New Med-Surg RN

RedInScrubs, ASN, RN · Jun 6, 2015

I had the same thoughts when I was in school, and accepted a med-surg position a year ago. Wouldn't go back, and I love the work way more than I thought I would.

That being said, some of the best advice I know that helped me:

1) Find a system for writing things down. Everything from when the doctor was in to the IV you started to the PRN med you gave. I use a grid/spreadsheet that I made myself in Excel, along with the Kardex for everything else. Helps me stay focused and also have a handy reference for if I have a rapid or code and needs everything on one place, but also just need a quick visual reference for how my day will look at a glance.

2) Make friends. Lots of them. Anyone from transport to RT to fellow RNs to surgeons are your support system, and will have your back if you show them you can be open and are on their team. Make as many friends as you can. It will pay dividends later on when you need favors, and help you feel supported and welcome every day at your job.

3) Always do a walking round FIRST after report, with the previous RN if you can. Seeing my patients in the room often helps me mentally know which to hit up first or last. Plus it often clues me into things the previous shift missed, like full foley bags, empty IV bags, or soiled patients that need attention right away and could be a time management problem later on if I happened to walk in and not be prepared to spend that much time in the room. Also helps me know what to grab so I don't run in and out twenty times, and often keeps them from feeling ignored and calling me twenty times while I'm trying to get my day together.

4) Carry extras of things you use often with you. IV caps, 2x2 gauze, stat-locks, tagaderm, and flushes are always in a pack I wear or in my clipboard, because I end up needing them all the times at random times. It helps keep you focused on the task and from running in and out of the room a million times when you have what you need at hand. You'll figure out a system as times goes on, but keep track of things you use routinely and make it a point to keep spares so you mentally don't get sidelined at unexpected moments like patient transfers, admissions, or discharges.

Good luck!!

Newbie_RN17 · Jun 7, 2015

Thank you so much for the advice! I'm pretty excited about the nurses I work with, they seem so nice and have been really helpful with answering my questions and teaching me what they can. How long were you on the floor before you started taking your own patients? This is my third week and I'm hoping to start taking at least 1-2 of my own so I can stop feeling like I'm in "student mode" still if that makes sense. I just got my license this week, so I'm hoping that now that I'm a full fledged RN and have a LOT more autonomy than I did as an RN applicant and don't have to have direct supervision I can start branching out on my own. I'm a dive in head first kind of person and feel like if I'm not thrown in the deep end, I'll never learn. Obviously, I want my patients to be safe, but I also need that ability to start thinking for myself.

RedInScrubs, ASN, RN · Jun 7, 2015

Thank you so much for the advice! I'm pretty excited about the nurses I work with, they seem so nice and have been really helpful with answering my questions and teaching me what they can. How long were you on the floor before you started taking your own patients? This is my third week and I'm hoping to start taking at least 1-2 of my own so I can stop feeling like I'm in "student mode" still if that makes sense. I just got my license this week, so I'm hoping that now that I'm a full fledged RN and have a LOT more autonomy than I did as an RN applicant and don't have to have direct supervision I can start branching out on my own. I'm a dive in head first kind of person and feel like if I'm not thrown in the deep end, I'll never learn. Obviously, I want my patients to be safe, but I also need that ability to start thinking for myself.

I took patients the third week of orientation. We had a total of eight weeks, two were just tasking, the last six were with preceptors. I took 1-2 the first week, and by the last I took a full load of 5-6. But I didn't feel "proficient" until probably.. Three months in? Took more than the orientation period, and it wasn't until about 8 months in that I felt like I could handle things in general.

It takes a while. You won't feel like "you got that" for a while. Hang I'm there, and don't be too hard on yourself. Med-surg is hard. And starting there is hard. Just remember friends are your best resource. :-)

NomadNurse_ · Jun 9, 2015

This is a great thread! I am in the same situation (new grad, med surg floor & did my practicum on a different type of unit). Bump!

Newbie_RN17 · Jun 11, 2015

I just started getting my own patients this week, had two on Tuesday and was supposed to have three yesterday but one came up WAY more critical than I was told in report so I got experience calling our rapid response team and dealing with a crisis situation. I'm really liking this job and getting to know my patients and, while terrible for the patient, I loved seeing her AFTER we stabilized her and solved the problem (her glucose was VERY low) and hearing her say how much better she felt. :) I know I've got a TON to learn and that I'm nowhere near where I will be in a year, two years, twenty years from now, but I've learned so much so far and I'm really loving my job and getting to know my patients. I work on a really supportive floor where teamwork is key, too, so I've literally heard no nasty talk behind someone's back and any time I've had a question I've gotten an answer. I feel so fortunate!

PCnurse88 · Jun 11, 2015

My unit sounds similar to yours - everyone had their own personalities but, collectively, they dealt with new grads REALLY well (and still do). During the last few weeks my preceptor would also take the role of charge RN because I was taking on her full assignment, so she was more of a resource for me than anything. As charge she would get a brief report on every patient our unit had, and would then sniff out cool things for me to see. My first wound vac was actually on someone else's patient, my first rapid response was really me standing in the corner of someone else's RRT, things like that. After I got off orientation and had my own patient load, I would still try to find new things that other people were doing and ask to shadow and/or help. Even now, nearly a year and a half in, if someone is doing something unusual that I've never seen (like our IV therapy team inserting a PICC) I'll ask to watch. And now that I've gained some experience I'm able to tell the new grads cool things I'm doing. I showed a girl how to hang blood the other day, and last week I even had a new grad of my own to precept when her normal nurse was out.

A year from now you'll look back and think "wow, I've learned SO much without even realizing it". Crazy to think last June 9 2014 I was on my first shift off orientation, and this June 9 2015 I was charge nurse on day shift with the sickest patient on my unit. Best of luck!

Newbie_RN17 · Jun 11, 2015

Thank you! It's so interesting to hear how much things can change in just one year! :)