New Nurse Needs Help!

  1. I'm a new RN who is about to start my first job in about a week at a very large and very busy teaching hospital here in NYC. I'll be working on what appears to be an extremely busy 30 bed cardiac/tele unit that I was told is usually staffed with 4 RN's. So that makes for pt.:nurse ratios of 7:1 to 8:1.

    As you can imagine I'm very excited and also pretty nervous at the same time. Does anyone have any helpful advice on how to survive orientation or useful info that helped them during their orientation? Anyone willing to share their stories about how they dealt with the stress of being a new RN in their first jobs, what helped, what didn't, would be greatly appreciated!
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    About NYCRN2

    Joined: Aug '01; Posts: 12
    New Grad


  3. by   MollyJ
    Go onto the unit with a helpful and humble attitude. At the same time, give yourself credit for what you do know. This is a hard balance to strike. If you act like you know it all, they'll all wait for your first screw up. If you don't make one decision alone, people look at you like a millstone. Try to strike the balance. Do more listening than talking. Try your very best, but don't expect constant perfection of yourself.

    If you find a congenial new grad or two or three that you can be friends with, this is great. I had many of my classmates around me as a new grad since I worked in the hospital I studied in and it was invaluable personal support. If not, keep in contact with nursing school buddies for support. With a little luck you will have a GREAT assigned or natural mentor. Again, we had lots of natural mentors among us, but I think this is more of a rarity than it used to be. Help others, including your aide, LPN, when you can so that they might help you when they can. Give your aide LPN good feed back when they let you know helpful observations (high, low bp's, low or high urine op's, etc). This helps for when they DON"T tell you things you needed to know.

    Have a plan of attack for organization but don't be surprised if events conspire to change it. Mine was report (who is your high priority patient?), review charts quickly for new orders, progress notes, and get med admin times and tx's on cheat sheet. See my highest priority patients first (i did this as I reviewed charts, MARs, TX's). Do assessments on highest priorities patients and then the rest. start meds. (I usually was a 3-11 person). The shift you work will change this. Sometimes, I just flew through the charts to get med admin and tx's times down but if you are getting a new admit or come onto an unstable patient, you see your highest priority patients first. When the exceptions happen, you may assess patients when you give them their 6 o'clock meds. (We all hate that, but you've got to let your priorities drive your time allotment). You will soon get a sense of typical med admin times on your unit. Where I worked we tried very hard not to schedule meds (expect for antiobiotics if indicated) at 4 pm or even 5 pm, but you were sure to have a boatload of 6 pm's. You get a sense of the rhythm of the unit, even to when the trays come, but __it just takes time___.

    I hate to say this, but expect to go home drained at first. It's just so new and it seems like every decision you make is so big, but over time, you start to see some decisions that are like decisions you made before, so you don't feel so blind sided by them.

    Good luck. Be patient with yourself. Time improves things and nothing can remove first day jitters. It just means you realize how important the job is and you care about it.
  4. by   sharann
    Hi NYC,

    First of all, congrats on graduating and passing boards. I was in the same sort of situation when I first started just over a year and some months ago. A 30 bed tele unit is an exciting place to work. The ratios however are not so exciting. Are you working nights? If so, then 7 patients should be your MAX. I hesitated to even respond to you because I don't want to be negative or scare you, but I will be honest. Cardiac/Tele should not have more than 4:1 or at most 5:1 patient/nurse ratios. Not only are these patients critical enough to require specialized MONITORED care, they can go sour quickly and without warning. The pace can be frantic at times. It is also fun at times too. If you have a good staff, and a low turnover you are probably going to be fine. The main thing is forgetting about what they said in school. If your 9am meds are given by noon, you are having a good day. If you feel your load is too high, you have a right to refuse to take report if you feel it is unsafe. You may lose your job but you will keep your licsence. I had to leave my unit sadly because it was taking a big toll on my well-being, but I miss it terribly because there is almost no other area (besides maybe ER/ICU) that you will learn so much in a short time. This experience will help you grow much as a nurse if you don't let it get to you when you go home. We are human and only can do 16 things at a time!
    Good luck.
  5. by   misti_z
    ask, ask, ask. watch, watch, watch. :d

    ask them why there doing this..... learn the tricks of the trade if they won't get you in trouble!!!
    ask your patients, some of those with chronic illness now a lot about whats going on, you can learn from them!
    watch as much as you can - bedside procedures. when i first started there was a code on my floor but in a different unit i wasn't busy so i went and watched.

    good luck
  6. by   frustratedRN
    great advice. i watch everything. i volunteer to do procedures that are not familiar to me or that i need practice with. for example, inserting ng tubes. if there is a code anywhere on my floor and i am able, i watch it carefully.
    i ask questions constantly. its important to learn who to ask tho. some nurses are really put out by questions. they are not your preceptor and resent having to answer them. at least thats the case where i work. i have found some very helpful nurses who give me great answers to my questions.

    the best advice was the being humble yet holding on to what you know at the same time. that is the hardest part for me. if you act too humbly they think you know nothing. if you act like you know something you are accused of being a "know it all"