New grad with a new job on med-surg! (Advice Please!)

tlh65 · Nov 26, 2007

>>>1) What methods do you find helpful in organizing your time? (tips and tricks)

2) How is nights different from days?

3) What are the most important things to remember as far as prioritizing? (Ex: meds 1st etc)

4) What kind of pt's and skills do you see and do MOST in med-surg (so I can re-familiarize myself)

5) What is your advice for me to best prepare myself?

Congratulations on your new job. I think Med-Surg is a great place to start and it sounds like you are ready!

In answer to your questions,

1) It is really hard to answer the organization question because I have to say organization is something you will master more and more with practice. While you are on orientation, watch your preceptor, get tips and hints from them and see each nurses different styles or forms of organization. You can take bits and pieces from each one. I would have to say that is the best way to find your own way to organize. Time management is very important but it also takes practice.

2) I don't work nights so I will pass on that - day shift is probably busier in the sense that there are more "people" around, i.e. - administration, docs, social workers, PT, OT, etc. When I say busier, I mean more distractions - also most of the patients are awake on day shift.

3) Prioritizing - again - it is individual. I usually come on and get report, look over my orders, labs (results), VS, and then what meds I am to give. I then will do all my assessments. Sometimes I will save my harder patients for last so I can have more time. Walkie-talkies are the easier ones if they do not have any specific needs at the time of my assessments. Again, it all depends on the type of patients, etc.

4) You will see ALL kinds of patients/skills on a Med-Surg unit. I see everything and all age groups (including Peds). Ortho, any respiratory problem, heart problems, diabetes, GI probs, surgeries, -- etc...

5) Take it slow - watch and learn from your preceptors. Ask for help when you need it - don't try to do everything yourself if you are unable - and ask questions anytime you are unsure of anything. Don't guess.

YOU WILL BE FINE - GOOD LUCK TO YOU!

SoulShine75 · Dec 2, 2007

thank you for the great advice!

Daytonite, BSN, RN · Dec 3, 2007

so, you're finally leaving the nest and going out on your own! it's a bit intimidating, i know. we all must go through this.

i think the biggest obstacle is organizing time. school really doesn't prepare you for the tasks you will have to do. some you already know. you'll have to give your patients their medications, keep track of their ivs and perform some procedures. however, there are others that you have yet to be introduced to that were never explained to you in nursing school. they will be detailed to you in your orientation classes in your first days of work. orientation is usually a couple of days of sitting in a classroom and getting mounds of information about the facility's way of doing things. it is important that you pay attention to what you are being told because these are generally the most important policies that they want nurses to know, be aware of, and follow.

something i have noticed lately as i have been an inpatient a number of times, is that instead of the clipboard i used to carry around, nurses are carrying 3-ring notebooks to hold their shift information. often these were just 1/2 inch or 1 inch thick. each nurse had their own. inside them they put their patient's kardex, which was a sheet for each patient printed off the computer with a synopsis of their orders. however, each nurse also had other information in these notebooks of their own choosing. some had conversion charts to help them do drug calculations. some had copies of certain facility policies. some had a list of normal lab values on a sheet of paper. if i had had one of these it would have been loaded with all kind of stuff. on my clipboard i used to have a very specific guideline i created to follow when patient's had chest pain (i've written about this before on the forums). when i was an iv therapist i created another specific guideline on what to do and chart when we inserted a picc line. i did these so i wouldn't forget anything. i also, for years, had my own head to toe assessment guideline that i carried on that clipboard since we primarily did narrative charting. so, think about doing something like having a clipboard or a 3-ring notebook with you all the time.

as for organizing. . .the starting point is what is called a todo list. if you are not familiar with making lists, this is a good time to start. a list will save you a lot of problems because it takes the burden of remembering everything off your mind. and when you are trying to do so many things as a new grad you don't need to be adding a lot of worry about whether you forgot something. i found this link some time ago that explains what a todo list is

http://www.ehow.com/how_3812_make-list.html - how to make a todo list

from day 1 when you get home and have rested a little you sit down and make a todo list for your next day of work. every once in a while something will have come up at work that will cause you to amend or add something to this list for the future. todo lists are a perpetual work in action. i must tell you that organizing never stops. from job to job and day to day i am always on the prowl to improve or change for the better my organizational method. they never tell you that in nursing school either. use your computer to compile your todo list so you can save it in a file, edit it and reprint it at the touch of a button. when i learned how word could help me do this with my report sheets (which i previously typed and xeroxed) there was no stopping me! in earlier days i printed my todo list on the back of my report sheets and crossed things off of them as i completed the task.

this is a copy of the last report sheet i used as a hospital nurse. i copied information about each patient i was assigned to from the chart or the kardex onto it, put notes from report on it, added information about the patient during my shift to it, gave report to the oncoming shift from it, put any todo lists or other notations (i.e. verbal or telephone order from doctors) on the back of it, and had a specific way i marked it to indicate i had completed my charting and physician order checks before i left for the day. i had it saved in a word file and i printed a fresh sheet out before i went to work each day with the correct date on it. the date was a thing for me. i always had a problem remembering what the date was so i had it printed out in large letters at the top of this sheet where i could find it easily. the original sheet also had commonly called extension numbers and doctor's office numbers that i had to call at the very top of it, but i removed them when i posted the sheet on allnurses.

[attach]5032[/attach] report sheet

that pretty much covers organizing your time. follow the sequence on your todo list. if you start wondering what you should be doing, pull out the list and look to see what you could be doing next.

i worked night shift for many years and as a supervisor was often on the night shift. it is quieter meaning that you don't have all the people that you see working during the daytime. it will just be you nurses and the patients. surprisingly, many patients will still be awake at night--some all night long. you will still have a routine to follow, vital signs to take, meds and ivs to give. the lighting will be dimmed, so get yourself a flashlight. i quickly learned not to depend on the facility to supply a flashlight. they either disappeared or the batteries were dead. for years i had flashlights that were powered with "c" batteries so they were a bit smaller than a regular flashlight, but they fit in my pocket just great. and, they were mine and always in my right hand pocket and at my fingertips. maglight has these small flashlights that take "aa" batteries that are pretty bright. the last thing you want to do is go into a patient's room and turn on the lights. it's very irritating to have the overhead light flicking on suddenly when you've been in the dark. you can check ivs, incisions and drains very easily with a flashlight. also, don't touch patients at night without calling their name softy first and getting some kind of response that they acknowledge you first. men, especially the stronger ones, who get startled out of sleep will inadvertently sometimes take a swing at anyone who disturbs them.

night shift people are often delegated some administrative tasks that the other shifts don't get because they are not as busy with patient things. often things like getting or checklists started, starting discharge summaries of people known to be going home the next day, double checking patient diet lists that go to the dietary department, making sure lab draws and x-rays for the next day have been ordered, that all the doctor's orders for the last 24 hours were transcribed and signed off, and that the unit is straightened up in general is to be done.

since i was a supervisor i also want to let you know that you should not feel that you are alone at night. as a supervisor we made rounds at least twice a shift. we got a general report on what was going on with your patients. i wanted to know if you had any patient's who were not doing well. i wanted you to call me if you were having any problems. if you got into a bind i definitely wanted to know. i was a second pair of hands to help you out if need be. i would help you with a procedure if you weren't sure of how to do it or it was your first time doing it and you needed moral support. i was the stand-in for your manager who was at home and sleeping. when i left in the morning i gave a report to your manager before he/she went up to the unit.

as for the skills you will need to learn, that will become clear as you start working on this unit. it will be dictated by the type of patients you get and the commonly performed surgeries. keep in mind that there should be a policy and procedure manual for the facility that you can review before you do any procedure for the first time. ask about this manual and where it can be found when you are in orientation. common procedures are ivs and foley catheters.

have you read about my iv problems as a new grad? i've written about them here and there on the forums. i was absolutely terrible at it. ivs are not as easy to do as some people would like to make you think. i have since been nationally certified in iv therapy i do know what i'm talking about. it took me 6 months of intensively working at bettering myself with the skill, and that was while i was taking the lvn iv certification course! and, i'm good with my fingers. . .i had 9 years of piano lessons as a kid and crocheted and knitted! i have, and always will, feel that iv skills are an rns domain and i think it is sad when an rn doesn't put in the time and effort to learn this skill well. and, it takes months and years to become a master in it. there is a thread on allnurses that a lot of people have contributed to with all kinds of little bits of information about getting ivs started and going.

https://allnurses.com/forums/f18/iv-tips-tricks-3793.html - iv tips and tricks

i also posted all kinds of weblinks to information on ivs on post #6 of this thread

https://allnurses.com/forums/f205/any-good-iv-therapy-nursing-procedure-web-sites-127657.html - any good iv therapy or nursing procedure web sites (in nursing student assistant forum)

the other skill that was hard for me was interpersonal communication. . .not necessarily with the patients, but with the other people on the staff. it is inevitable that you are going to run into people who are going to think differently and do things differently. some will just have different ethics. it makes for some very heart wrenching moments. my worse ones were dealing with subordinate staff (cnas) who got disrespectful, nasty or outright refused to do something. now, there was a challenge! delegation is a whole other ball of wax. since you didn't ask about it, i'm not going there.

hope i've been of some help. i precepted many new grads. be aware that we all have gone through what you are going to go through. some will bend over backwards to help you through; others won't. but, don't be afraid to ask, ask, ask. everyone discovers their own little ways that eventually work for them and you will too as time goes on. the nurse educator, your manager and any preceptors who are assigned to you will be your primary supporters. and, occasionally a unexpected supporter may come out of no where. they, in a way, will replace your school instructors. however, you will primarily have to find a lot of information on your own and after work hours.

my best wishes on your new job. i think a med/surg unit is a great place to start a career. there should be a routine there and that, i think, is important when you are new to a profession. the routine gives you an anchor to build upon. if there is anything you want information on or want to ask you can always pm me if i haven't found your post since i don't usually hang out on this forum. here is a link on time management that you can explore in your free time:

http://www.mindtools.com/pages/main/newmn_hte.htm

nursekatie22, RN · Dec 7, 2007

i've just hit my fifth month of being an rn and all i have to say is do not be intimidated enough to not ask questions when you need to. i don't care if you're in front of a patient, their family, or anyone else.

if you don't ask questions, you won't learn and you'll not be doing yourself any favour. there are still a couple nurses on my floor whom i'd rather not bother if i don't have to, but if i don't understand something, i ask.

there's this doctor that no one really likes and is scared of at times, and he wrote something in a pts chart that i didn't understand (not handwriting-wise, for once though!). well, since i work nights and hardly ever have doctors come to the floor, i took the chance to ask him about this test and why he was odering it. he totally sat there for about 10 minutes and explained why, etc. he didn't seem overly pleased, but i got my information and it helped me be more assertive!

also, take time to chill out! sometimes it gets really frustrating doing what we do and sometimes i need a few seconds to remind myself that "this too, shall pass"!! deep breathes are nice..... :lol2: