I’m a new grad in medsurg and I’m struggling

Editorial Team / Admin · Apr 20, 2020

Moved to First Year After Licensure forum.

brownbook · Apr 20, 2020

As a new grad you cannot be expected to read all the clinical notes, study"and see the "big picture" on every patient you have.

Get a basic organized routine, via a brain sheet, and stick to it. Put "brain sheet" into Allnurses search box.

Find a routine, a brain sheet, that works for you. You will get better and faster. THEN after you get a good routing down, you'll have time to "study" and read clinical notes on more complex cases.

Focus on basic safety you KNOW from nursing school. A diabetic's glucose/finger stick before insulin, a patients baseline blood pressure before routine antihypertensives, a patient's level of consciousness before pain meds, pertinent allergies.

Editorial Team / Admin · Apr 20, 2020

Disclaimer: not a med/surg nurse. Procedural/surgical.

I do not read every single note on my patient. Epic has a quick summary that lists current active problem list as well as the general problem list. I worry about H&P, most recent labs, and most recent progress note. Reading every note is simply not realistic, especially on these patients who have been admitted for weeks or even months. You need a quick way to see what is relevant to the patient's care for your shift. As recommended above, find a brain sheet. Speed will come with experience- and it's going to take you at least a year to feel comfortable as a nurse.

buckchaser10 · Apr 21, 2020

Who do you have on your rounds? MD's should know their patient either from taking care of them the previous days or through doctor to doctor report. In a normal round setting you would just need to provide anything the night nurse deemed important (from report) and your observations so far today. If you are getting assessments done then you should be able to speak about your patients in rounds. I think we as nurses are often too much of perfectionists so we think we need to know everything. The point of rounds is to bring the team together and formulate a plan based on everyone's knowledge, not just quiz the nurse.

All this being said, I'm describing ideal rounds. Your hospital may be practicing it's own variant.

Rosini · Apr 21, 2020

Our rounds consist of case management and the hospitalists. We are expected To provide who all is following the patient, whether or not they have signed off on the patient, and whether or not the plan is to discharge that day. If so, what are they waiting on (placement, home health, equipment, etc...). I know what I am supposed to know going in, but for the life of me I cannot get a hold of my morning enough to get the meds passed, assessments, and gather that info on 5 patients. I also can’t come in early right now because they closed our unit so my last 3 weeks of orientation have been floating. I don’t even know where I’ll be that day until huddle. That part I understand is part of the pandemic and won’t be the norm, but right now that’s my norm.

buckchaser10 · Apr 21, 2020

Yeah so case management should know the bulk of that info. You should only have to provide pertinent info from your assessment. Their job is literally managing the patient for discharge. Social services and case management should be managing discharge needs. Hospitalists are the ones that determine discharge, not the RN. I've worked with flaky hospitalists who rely on the nurse to determine discharge. This is sketchy and setting people up for a lawsuit.

Time management comes with repetition. Some day you'll look back and laugh at what used to fluster you. As far as coming early, don't be someone who comes in early to learn your patients off the clock. Management will love you but you are a trained professional and your time is worth something. All work should be done on the clock.

Have you spoke with other nurses to see if they are having similar issues with these rounds?

Rosini · Apr 21, 2020

First, thank you so much for taking the time to reply. I have talked with other nurses in my unit, but they all keep telling me ‘some people just can’t handle it, you need to learn to see the big picture’. But then I talk to nurses outside of my hospital and they respond much the same as you just have. But here I sit in this unit. I suck it up, put on my big girl britches, and go in every day. But I’m miserable and each day instead of feeling better, I am seeing more and more just how much I am responsible for. Am I being childish or dramatic? I don’t know. I know I am scared a lot. I know that I feel pressured to compromise care for reading through notes and so I figured I would come in here and seek counsel.

Again thank you for your time. If anything, I feel less alone and more like just maybe this isn’t all about my lacking.

Adedoyin07, BSN, RN · May 13, 2020

We’re in the same boat hun! Just take it one day at a time. I started last October as NOC RN, sometimes I ask myself if this is actually what I wanna do, and sometimes I smile all the way home feeling fulfilled! I heard 1st year transitioning from SN to RN is mostly hard but we’ll get there little by little and become better. Key for me is effective time management! As soon as you get report, do quick assessment focusing on why they’re here and do your meds, then check clinical notes and the rest. ALWAYS MAKE USE OF STICKY NOTES for important things! Good luck hun

Career Columnist / Author · May 31, 2020

Consider journaling, brief notes at the end of each day. What went well, what did not, where did things spiral out of control? What could you have done differently?

There's benefit in reflecting on your practice and looking back to see your progress. Best wishes!