Essential Skills~Input from ALL Nurses!!!

[msnursealot]

Okay, so here goes..another "silly student" question. What was the hardest thing about transitioning from student nurse to NURSE? I will be starting my RN role transition this week. I will be graduating in 2 months!

My preceptor asked me to make a list of things that I really wanted to focus on or special that she can cover to make sure I get all I can from the experience. The problem is, I find myself sitting here making a list of all the "skills" that I feel I only performed on dummies (easy, you know what I mean).

I know I want to practice lots of IV starts, lab draws,etc..But I honestly don't know what to ask..Clinicals are truly unrealistic compared to actually being on the floor.

What do you wish you would have learned before graduating? What do you think all new grads need more practice with?? Any suggestions? Comments? Hints?

LPNs, RNs, seasoned & new---please throw me a bone. I know this is a golden opportunity to get a preceptor that is so giving---Thanks in advance!!!

[goodn]

Learning to wait 4 hours until you have time to go to the toilet!!!

Really? 4 hours? What if you're a premenopausal mama that has to go every hour on a particular day of the month?

[SmilingBluEyes]

Really? 4 hours? What if you're a premenopausal mama that has to go every hour on a particular day of the month?

IN MY experience, 4 hours to get to go pee, you're doing good. I never get time to pee the 1st 4 hours of my shift, unless the floor is absolutely DEAD. It's usually more like 5 or 6. Anyhow, your case, I suggest Poise pads, perhaps. And a lot of luck. Or avoiding hospital or long-term care nursing. Because, rare is the hospital or LTC nurse who has time every hour to go potty! Sorry to be a bearer of bad news.

[goodn]

IN MY experience, 4 hours to get to go pee, you're doing good. I never get time to pee the 1st 4 hours of my shift, unless the floor is absolutely DEAD. It's usually more like 5 or 6. Anyhow, your case, I suggest Poise pads, perhaps. And a lot of luck. Or avoiding hospital or long-term care nursing. Because, rare is the hospital or LTC nurse who has time every hour to go potty! Sorry to be a bearer of bad news.

No problem with pee. Might be time to say goodbye to my uterus though. Hysterectomy here I come!

[SmilingBluEyes]

bless your heart; I feel for you!

[Jayla]

I agree with everyone that says time management is crucial. My first preceptor was incredible at time management. I still use the hourly patient-grid that she introduced me to, and on it I write everything I need to do in my 12 hours, and add items as the day continues. I even write on it things like, "check charts" and "check lab results, vitals" etc. As a new nurse (I just graduated last spring) everything happening at once can be very overwhelming. Reminders of even the little things are helpful for me.

One thing that I wish would have been explained better during my orientation is who to call regarding a patient's needs. Now, I don't know what setting you're working in, but I work on med-surg floor in a teaching hospital. Sometimes it's hard to know which "team" a person is on, which resident to call, or whether I need to call the MOD (medical officer of the day), who is usually a PA, or just call the attending. I've been told by other nurses that it is just as confusing at other hospitals, but I'm not sure. Anyway, during orientation my preceptor was typically the one to figure that out, and now it's sometimes a struggle for me. I'm sure there's some rhyme or reason to it, but it's never been explained to me...

Good luck!

[CoffeeRTC, BSN, RN]

Assessment skills are so important. When I was in school I precepted in labor and delivery. It was a great experience but I didn't really work with sick people. When I started working in a surgical ICU I knew I really needed to work on assessment. I made a point of listening to lung sounds on every patient in the unit so I could learn to differentiate between different sounds. Just by spending a few moments talking with a patient you can see so many things- are they confused, SOB with activity or speaking, have they had a CVA and slur their words or have a facial droop. The advice about checking pumps and drips is great- I don't know how many times I've gone to assess a new patient and there is only 10cc left of a drip they're dependent on, or something has been labeled wrong. You always want to check for the things you may need- you don't want to be stuck if something happens- do you have suction, if your patient is on a monitor are all the alarms on, even if nothing is running through the IV can you flush it if you need it quickly. Skills like foleys and IV sticks will come with time (I'm still terrible at starting IV's) but having strong assessment skills and maintaining the safety of the patient are a great place to start.

Darn you said it before me! All the advice is great, but you need to actually LOOK at the patient and LISTEN to them. If they say "it feels like I'm having a heart attack" they just might. Too often we are focusing on our skills and the "numbers" but forgetting the patient. Just remember....it will come with time.

[Morguein]

I'm not sure what department you work in; but I would definitely focus on thoroughly and systematically (head-to-toe) assessing my patients. You'll get a real good picture of your patients this way and will be more than able to communicate your patient's needs to the docs who ask. And I'm with all those who have mentioned organization. That is SO important. I have my own sheet that I've printed up. It has each system (neuro, resp, CVS, GI, GU, Skin, lab values, etc..) and when I get report, I just circle or check off those that apply. For example, on my sheet for neuro, I have "gag, cough, corneals." And if they have positive gag, cough and corneals, i'll write a plus sign next to each one. Another example, under resp, i have "CT y/n right/left suction/drain level @" which means Chest tube yes/no right/left; and I circle those that apply, and i write down the current level the drainage is at. I find that having a circle/check/mark system helps speed up my report taking. Under my CVS (cardio vascular), I have "line placements." And this is where I write down where all their IV, PA (pulmonary artery), A lines (artery) lines are etc... On the back of my sheet, I printed up the hours I will be there with plenty of space under each one. This is where I write down all the meds to be given under those times. I also write down surgeries, CAT scan/MRI/Nuclear med travels, and anything that needs to be done under the correct time. I can take one look at this schedule and get a pretty good idea when I may have some extra time to go to lunch or give a bath etc... I hope this helps.

[PamUK]

Don't overlook the psychological side of nursing, which to my mind is the most important skill you will ever learn. Physical skills can take over when you are busy, but never forget to ask the patient how they are feeling inside their heads. Ask them about their family, their pet, their job even their hopes and aspirations if appropriate. Get them to talk about their illness... I don't mean during the asessment's, but when you are doing a dressing, starting an IV, that sort of time - they love it! Learn to connect with them and you'll get a wealth of information, that you probably wouldn't otherwise get. If they don't want to talk, you will get the message, but they wont forget that you asked.

You also have to learn that patients with a long term illness will know a lot more about their disease than you could ever hope to know... sometimes more than the doctors! But ask them about their illness when you have some spare time because they will keep you forever!

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