kiddo, i was scared to death, let me tell you. you have to roll up your sleeves and just dig in putting your emotions aside. half the battle, i think, is knowing that it is going to be a challenge.
one of the reasons i strongly urge new grads to get their first acute hospital jobs in facilities that have a new grad orientation program is because these facilities are aware that new grads are scared to death and don't have the experience to pick up the ball and run with it like an experienced nurse. these programs are designed to ease you into your new role. but, don't get me wrong, they are employers as well and expect new grads to put forth the effort to make the transition. you are only going to be given so much slack. this is where those with positive attitudes and willingness to dig in and hunker down will triumph over the slackers who questioned every assignment, hid behind doors when volunteers were asked for, were always sitting at the back of the class more interested in thier cell phones and kind of slid through nursing school by the seat of their pants and breathing a sigh of relief when they passed a class and had no clue as to how it happened.
regarding the calling of doctors and when to know to call, i have information on something called safe for this. safe is an acronym that stands for "situation-assessment-findings & figures-express & expect". if is a guideline for communicating with doctors. someone posted this on another thread and here is a good synopsis of how it works:
verify that the doctor know this patient. if not, provide a brief history.
what events prompted you to call, be specific
get directly to the point
if the situation is urgent, say so
what do you think the problem is?
state your primary concern
what is your assessment of the current situation, be specific
f- (findings & figures)
give findings specific to the problem (example: lung sounds, pain, level of consciousness, medications given)
give figures specific to the problem (example: vital signs, lab values, intake & output, infusion rates of ivs)
e- (express & expect)
express what you think the patient needs
request orders for tests, medications or treatments
ask the doctor to come see the patient if you think it is needed
clarify the doctor's plan of care if the orders you receive aren't clear or you feel they don't address the patient's need
there is another technique called sbar (situation-background-assessment-recommendation) which is probably more popular and well-known and very similar. the technique is owned and taught by a company who own this property. you can probably find information about it on allnurses by searching for "sbar".
as for knowing the side effects of medications, speaking for myself, i always worried about that and normal dosages. i used to carry my own drug handbook
to work with me, but after awhile it became a pain to lug it around and keep track of it. others started using it and i worried that it would grow legs and walk off. today if people have a palm pc that would help. many facilities provide drug information for their nurses in different formats: pdr, online computer resources or the in house pharmacy. with there being such a big focus by medicare and jcaho (my instructors now tell us that jcaho want to be referred to as "the joint commission" and not as "jayco" anymore) on medication errors and improvement of medication administration techniques, it is likely that the hospital you end up working in will have more than adequate drug resources available for you to use and will encourage you to use them. much of the time i ended up giving a drug after quickly ascertaining that the dose was not lethal and then checking on it after i got home from work.
you will be given a preceptor who you should develop a good relationship with so that even after your official orientation is over, you can go to this person with questions. there should be other nurses on the unit you will be working who you will also be able to ask questions of. when i was a supervisor i used to make sure that all the new grads knew who i was and that they could always page me if they had a question or needed help with something. supervisors, managers and charge nurses have a responsibility to help you new grads in making the kinds of decisions you are now concerned about. this is how you learn these things, through their guidance.
now, i'm a realist about the working world. if you make a mistake, catch it and if it hasn't harmed a patient, i say thank your lucky stars you were the one that caught it, silently beat yourself up, vow to never do it again and keep your mouth shut about it. however, if someone else catches you in a error, then, yes, you fess up to it immediately, grovel, kowtow and kiss feet, offer your back for a beating, promise to do better and hope to the great spirits that you aren't going to get written up for it. if you do get written up, take it like a (wo)man because there's nothing you can do about it and it's only red tape, beat the you-know-what out of yourself, and vow to never do it again. nothing will hurt you worse than getting caught lying and covering up for something you've done wrong when you've been confronted with it. that kind of negative character flaw will follow you longer than the actual error. you are going to make some mistakes. most of them will be errors due to inexperience rather than errors involving patient safety. we learn from these errors and hone our organizational skills. one thing i should also say about errors if people haven't already learned this. when you do make a mistake, analyze how it happened and correct your practice so you won't be likely to make the same faulty judgment that leads to the same error again and again.
i always kept organized by having a "report sheet" or what some people call a "brains". it is a piece of paper on which you write information about your assigned patients for the shift you are working. i took down information from the kardex, information i got from report, information i collected about the patients throughout the shift, and wrote notes on it about things i didn't want to forget. i gave my end of shift report from this sheet. i've made a number of them over the years for my own exclusive use. most places usually provide one for the nurses to use, but i never liked the ones provided, so i started developing my own. here is a copy of the last one i used when i was working:
i'm also attaching a file of a powerpoint presentation on how to precept. now, i know you are not going to be a preceptor any time soon, but i think it's important that all new grads know what the responsibilities and duties of a preceptor should be. some facilities don't clarify just what their preceptors should be doing for their new grads. here's a document that will let you in on that.
as for the process of getting organized, this is something that we each learn on our own and by watching and checking out how others do it. you will find that the way some nurses organize will work well for you while others won't. i found organizing to be pretty much a career long pursuit. there is always a better way to organize my time. it all starts by determining what your tasks are that you absolutely have to accomplish on your shift and by what time (deadline). write them down on a list and cross them off as you accomplish each task. these "todo" lists get more and more longer and complicated as you get more experienced and learn the little nuances of your job. eventually, you can keep the list in your head rather than write it down. here are a couple of websites with some good information on organizing your workday. there is also information on prioritizing as well.
when you are in orientation at your job, you will be instructed on a number of different things by the facility nurse educator. with new grads they often go over situations such as when to call a doctor, how to take verbal and telephone orders from physicians, handling code blues and when to call a code blue. they also will give you a lot of information about specific policies and procedures that nurses frequently encounter during their practice and they want you to be aware of and follow. i always carried a clip board that had copies of some policies on it so i could refer to them quickly when a situation requiring them came up. an example of two policies i carried around were the hypoglycemic policy for the insulin dependent diabetics and the policy for patients who got v-tach (on the telemetry unit). the nurse educator at the facility where you work will be another resource person that you can go to for answers or help. but, let me caution you that she has a different agenda than a nursing instructor. while she is there to help you learn, she also has a supervisory function and will be reporting your progress (or any non-progress) or problems you might be experiencing to your nurse manager. it's very important that you choose a place of employment where you, as a new grad, are going to be accepted and coddled as a newbie and brought along gently. i think you know what can happen when a few witches or two somehow get put in charge of new grads.
you can also post a question on allnurses, pm or e-mail any nurses you have made friends or contact with here on allnurses when you have questions or dilemmas you want to discuss. you'll have a few questions as a new working grad i am sure! don't throw any of your nursing textbooks or notes away. you'll be wanting to read back through them periodically with questions you'll be coming home from work with.
we've all been there. you're a strong person. you can do this.