Job Orientation

Contrary to what many people have told me, which is, "Forget everything you learned in school. This is the real world!", you do indeed use what you learned in school every day.

Maybe you are having a block of sorts thinking that nothing you learned in school is useful, just because you didn't get a lot of time with nursing tasks?

Let's start with your first question: "How/when to assess?"

Assessment techniques in school are exactly how they are in the real world. You assess every system formally at the start of shift, and you are re-assessing every time you walk in the room. Your re-assessment is called a "focused assessment," and it's based on what the patient tells you and what you see even if the patient is saying everything is ok. Relate what you see/hear to the reason for admission and with co-morbidities, patho-wise.

Everyone telling you different things...

Yes, it can be very frustrating to have different preceptors telling you different things when you're a newbie. I ran into the same problem, and, as time went on, I spent a lot of time with the policy and procedure manual. (That helps a LOT!)

I also learned to recognize between differences in nurses' technique (neither right nor wrong), and I was eventually able to choose the technique that worked for me. My organization right now is based on a little bit of this nurse's way of doing things and a little bit of that nurse's way of doing things, and I am still tweaking as I go along.

It is soooo overwhelming at first. Literally everything seems new. The simplest of nursing tasks can make you anxious, like hanging IVs and IV pushes, as you stated. You will be surprised how quickly you no long focus on the steps in the task per se, and you're focusing more on why you are pushing that med or hanging that IV and, by reassessing the patient, you are better able to evaluate whether or not it is working.

And the paperwork. Oh my! It seems like a new piece of paper is being thrown at you every minute, and you can't see how it all fits. Eventually, you will know not only how to complete the paperwork, but when a new procedure is scheduled or someone is moved/transferred/coding, you will know which ones need to be completed.

There is a LOT that experienced nurses don't come out and say because it's almost too natural for them to be able to break it down and explain it. A lot of it is on you to be able to put it all together. I know that sounds frustrating, but you have to do it that way.

Hang in there. Just give it time. I look back on the past four months, and I am amazed at how far I've come...and how far I still have to go.