Concerns over starting work

Gail-Anne · Sep 12, 2005

Why would you tell them, unless asked? (I'm assuming you aren't looking to work resp or cardiac). Always say what you can do, not what you can't! e.g. "I have limited experience with starting IV's"---not "I suck at starting IV's"!! "Do you perform your own venipunctures for lab work? That's something I'm not familiar with, I'll look forward to learning that in my orientation."

Get what I mean? Do not lie, just state that it's a skill you look forward to learning.

And start listening to chest sounds and hearts, children, boyfriend, parents, strangers on the street ( OK maybe not strangers!) but you get the drift.

Once you get working make use of the clinical nurse. Physio and Resp thereapists are both experienced with lung sounds, they are a great resource too.

Mind you, I'm Canadian, the Americans may object to my giving advice!

A pt is a pt and a good nuse is a good nurse regardless of which side of which ocean they trained. Good luck

EnglishRN · Sep 12, 2005

Thanks for the advice. i think I am just lacking a little confidence in myself since having the kids. I am an expert on Dora the explorer!!!!!

suzanne4, RN · Sep 12, 2005

Do you already have a US nursing license?

You may wish to check out the International forum, you will find many helpful posts for you.

lady_jezebel · Sep 12, 2005

Many employers have a checklist of skills, and the job applicant is to self-rate her/himself for competency in each skill -- for example, starting IVs, drawing blood, assessments (which includes auscultating lungs/heart sounds), inserting foleys or NG tubes, wound care, drug calculations/administration, drain management, therapeutic communication, etc...

As for auscultation, a med-surg nurse really only needs basic skills. I would know these things beforehand, for they are assumed knowledge & not really part of orientation (ie. all students do it in nursing school over here). Make sure you know where to listen for the heart sounds, but don't worry about s3/s4 sounds or locating murmurs (the regular "lub dub" heard are the s1/s2 sounds); as for lungs, just know how to distinguish "clear" sounds from diminished or coorifice sounds, and what crackles sound like -- if you know these things, you'll be fine on the job; crackles can indicate fluid or other things, as can diminished lung sounds. Of course you need to be able to id wheezes too, but often the pt looks like they're in distress or they're audible without a stethoscope; in this case, a pt may need a nebulizer treatment or to deep breathe and cough. Look in a textbook for diagrams of where you place the stethoscope on the body to hear the heart or lungs. For the heart, I usually listen to the left of the sternal border or the heart's apex. You can detect artificial heart sounds (a "click") with implanted valves. For the lungs, it's often adequate to just listen to the top lobes (front/back) & bases (also front/back). It often helps to have a pt take deeper breaths through their mouth while you auscultate, to make the breath sounds louder & more distinguishable. Finally, you count the heartbeats as you're auscultating for 60 seconds & notice if the rhythm is "regular" or "irregular" (or you can palpate the arterial pulse, count for 15 seconds & multiply times 4). As for lung sounds, you can listen for only a few seconds in each field; when you count respirations, do it without auscultation for 15 seconds & multiply by 4 for the breaths/minute.

You'll need to auscultate the abdomen as well, for the absence of bowel sounds can indicate an ileus (also, sometimes they're absent after any routine surgery & a pt will become nauseated & throw up if they eat before the sounds return, indicating that the GI tract is still "asleep" from anesthesia). Just use the bell of the stethoscope & hold it lightly over the abdomen, and listen to the four quadrants around the umbilicus; the sounds can be very subtle, like "tinkles" or "gurgles"; in order to determine that bowel sounds are "absent", you must listen to a full five minutes -- this is b/c the diagnosis of absent bowel sounds can indicate something very serious. If you notice the abdomen is firm & without sounds, call the doc immediately if this is an unexpected finding!

By the way, what technical skills are regularly performed by UK nurses? Just wondering, for I've always dreamed of working overseas.

EnglishRN · Sep 13, 2005

Yes I do have a US license. I passed the NCLEX in 2000. We have been stationed overseas but are now back in the US.

In the UK, we do everything that you do. I think Cannulation and Venepuncture are becoming part of an RNs role too. The main reason we ddn't do them before was that we were taking on more of the Doctors duties and getting paid a lot less than you do here. As an Acute Med RN ( Med/SUrg are seperated in the UK), we do basic nursing care, vital signs, Drs rounds, paperwork!!!!!! Wound assessment and management. Foley Cath and NG insertion. Drug rounds. IV drug and fluid administration. Basic Telemetry. Central line measurements and line care and much more.

Thanks for your advice. I will be fine once I start work, just the unknown