I start my first job soon!

GSDlvrRN, MSN · Jul 10, 2019

I have worked in a CT surgery unit for a year and a half. We get patients post op day 2 most of the time. (Not a CVICU). Are you talking about an ICU setting with fresh open heart patients? Or more of a tele unit after they come out of ICU?

There is a lot that I just could not possibly go over. You should (hopefully) get a binder or something to help you through orientation. You should be supported by an educator and/or preceptor to help you learn and perform well enough to work on your own. You should also be required to attend education classes for various things including chest tube management, EKG reading, 12 lead interpretation, drips, heart failure, sepsis, IV pumps, and so much more. You can’t learn everything before you hit the floor. Appreciate the orientation process and take charge of your own learning. You will learn what you are expected to know AND APPLY.

I don’t encourage book studying because I’ve met nurses who can recite the book but are useless on the floor. It doesn’t matter what you know, but you have to understand it and apply it.

DO NOT memorize things by the book, or how you did in nursing school. In real life you can have a heart failure or pulmonary hypertension patient with BP 90/60 and it could be a very good pressure for them, and no you will probably not be giving a 1000 mL NS bolus to make the blood pressure numbers look better. You can have a patient with pericardial effusion needing lasix and you will not hold it for BP 99/56, because you’re scared of the “low” BP, they need the lasix to take off the fluid and the BP is low because they have an effusion. You will also have valve replacement patients with thin blood, but not thin enough, INR of 2.7 , and you will not be afraid to give them their Coumadin, and you will not hold it because the INR is flagged in the chart as high. This INR is good for the patient and the docs may want it at 3.0 or 3.5, depending on the patient. You can have a patient sating 95% on room air and you will not put them on 1L oxygen for the sake of getting them up to 100%. You will also have a COPD patient sating 90% and you will not put them on 2L to get them to 100%.

Basically, think about what you’re doing, don’t just think about the numbers! The patients will not leave the hospital with all their labs in normal range, and it is not appropriate to correct all of them according to all the lab values you memorized in nursing school.

Also don’t get ahead of yourself. Appreciate the orientation process and your first year of nursing in a new grad nurse position. It is okay to be new and make mistakes. It is okay to not be “as good” as the experienced nurses. It is actually better to be cautious and not over confident and pompous. I’ve learned the over confident and pompous new grads are actually the most unsure and scared, it’s a way they try to show people that they know what they’re doing. It’s okay to not know what you’re doing, but it is not okay to go on not knowing and do nothing about it.

And read your policies. Experienced nurses can teach you how “they do things” and it can be totally reckless and they can think people who write policies have no idea what they’re talking about. Policies will protect you and they are worth the hassle everyone makes them to be.