Advice for a new nurse!

KStudentNurse70 · Jun 15, 2016

Sounds like you're in the same situation as me! I could use some advice right now too, so nervous I've been sick over it [emoji30]

Ajefferson · Jun 16, 2016

I know how you feel! But we both passed nursing school and the NCLEX so I'm sure with some time we will both become confident at our jobs, (fingers crossed)!

KStudentNurse70 · Jun 17, 2016

I haven't even passed the nclex yet!! Take it two weeks from today 7/1/16, I'm currently working on my permit as a graduate nurse [emoji16]

Ajefferson · Jun 17, 2016

Well good luck! I hope you pass!

PCnurse88 · Jun 18, 2016

1) Use the search feature here on AN because there are literally millions of threads with great advice.

2) To add to those lists and emphasize some stuff, find a brain sheet that works for you. You may need to adjust once you're taking patients; when I began my second job, I used a totally different sheet that matched more with charting than the one I used as a new grad.

3) Always keep an extra set of scrubs/socks/underwear/deodorant in your locker.

4) Get a feel for what protocols/policies your floor uses a lot and print out a copy to keep either in your locker on on/in your clipboard. For instance, my unit does a lot of detoxers/CIWAs and a lot of heparin drips. I printed both protocols and cut them up and paste the scores for the CIWA and the titrations for the drips onto my computer if I have a patient with either in place.

5) Get your own malpractice insurance. A lot of my coworkers use NSO and I recently purchased through them as well.

6) Ask to shadow specialty nurses, ie wound care nurse, IV nurse, RRT nurse, phlebotomists if applicable.

7) If you're working a tele floor, practice interpreting strips of not-so-common rhythms.

8) Remember that sometimes no one has any idea what they're doing. No one, not even the most experienced nurse or doctor, has seen every single illness/injury/disease and there are times when no one has the right answer.

9) It is better to ask questions and feel stupid than to make a mistake and get fired. If something doesn't seem right, ask the doc. If the doctor's answer seems fishy, ask for a second doctor's opinion. Use your preceptor, charge nurse, and manager. If you feel that your patient is suddenly a lot worse, call that rapid.

10) Personally, I am tactfully honest with patients. If I have to start a new IV, I tell them it's going to hurt. I've had doctors come in for a bone marrow biopsy and say "this might pinch". It's going to do more than pinch; be honest. Treat the patients like people rather than invalids or children.

Best of luck!

cmcgeorge · Jun 29, 2016

I work PRN on a step down medical floor and recently starting working in an ER. My advice is to introduce yourself to your patients, let them know the plan, and get the assessment out of the way as soon as possible. I start with the sickest patient first or in the room of the patient I get report on last and work my way backward. When I'm doing my last patient assessment...depending on the time....I start administering medications/doing blood sugars and then work my way back. At this time I also review labs, vitals, and new orders very quickly. If it's slow I will chart, but this can bite you if all of sudden you get a new admission. You will get the hang of this later. I also have my own way of listing what Needs done on a paper kardex, like when antibiotics are due. If it's really busy and your patients are needy this works really well. As a new nurse I would worry about charting later. Some nurses spend the first 30 minutes of their shift looking things up....not good if the patient codes before you assess them! Normally it calms down around 10 or 11....but not always. You can chart, look things up, and review orders more thoroughly later. I tend to change iv's, dressings, etc when I'm doing my morning medications. Just remember the patient is your priority and you will be fine â˜ºï¸

Ajefferson · Jul 2, 2016

Thank you so much for this! It's just a lot to juggle all at one time while trying to learn hospital procedures, where everything is, and the Emar!

silhouettedreams · Jul 13, 2016

Hello! I'm new to med surg, I worked in psych for two years before now. I can tell you a few things that I've learned since I started in med surg!

I always go into work twenty minutes early to look at charts. I don't get paid for that twenty minutes, but it's worth it in my opinion to start my day organized. I write down pt name, room number, code status, date of admission, reason for admission, pertinent hx, diet, if they are on tele, if they need accuchecks, if they have a central line, if they are Q2 turns, any special treatments they might have, times when they have meds due, and any other relevant info. I look at all of their orders, and write down anything relevant to my shift or the next shift. I look at recent VS and labs. If I have time, I'll look at the most recent physician note. This sets me up for report, and sets me up to ask any questions I need answered by the dayshift nurse. After report, I'll take a vitals cart and start assessing my pt's in order of priority. I'll do a head to toe assessment in this time, and take along any meds I can give at the time. I check the date my IVs were inserted, and the time my tubing was hung so I know when they need to be changed. After my 2000-2200 meds are passed I begin dressing changes, walks, other odds and ends. I do focused assessments between 2300-0000. After those are finished I begin charting. Around 4 I start another round of focused assessments. At this time I clear out IV pump volumes, empty drains, make sure my IV bags will last until dayshift comes on, odd and ends. AM meds start at 0500. From 0600-0700 I try to toilet everyone and wrap things up, finish charting, etc. I try to write down relevant notes for report so that I start organized and don't miss things. I also try to set things up for dayshift as much as I can. After report I occasionally stay late to finish up charting. Of course, admissions can mess up my time frames for these things, but I adjust and prioritize as needed.

My biggest advice is find a few coworkers who are willing to take you under their wing, and ASK TONS OF QUESTIONS. If someone is doing something you haven't seen, ask to tag along! Ask people how they would handle things. Use your coworkers as a resource.

Ajefferson · Jul 13, 2016

Sounds likes what you are doing is very productive and organized! Thank you so much for this advice. Do you use any "brain sheet" to write all your orders, meds, or to do list for each of your patients?

silhouettedreams · Jul 14, 2016

My unit has a brain sheet that we all use. It's pretty generic, and I just write that stuff in wherever I can fit it. Lol. You should be able to find a brain sheet on Google, or build your own once you have an idea of what things you'd like to write down.

Stitch3296 · Jul 15, 2016

Congrats on the new job and passing nclex! I was in your shoes last year. Been working med/surg NOC shift for almost a year. Here's what my night looks like.

2300-2330ish. Get report on my 6pts.

2330-2400 Spend time looking up my pts, i.e. meds scheduled for my shift. Sometimes a quick look at h&p if there's time. I also sometimes prior to looking up meds will assess the last pt I get report on. After looking everyone up, I quickly prioritize who I'm going to see 1st.

I prioritize based on acuity 1st, then who has 2400 meds, blood sugars, or who has uncontrolled pain.

2400-0200. Assess all my pts and pass scheduled meds. Chart the assessment a you go. I try and finish all my assessments by 0130. 0200 we have a team huddle where we quickly check in with eachother and ask for help if we need it, or offer help if we're able. Love three team atmosphere we have ava being able to help one another.

0200-0400 finish charting all the non-assessment items, like education, braden, fall risk, my note. Also passing any scheduled meds or pain meds called for. If I haven't yet, look at h&p and last drs note to ascertain the current plan for pt.

0400-0630 Pass AM meds and do any blood draws scheduled for my pts with PICCs. Also one last check in with pts for pain meds and making sure their IV fluids wont run out in the 1st 2 hours of the next shift ( set your co-worker up for success)

0630-0700 Check new lab values for pts (lab draws between 2-4, so results are usually in) Message MDs if necessary about labs. Finish my nurses note and progress summary. Look at h&p if I haven't had time. We have some day RNs who really want a lot if info/background. So it's nice to be prepared, but not always possible. And it's ok to say "I don't know, you'll have to look that up". It doesn't happen often

that I say this, so if I do they know the night was busy.

0700-0730 Give report. Hopefully it's only to 2 nurses, but sometimes it's 3. Rarely 4.

0730-0740 If necessary, finish my notes and summary

Words of advice:

Be patient with yourself, this is where the real learning begins. At first it can feel overwhelming.

Don't be afraid to ask questions.

Approach your day with an attitude of "what can I learn today?"

Help you're co-workers every chance you can, especially your CNAs.

Nursing practice is like an onion, there are many layers. As you get comfortable with one aspect, you'll add another layer.

Advocate for your pt.

This was longer than I intended, but good luck too you in your new position