Clinicals ---

[sunbug]

I finished our first clinical site. I was at a nursing home, horrible, their skin was like tissue paper ! and so many things to just do palative care on!!

Now we are going to start our hospital site.

My first time Im sceduled for MED/SUrG

IM SO excited and freaked out.

I have so many note cards that im swamped.

HAS anyone been through MED/SURG rotation --

What was the most important things you wish you had note cards for the first week?

Im afraid i will forget what a normal bp reading is , or how to assess med interaction---and my patient will end up arresting or something.....

ANy help to ease the nerves would be appreciated!

What should I bring with me for notes?

Thanks

[That Guy, BSN, RN, EMT-B]

Make a card for yourself that says relax, breathe, you can do it. I noticed so many times with the other students they would just be freaking out to no end. If you take a second to just stop and regain yourself, you find that it becomes a lot easier.

[SPNCandace]

I agree with That Guy. Note cards really won't help when you are on the floor. Just don't freak out and remember the things that you learned in theory. Plus you will have a clinical instructor there who will help if you have any questions. Your biggest problem once you are on the floor is getting over the nerves and having the confidence that you can do it. That's what I had to learn the hard way. I have one more day doing Med/Surge then I will be in leadership clinicals. Just have confidence and don't fret. You'll be fine!!!!

[TheSquire, DNP, APRN, NP]

You seem to think that your Med-Surg rotation will be different from your geriatric rotation in ways other than a change in setting. Where do you think all those half-neglected nursing home patients with stage 3 pressure ulcers, nosocomial multi-drug resistant infections, and families who never visit go once it becomes blatantly obvious that their momentary acuity is beyond the capability of the LTC to care for?

(Bonus cynicism points if you answered, "A funeral home". If you answered "An unmarked common grave" you're worse than I am.)

A "young" patient on a med-surg floor is someone under 60 years of age. Multiple co-morbidities and polypharmacy are the rule. You are going to seriously question the efforts being put forth to keep some of your patients alive, and wonder why they're not getting palliative care instead.

...Have fun in med-surg!

[TheCommuter, BSN, RN]

Many of your med/surg patients are going to be chronically ill elderly people who have been sent there from nursing homes with an acute disease process (pneumonia, MI, sepsis, etc.). until their condition stabilizes enough for them to return to the nursing home.

You are also going to have plenty of elderly patients who still live in the community rather than an institution. These "healthier" old folks are usually going to be treated after having undergone elective procedures such as hip and knee arthroplasties, laminectomies, etc. You are also going to see older people who have had major CVAs, acute renal failure, and so forth.

The reality in America is that most hospital patients on adult med/surg units are elderly people, and sometimes you'll feel as if you're working in a nursing home. After all, health declines as one ages.

[Nurse SMS, MSN, RN]

TheSquire and TheCommuter are right. Most med/surg patients are elderly.

I never once had time to check a note card last semester in med/surg. It was far too busy and the time flew.

[bambam1288]

I wish I had a good worksheet from the start. I attach one I made.. it help me gather the important data that I needed when I got home to work on my paperwork. the other thing is concept mapping. laying out the patient labs, meds, and diagnosis really help you see the holistic view of what is going on and then I add in intervention that related to the whole picture. It is a really good way to mix theory with clinical and help you get more out of the experience.

Lastly remain calm.. your there to learn not be the exprience nurse who works off of intuation. It is okay to say I think is what is going on or I am unsure.

Good luck you'll do great

BAM

nsg worksheet.doc