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Just Transitioned to Hospital Nursing, Help!


Specializes in Medical/Surgical. Has 3 years experience.

Hello everyone, 

I have been a nurse for two years now. My first year and a half I worked with a pediatric home health company. I absolutely loved my job but to be honest I did not learn very much. I just transitioned to hospital nursing and work on the medical/surgical floor. I trained for 10, 12 hour shifts and I honestly still feel completely lost. I feel like I don't remember much from school and it is incredibly stressful for me. My coworkers are not very open to me asking questions and from the beginning have just thrown me into it. I explained to them that the previous job I had was completely different from hospital nursing but I feel that they think I am already an expert. Every time I have to go to work I am terrified and can't sleep much the night before. I am not sure what to do, I am so scared to make a mistake and don't want to keep asking questions. I can't afford to pay for a refresher course. What can I do? Are there any other resources I can look up to help better my skills as a med-surge nurse?

Thank you in advance!

Edited by Tiny_but_Mighty15

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 10 years experience.

What skills are you struggling with specifically?  If you know the basics of safe technique, then you just need practice. I am picturing things like Foley placement, drain management, IV placement, sterile dressing changes, wet to dry dressing changes, basic skin care/prevention of decubitus ulcers, etc. Review the steps for these techniques. Review them in your mind as you gather supplies. Go through them as you perform the skill. Then chart all of it. 

The number one thing to help manage anxiety as a new floor nurse is time management. I suggest you make sure you have a good brain sheet. Mine was a single piece of paper. I drew columns, one for each patient. I put the room number at the top. Down the left side of the sheet, I wrote out every hour for my shift, from 0700 to 1900 or 1900 - 0700 if you work nights. After getting report, look at your patient's chart. Starting with their MAR, write "Meds" at the times you have meds due for each patient for the entire shift. Usually its 0900, a few around 1100 - 1300, lots around 1600, maybe others scattered here and there. If you have labs due, write in the time for those (ie: Vancomycin trough). For diabetics, write in when their blood sugar check is due. If you have dressing changes, write those in. Put each thing at the time its due or, if not timed, when you want to perform it. Make note of your grace periods (the time you are considered "on schedule" for a med - usually 30 min to one hour before and after the time on the MAR) in your mind, as this will help you with scheduling your day. If you have general things, such as an MRI or procedure, put it at the bottom of their column in a general comments type box. 

Once you have done this for all of your patients, look over your day. You will see holes where nothing is due for anyone. Those are your charting times, times to review this brain sheet and times to make a new column for any admissions you get. Knowing you have these spaces will help quite a bit with the sense of franticness. 

Next, get to know your techs. Build a relationship with them and start delegating. Not delegating is the number one thing that will tank your shift next to basic time management. 

Always review your supplies before you go into a room to perform a task. Having to run in and out of rooms, especially if they are on any kind of precautions, is a HUGE time suck. It pays to take a moment and check that you have everything you need before you go in.

Research and practice ways to get out of the room quickly. Patients are lonely and love to talk, but we don't have time for a lot of that, particularly when you are a newer floor nurse. 

The first six months are incredibly difficult, anxiety producing and scary. It's important you spend your time off managing your mental and physical health. That's hard in the time of Covid, so get creative. If the nurses on your floor aren't helpful, find a mentor from among your peers from school or even your instructors that you can talk to. 

Hang in there. It definitely gets better. You have to give yourself time to adjust.