Advice For The New Nurse Entering Med-Surg

Long Term Care Columnist / Guide · Aug 9, 2004

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.

:)

RNPATL, DNP, RN · Aug 9, 2004

Marla - outstanding post! This information will go a long way to helping new grads in med-surg ... thanks .... ok, let's keep this going .... what a great thread for our new M/S nurses.

lady_jezebel · Aug 9, 2004

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!

Ruby Vee, BSN · Aug 9, 2004

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.

Lilnurse0803, RN · Aug 12, 2004

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. :)

Purlple · Aug 12, 2004

great posting...

salzarn · Aug 12, 2004

Thanks--that's exactly the kind of stuff I need to hear! I do love med-surg and don't want to become so discouraged with being an inexperienced new nurse that I end up quitting.

Read my "cry session" under the introductions/greetings!

Thanks again.

barefootlady, ADN, RN · Aug 28, 2004

Be flexible, he who is flexible will not get bent out of shape(too badly that is)

Be willing to watch and learn from the older pros even is they are not that much older

Be an advocate for the patient Always

No gossips unless its about movie-stars and such, these are people you will work with everyday.

Don't be afraid to say I don't know, please help me. That is the way we learn and grow into new experiences.

Communicate with the HN/CN to let them know your needs/wants in the orientation experience.

Be on time

Be willing to work when you hit the floor

If your assignment is easy, help a coworker, even a small favor can gain a helping hand when you need it.

Remember nursing is not a fashion show, look professional, it gives you and the patients confidence.

Just a few ideas, I am sure there are hundreds more, hope these help

RNPATL, DNP, RN · Aug 29, 2004

Be flexible, he who is flexible will not get bent out of shape(too badly that is)
Be willing to watch and learn from the older pros even is they are not that much older
Be an advocate for the patient Always
No gossips unless its about movie-stars and such, these are people you will work with everyday.
Don't be afraid to say I don't know, please help me. That is the way we learn and grow into new experiences.
Communicate with the HN/CN to let them know your needs/wants in the orientation experience.
Be on time
Be willing to work when you hit the floor
If your assignment is easy, help a coworker, even a small favor can gain a helping hand when you need it.
Remember nursing is not a fashion show, look professional, it gives you and the patients confidence.
Just a few ideas, I am sure there are hundreds more, hope these help

This is GREAT advice to our new nurses headed to med-surg. Thank you for your contribution. I hope other experienced nurses take this thread seriously and provide some guidance and wisdom for our new nurses.

There have already been several comments about how helpful this thread has been. I hope some of the students that are about to graduate and post on the student forums come over and read this thread as I think some of the information is very valuable.

Let's keep this going folks.

nursbee04 · Sep 7, 2004

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) :)

RNPATL, DNP, RN · Sep 7, 2004

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) :)

Know that the information you have provided here will go a long way for someone who is needing to read what you have had to say. This is a wonderful thread and its quality only gets better as people like you continue to post wonderful information that is VERY helpful for new med-surg nurses. Thank you!