New grad job FLOAT to 13 floors! Qs for medsurg nurses!

Lev, MSN, RN, NP · Nov 30, 2015

Oh my! 13 units is a lot.

1) Are most med surg units basically the same, skill-wise? So if I learn how to work in one unit it won't be that different going to another.

Med surg units require the same basic skills, such as nursing assessment, IV starts, and med administration, however especially in a large hospital with 13 med surg type floors, each one is likely to have its own specialty, with specific skills for each unit. For example, on a GI unit you will see more NG tubes. On an ortho unit, you will have to know more about transferring patients or using the CPM machine. A neuro floor will have more patients who require neuro checks. The best way to succeed is to request patients who are typical to the floor you are orienting on and not "overflow" patients from other med surg floors. Hopefully you won't have a lot of competition from other new grads.

2) They are not teaching us IV starts but expect us to have 3 successful ones by the 3 months in order to pass. What do you suggest--spend money on a course or self study and practise in real life?

I think it's best to practice in real life. Tell you preceptor up front that this is something you need help with and hopefully he or she will find some good patients for you to practice on.

3) What key skills should I review???

Key skills to review are nursing assessment, vital signs parameters, lab values, CPR, cardiac rhythms (know the deadly ones) and pathophysiology of common disease states. Always look up a med if you are not familiar with it. The eMar usually has a quick reference you can check which comes up as you scan the med. Watching skills videos on IV starts, NG tube insertions, suctioning trachs (if your med-surg floors take those), setting up tube feeds, foley insertions, etc are also helpful.

4) Any advice/tips, anything I should know before I start?

You are about to be very challenged as a new grad and as a nurse in the float pool. The most important things are to keep an open mind, don't argue, ask questions, and use your resources.

nurse1990 · Dec 1, 2015

Oh my! 13 units is a lot.
1) Are most med surg units basically the same, skill-wise? So if I learn how to work in one unit it won't be that different going to another.
Med surg units require the same basic skills, such as nursing assessment, IV starts, and med administration, however especially in a large hospital with 13 med surg type floors, each one is likely to have its own specialty, with specific skills for each unit. For example, on a GI unit you will see more NG tubes. On an ortho unit, you will have to know more about transferring patients or using the CPM machine. A neuro floor will have more patients who require neuro checks. The best way to succeed is to request patients who are typical to the floor you are orienting on and not "overflow" patients from other med surg floors. Hopefully you won't have a lot of competition from other new grads.
2) They are not teaching us IV starts but expect us to have 3 successful ones by the 3 months in order to pass. What do you suggest--spend money on a course or self study and practise in real life?
I think it's best to practice in real life. Tell you preceptor up front that this is something you need help with and hopefully he or she will find some good patients for you to practice on.
3) What key skills should I review???
Key skills to review are nursing assessment, vital signs parameters, lab values, CPR, cardiac rhythms (know the deadly ones) and pathophysiology of common disease states. Always look up a med if you are not familiar with it. The eMar usually has a quick reference you can check which comes up as you scan the med. Watching skills videos on IV starts, NG tube insertions, suctioning trachs (if your med-surg floors take those), setting up tube feeds, foley insertions, etc are also helpful.
4) Any advice/tips, anything I should know before I start?
You are about to be very challenged as a new grad and as a nurse in the float pool. The most important things are to keep an open mind, don't argue, ask questions, and use your resources.

Thanks for the thorough response! Exactly what I was looking for. I'm actually split in between another hospital so 9 in one, and 4 in the other. I didn't know neuro was considered med-surg :/ I think we do everything but ER, ICU, and speciality floors but I'm not 100% sure. 13 is alot, I am afraid I will feel overwhelmed and buckle under the pressure. It's hard enough getting accustom to 1 unit and finding where everything is but 13? I hope I can do it :)

Great suggestion btw I will let my preceptor know that I would like to practise my IV starts. Should I also let her know I have never actually done it on a patient before?? Some nurses would see it as a learning opportunity but I also know some who don't want to be liable should anything go wrong :/

For researching the disease states I've talked to an NRT nurse who said she used to do that and now stopped because there was so many she could never keep on top of them all :/ I will ask my preceptor(s) what the most common 3 are for each unit?

My first shift is on Wednesday!

Lev, MSN, RN, NP · Dec 1, 2015

Thanks for the thorough response! Exactly what I was looking for. I'm actually split in between another hospital so 9 in one, and 4 in the other. I didn't know neuro was considered med-surg :/ I think we do everything but ER, ICU, and speciality floors but I'm not 100% sure. 13 is alot, I am afraid I will feel overwhelmed and buckle under the pressure. It's hard enough getting accustom to 1 unit and finding where everything is but 13? I hope I can do it :)
Great suggestion btw I will let my preceptor know that I would like to practise my IV starts. Should I also let her know I have never actually done it on a patient before?? Some nurses would see it as a learning opportunity but I also know some who don't want to be liable should anything go wrong :/
For researching the disease states I've talked to an NRT nurse who said she used to do that and now stopped because there was so many she could never keep on top of them all :/ I will ask my preceptor(s) what the most common 3 are for each unit?
My first shift is on Wednesday!

Yes, there are med/surg floors that specialize in neuro. Those floor typically have telemetry monitoring. Knowing that your job is between two hospitals mean that there will be specialty floors that overlap between the two places.

As far as the IVs, you don't have to mention that you haven't done it before on a real patient, but definitely tell you that you would like to be walked through the procedure as you make an attempt.

There really won't be just three common ones. Research them as you come across them so next time you have a patient coming in with cholecystitis, for example, you will know what to expect.

nurse1990 · Dec 1, 2015

Yes, there are med/surg floors that specialize in neuro. Those floor typically have telemetry monitoring. Knowing that your job is between two hospitals mean that there will be specialty floors that overlap between the two places.
As far as the IVs, you don't have to mention that you haven't done it before on a real patient, but definitely tell you that you would like to be walked through the procedure as you make an attempt.
There really won't be just three common ones. Research them as you come across them so next time you have a patient coming in with cholecystitis, for example, you will know what to expect.

Okay I shall. Can I say "I havent had much practise with IV starts so would you mind walking me through them the next time you do it?" Hopefully she won't mind :) And yeah thats what I was planning on doing. The girl said that it would be "impossible" and she gave up after a few months. But maybe I will until it gets to be too much.

Q--If your on a cardiac unit, the telemetry strips your just intended to read and state the rhythm? Thats it right. And monitor the ECG? Just wondering I have never been on a floor with telemetry before. In my past floor the ECGs came up already interpreted.

Lev, MSN, RN, NP · Dec 1, 2015

Okay I shall. Can I say "I havent had much practise with IV starts so would you mind walking me through them the next time you do it?" Hopefully she won't mind :) And yeah thats what I was planning on doing. The girl said that it would be "impossible" and she gave up after a few months. But maybe I will until it gets to be too much.
Q--If your on a cardiac unit, the telemetry strips your just intended to read and state the rhythm? Thats it right. And monitor the ECG? Just wondering I have never been on a floor with telemetry before. In my past floor the ECGs came up already interpreted.

No she should let you do it, but walk you through it. That is how I taught my orientee student. I told her where to stick, which angle to hold the catheter, how fast to insert the catheter etc..I had her practice inserting IV catheters into a glove stuffed with gloves.

Correct about the strips. The EKG uses 12 leads and is a one time snapshot of the heart's electrical activity. Your typical tele monitor is a 3 or more commonly 5 lead view of the heart and provides continuous monitoring. On the floor, you will most likely have to print a 6 second strip each shift and write a quick interpretation.

bluebirdflyx · Dec 1, 2015

The patient care, medication administration, and skills will come with time and will be similar to each floor. Eventually you will get more comfortable with that. What always throws me in a new job is the paperwork or protocols for various things that come up.

Don't overlook having them orient you to each floor's system for doing things. Know where they keep the MD phone numbers. If a critical lab comes in know what to do with it. I learned three months into my job we have a "Critical lab book" where we're supposed to record those values in addition to the EMR. Nobody told me during orientation. :banghead:

Keep a small notebook or piece of paper that has the extensions for the kitchen, the lab, the pharmacy, etc. Going between two different hospitals you will need to know who to call if your patients diet is wrong, or if the meds aren't right, or if their bed malfunctions. Make friends with the unit secretaries!

AJJKRN · Dec 1, 2015

Get yourself a good brain sheet for pertinent Pt info and maybe even a med/task list sheet to help keep things straight, on task, and checked off.

And remember that Med-Surg is just about anything under the sun!

Barnstormin' PMHNP · Dec 1, 2015

I would also get a permanent notebook divided up by the different floors you work and put pertinent info in it. Even simple things like where supplies and equipment is kept and whatever you have learned that day on the floor, names of the nurses on the unit etc.

TNT_RN09, BSN, RN · Dec 1, 2015

Your hospital doesn't require a year experience before going to float pool?

JerseyTomatoMDCrab, BSN · Dec 1, 2015

2) They are not teaching us IV starts but expect us to have 3 successful ones by the 3 months in order to pass. What do you suggest--spend money on a course or self study and practise in real life?

Well, I will tell you what I DON'T suggest. I certainly don't think you should sneak a few IV start kits and 22g angios home in your pocket. You absolutely shouldn't practice on your family and friends in your kitchen. You must not start with your 19 year old football player brother and work your way up to your tiny mom once your skills improve. This will not help your skills tremendously and be a good story to tell later on.

Don't do it.

nurse1990 · Dec 1, 2015

Well, I will tell you what I DON'T suggest. I certainly don't think you should sneak a few IV start kits and 22g angios home in your pocket. You absolutely shouldn't practice on your family and friends in your kitchen. You must not start with your 19 year old football player brother and work your way up to your tiny mom once your skills improve. This will not help your skills tremendously and be a good story to tell later on.
Don't do it.

Lol. Well I don't have any family willing to let me practise unfortunately.