need advice on getting big picture

Nurses New Nurse

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Not sure if I should post here or general nursing, but here goes..I am a new RN on a med/surg floor after working 8 months at a rehab. I have been on orientation for 4 weeks and have asked for more time b/c I feel like I am not getting certain things. Any suggestions/feedback would be helpful.

1) pt's come in with all different problems and some stay longer than others. at times I don't feel I am grasping their disease process and feel incompetent.

2) Medical jargon in report (paraspinal mass...lacuna infarct, etc.). I don't know what these things are and don't have time for research..I feel like I should know these things before caring for pt. and so I feel incompetent.

3) medical tests. CT scans, bone scans, MRI's. Why are they ordered...if someone has no evidence of a fx with a CT scan, then why 2 bone scans? When do we get results?

4) I really suck at lung sounds!

I have spoken w/my manager and she is aware of how I am feeling and have asked for assistance but I would like to know if others have felt the same way and what has helped.

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Specializes in ICU/ER.

I too do not know all the medical terms, I just ask during report, they tell me pt has **whatever** and I just say "oh I dont know what that is". I always believe honesty is the best policy and if you dont know, ask. Hopefully as time goes on the pieces will click together. It is pretty overwhelming being a new nurse.

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Specializes in telemetry, med-surg, home health, psych.

Yes, ditto above advice......just ask !!!! Do not feel as if you should know all of this now, it is too soon....you are in learning mode right now....a year of school clinicals is not equal to a month on the floor...

You will slowly begin to grasp what is going on....please do no feel overwhelmed, just keep listening, watching and asking questions....

I still ask in report at times and I am 20 yrs + in nsg. !!!!!

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Specializes in Rodeo Nursing (Neuro).

I think this is a very appropriate question for the First Year forum, albeit one that doesn't magically evaporate when you start your second year. There's a lot of terminology, and I've seen nurses with decades of experience have to scratch their heads and wonder, "What's that?"

I agree with the above advice, but would also suggest looking up terms and/or diagnoses in a good medical encyclopedia when you get home.

I've been disappointed, a bit, to discover how little use my old nursing school textbooks have proven as reference tools, but the medical encyclopedia and drug guide are still useful. I also have a PDA with a couple of drug guides and Taber's installed, so I can look up a fair amount of info easily, on the job. A Web search, either on the job or at home, can also provide a lot of good info. So, basically, I may rely on my PDA and my peers for enough to get by on, then look it up later to get more details when time permits. It sometimes amazes me how much better information sticks to my brain when there's an actual patient to relate it to.

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I agree with the above advice, but would also suggest looking up terms and/or diagnoses in a good medical encyclopedia when you get home.

... So, basically, I may rely on my PDA and my peers for enough to get by on, then look it up later to get more details when time permits. It sometimes amazes me how much better information sticks to my brain when there's an actual patient to relate it to.

I think part of the fear of the newbie is that whatever little bit of basic info they can quickly get on whatever terminology they are unfamiliar with won't be *enough* and that there may be too much risk that they'll miss something *really* important because they didn't have sufficient knowledge of the condition. Even if nothing goes wrong, the newbie might feel that they don't *deserve* the level of responsibility that day for that patient.

I think nursing education would do well to prepare nurses to be able to start work WITHOUT having spent the previous night reviewing the diagnosis, pathophys, symptoms, prescribed meds, etc backwards and forwards. In school, there's often so much emphasis on being SOOO knowledgable of each patient's condition that when they start working, newbies can feel it's *irresponsible* to NOT be THAT prepared.

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I too do not know all the medical terms, I just ask during report, they tell me pt has **whatever** and I just say "oh I dont know what that is". I always believe honesty is the best policy and if you dont know, ask. Hopefully as time goes on the pieces will click together. It is pretty overwhelming being a new nurse.

I do the same as racing-mom. I feel no shame in not knowing something, and I don't feel embarrassed (sp?) in asking. A short answer reply to my question along with a roll of the eyes is sometimes what I get in response, but I'm going to keep on asking.:twocents:

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Specializes in Utilization Management.

It also might help to click onto this website and practice listening to heart and lung sounds:

http://www.med.ucla.edu/wilkes/intro.html

I don't know about other nurses, but I'm always happy to help new nurses learn to take better care of their patients. Even so, there are many dx's I'm not familiar with. (The latest being von wegen--something-or-other, some kind of vasculitis.)

So what I usually do is Google up the information on a reliable website like WebMD and print it out, and put it right in the front of the chart. Helps me to read it over and review it. Then when I go home, I read as much as I can about it so I feel comfortable with it.

Because as rare as it might be, you'll probably see it again, and someone will probably still need the info.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

please don't misunderstand what i am going to say as being mean. i am blunt and get to the point. i am trying to answer you and help you. i was a new grad too and had all the same problems.

school and learning did not stop when you graduated. in fact, it started.

pt's come in with all different problems and some stay longer than others. at times i don't feel i am grasping their disease process

you just have to either pick up a book or go online and start reading about these diseases and their medical treatment. it's something that every nursing student should have started doing in nursing school. this thread has some great websites that have disease and test information on them if you don't want to shell out the dough for the reference books:

medical jargon in report (paraspinal mass...lacuna infarct, etc.). i don't know what these things are and don't have time for research..i feel like i should know these things before caring for pt. and so i feel incompetent.

sorry to be blunt, but don't you think you ought to make the time to find out what these things are? i used to write them down and look them up when i got home in my copy of
taber's cyclopedic medical dictionary
. but, i had to learn to make the conscious effort to write the words down--only takes a couple of seconds.

medical tests. ct scans, bone scans, mri's. why are they ordered...if someone has no evidence of a fx with a ct scan, then why 2 bone scans? when do we get results?

this is why you look up information in reference books on these different tests and why they are done. it is also why you look up the different diseases and read about what the doctors order to diagnose them and why. you also can ask a doctor why he ordered a specific test if he didn't put his reasoning in his progress notes. the worst he can do is stare at you and not give you an answer, in which case, he's a jerk.

i really suck at lung sounds!

so did i when i was new. you practice, practice, practice. it's like riding a bike--you'll never learn how if you don't get on the bike and work at it.

you are a paid employee now and the facility expects a return for the money it has invested in your on the job training. some of your training and development is on your time now--especially things that should have already been learned. that's what it means to be a professional.

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Thank you all for your support...to daytonite..I appreciate the message and maybe I wsn't as clear as I needed to be, but while I am at work I don't have much time for research..I do take the time when I get home so that I have a better understanding. I was simply looking for some support and suggestions...I feel your response is rude and condescending and really not helpful when I am simply trying to become more proficient in my position.

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Specializes in ICU/ER.
.to daytonite..I appreciate the message and maybe I wsn't as clear as I needed to be, but while I am at work I don't have much time for research..I do take the time when I get home so that I have a better understanding. I was simply looking for some support and suggestions...I feel your response is rude and condescending and really not helpful when I am simply trying to become more proficient in my position.

Woah---Daytonite put alot of thought into that post and I thought it was very informative and helpful. The nice thing about all nurses is not only do we get emotional support as in "you will be fine-your doing good-things will get better" but we also get reality and facts, we get actual help in what our problems are, sometimes it may not be the exact advice we were seeking, but all the same someone took the time to try and help you. The adive Daytonite provided may not fit into your exact situation, but your not the only one reading this post, i for one thought the advice provided was great. A link to a site to help with lung sounds---pretty nice link, nice resource. Alot of people will be happy to find that.

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Specializes in telemetry, med-surg, home health, psych.

yes, you seem to have taken the offensive too quickly re: daytonite's post....I think it was so well thought out and nicely written....Gave great information to help you and anyone else with similar concerns...

We really are here to help each other....we get enough flak at work without getting it here, also...we come here to vent, get and give advice....Please do not ostracize one who is trying to help...

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First off, Daytonite, thanks for sharing some good resources and the encouragement to newbies to remember that it's normal (as opposed to a sign of incompetence) to not know everything. And for a reminder to all that practicing nurses have a professional responsibility to continue to put an effort to learning new things throughout their career.

I can see where the OP may have felt a bit unjustly criticized. It sounds like there was an assumption or implication that the OP expected to never have to crack open a book again after graduating or that the OP was complaining at the injustice of having to still learn things now that they're working. What I heard was someone who wants to provide the best care to their patients and is fearing that perhaps they don't know enough to properly fulfill the responsibilities of their job.

I understood that the OP *wanted* to know more about the diagnoses, tests, etc but was finding there wasn't enough time to look those up along with everything else. If the OP had stopped to look those up, they might've been late giving an important med or some other thou-shalt-not newbie mistake. It can feel like damned-if-you-do, damned-if-you-don't.

And while you can learn a lot at home for "next time", that means that you didn't know that stuff *while* caring for that patient. Students have often been taught that they should know *everything* about a patient (hx/diagnosis/tests/txts) and it's just not possible in most environments for each nurse to know *everything* about each patient they care for everyday. So many newbies are having to learn through trial and error what's "enough" to get by with to give safe care without getting bogged down in details, that, though important, are not a high priority in regard to your particular realm nursing care.

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