Help, I'm getting worried to be oriented at ortho floor

Cattitude · Nov 23, 2008

Oh don't be scared! I worked on an ortho/neuro floor as a brand new RN and it was a great experience. You will learn so much and it does take a while but you;ll be fine. The best advice I got? If at the end of your shift, all the patients are breathing its a good day

AprilCNA · Nov 23, 2008

Definately don't be worried! I see a lot of new grads and new RN's who have never worked on the floor and do just fine :) Go into it with an open mind and know that you will see and learn a lot of new things :) I was scared at first as a CNA , granted we don't have as much work to do with meds,charting etc, but once I got used to the floor I grown to love it and plan on staying when done with nursing school. Good luck and I believe you will enjoy it :)

rngreenhorn · Nov 23, 2008

RUN!!!!!!!!!! You'll see more broken hips than a person should be allowed... Ortho is my least favorite place on earth.

But-- don't let that scare you. It's a good place to learn... good luck.

suzy253, RN · Nov 23, 2008

I'm sure you'll do fine. You'll just learn as you go. Good luck.

oramar · Nov 23, 2008

I happen to think ortho is a very fine place to start.

anneles · Nov 23, 2008

Thanks for those who replied. I really appreciate it. I know it's normal to be scared in discovering and doing new things but, just like what all of you said, I'll be ok and I'll learn a lot.

I'll update all of you about how I'm dOIng on thE floor.

thanks again. If you have more words of encouragement, I will be very happy.:redbeathe

Roy Fokker, BSN, RN · Nov 23, 2008

Hey there! :)

I started out on an ortho floor. Very busy, very difficult... but also quite rewarding. Here's what I learned:

* A good chunk of your patients will be elderly. Elderly means more co-morbidities. If you are scheduled to work nights, you'll eventually become intimate with (and come to detest) "Sundowner's Syndrome".

* Frequent assessments are crucial - especially on your post-op patients (of whom you'll see many). Quick checkpoints? Heart and lung sounds, vital signs (pay special attention to heart rate, respiratory rate and blood pressure), pulse and neuro checks, mental status, bowel sounds, urine out put and pain level.

* Speaking of respiratory rate - don't get into the bad (and unethical habit) of "guesstimating respiratory rate". In your job you'll be giving a LOT of narcotics and they tend to suppress respiratory drive. Believe me, it's better to spend an extra 30 seconds to count the rate than to code a patient.

* General rule of thumb: If their pressure, neuro/vascular checks and urine output are ok, that's half the battle won.

* Mobility/activity/exercise is a HUGE issue. Yes, you'll have PT and OT to assist you but as a nurse never shy away from encouraging patients to walk, ambulate or just plain move as much as then can. Don't worry about being perceived as a "mean nurse" - your patients will thank you later when they leave the hospital earlier without complications like pneumonia etc. Remember, you're there to heal them; not coddle them. Just be sure you adequately medicate them for pain before activities.

* Neruo-vascular checks. You can't be an ortho nurse until you have this down COLD. Period. You just need to see a victim of compartment syndrome to understand why...

* The incentive spirometer. Strive to be the incentive spirometer nazi of your floor. If the patient says "but I just did it 30 minutes ago"... doesn't matter! Can't hurt doing it again. Make sure they do it correctly - slow and steady. If they do it really well, it'll make them cough too - which is also a good thing

* Advocate for your patient's pain control. If you don't think it's being controlled well enough, speak to the surgeon or the medical doctor on call. Conversely, if you think that the pain medication prescribed is doing more harm than good, DO convey that to the docs. Never shy away from advocating for your patient. For that matter, do pass along anything you think needs to be passed along (e.g.: "patient has been feeling pretty depressed and stressed out the past couple days. Can we do something to help? Consult? Medication? Anything?")

* You will learn pretty soon that surgeons in general do not want to be bothered with "medical" issues of the patient (e.g.: blood sugar). Pain control depends - some surgeons manage it for their patients but more often than not, anesthesiologists will be consulted for pts. with PCAs/Epidurals/Blocks. This is important because when you have to call some one to address a problem, you need to call the right person. Try to make sure you pick this up during orientation.

* Speaking of "calling someone" - unless it was an urgent issue; I usually asked the other nurses on the floor if they wanted to speak to the on call physician/surgeon as well. And before I called the Doc, I had the latest lab results and vital signs on hand. Trust me, this helps.

* Don't ever be afraid of "questioning an order". I once had an anesthesiologist order over the telephone "Dilaudid 6 mg IV push. Repeat dose in 15 minutes" ... on an 88 year old lady weighing all of 120 lbs with a pressure of 110/60. I repeated the order three times but each time he insisted the order was correct. Needless to say, I didn't carry out that order.

While you may not face such a dramatic example as mine, don't let it stop you from asking for clarification or questioning doc's orders. For example: A simple "You want to give 40 mg of Lasix IV between the units of blood? Can I ask why/Could you please explain why?" often does the trick.

* Be aware of your patient's lab work. Some of the common ones you'll watch for are: "H & H" (Hemoglobin and Hematocrit - relates to blood count. Too low and you'll be transfusing blood), PT/INR/PTT/Platelet count (relate to blood coagulation), WBC (White count - relates to infection), BUN/Creatinine (relates to kidney function and fluid balance), Na/K levels (electrolyte and fluid balance). Be aware that many drugs are nephrotoxic and need to be dosed based on pt's renal function (for example: Lovenox is more renal dependent than Heparin).

Don't be scared. Approach your job with confidence :) Your floor mates are just 'testing you'. They are wondering if you have what it takes....

... GO GET 'EM!

cheers,

debi49 · Nov 23, 2008

You'll be fine! Ortho will be a good place to start. and you'll have oreintation, a preceptor etc. Dont waste another moment fretting!You got a job! Yeah!

Southern Fried RN · Nov 23, 2008

Excellent advice Roy!!! Ortho is one of my least favorite areas, I still feel a little iffy on it, but you summarized the main points very well!

One thing I have noticed about dealing with ortho patients in PACU is a large amount of them seem to have HIGH narcotic tolerances. Some of them just come out screaming in pain and loads of IV morphine (and sometimes Dilaudid) does nothing. I guess it comes from taking Lortab and Percocet for years before having that knee/hip replacement. Some people have gotten downright nasty with me in PACU over pain issues. Luckily they actually leave in an hour or two and the surgeons start them on Oxycontin and IM Dilaudid. From what the ortho floor nurses tell me it is a downside to the floor, there are some patients who cannot be satisfied with pain control unless they are unconscious!

:twocents:

Good luck!!

NICU_nurse2b · Nov 24, 2008

My first job is in ortho. I've been out of orientation since June. Ortho was not my first choice, it was actually the last thing I wanted to do. It has grown on me and I couldn't imagine starting out any where else.

Excellent post Roy!! I wish I had that info when I first started.

After nursing school, I wanted to go into Psych. I was shocked of how many Psych issues I have delt with in my short time on the floor. Sundowners, narc dependency (big time in ortho ,esp. back pts), alcohol withdrawl and delerium. When I started, I heard, "we don't have many codes in ortho". First day on floor orientation, I had a code. Had another code a few weeks ago and have had several rapid responses with the pts going to ICU.(these usually happens right at shift change for some reason, not a good way to start off your shift!) But I really love it. It is great to see a pt who could hardly walk before surgery and see them improve so much in just a few days. Enjoy your first job and remember you will not be Super Nurse right off the bat. It took me awhile to learn that!

Dinsey · Nov 24, 2008

I'm actually two months into my first nursing job - on an ortho unit. I have a few shifts left of orientation. Ortho - especially adults - was NOT my first choice either, but there weren't many options when I was looking for jobs. But our unit also gets med/surg patients, so there's a nice mixture.

It does seem repetitive at times - hips, tib-fib fractures, knee replacements, various arm fractures, etc. We're a Level I Trauma and a county hospital, so we get a lot of people with multiple and complex traumas (MVAs, etc) as well as elective procedures.

I can say that I'm learning a lot. I feel my assessment skills improving every day, I'm learning a lot about pain control, and other "basics" of nursing - promoting tissue perfusion, preventing infection, ambulating, dealing with psych issues (especially the folks we get from trauma) and families.

I won't stay here forever, but I do appreciate what I'm learning and I don't regret it at all. Roy's notes are spot-on!

Good luck. You will do just fine.