to offer an alternative perspective.
I'll be a new grad BSN (second degree, 20 years prior career experience but not healthcare), and I was singularly unimpressed with the nurse recruiter I spoke with at DH.
After a cursory questioning, she told me since I had no prior healthcare experience, DH would "insist" I spend a year on Med-Surg. She then said, rather testily, (and this is a verbatim quote), "I don't even want to talk to you until you have your license in hand."
Fine by me. I don't want to talk to DH again, either.
Mind you, I was polite and to-the-point throughout this phone conversation, which lasted all of 3 minutes. Maybe she was feeling stressed that day, but it certainly didn't leave me with a good impression of DH. There are too many other hospitals for a new grad to choose from. And, btw, I rank in the top 15% of my class and have stellar letters of rec for my preferred practice area.
Just another opinion. I don't doubt the others who say nurses are very happy there.
Does anyone else feel like this thread is
I'm a mother/baby nurse and proud to be one. Compared to lots of units, we mother/baby folks might be considered lucky to have such 'cake' jobs, and some days I'd agree. Other days I leave work exhausted, with sore feet, sore back, dry mouth, empty stomach, and full bladder from running between one crisis and another. We do have our fair share of crises; when they are bad, they are really bad. But this isn't about those crises, nor about the frustrations we encounter as mother/baby nurses. This entry today is about the things that remind me why I do this job and why I love it. Please forgive the mixture of generalities and anecdotes; I hope you will find something in here that strikes a note of internal recognition for you.
I love it when I take care of parents who are genuinely happy about their new baby. While I recognize that we all express emotion differently, it never fails to hit me right in the solar plexus when I see a daddy hold his baby for the first time and his eyes well up with tears. Or a grandma who stays up all night holding and soothing her laboring daughter, doing it as much to comfort her baby as she's doing it to be one of the first to welcome her new grandbaby.
I love it when women's bodies do what they are sometimes told they can't do. I love it when someone comes in and delivers a breech baby vaginally too quickly for anyone to tell her she 'needs' to be in the OR, almost like her body is saying, "C-section? Pffft!!!" Or when a primipara delivers her 10-pound baby over an intact perineum (I've only seen it rarely, but I have seen it).
I love it when patients refuse things we do in the hospital that aren't really as necessary as we are fond of making them out to be. I like being able to be the one who backs them up when they do this, too.
Watching breastfeeding work is almost magical for me. More times than I can count I have a baby who would make a great breastfeeder (which is most of them) but mom doesn't want to, which is of course her decision to make. Or I have a mom who desperately wants to breastfeed but baby isn't very interested, or is in NICU and not stable enough to feed (in which case Mom pumps, but it's nowhere near the same thing). Or baby is a great nurser and mom is motivated, but there is some other issue - very sore nipples, or milk supply issues, or jaundice that necessitates a bilibed, which can take away from the closeness of the breast. What I love seeing happen is the combination made in heaven: a baby who wants to nurse, a mother who responds to that, and no complications in between. It's the way things are meant to work and for me, it is one of the things I wish I could put on display in a museum. (I'm not faulting people for having breastfeeding difficulties, please don't misunderstand. Sometimes things happen that aren't failure on anyone's part.)
I've mentioned this elsewhere, but for whatever reason I bond well with young teen moms. Your guess as to why is as good as mine, but we tend to get along really well. A few years ago, I took care of a girl who was with us for about a week as an antepartum in preterm labor at 27ish weeks. After she delivered her baby a few days later, I took care of her postpartum as well. She amazed me in so many ways. She pumped every three hours while awake and insisted that I wake her every three hours to pump at night as well. She insisted on carrying the milk over to NICU herself just so she could say hi to her baby in the process. We talked about her life and her goals. She hadn't been dealt the best deck of cards to begin with, and hadn't really planned on having a baby before finishing high school. The baby's dad had long since dropped her. I had more free time than usual those couple nights and spent as much time talking with her as I could without her kicking me out of her room. I did my best to encourage her - her goals were worthy ones, and while she might have to rearrange her priorities to include her new son, she owed it to herself to not give up on those goals. Before I left that last morning, I went in one last time to check on her, and she was asleep, so I wrote a note on a paper towel letting her know I'd be thinking of her and her baby in the weeks/months to come, and signed my first name to it.
Fast-forward several years. About six or eight months ago, I was working in the nursery and the phone rang. "Elvish, it's for you," called the tech. I answered and it was this former patient. Clearly she had kept the note and asked for me by name. "I just wanted you to know I remember what we talked about," she told me. She related how she graduated from high school, was currently studying to be a beautician, and that her premie son was now a healthy, well-adjusted four-year-old. "And I just wanted to let you know that we made it and we are okay." (As you can probably imagine, the tears turned on like the fanciest faucet; fortunately, the nursery wasn't busy at the time.)
When I have an awful, frustrating day and swear I am going to quit my job, these are some of the things I try to remember. What about you? What inspires you about your job? What keeps you coming back?
Your post makes me think of this paraphrased quote: "You're either part of the problem or you're part of the solution." I say, bring on your "all natural kind of girl" attitude and help solve the problem! Go change things, one delivery at a time.
OB NEEDS more nurses who believe in natural childbirth!
If nothing else, it will get your foot in the door, gain you some experience, and then you can move onto a facility that is less interventionist and employs midwives.
Even though the majority of births I see are highly managed with Pit or Cyto and an epidural, I still see enough natural births with midwives, or even waterbirths, that make dealing with everything else totally worth it.
There are enough women out there that desire a more natural birth, and will appreciate having a nurse who respects and will help her achieve those desires, and they will appreciate you and always remember you for it.
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