New grad on 11pm-7am Med-Surg

Franlpntorn · May 12, 2005

first things first take a breath. ok now feel beter? no take another one.

just started in jan 05. 7p-7a. same thing but do have a few years on you.

check out the thread lot more there.

"time management "

start with a chart sheet. use the same charting thats in the computer at work. if it starts with nero your sheet does the same.

enjoy the days and when you move to nights get tivo.

nights are slower then days this helps. your precepter will be your key. don't forget the basics you learned in school.

most jobs are med/ surg but after a year you could move to icu/er or sooner if they need someone. don't turn down acls or pals.

the best thing about hospitals is your needed and the benefits.

watch your preceptor, what kinds of questions are asked, (school never does a good job of this) what does her charting look like, how is her time management, don't be shy ask questions. if your text books have flow sheets reread them, if not pull out the books and go through the assessment chapter not the full one but the shift assessment. the pain one is good that sort of thing. your assessmet is every thing. are they sob with o2 on, did they just go the bathroom or are they this way all the time. ask them and then teach them the right way . then chart the teaching. look at the mar and see when your meds need to be given. most places 1hr before and 1 hr after.

we have pt summeries with admit dx and hx get a picture in your mind and if they don't look right find out why.

if you have good skills you should'nt have a problem. you are almost an rn so you know something. the nclex is the first test, life is the rest of it.

learn where the supplies are iv 's bed pans, ect. learn the computer, get orginzied (like that happens) but try. it may take time to learn to do a shift assessment under 15 mins but it will come. use what was said in report, did the pt change from that assessment. learn the p&p from your hospital. depending on the hospital oriention lot of this is covered in it. they will teach you a lot and it might be overwhelming at first but take each day 1 by 1. there should be some class room time in there too. keep a small note book with you and 3 pens and jot things down. ( just like school) 8 weeks is a lot for some places. they don't expect you to be a super nurse but a safe one. when do you take the nclex?

study for that first then worry about the job. just remember to take a breath now and then.

my charting is still slow and i'm getting better at the time managment. yes still learning each day. the other nurses will tell you the same. they will help you all you have to do is ask. don't let them bully you, your there to learn to do what you were educated to do...to be a nurse.

life is a learning curve.

NurseKate · May 13, 2005

I concur with what the previous poster stated.

What you're feeling is normal. Confidence comes with time. I think med-surg will be a great place for you to work (but maybe I am biased being a med-surg nurse myself). Try it. If you don't like it then you can always switch into something else, but the information you take with you will be invaluable. You'll most likely find that you will be learning a lot of information and skills that you can take with you to the critical care setting or any other setting that you may go into.

You will have time with a preceptor where you can ask a million questions. as time goes on you will start doing things on your own and have more autonomy. The key to a good oreintation is a good preceptor. If you ever feel like your orientation is not going well or are having difficulties with a preceptor, MAKE SURE YOU LET SOMEONE KNOW SO ADJUSTMENTS CAN BE MADE. This orientation experience is for you...so make sure that it's a good experience for you. You will find that you will continue to ask a million questions after orientation, but that's NORMAL. Your career is a a continual learning experience. People I work with who have been in nursing for years still ask questions about things they aren't sure of. Just remember the importance of knowing your limits and not trying to be stoic for fear of looking stupid when you ask someone something. Knowing your limits is key to safe practice! Something I have noticed about you already is that you have already mentioned areas that you aren't as strong in. That's a good start because you already have some idea of things you should focus on during your orientation. I think you're already off to a good start!

Nights may be a good shift for you depending on if you can sleep well during the day, etc. It really takes some time to get the body used to the switch. From my experience there are less medications to be given during night and sometimes the pace is a little slower. However, some nights will be VERY busy because contrary to popular belief there are a lot of people who don't end up sleeping during your shift. Don't be afraid to ask for help if you are feeling overwhlemed. Hopefully the bunch you work with will be supportive, resourceful, friendly, and helpful. When prioritizing always remember your ABCs (airway, breathing, circulation) and watch how your preceptor prioritizes. Ask him or her for tips on things to remember or things to think about when prioritizing. It doesn't come naturally at first for most people. Use your orientation time to get help with prioritizing. It takes a while to get the hang of. You may also find that you will constantly be re-evaluating your practice and thinking, "Next time I will do this differently and see if that helps..."

I'd also suggest that you set up support outside of work. You may want to get a group of friends (who are new-grads) together every so often to form a sort of support group. It's a challenging transition from student to nurse, but you aren't in it alone. There are so many other people who are experiencing the same doubts and concerns you are feeling right now. I felt the same way when I started, too! It takes a while to adjust, but keep telling yourself that you can do it because you can!

P.S. Also, other forums here on allnurses.com are very helpful, so feel free to ask questions on the forums as well. :) Good luck to you and congratulations on getting through nursing school!

Tweety, BSN, RN · May 13, 2005

I'm not a new grad and there are days when I feel overwhelmed and ready to quit. :)

Expect those feelings and live through them. That first year on med-surg, or anywhere for that matter, it's going to be tough. You're leaning so much that first year.

Sometimes I still feel like a fumbling fool. The other day a patients family asked my manager "is he just out of school?". :)

pricklypear · May 14, 2005

1:5-6 is totally do-able!! You are lucky. There are some med-surg floors where 1:10-12 is the norm!! Sounds like you made a wise choice!!

moliuchick, RN · May 14, 2005

I just accepted a position on a Med-Surg/Oncology/Hospice floor (predominantly med-surg) on the 11pm-7am shift. I have read posts and heard comments about how med-surg is too overwhelming for new grads. Is this true? The nurse-patient ratio is 1:4-5 during the day and 1:5-6 on nights. I'll be orienting on days for 5 weeks and then nights for 3 weeks, and then I will have my position on 11pm-7am. Do you think this is a bad shift for new grads? I am so worried about everything. Did I pick the right floor, the right shift, the right hospital?? I have no idea what area I want to go to, that's why I chose med-surg. Eventually I would like to do critical care so I figure med-surg will be a great start towards that. I'm SOOO TERRIFIED that I will be too overwhelmed to do this and that I will crumble under the pressure and quit. I have always been shy, timid, and non-confrontational. I feel like I won't be able to look at all my tasks and be like ok, this is what I need to do, this is what I'm going to do, and go about it. I feel like I'm still going to be like how I felt as a student, questioning my every thought and action and not doing things until I'm told or until I ask if I should be doing it. I feel like school did not prepare me AT ALL to prioritize, organize, or communicate. I'm so scared that I wish I wasn't about to graduate in A WEEK!!! AHH!!! And I start orientation on July 11. It could not come slow enough. Does anyone have any advice??? I am second guessing myself and this choice, NOW THAT I'M DONE SCHOOL!!!
(I'm only 20 and this is my first career. A lot of people contribute my age to the way that I'm feeling. I just don't know)

First, I would like to congrat you on finding your very first nursing job. To start off, I want to use a common phrase that most NCLEX questions have used, "You seems to be nervous about your new job, let's talk about it" (in reality, I want to just tell you,"you will be just fine, don't worry!".

The reason why I am telling you this is that I am just like you , I am non-confrontational, shy and timid sometimes. But I always use a techique that was taught by someone famous (like a inspirational speaker, can't remember exactly who), I will take a person such as a smart classmate who is always confident and pretend I am her. I will act and sound like her and by doing that, I will be able to boost up my self-esteem.

I don't think you are too young to be a nurse. As a matter of fact, I think you are very smart and very capable to be a great nurse. Younger people learn faster and they are more flexible. I am 37 and I have just graduated from my ADN. I have not found a job yet. You should consider yourself lucky since you can find a Med/Surg job so quickly. Med/Surg is the best place for you to build your experience. And it will totally be benefitial for you to start at night because night shift is calmer and you can learn more. Don't be a afraid to ask questions, no one expect you to know a lot as a new grad. Oh, almost forgot to tell you, English is not my first language, it is extra hard for me to remember all the med terms and speak as well as all the American born nurses do. I think I should be more scare and timid than you are. Good luck with your nursing career and update us on how you do on your first night!

grinnurse, RN · May 14, 2005

I have no idea what area I want to go to, that's why I chose med-surg. Eventually I would like to do critical care so I figure med-surg will be a great start towards that. I'm SOOO TERRIFIED that I will be too overwhelmed to do this and that I will crumble under the pressure and quit. I have always been shy, timid, and non-confrontational. I feel like I won't be able to look at all my tasks and be like ok, this is what I need to do, this is what I'm going to do, and go about it. I feel like I'm still going to be like how I felt as a student, questioning my every thought and action and not doing things until I'm told or until I ask if I should be doing it.
(I'm only 20 and this is my first career. A lot of people contribute my age to the way that I'm feeling. I just don't know)

I have to say now that grad. is over and I am closer to being a "real" nurse I am starting to get a little "freaky" about it all... :eek: B/C of family needs I took a day shift on M/S for the same reasons you did to eventually get back to ER/CCU. I am already wondering too if this was right thing too!! I do however feel prepared from my school to take on the challenge except in the skills area. If it is a skill I have never performed before is it ok for me to ask my preceptor to show me or what? I did my preceptorship in ER and feel great about certain things and even have confidence (somewhat) in those areas but the rest does seem overwhelming to me.

From reading the posts on here I know it is a normal feeling that we new grads are having. I am like :smackingf and asking myself.........girl, what have you gotten yourself into????? :uhoh21: I think for now I will concentrate on NCLEX and "I'll worry about that tomorrow........after all tomorrow is another day".

Good luck to us all fighting our fears and rising to the challenge of our careers!!

NurseKate · May 14, 2005

I do however feel prepared from my school to take on the challenge except in the skills area. If it is a skill I have never performed before is it ok for me to ask my preceptor to show me or what? I did my preceptorship in ER and feel great about certain things and even have confidence (somewhat) in those areas but the rest does seem overwhelming to me.

Definitely ask your preceptor for help!!! Your preceptor is there to help YOU. If there is something you have not done before then you need to ask for help. Maybe say, "I learn best if I watch it first and then do it." or "I learn best if you're there talking me through it." etc. As a nurse it is not important to know everything...it's important to know what your limits are and seek help for the things that you are unsure of. That's part of what makes safe nursing practice. Even if you have done the skill before but still feel unsure then maybe say, "I have done this a few times before, but I would feel more comfortable if you could watch me this first time in case I have questions..."

I have been off my orientation for some time, but I still see things I have never seen before and still have to perform tasks I have never done before! The way to deal with situations like this is to ask for help, have someone who knows how to do the skill show me what to do, read the policy on the procedure, and even ask my nursing supervisor for help. You don't want to go in feeling unsure and just start doing something you are unsure of. It is overwhleming, but you will get through it! Good luck to you on your new career! :)

shape0fmyheart · May 15, 2005

Wow! I completely forgot that I posted this until now, and it was so nice to read all of your replies! Thanks everyone, I really appreciate it. It helps a lot to hear some encouraging words from people who have been where I am or who are there now. My pinning is in 4 days and graduation in 7! . :balloons:

I just keep telling myself "hey, you can do this!"

Shomitay · May 15, 2005

Wow! I completely forgot that I posted this until now, and it was so nice to read all of your replies! Thanks everyone, I really appreciate it. It helps a lot to hear some encouraging words from people who have been where I am or who are there now. My pinning is in 4 days and graduation in 7! . :balloons:
I just keep telling myself "hey, you can do this!"

Congratulations!!

I just wanted to tell you thank you so much for posting this. I too will be pinned in just a few days ... Next Thursday!!!! And Graduation is Saturday. The last six weeks, I've not been able to sleep at night because I'm getting nervous ... they're going to trust me with lives in a couple of weeks!!!! :eek:

I also just got a job in med surg. I'm doing part of my managment there, and had just 6 patients the other night ... I was jumpin through hoops, and felt really incompetent by the time I left. But I know it will get easier eventually ... it'll just come with experience.

I can do this!! .... and so can you!!!! :balloons: Just hang in there!!