First RN job

[newstudentn09]

I just accepted an RN job on a neuro floor where I currently work, although not in patient care. I had been applying since mid April and after roughly applying for 70 jobs I got my first interview. I was incredibly nervous for the interview and while I don't believe that I answered the questions as good as I could have if I hadn't been as nervous, I was offered the postion. To say I was surprised is an understatement. The hospital I work for is a teaching hospital and is stroke certified. I'm very excited but terrified at the same time. From what I was told, the patient ratio is 1:4/1:5 and the orientation time is 6-8 weeks. I've heard very good things about this unit and have been told that the preceptors love to teach and their turnover is low. I never had neuro experience in clinicals so don't know what to expect. The patient population as well as the specifics of the unit were went over in the interview but due to my nerves, I don't remember all of it. From what I do remember, the patient population consists mainly of stroke patients, spinal surgery, seizure monitoring and head trauma/injuries that are not critical enough for the medical ICU. I think I'll be able to learn a lot on this unit and like that I will also get cardiac experience as many of the patients are telemetry. I'm curious though as to what are the most common skills used for this type of unit? For those of you familiar with this setting, does 6-8 weeks of orientation seem appropriate for a grad nurse? They do have a new grad orientation I will complete but I'm not sure what all that involves. Any tips, advice or other words is very appreciated! And good luck to all those new grads!

[xtxrn, ASN, RN]

My first hospital job was on a neuro floor....

Blown pupils are a late sign-- trust your gut if you see any changes in behavior, orientation, or agitation....everybody always talks about the pupils... find out from your preceptor what the general preferences are for the docs about when they want to be notified about suspected ICP changes.

Seizure patients don't always have incontinence, loss of consciousness (even with temporal lobe- it can be a partial loss- depends on where the focus is). I've heard nurses call patients fakes because they didn't pee.... don't use that as a measuring stick. Some simple partial seizures are just little twitches, a funky smell, or hearing changes.

If a patient has compromised LOC, have suction set up and ready to go... better to waste a suction catheter/Yank than deal with aspiration.

If someone comes in with new TIAs or a possible CVA, be sure to check that Speech (or whoever) does their swallow study before giving them anything to drink/eat... patients can't always feel changes. Note drooling (as well as the good old facial droop- but that's not a sure indicator).

Decadron IV can cause genital heat sensation that freaks patients out, and they don't want to tell you, but will get a weird look on their face (I'd warn them ahead of time that it's a possibility, and isn't anything to worry about). Decadron can also cause hiccups (to the point of pain)... not sure if they still use a very low dose Thorazine, but it used to work wonders.

So much more-- soak up all you can from the preceptors-- ask all sorts of questions. Check out any neuro reference books for nurses...online sources are good.

Just be open, and ask questions :) It's a hard floor, but can be a great place to work. I loved neuro, though a year or two of general med-surg would be good- don't forget the lungs, heart, kidneys, skin, etc just because you're specializing- it's easy to do when you're new....plan on feeling a bit dumb now and then- it's normal :)