New to acute care and just not getting it.

[Googlenurse, ASN, BSN, RN]

Any tips? 
I have two weeks left and worried I won't get it. I'm on a med surg/tele floor. 

The ratio is 6:1 with no aide most nights.

You would think it would be a breeze for someone who came from subacute with 30 patients at night. But it isn't. 
 

For example, how am I supposed to know calcium gluconate and regular insulin to lower potassium levels is supposed to be given IV and not SQ? The doctor wrote the insulin to be given SQ, but he was wrong.  I only found out because I asked a colleague. 
 

I am used to being more independent, but it seems I constantly have to ask questions. And constantly look out for mistakes from doctors in acute care. 
 

Oh, and tele? We don't have tele monitors, so we have to print our own strips every four hours. And no IV team either. So we start those  too. 
 

I'm very nervous, like a new grad. I'm worried I might be too far gone and too old to work in acute care. Last time I was in a hospital was during clinicals in 2004.
 

Any tips to make this transition smoother? 

[Nurse Alexa, MSN, RN]

The best tip I could give you is to ask questions of your colleagues when you have them. You will be new to that unit and it is normal to not know everything coming from subacute to acute.

I do not think that it's too late for you to go back to acute nursing. I would continue to work at it and see how the months go.

The one thing I will say - it can be difficult at times working at teaching hospitals. It seems the doctor mistakenly put in the wrong route for the medication, and these kinds of mistakes do happen in hospitals with a lot of residents.

All of us nurses have to keep our eyes out for those mistakes. I wouldn't give up on the position just yet - I would give yourself more time to adjust and see how it goes with more experience on the unit.

 

Hope this helps ?   

[Googlenurse, ASN, BSN, RN]

I think I am going to start out per diem every weekend and then progress to full time. 
 

I think when the hospital nurses hear "experience" they think acute care experience. Also, none of the nurses I've preceptors with worked sub acute, so they'd don't know where I'm coming from. 
 

I even messed up giving report. I didn't even know there is a certain way to give report in acute care. Where I worked before, we had report sheets and bedside report.  There was no reason to state diagnosis or the doctor because everything was on the report summary. 

[Been there,done that, ASN, RN]

You did a great job catching the doctor's error. Do you have pharmacy on nights? A pharmacy check would have helped you catch the error. I probably would have given it as written. Asking questions is FINE, That's how we all learned.

Printing your own strips can be time consuming. The big question is... who is watching the monitors? If it's NOBODY... it's a sub par facility.

 There are different ways to give report. Did your preceptor teach you how it's done on your unit? If the powers that be will let you go to per diem, and you can afford it, that could be a good way to learn.

I think you've got this. 

Best wishes.

[Tweety, BSN, RN]

It will be hell, but you're not supposed to get it and your fears and concerns are perfectly. normal.  You'll be fine in about a year...just kidding but not really.

[Googlenurse, ASN, BSN, RN]

The rationale for not giving regular insulin SQ when trying to lower potassium is that it doesn't work fast enough. So it has to be given IV. At least that was what was explained to me. I looked it up and got different responses.

 

Also, we don't have an in-house overnight pharmacy. It's an outside pharmacy for nights. 

[Googlenurse, ASN, BSN, RN]

Been there,done that said:

You did a great job catching the doctor's error. Do you have pharmacy on nights? A pharmacy check would have helped you catch the error. I probably would have given it as written. Asking questions is FINE, That's how we all learned.

Printing your own strips can be time consuming. The big question is... who is watching the monitors? If it's NOBODY... it's a sub par facility.

 There are different ways to give report. Did your preceptor teach you how it's done on your unit? If the powers that be will let you go to per diem, and you can afford it, that could be a good way to learn.

I think you've got this. 

Best wishes.

Thanks. nobody watches the monitors. We just print them every four hours. 

[JBMmom, MSN, NP]

An "acute" care facility that admits telemetry patients with no one watching a monitor and no in house pharmacy overnight sounds like a very sketchy "acute" care facility. 

As for you not getting it, give yourself time and grace. I transitioned from taking care of 30+ patients in long-term care and short term rehab to a med-surg floor and the learning curve was steep! You've probably got excellent time management skills and quick assessment skills that you're not even aware that you have. Give yourself credit for what you DO know, the other things will come with time. And you do have time, no one expects you to come off orientation knowing everything. Ask your coworkers whenever you need to, hopefully they're not a unit full of people that forgot they were once new, too. It's an added layer of difficulty when you can't be sure the MD orders are correct either, but you'll learn quickly which ones you can trust. 

And anyone giving you a problem about report needs to get over themselves. If they offer constructive feedback, or better yet, a template that will simplify your life, great. If not, they can look everything up in the chart as well as you. Good luck!