New Nurse Advice Please

Newbie4567 · Apr 1, 2020

Hello there,

The first thing I want to say is: BREATHE. It is going to be okay. You got this. You passed the NCLEX. Your hiring manager chose you because she believes in you. Trust me, if she really felt like you weren’t a good candidate, she would not have chosen you.

Next, the first weeks of your orientation are going to be the basics. Assessment, organization, planning care, medication administration. All of these things are going to become easier with practice. I understand you’re afraid that you’ve forgotten all your skills, but it WILL come back to you when you review. I would practice your assessment skills on a friend or family member.

My basic assessment (as an ICU nurse) is:

-Neuro: assess orientation, movement of extremities, as pt to smile and stick out tongue for facial droop. Check pupils. Assess for pain.

-CV: feel radial and dorsalis pedis, ask about palpitations/numbness, tingling. listen to heart sounds, assess temperature of skin, capillary refill, and edema. If on telemetry, assess rhythm.

-Respiratory: lung sounds, ask if feeling short of breath, verify amount of o2 patient is receiving

-GI: listen to abd sounds, THEN palpate abd. Ask about pain during palpation. Ask about last bowel movement. Assess feeding tube/tube feeds. Ask about nausea/vomiting.

Gu: assess foley (if one is in place), perform foley care if possible, assess NEED for foley, assess color and quantity of urine if possible, review I&o’s in chart

skin: verify status and stage of all wounds, perform wound care as needed. Sometimes, I assess wounds later in the day as this can be very time consuming.

Remember to specialize your assessment to your patient! For instance, perform a more thorough neurological assessment on a patient who recently had a stroke. Lots of educational websites are available to review lung sounds, heart sounds, and CV rhythms.

I would review the most common medications you will see on the floor. Trust me, no one expects a brand new nurse to remember every single med they are given. I would review common BP meds, diuretics, pain meds, blood thinners, anti-arrythmics and seizure meds. Ask your preceptor about the formulary available to nurses at your hospital, or download a medication administration app. Feel FREE to call pharmacy about a medication route, dosage or timing that you are concerned about, for example if a new NG tube has been placed on a patient who failed their swallow eval, can they still take their scheduled chemotherapy pill crushed?

As for organization and planning care, that will just take time. Utilize your resources and your preceptors. Ask about hospital specific care bundles. What does your hospital do to prevent CLABSI? CAUTI? Falls? Is there a rapid response team? Review the signs and symptoms of sepsis (essentially...high temp, low bp, and high HR). And don’t be afraid to ask questions.

From one new nurse to another, you got this!

louis18, BSN · Apr 3, 2020

On 4/1/2020 at 10:42 AM, Newbie4567 said:
Hello there,
The first thing I want to say is: BREATHE. It is going to be okay. You got this. You passed the NCLEX. Your hiring manager chose you because she believes in you. Trust me, if she really felt like you weren’t a good candidate, she would not have chosen you.

Next, the first weeks of your orientation are going to be the basics. Assessment, organization, planning care, medication administration. All of these things are going to become easier with practice. I understand you’re afraid that you’ve forgotten all your skills, but it WILL come back to you when you review. I would practice your assessment skills on a friend or family member.
My basic assessment (as an ICU nurse) is:
-Neuro: assess orientation, movement of extremities, as pt to smile and stick out tongue for facial droop. Check pupils. Assess for pain.
-CV: feel radial and dorsalis pedis, ask about palpitations/numbness, tingling. listen to heart sounds, assess temperature of skin, capillary refill, and edema. If on telemetry, assess rhythm.
-Respiratory: lung sounds, ask if feeling short of breath, verify amount of o2 patient is receiving
-GI: listen to abd sounds, THEN palpate abd. Ask about pain during palpation. Ask about last bowel movement. Assess feeding tube/tube feeds. Ask about nausea/vomiting.
Gu: assess foley (if one is in place), perform foley care if possible, assess NEED for foley, assess color and quantity of urine if possible, review I&o’s in chart
skin: verify status and stage of all wounds, perform wound care as needed. Sometimes, I assess wounds later in the day as this can be very time consuming.
Remember to specialize your assessment to your patient! For instance, perform a more thorough neurological assessment on a patient who recently had a stroke. Lots of educational websites are available to review lung sounds, heart sounds, and CV rhythms.
I would review the most common medications you will see on the floor. Trust me, no one expects a brand new nurse to remember every single med they are given. I would review common BP meds, diuretics, pain meds, blood thinners, anti-arrythmics and seizure meds. Ask your preceptor about the formulary available to nurses at your hospital, or download a medication administration app. Feel FREE to call pharmacy about a medication route, dosage or timing that you are concerned about, for example if a new NG tube has been placed on a patient who failed their swallow eval, can they still take their scheduled chemotherapy pill crushed?

As for organization and planning care, that will just take time. Utilize your resources and your preceptors. Ask about hospital specific care bundles. What does your hospital do to prevent CLABSI? CAUTI? Falls? Is there a rapid response team? Review the signs and symptoms of sepsis (essentially...high temp, low bp, and high HR). And don’t be afraid to ask questions.
From one new nurse to another, you got this!

Thank you so much, I appreciate your reply! I'm reviewing all of it right now! I'll try my best!

buckchaser10 · Apr 3, 2020

On 4/1/2020 at 9:42 AM, Newbie4567 said:
Hello there,
The first thing I want to say is: BREATHE. It is going to be okay. You got this. You passed the NCLEX. Your hiring manager chose you because she believes in you. Trust me, if she really felt like you weren’t a good candidate, she would not have chosen you.

Next, the first weeks of your orientation are going to be the basics. Assessment, organization, planning care, medication administration. All of these things are going to become easier with practice. I understand you’re afraid that you’ve forgotten all your skills, but it WILL come back to you when you review. I would practice your assessment skills on a friend or family member.
My basic assessment (as an ICU nurse) is:
-Neuro: assess orientation, movement of extremities, as pt to smile and stick out tongue for facial droop. Check pupils. Assess for pain.
-CV: feel radial and dorsalis pedis, ask about palpitations/numbness, tingling. listen to heart sounds, assess temperature of skin, capillary refill, and edema. If on telemetry, assess rhythm.
-Respiratory: lung sounds, ask if feeling short of breath, verify amount of o2 patient is receiving
-GI: listen to abd sounds, THEN palpate abd. Ask about pain during palpation. Ask about last bowel movement. Assess feeding tube/tube feeds. Ask about nausea/vomiting.
Gu: assess foley (if one is in place), perform foley care if possible, assess NEED for foley, assess color and quantity of urine if possible, review I&o’s in chart
skin: verify status and stage of all wounds, perform wound care as needed. Sometimes, I assess wounds later in the day as this can be very time consuming.
Remember to specialize your assessment to your patient! For instance, perform a more thorough neurological assessment on a patient who recently had a stroke. Lots of educational websites are available to review lung sounds, heart sounds, and CV rhythms.
I would review the most common medications you will see on the floor. Trust me, no one expects a brand new nurse to remember every single med they are given. I would review common BP meds, diuretics, pain meds, blood thinners, anti-arrythmics and seizure meds. Ask your preceptor about the formulary available to nurses at your hospital, or download a medication administration app. Feel FREE to call pharmacy about a medication route, dosage or timing that you are concerned about, for example if a new NG tube has been placed on a patient who failed their swallow eval, can they still take their scheduled chemotherapy pill crushed?

As for organization and planning care, that will just take time. Utilize your resources and your preceptors. Ask about hospital specific care bundles. What does your hospital do to prevent CLABSI? CAUTI? Falls? Is there a rapid response team? Review the signs and symptoms of sepsis (essentially...high temp, low bp, and high HR). And don’t be afraid to ask questions.
From one new nurse to another, you got this!

This is great advice! My two cents to add: Nursing school was all about getting you the critically think and give you a very minimal base to expand on when you hit the field. After all nursing is a massive field and there is no way they could teach you about every possible facet. Anything that will be useful to you will be learned on the job so don't worry too much about having forgotten stuff from school. After a couple shifts in your anxiety should lessen about what you know but I will warn you to be prepared to get frustrated with your lack of time management. This is a huge learning curve with new nurses and old nurses alike. Oftentimes you will not be leaving at your scheduled time which can create home life strain and possibly have management breathing down your neck too. Life goes on and you'll get better at it. You'll look back one year in and be amazed at how much you've grown. I'm excited for you and look forward to an update once you start working. Good luck to you!

Joan Michelle Rosali · Apr 17, 2020

Hi I agree with Newbie on this one. Her assessments are so onpoint. We were taught that we should do focused assessment in 5mins because in reality, nursing is all about time management. And also in nursing everything is about assessment. Giving meds?Assessment. After intervention, assessment. I was just wondering how was your work?How was the adjustment?Iam an international nurse trying to be a nurse in Canada and Iam just overwhelmed. Just because Canadian nurses have so much scope compared to my previous country. Iam about to go into clinicals and Iam so nervous. I can just imagine your situation. But every nurse that I talked to always say that it will get better and dont worry if you are not as fast as the rest. Critical thinking and time management grows hand in hand with experience. I hope to hear from your work adventures soon! ??