New to med/surg

[dallet66]

I need some advice. I just got hired on to a med/surg ward and start orientation next month. I am not a new grad. I've been a nurse 5 1/2 years. For the first 3 1/2 years I worked in skilled nursing. For anyone who's actually worked it, it's hard work with a wide variety of patients and tasks. However, it is also nursing after they've been released from the hospital, so they are not longer acute (hopefully). I normally had 18-22 patients and was used to not sitting down one single time the whole shift. We had occasional peripheral iv's short term, but most were picc lines, occasionally ports.

For that last 2 years i've worked in an urgent care clinic. This gave me even more skills that you don't do in skilled nursing (splinting, quick iv's, blood draws and sample collection, completely different types of meds etc) and triaging patients quickly to decide if they need to be seen quickly or if they can wait. Naturally there's lots of skills I'm not mentioning.

So, I'm starting med/surg. There is a huge amount I have not done as a nurse yet, I readily admit that. I have no experience with chest tubes, ng tubes, blood administration, tpn administration, accessing a port, and what feels like a million other things which I learned in school but have not done in practice. I don't want to feel like a total loser when I start since people might expect me to have done these things already. So, my question is, what do you guys recommend I review in the next few weeks? I feel like I need to review everything, which is overwhelming and no time for that much. I have access to online learning modules. Please help!

[RegularNurse]

Insulin and pressure ulcer staging

[dallet66]

Yea those are both things I'm extremely familiar with from skilled nursing. We had tons of diabetics at the facility and pressure ulcers, skin care and skin assessment also done daily. We did not have a wound care nurse so all dressings and wound care was done by us, including wound vac changed. Any other thoughts related to med/surg hospital unit?

[adventure_rn, MSN, NP]

My guess is that between the SNF and urgent care, you're probably pretty well-prepared. I'd ask your preceptor what diagnoses, meds, and skills are common on the unit, then brush up once you start. Even within med-surg, your unit may have a focus (i.e. cardiac medical, GI surgical, ortho surgical, etc.); I'm guessing that if specific nursing tasks are frequently ordered on the unit, you'll pick them up during orientation. I'd always recommend thoroughly reading through your unit policy before performing a task that you don't do very often, and know when to ask for help or clarification.

Best of luck!

[caffeinatednurse, BSN, RN]

Do as much as you can while you're on orientation. Ask other nurses to let you know if blood transfusions, TPNs, etc. pop up during their shift. Not only will you be getting experience with these skills during your orientation, but you'll be helping out your fellow nurses since some of those tasks can be really time-consuming. Even when you're off orientation, always grab another nurse for back-up if you're not comfortable doing something by yourself or you just want a second set of eyes. Otherwise, try not to worry too much about it. Skills are easily re-learned, even if the last time you saw something done was in nursing school. Look up anything you have questions about. Get to know your policy and procedure handbook. And speak up if you have any questions. You have a great skill base already.