Advice Re: med surg rotation

[Gampopa]

Hi:

We were just given our med-surg I rotation and I and another student were placed on a rehab unit with a total of 6 patients. My initial gut feeling was that this is not a placement where I will learn the skills I need to learn such as blood draws, cath. placement, wound care, etc. When we were oriented to the unit we were shown the equipment room and the RN showing us around repeated "we don't use that, I've never used that, etc." When we asked just what she does, she said that they do a lot of urinary and bowel managment on that floor. OK. These are certainly important skills to learn and there are important nursing practices to be learned on that unit but I am still really, really dissapointed. When I hear of my other classmates describe their placements it sounds nothing like what I got. When I told my clinical instructor my concerns she acknowledged that it was not a high acuity area, and while I wouldn't see the things that my fellow classmates would see it would still be a good experience. Besides, I'll have other clinicals where I'll learn those skills and in this unit I'll probably end up with two or three patients where as my classmates in organ transplant and ortho/neuro will have one.

I just need some feed back. Do you think I should stick this out and learn what I can on this unit or ask for a reassignment? Is there a difference between a med surg I rotation where you see a lot of different things and one where patient acuity ( and census) is pretty low but you get to know your patient really well? It was emphasized that med surg I is a foundational course where you get to practice your basic skills but I'm really doubting I'll have that opportunity.

Thanks for any input.

[canoehead, BSN, RN]

The most important thing you need to learn is time management, and you can get that in this clinical. My instructors used to tell me (and they were right) that the skills will all come, but relationships with tough patients and juggling responsibilities are the things that take the most time as a new grad. As a student get right in with the PIA patients and ask them what helps them, and what doesn't work. They will cut you some slack because you are learning and some like to get the chance to teach, rather than receive the teaching.

The patients you described are some that you can almost take total care of without having someone watch you constantly. See how it feels to do it yourself without prompting...are there things you miss? Use it to build your confidence. The next rotation you go on you'll know that you've got the very basics down pat, so you can concentrate on higher tech stuff.

[suzanne4, RN]

I agree with the above post. You are actually going to come out ahead. :)

New buzz word going around: prioritize. You are definitely going to learn the meaning of this and this is one of the most important aspects of nursing.

These patients are going to require more care than many other patients, or they wouldn't be there. You will learn the proper way to assist someone with ambulation. You will be able to pay closer attention to what the physical therapist does and be able to incorporate some of those skills into your care of the patient. Many of these patients still have medical problems, they will have heart conditions, as well as diabetes, so your care plans are definitely not going to suffer for lack of information to put on them. The may not have IVs, but they will have everything else.

Good luck and keep your eyes open. I promise that you will be learning something new at each clinical.

:balloons:

[Tweety, BSN, RN]

You have a choice? We didn't in school. But rehab is more than just bowel and bladder and shame on that nurse for saying that.

You can definately practice your head to toe assessments, pyschosocial skills, time management, medications, etc. all sorts of nursing stuff.

Good luck.

[MelissaRN]

One of my really good friends works on a rehab floor in my hospital and believe me they do more than just bowel and bladder management. Yea they do that stuff because they have a lot of quads and paras, but they also do central line draws, IV antibiotics, trach care, sometimes vents on the stable quads. They deal with ALOT of head injury cases that are relatively stable. Once in a while they'll get a patient that has been rushed through the system to their unit and that patient needs alot of care. They've had MI's there and in the last year 3 codes two of which she helped out on.

Don't worry about your placement, keep your eyes and ears open, read charts and ask questions. You get out of it what you put in it.

[cabbage patch rn]

I would most definately stick it out. Sounds like you will have more time to give to your patients, somthing that you will yearn for later on. There wasn't an abundance of skills when I was in school. I learned the majority of my nursing skills while I was employed as a G.N. and even then it's not too late. It's when you leave nursing school that the learning really begins, school just prepares you for the NCLEX.

[Gator,SN]

I agree with all the above posts.

I had to go to rehab during my M/S clinical rotation and it was a good experience because I learned what the patient will be going through when they leave my unit and start rehab. From the time a patient is admitted, I start to concentrate on their discharge needs. Knowing what is available and what to expect, helps me to start educating the patient and get them ready for the next step in their recovery.

True you won't get the same skills opportunities as your classmates but you will learn something valuable.

Good luck and don't get discouraged!

Gator

[unknown99, BSN, RN]

You have a choice? We didn't in school. But rehab is more than just bowel and bladder and shame on that nurse for saying that.

You can definately practice your head to toe assessments, pyschosocial skills, time management, medications, etc. all sorts of nursing stuff.

Good luck.

Thank you, Tweety!!! I am a rehab nurse and you are 100% correct!!! And, Melissa RN, so, so true!!!

Bless the acute care nurses who get our patients stabilized, so we, the rehab nurses can get them on the long, hard road to recovery!!!

[Gampopa]

Thanks for all your comments... I think I got caught up on wanting to learn the fundamental skills right now while they're still relatively fresh in my mind from lab. But the most fundamental skill is how to communicate with the patient to find out what they need and how they feel about what's going on. This will be a good rotation to focus on developing those skills.

[Tweety, BSN, RN]

Thank you, Tweety!!! I am a rehab nurse and you are 100% correct!!! And, Melissa RN, so, so true!!!

Bless the acute care nurses who get our patients stabilized, so we, the rehab nurses can get them on the long, hard road to recovery!!!

High five at ya! Woot!

[kimtab]

I completely agree with the posters who are telling you that the time management you will learn by having multiple patients is more valuable than any clinical task you will miss out on performing. I just graduated from a program where we did not have multiple patients until the last 5-week rotation. It was a bit of a shocker to make the transition, and I found myself wishing we had been assigned multiple patients in earlier rotations.

Kim