What is it like as a neuro nurse? ALWAYS INTERESTING!
Your patients may have thinking processes that just don't line up with reality, but each patient has a different variation of that. I've had a walkie-talkie, A&O x3 or 4 patient that JUST COULDN'T UNDERSTAND why we freaked out when they removed all the dressings from their orthopedic injuries and started improvising their own TX (and then got mildly combative when we tried to be involved in re-wrapping the bandages). I've had patients that were barely able to move their limbs, trached, aphasic, unable to swallow, NG or PEG tube, to be turned every 2 hours, who I WOULD SWEAR understood 80% of what was going on and why, and who were cooperative and pleasant. Also hemiplegic patients screaming and cursing like sailors one moment, then singing along to pop songs the next.
On our units, neuro checks every 4 hours are standard, making copying forward (and then accurately editing!) documentation a very useful skill to have. Also useful: a good sense for subtle changes in patient's mentation, and a stealth (conversational) way of accurately assessing how oriented the patient is.
Expect Traumas, CIWAS, strokes, aneurysms, spinal precautions. EXPECT PAIN! Neuro patients tend to be left in more pain than some other patients, because too much pain medicine would make it harder to see neurological changes until they're BIG changes. It's useful to ask the doc what the patient can expect their pain to be out of 10 after any given procedure, and then to reinforce that with the patient when you're talking to them. Also try to find out how long the pain usually lasts.
Fall risk management and knowing how to cajole sitters out of management when there are none to be had are big skills. Also knowing when to ask for restraints, to keep those hard-won NG tubes, embattled PEG tubes, and much-touched IV's in place.
Mood swings and head trauma are best buddies. Neuro is a hard specialty if you want to know that your patients feel satisfied with the care you're giving them (you may be giving great care; they may or may not have the capacity to remember what you're doing or why, PLUS the pain issue), but great for honing assessment skills, knowledge gathering, being there for patient families, developing good nonverbal communication, and seeing dramatic turnarounds. Brains are truly amazing in how they can build new connections, and you can literally see patients' personalities, motor skills, and thinking improve shift by shift.