new grad nurse med surg

Published

seeking help

I am a new grad nurse on a med surg floor with primarily pancreatic, bariatric and vascular patients. I've started a few weeks on orientation so far and I feel so defeated, anxious and incompetent while I am on the floor. There are so many things going on and so many people on the floor. I read all the information on my patients and after I check on them and do my assessments, I feel like I don't really know what's going on. Especially if someone was to ask me for report. I don't know how to give a good report. We do patient rounds in the morning involving the SW, case management, PT, OT, DON etc. I just don't understand the information they want during rounds or better yet what keeps someone from getting discharge. Family's call for reports, SW wants report, PT want s report, NA want report. I'm just so stressed out. I don't know why I am still confused when I am reading up on all my patients. I should know them. Especially when I am constantly checking my notes and writing stuff down just in case some one asks me. How do I know when the patient will be discharge, what services they might need, etc.

Anything will help. Thank you

Up Vote Up Vote ×
Specializes in Psychiatric RN & Retired Psychiatric CNA.

Here is an amazing report sheet especially for med surg.

Buy a clipboard that can open, and have extra prints handy for other patients.

I'm pretty sure other nurses can chime in with their input. Good luck!

1
Up Vote Up Vote ×

I second using a cheat sheet. It doesn't have to be fancy. I just use a blank sheet of paper, jot my report findings in blue, assessment data in red and make a schedule in the side for when to do tasks. You will be more comfortable with report as you do it frequently and understand what you need to report

2
Up Vote Up Vote ×
Specializes in Ambulatory Care-Family Medicine.

In addition to coming up with a cheat sheet/report sheet that works for you I also suggest just asking those people what they want. Next time you see the SW ask her what type of info she needs to do her job, same with PT/OT, Case manager, etc. they probably know that you are new and hopefully won't mind giving you some guidance so their jobs are easier as well as yours.

For family updates if they are calling on the phone I just tell them if the patient is stable and if the patient mentioned anything specifically they want the family to know (when they're going to surgery, etc). I dont give out more info on the phone because I honestly don't know if the person on the other end is really who they are claiming to be. If family is there in person I'll give them a little more info (labs are stable, waiting for such and such to happen, dr mentioned this, possibly going home tomorrow, etc). Don't ever be ashamed to tell a family that you don't know something. If I don't know something I'll pull up the drs note in the room and skim through it and if t doesn't specifically answer the question I'll tell the family the dr needs to address that and leave a note for the dr to discuss it on rounds so they'll put the answer in their note.

Up Vote Up Vote ×

In my experience, on GI surgical floors....

Doctor wants to know if theit pain is controlled, if they're tolerating the diet, if they've pooped.

SW wants to know if they can take care of the dressing, TPN/antibiotics, ambulate safely at home or whereverse they're going and whether they need special transportation.

PT/OT wants to know what their activity has been, any limitations, what your understanding of their baseline is.

Maybe sit down with a trusted coworker and go other a rounds report to point out areas you may be weak in?

Up Vote Up Vote ×
Specializes in Neuroscience.

Nurse to Nurse report: The purpose is to give them a baseline in which to start their shift. The printout posted by Shook is similar to what I use. Keep it simple.

When you get report, what information does the nurse give to you? If I'm going through the systems, it sounds something like this:

PMH: Diabetes, Hypertension, GERD, Smoker 1 ppd. Hysterectomy, Appy, Chole.

DX: MVC (motor vehicle crash) on 6/22, restrained. Compound fracture of L femur, in external fixation.

Resp: Room air. Requires 2L NC at night. Diminished in bases.

Cardiac: Normal Sinus Rhythm, occasionally has PVCs. Hypertensive at baseline with systolic averaging in the 140's. Upper extremities have good pulses. Weak pulses in feet. Tmax was 100.2 last night, but temp came down with tylenol.

GI/GU: Consistent carb diet, NPO at midnight. No BM yet. Foley in place. Urine output adequate.

Neuro: Glasgow of 13. Patient opens eyes to speech and is confused to time and place. PERRLA at a 3 to 3.5

Skin: Left hip is ecchymotic. Left leg in external fixation, bandages clean and dry. Scattered abrasions on both arms from airbag deployment. Turn Q2

IV: 20g L arm, 22 g R hand.

Fluids: LR @ 75

Tubes/Dressings: JP drain at L knee. Empty Q6 hours. Serosanguineous output. Turn Q2.

Labs/BS: ACHS fingersticks. High as 306 today, covered everytime and they just increased her Lantus.

Issues: Oxy Q4 and IV morphine for breakthrough pain. Pain has been at a 4. Tylenol for fever. Patient's family at bedside. Watch out for sister, she challenges everything you do so be prepared to explain medications and why you are turning the patient. Husband at bedside and will spend the night.

A good report will take anywhere from 4-7 minutes, less if they had the patient before.

If you're unsure what someone else wants, just ask. You don't have to magically guess what's needed, and as you ask you'll start to learn what is needed from whom.

Also, if you get one of those nurses who has to know specifics, I just tell them "I don't know off the top of my head, but it is charted."

Up Vote Up Vote ×
Specializes in Dialysis.

It will take you a bit to get acclimated to your unit. Just use a simple report, and remember, 1 year will fly by and you will be helping someone new! You're new and learning, and you'll figure out what's important for each entity in no time. Each unit is different. If unsure, ask a senior nurse or your charge nurse on your unit. Usually, they are willing to share their knowledge. Good luck, and just take everything in!

Up Vote Up Vote ×

It is going to take some time to synthesize all of this. If you continue to pursue additional knowledge and also learn from the experiences you are presently having, it will all come together more quickly than you can imagine right now.

I agree a good brain sheet is in order. Other than that, focus on integrating what you learned in school with what you see in front of you.

Everything will be okay if you don't defeat yourself through negative thinking!

This is coming from someone who, when new, called a Code and some jerk came flying in the room and screamed, "What happened here?!!" Answer: "...........? He has cancer......" :sorry:

Up Vote Up Vote ×

Does the facility have a new nurse residency program? It has been especially helpful for me, even working psych.

You're going to be fine. Give a few months go get more acclimated and then maybe consider transferring if you still hate it/

Up Vote Up Vote ×

New Grad three weeks in, are you receiving feedback from your preceptor? These are great questions to ask. Keep at it you will get there, Med Surg floors can be tough, but the experience gained is priceless. Med Surg and Fundamentals books. Find a Mentor also. Each day repeat to yourself, I can do this! Keep a postivie outlook the time is going to fly by.

Up Vote Up Vote ×

I concur with basically all replies. Med-Surg is great for new grads because IMO it gives you the opportunity to hone your skills before you choose a specialty. All new grads should do at minimum 6 months of med-surg.

Everyone gave great advice, I'm only going to reiterate giving yourself time to get into a routing and learn how the unit functions. Before long you'll know what everyone expects or what type of information they're seeking, such as SW, Drs, etc. It will get better. Just know you will have good and bad days. No two days are the same on med-surg.

Up Vote Up Vote ×

I feel your pain. I'm 6 months into my first med/surg position. Couple of things that have helped me.

Ask lots of questions! Every time you go back for another day try to do one thing better. I made my own sheets for giving report and as the day goes on I fill it out and write things I have to remember to tell the next nurse. Ask the nurse who is giving you report if she/he knows the plan for discharge. Then you'll feel more ready for rounds and can add in your own assessment of the patient. Don't participate in too much social talking right now. You'll only get more behind. When you're overwhelmed tell yourself that you will get it all done but some things will have to wait. I'm always asking myself (or sometimes others) - what's my priority? I still really struggle with that.

Good luck! Don't give up!

Up Vote Up Vote ×
+ Join the Discussion