What is your best tips for new grads starting on med-surg - page 2

am starting on the unit next week. It is a post op surgical care unit. I will admit I am NERVOUS probably a little too nervous. This particular unit has lost quite a bit of nurses recently and now... Read More

  1. by   nurse824
    Hi Tonya, I have been nursing for over 20 years, the majority being med-surg! The only advice I can give you is to be your normal friendly self. Nurses young and old will fall over backwards to answer your questions and alleviate any anxieties. I think everyone remembers what is was like to tread water and before you know it, you'll be swimming like the rest of us!
  2. by   Faby
    Hi Tonya: Congratulations. With all those tips you'll be fine.
    Don' forget to ASK EVERYTHING you don't understand or know. Don't be afraid of asking questions, it's better than making mistakes.
    You have to feel yourself secure. Be accurate in your observations as well as in your writings. Give priority to unstable patients or sitiuations. Care for them first. Allways OBSERVE everything, you'll become an experienced observer soon, so to detect abnormalities and correct them. I'm not kidding about this, you'll use observation everywhere and at any time.
    Good Luck
  3. by   RNKPCE
    One piece of advice an instructor gave me was ..... don't put off doing something now as you never know if you will have time at the end of the shift. I remember that when I know I have to do certain things like change a dressing sometime during my shift, if I have time to do it,,,,,,,,, get it done.

    Also have some sort of sheet to keep track of what you have to do when. I have used this one sheet. I will describe it to you.

    It looks kind of like a spreadsheet. I have the room numbers of the pateints going vertically down the side and across the top the hours of my shift ie 7a,8a,9a, etc. Then I put check marks the box that corresponds with times meds are do for that particular patient. Or I will write FS for fingerstick under the 8a slot for room 212b. Before I go out of report I will have an idea of what the busiest time of my shift my be. If I see lots of checks in the 8a hour I know I will be real busy then.

    It might be hard to visualize but it works. Or find something that works for you. Shadow someone who has a reputation for being organized on the unit you will be working out, that is a great way to get tips.

    Good luck in your new job!
  4. by   MandyInMS
    Great tips so far on time management
    Make sure you get a proper orientation period also..best of luck to ya
  5. by   WhiteCaps
    When you hired in, did they explain the orientation program?
    I would recommend working where they have a good preceptorship program. They want you to succeed as much as you do, and a good orientation will help you. Give your best and learn from their best.
  6. by   EastCoast
    Hi, good advice i'm sure most of wish we had starting out. I wish i knew half of this when i started.
    Here's my input.

    Find a mentor. This would be a 'good nurse'. You will know her when you see / meet her. Or find someone who reminds you of a professor/nurse you have admired. Follow her good examples. Use her to help you be successful.

    Find a buddy on your shift. It's just nice to have a friend/collegue who can sympathize over a bad nite.

    Report for work 15 minutes early, take a few minutes to 'settle' into the mood of the unit and look at the kardex. Or get a juice and gather your pens/etc . Be ready for report. Don't be a 5 after the hour slacker. Even if your relief comes in late it doesn't mean you should.

    If your off going nurse gives you report and it sounds like a mini disaster...ask if she would go down to the room with you to explain things or better yet do a 5 minute walk round prior to getting report.

    Know your patients...even a little. Nothing sounds more ridiculous when 4 hours after your shift starts you know nothing about your patients when someone asks.

    Most important and usually overlooked : Maintain an Intake and OUtput. Make sure that when the doc asks you if the pt. is peeing you can respond with a reasonably true answer. The IV fluid the patient gets in the OR/PACU needs to be figured in to your I/O. Record it (even if the other shift didn't)

    Worry if your post op isn't peeing. No urine output requires attention.

    Keep your patients room the way you would like it to be if it was yours. There is no need to keep the angel food cake from yesterday or the 8am apple juice. When you give your first set of meds take a peek and throw out unnecessary. Do the same when you do your last set of meds.

    Ask the patient on last rounds if they are all set.

    Ask your coworkers if they need help when you are not busy.

    If you are a smoker...respect the non-smokers who might not leave the floor for break. (i can say this having been a smoker). It is truly annoying when someone is 'going for a butt' several times in a shift.

    Be nice to families.
    Don't make ill calls you M.O.
    If you hate your job....find a place you will be happy.

    Good Luck.
  7. by   barefootlady
    Tonya, all the above suggestions are great. Watch what the experienced nurses on the unit do and how they manage their time. Ask them for tips, but remember, everyone works at a different pace. I always checked on the patients who were scheduled for early procedures, made sure they were ready and the most critical patients before doing meds. I wanted to know their status first. I always tried to take the few extra minutes to see each of my patients before I really started my day, seemed like they appreciated knowing who their nurse for the day was and that I was going to be bringing the meds soon. This was a good way for me to do a quick eval and maybe pick up on a potential problem overlooked by the reporting nurse. A clip board with handy notes and phone numbers covered with plastic or clear tape is a life saver. Especially your sliding scale insulin protocol, H&H, and INR values. Experience is the best of all teachers and you will soon learn what works best for you. I hope you enjoy the new position and will let us know how you are doing. Good Luch.
  8. by   jansgalRN
    If you aren't comfortable with something, speak up. Only you can determine this. Having been a nurse for over 6 years (floated all over for 3), I can honestly say that things didn't start to come together for at least 6 months. After about a year or so I remember thinking, "Oh, so that's why I learned this". It just kind of clicks at some point. Remember this: None of us were exposed to everything or much at all during clinicals. Confidence will help earn the respect of seasoned nurses who can teach you more than you can learn in a book. Think about it this way, usually lessons do not come easily, take advantage of someone else's. Also, people who aren't afraid to admit that they need help or don't know something use confidence just in asking! Best of luck to you and all new grads and future nurses! We all need you and are glad to have you on board!
  9. by   EMcDLPN
    congrats! every thing i have read so far is great advice. from my point of view know your meds inside and out. take into consideration every aspect... crush vs dont crush! that may seem minor but the number of times a patient is on an extended release pill and is supposed to have pills crushed is high. make sure the physicians comunicate with each other. too many times one md will put pt on a cardiac med, and one hour later another md puts them on the same med but different name.last but not least do not be afraid to ask questions!!! good luck
  10. by   poki
    Get your own routine for your shift and try it for a couple of days if it doesn't work well then go for another way to do your things on a timely manner..keep it up. I've an RN for less than 2 years and still trying to set up my routine.. Always carry your book and always ASK. Make sure you take care of YOUR pt's first. Don't hesitate to ask for help when in a hurry or PRN. Good luck!
  11. by   jnette
    Great tips here. As you know, I, too, will be starting med/surge soon... start orientation for PRN in two weeks.

    Everyone says "don't be afraid to ask" and I agree wholeheartedly with that ! HOWEVER.... does this get on the other nurses' nerves? There's that part of me, of course, that doesn't want to bother the others, as I know how overloaded everyone is already... but I can't afford to make mistakes, either !

    Hard place to be in for awhile, y'know? I'd rather be safe than sorry... but I hate to be a pest, too !
  12. by   RN-PA
    Originally posted by jnette
    Great tips here. As you know, I, too, will be starting med/surge soon... start orientation for PRN in two weeks.

    Everyone says "don't be afraid to ask" and I agree wholeheartedly with that ! HOWEVER.... does this get on the other nurses' nerves? There's that part of me, of course, that doesn't want to bother the others, as I know how overloaded everyone is already... but I can't afford to make mistakes, either !

    Hard place to be in for awhile, y'know? I'd rather be safe than sorry... but I hate to be a pest, too !
    I had a REALLY rough time starting my career due, in part, to a lousy orientation among other things. I also lacked self-confidence and had a LOT of questions. I found which nurses I could ask without fear of repercussions (snide remarks, talking behind my back, etc.) and was careful to not ask a question if the nurse was especially harried or upset with her own patient load. If I was struggling with a number of problems, I would vary which nurse I'd ask-- Take turns with asking different nurses. Also, I would first try my best to find out the answer on my own (look up meds, go to the hospital's policy and procedure book, speak to someone in the Lab or Pharmacy). I KNOW I must've been a pest at times, but I always was looking out for my patients, and that kept me asking questions. Better safe than sorry! Consequently, I am MORE than happy to answer questions, even if I'm having a rough night. I remember all too well how it felt to have questions and doubts. HECK-- I still DO!

    I can't add much to the great advice already given on this thread-- All the best to anyone starting out in Med/Surg!
    Last edit by RN-PA on Oct 2, '03
  13. by   inna
    *I try to finish my pt's charting after I gave them their early meds and did my assessment. I found that when I'm done with my notes per pt. I'm more relaxed and able to carry out new orders.
    *Always jot down on my handy paper all the things I need to follow/check re:that pt. That way I won't be forgetting or missing something esp. missing meds, I&O's, dressing changes, critical V/S, calling MDs etc... And it's a lot easier when giving a report to the next shift.
    *I would let everyone know that I'm a new grad so that they could extend their patience on me whenever I keep on asking.
    *Be familiarized with the Md's faces so that when they're around I could ask them right away and check their orders and clarify their handwritings while they're still around.. that way I save my time calling them.

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