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

nurse1990 · 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.
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!

Great Ideas!!! Thanks everyone :) I will make sure to take your advices. My first day is tomorrow so I will speak with my preceptor about the IV start and hopefully she is supportive and nice. I have heard horror stories about peoples nursing orientation and don't want mine to be the same.

AJJKRN · Dec 1, 2015

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

Ours is a minimum of two years experience. I'm assuming that there is no floating differential offered. Could be wrong though.

la_chica_suerte85, BSN, RN · Dec 1, 2015

I am but a humble nursing assistant and was floated for the first time to a medsurg floor (my floor is tele but still pretty much medsurg) and I was completely terrified (especially since I'm only about 3 months into this job). What I learned:

Not all floors (even if they're medsurg) are the same. There may be subtle things going on or big changes that are special to each floor. For instance, the floor I floated to is trying to have one side completely dedicated to strokes. This wasn't terribly different from the stuff I encountered on my home unit but the way they did staffing and the way they stocked supplies was completely different.

Recognize and accept that all units have different cultures. Though mostly everyone was nice enough on both floors I worked on, I found, maybe, that the new unit I was on had more cohesiveness. There were older nurses who had been there a long time and I suspect this is why. So, be ready to absorb all the different things coming at you and the different ways each unit's group flows.

Everyone is going to have a different opinion on how something is done. Just try to remember what each person has a preference for and work from there on developing your own ways of doing things.

If your hospital is old-ish, your floors might be arranged completely differently. Lights you thought would work one way don't and beds are different and weird and some stuff is just hard to figure out. I've witnessed this in clinical, too. In the same hospital, one unit looks like Silent Hill and one unit looks like Pollyanna....why?!

You might also get forgotten a lot and have to re-introduce yourself to the same people and have to go through the same conversations. There's a lot of staff to keep track of but just roll with it and try not to take it personally.

With 13 units, you're going to have to stay on your toes. A lot of stuff is going to blend together on you but you'll pick it up quick and remember more and more each day. Never be afraid to ask for help! Good luck!!

turtlesRcool · Dec 2, 2015

I'm in a similar situation. New grad in the float pool. My best advice is not to be afraid to ask someone. The nursing itself isn't that different from floor to floor, but what you specialize in will be. A "home floor" nurse will be able to help you with the nuances of what they do every day. Most people (at least at my hospital) are happy to answer questions. Sometimes I think the hardest part is finding where things are physically kept on each floor. I have no idea why the clean utility closets can't be set up the same way, but they aren't. My rule is that if it's taking me more than a couple of minutes to locate something on my own, I'll ask for help.

Also, be willing to jump in when necessary. You will be learning the ropes and trying to get your time management down (and the experienced nurses will mostly understand that). But if you can show that you are willing to help out where you can, even if it's only popping into another nurse's room to help with a boost, people will remember that and be more willing to take a few minutes to help you out.

laura_on_ice · Dec 12, 2015

A new grad was asking me some questions (I'm a float, graduated with my RN/BSN in 2007) and I wrote a ton of stuff out... similar to your question, so thought I could copy/paste it here!

[COLOR=#000000]Those are definitely normal feelings, even though they don't feel great inside. It IS a lot of information, and you definitely don't learn it all in school. It takes a couple months to feel like you can "get through" a day, and a couple years to start to feel like you've "got it." I always say, anyone can do any one thing a nurse is supposed to do... we just have to know how to do ALL of it... and we certainly don't learn it in a day. Take it one day at a time. [/COLOR]

[COLOR=#000000]

[/COLOR]

[COLOR=#000000]What I realized about nursing school in retrospect may be valuable: nursing school doesn't teach you how to do everything--it teaches you basic procedures and how to think. You could also compare n[/COLOR][COLOR=#000000]ursing school is l[/COLOR]ike taking a cooking class where all the ingredients are laid out, pre-measured. You're guided through the procedure and the end result comes out just fine.

[COLOR=#000000]Being a new nurse may feel like cooking something you know how to cook--but in someone else's kitchen. You hope that all the ingredients for your dish and at least basic tools are there, but you have no idea where they are. You open a drawer in hopes of finding a spatula, and find the spices. You fumble and feel stupid, and it really has no reflection on how good a chef you are. The bottom line is, it takes time to adjust to a new environment. Spend a week in their kitchen, you'll look better. Spend a month, you might start getting into their recipes and using ingredients you don't have in your own home. [/COLOR]

[COLOR=#000000]

[/COLOR]

[COLOR=#000000]The good thing is, you won't be alone right away. The people who are training you know where stuff is, and can point you in the right direction. I tell my students, when trying to find something (phone number, a dressing, procedure, whatever), it's ok to challenge yourself, but also remember to give yourself a break: "try three times, then ask--don't waste time trying to be totally independent too soon." If the person whose kitchen that was was in the room, I could just ask "dude, where is your spatula?!"[/COLOR]

[COLOR=#000000]

[/COLOR]

[COLOR=#000000]First job[/COLOR]

[COLOR=#000000]My first job was in 2007 at a transitional care unit (TCU). I explain the patient population of TCUs as, "imagine taking all the sickest, weakest patients from the hospital--all people who couldn't make it on their own at home, and put them in one place to get better." I describe starting as a new nurse here as "baptism by fire." We had three days of classroom training, three days on the floor, and then we were on our own. There were 9-12 patients per nurse. A couple months in, I was appointed house supervisor on the weekend, overseeing 40 beds on the TCU plus two long term care units and memory care. This taught me time management. Imagine having 2 hours for meds (hour before, hour after) and 10 patients: you get 12 minutes per patient. I tried to keep my agenda to 10 minutes each (5 minutes meds, 5 minutes assessment) because who knows where you'll need the other 2 minutes. Of course, burnout on TCUs for new grads is pretty high--I got into the hospital after a year and a half.

[/COLOR][COLOR=#000000]How did you do it?[/COLOR]

[COLOR=#000000]Biggest things that helped me get through that is memorizing a basic head-to-toe assessment. Introduce yourself, ask if they have any pain, and state you'd like to do a quick assessment. No matter where you are, what the patient population is, it should be reassuring that you can do a head-to-toe. I write on my paper: VS,

[COLOR=#000000]

[/COLOR]

[COLOR=#000000]The quick head-to-toe happens every day in every patient population, but it takes practice to become efficient. I used to kick myself for forgetting to ask if they had a BM, I hated going back to 10 rooms to ask each one if they pooped today! But, I taught myself a trick to remind myself: every time I put my stethoscope on their belly, I asked: any gas? any BM? It sometimes was tough and frustrating process to teach myself, but now definitely worth it. [/COLOR]

[COLOR=#000000]

[/COLOR]

[COLOR=#000000]Getting the hospital job was a nice break in some ways, but there was SO much more charting and technology and procedures! That can be overwhelming, but you'll get it. My biggest tips for new people there is, find out where the resources are that are printed or online, especially things that are used to teach the patient. Never had an appendectomy patient? Good news is the patient only has one appendix, and probably doesn't know much either! You can read through the "after your appendectomy" handout, use the information to guide your assessment (e.g., notify the doctor if there is redness, warmth, swelling, or pus coming from the incision; fever over 100.4*F; vomiting and inability to keep food/fluids down), and realize you should look at their incision, check their vitals, and see how their intake/output is doing. Then, you can chart what you see and go over the handout with the patient. You learned, they learned, and they know how to take care of themselves now. You can do the same for any diagnosis--COPD, ablation, amputation, pancreatitis, whatever. If your hospital has no patient information handouts, I recommend Mayo's website. Patient Care and Health Information - Patient Care and Health Information - Mayo Clinic and for the non-english speaking patient, https://www.healthinfotranslations.org/ It's impossible to know everything in the beginning, so use the tools available to you! It's not a 300 question test with no books. And, every nurse has been in your shoes at some point--and even the most experienced nurses feel like you do today when they have to float to a new unit (just ask how they would feel about being floated to a patient population they've never met, or how they did feel when they had to!).[/COLOR]

[COLOR=#000000]

[/COLOR]

[COLOR=#000000]Other thoughts....[/COLOR]

[COLOR=#000000]

[/COLOR]

[COLOR=#000000]You will run out of time and not get to things: communicate this to the next shift. It's a 24 hour facility and it's impossible to do everything on one shift. The key is communicating: I ran out of time and didn't change the dressing. or, They were off to a procedure and I hung the fluids when they got back, but I could not catch them up on their afternoon meds. or, We changed the diaper 5 times today and here at change of shift, they just pooped again--this one's yours. That is better care than leaving it for them to "discover" and prevents you going into overtime.[/COLOR]

[COLOR=#000000]

[/COLOR]

[COLOR=#000000]Always always always do your safety checks. I once scanned a 63 year old man, and he popped up in the computer as a 14 year old girl. Weird, but if I wasn't paying attention and it came up as a different man in his 60's, I could've made some big mistakes. I've walked into a room thinking I had one patient's meds, and realized I had another nurse's patient's meds and had to return them all. Yikes! [/COLOR]

[COLOR=#000000]

[/COLOR]

Admit mistakes. You will make them. Try to prevent them by looking for special instructions on medications, asking if there are pre-procedure checklists and following them carefully, and being familiar with best practices, but know you're human too. We have high and low potassium replacement protocols, and a potassium level of 3.5 might need to be replaced. There's been quite a few times I've caught myself halfway through the day before I realize it needs to be replaced, or even gotten to change of shift and someone asks, "did you replace their potassium?" and I said, "no--I must have totally missed it; thank you for telling me in person!" and then I look closer the next times.

[COLOR=#000000]Give yourself a break. The first couple years might feel like forever, but they will also fly by. It's a good time to try to make good habits, including taking care of yourself. Do your best at work, forgive yourself on the tough days, and do something happy! [/COLOR]

You WON'T learn everything right away, but here's an idea of the floors... stick with what's interesting to you first, or take it one patient at a time.

Medical

Pretty much everything that can be treated with medications is found on this floor. Probably has the most elderly patients in the hospital and the most confused patients--it's VERY busy all the time. You will predominately find:

- infections including pneumonia and bronchitis, diarrhea (viral gastroenteritis vs. Clostritidum difficile), soft tissue wounds or cellulitis, sometimes a bad case of shingles, gout, hepatitis, or flu. There's a fair amount of people in isolation rooms here.

- COPD and asthma exacerbations

- dehydration, "failure to thrive"

- alcohol withdrawal and other drugs of abuse

- someone presenting with confusion or who has a fall, but did not have a stroke or a heart attack and did not break a bone

- pancreatitis, or abdominal pain with no clear etiology, and GI bleeds

Surgical

Opposite the medical floor, in that if the patient is on this floor, they're likely going to have some sort of surgicalintervention. Seems like the youngest patients end up here. Common findings include:

- Gall stones (sometimes the gall stones cause pancreatitis, and they might sit on the medical floor or on the surgicalfloor for up to a couple weeks til the pancreatitis gets better before they're able to have surgery for it), and Kidney stones- Bariatric surgeries, including lap band, bypass surgery, etc. as well as things they need later on like a pannectomy

- Appendectomies (usually home same day or the next)

- Bowel resections, exploratory surgeries, colostomy, ileostomy, urostomy / ileal conduit, and neobladders... super cool surgeries, but often are done as the result of cancer, so that part is not so cool.

- Hysterectomies, oopherectomies, a lot of TURPs, the occasional penile implant

- Lung surgeries like wedge resections, chest tube patients from collapsed lungs, and some of the heart surgerypatients (though they typically don't give these patients to floats... who knows, though, they might)

- Vascular surgeries, including amputations, bypass grafts in legs and arms, etc.

- Jaw surgeries, mostly in high schoolers and young college students on spring and summer break

Orthopedic

If the surgery needs to be done on a bone, and that bone isn't in your spine or head, this is where the patients hang out pre- and postoperatively.

- Hip and knee replacement, average 3 day stay (surgery day is day "zero," then they typically discharge "day three," if it's past day three, they probably have some complication going on or they aren't reaching therapy goals)

- Elbow, ankle, shoulder replacements

- ORIF of fractured extremities, occasionally external fixation may be seen

- Revisions of any of the above due to hardware failure, infection, or something like the hip keeps popping out.

Neurovascular

This is a smaller unit with specialized neuro care... it's the "spine, brain, and stroke center," so as you might guess they typically see:

- Spine surgeries including laminectomies, discetomies, and fusions

- Brain issues like seizures, migraines, narcolepsy, vertigo, and some of those "confusion" patients from above

- Meningitis, CSF leaks

- Strokes, whether from an aneurysm or clot

- Brain surgeries... usually due to tumors or abscess

Cancer Care

Self explanatory, but floats generally don't get patients who are receiving chemotherapy or radiation therapy. We more often get medical overflow patients (so the same types of things as on station 66, except they try to keep as many people with infections OFF the floor due to the high risk cancer care population), or post-surgical patients that had surgeries like those described under Station 33, but more often for the reason of cancer. It seems this floor most often sees the longest stays and takes care of the most patients for end of life care

Cardiac Care

Primarily focused on the diagnosis and treatment of chest pains, arrhythmias, and heart failure. An extra close eye on intake/output, electrolytes, troponins, BNP. Extensive teaching is done by the bedside nurse to help patients learn how to modify their lifestyle per the recommendations of their cardiologist or electophysiologist. Sometimes the intreventions are medical (medications only), sometimes a procedure is required--there are many, many tests and procedures available, as are there many IV drips that can be used to convert rhythms and correct electrolyte imbalances that may be causing arrhythmias. These nurses are very skilled in identifying all heart rhythms rhythms in a blink, responding to codes throughout the hospital (they have a system for who goes to codes, and who watches the patients of the nurse who has to run). Of note, if they need a bypass surgery, they end up in ICU and then the surgical floor.

Observation

Obs is a fairly new concept to hospitals, and they are just starting to make dedicated units for them (the last 5+ years they've been mixed in with the rest of the sicker patients). The population consists of people who are expected to be just overnight--for example, an appendectomy, podiatry surgeries, pacemaker placement, ablations, laparoscopic hysterectomies, chest pain that's probably not a heart attack but should be watched overnight just in case, back pain not needing surgery. This is a very fast-paced unit where the pateint arrives, you feel you have barely introduced them to the unit routines, and you're teaching them what they need to know to take care of themselves at home. There's a wide variety of diagnoses. Insurance doesn't pay for a lot of things, so not over-doing care is important, but also is providing them with the proper information and teaching so that they can finish caring for themselves at home and not end up back in the ER.

laura_on_ice · Dec 12, 2015

Sorry about the copy-paste that made the first line wonky on my post! Looks like it does the wonky stuff and then the beginning of my sentence is underlined in light blue. Weird. Hope it doesn't distract too much from the content above!

nurse1990 · Jan 20, 2016

Sorry about the copy-paste that made the first line wonky on my post! Looks like it does the wonky stuff and then the beginning of my sentence is underlined in light blue. Weird. Hope it doesn't distract too much from the content above!

It was a great read! Ive been working for the past month and encountered about half of the things you talked about! Love your quick head to toe, thanks