NEW NURSE ADVICE

cheska_rn, ASN, RN · Nov 6, 2009

I am not an RN (yet!), but just wanted to wish you good luck on your new job!

nursemike, ASN, RN · Nov 6, 2009

Congratulations, and good luck. I once heard a nurse who was precepting a new hire say, "She's not the sharpest tool in the shed, but she shows up on time and works hard the whole shift. I can teach anything but work ethic. As long as she has that, she'll get the rest." We need more preceptors like that.

More specific points: I still find my shift goes better if I get there a little early to get myself organized before report. Used to be a half hour, now 15 minutes is usually enough. We no longer use printed Kardexes, so I make my own--meds due, other tasks, spaces for assessment.

Also, as the saying goes, there's no such thing as a dumb question. Well, I may have pushed the envelope on that a time or two, but it's generally true.

Even if it's something it seems like you should know, even if people tell you it's something you should know, it's better to ask than screw up. Try not to keep asking the same questions over and over, though, and try to work toward finding your own answers using the resources available to you, as you get more familiar. Still, one of my landmarks in my first year was when my mentor, a great nurse with decades of experience, came to me for advice. You never outgrow the value of getting two heads together.

Be happy. Maybe the most important lesson I've learned in life is that being happy is not the same as having fun. Fun is important. We all need it. But it is no substitute for being happy. Nursing provides opportunities to have fun, and I'm all for them, but if it was all fun, all the time, we'd have to pay to do it. There will be tasks, there will be shifts, there will be entire weeks when it just isn't much fun at all. But if you can say through it all that underlying everything, I'm happy being a nurse, you won't give up and you won't burn out.

Most of your worst moments will be funny stories, six months later.

Someone, maybe management, put up a paper in our breakroom with The Optimist's Creed on it. It's bs. I consider myself an optimist, but I'm a human being, not a greeting card. I sweat. I cry. I cuss. (I try not to do any of these things in an inappropriate way at work, but some of the footprints on the Pyxis machine are mine.) Cut yourself enough slack to stay sane. You can't be perfect, but you can be real, and a lot of patients respond well to real.

webmansx, ASN, RN · Nov 6, 2009

Dances with cats....I wish I had read this when I started..I thinks things would have been much better for me

jessiern, BSN, RN · Nov 6, 2009

1. Ask questions. You are new, and that is okay. I was too reluctent starting out to ask questions for fear of looking stupid.

2. If it doesn't feel right, it probably isn't.

3. Ask for help if needed. Again, something I had difficulty doing.

4. Sometimes a good 5 minute cry in the linen closet is needed. Keep some extra powder with you to hide the evidence.

5. Don't focus so hard on the job that you lose track of the patient. We all are guilty of that, I believe, and I struggle with that every shift I work.

6. Keep a small notepad with you at all times. Jot quick notes about what you need to do, chart, ect. Sometimes you may not sit down until the end of the shift to chart, and your notes will really come in handy.

7. Don't give a medicaiton if you don't know what it is for. EVER!

8. Learn from the more experienced nurses.

nursemike, ASN, RN · Nov 6, 2009

Dances with cats....I wish I had read this when I started..I thinks things would have been much better for me

Here's a thing about cats: they can't talk, but they do communicate. I think cats teach you empathy. Plus, you know, the worst patient ever isn't half as demanding.

maleRN2010 · Nov 7, 2009

Hi everyone,

I am a new nurse starting my first med-surg job tomorrow at 7a. I am excited and petrified at the same time. I did an accelerated program and my clinical experiences were weak at best. I have a short preceptorship - only 5 weeks. This frightens me even more. I know that fear and anxiety do more harm than good so I am trying to keep perspective. I see a lot of posts about the necessity for prioritization and organization. My previous career was very unrelated, so my organization and management skills are very different. I had time to plan activities throughout the day and could control interruptions. How will I survive? The fact that I am older is a concern as well. Can an old dog be taught new tricks? I worry that my forgetful nature and sometimes scatter-brainess will prevent me from doing a good job. I will be swamped and drown, yet I want to get this experience under my belt and move on after a year to community/public health. Any words of wisdom? Am I just freaking out about making a success of a change of career?

maleRN2010 · Nov 7, 2009

Hi everyone,

I am a new nurse starting my first med-surg job tomorrow at 7a. I am excited and petrified at the same time. I did an accelerated program and my clinical experiences were weak at best. I have a short preceptorship - only 5 weeks. This frightens me even more. I know that fear and anxiety do more harm than good so I am trying to keep perspective. I see a lot of posts about the necessity for prioritization and organization. My previous career was very unrelated, so my organization and management skills are very different. I had time to plan activities throughout the day and could control interruptions. How will I survive? The fact that I am older is a concern as well. Can an old dog be taught new tricks? I worry that my forgetful nature and sometimes scatter-brainess will prevent me from doing a good job. I will be swamped and drown, yet I want to get this experience under my belt and move on after a year to community/public health. Any words of wisdom? Am I just freaking out about making a success of a change of career?

ellakate · Nov 7, 2009

Hello, maleRN2010! My advice: Focus on what you CAN do. When I was out of school a few months, I was put in charge on night shift. The worse thing that I could envision (from my limited perspective) was a code and that I would have to perform CPR. Every evening, as I applied my makeup, I would repeat, "A is for airway. Open the airway. . . . .B is for Breathing. . .C is for circulation." As I pictured the event, I was able to do the right thing. I walked myself through different scenarios, just to stay on the ball.

I have always prayed a lot at work. Mostly thanks. The Man and I have a casual relationship.

Focus on the task at hand. Multitasking quit working for me about 10 years ago, but I just realized it last summer.

Also, remember, you are the new kid. You aren't supposed to know everything.

Of course an old dog can learn new tricks.Remember the old tricks. You might need them too.

Breathe, often and deeply. :specs:

nursemike, ASN, RN · Nov 7, 2009

Here's the thing about being older: you've been alive longer than someone who is younger. Which means you've been dealing with people longer. A big part of nursing is dealing with people. So you probably have more practice at one of the most important parts. This includes patients and co-workers. Among your new peers, you will likely find some who have their hands full getting their own crap done and others who really enjoy teaching. You may, as I have, meet nurse half your age when ten years experience. You probably won't have a lot of trouble figuring out who you can look to when you need help. You've probably heard the expression, "nurses eat their young." It can be even worse for the old young. But it's a really overused expression. A lot of nurses--I would say most--are smart enough to see that the nurse they help succeed will be a help to them, one day. Also, life experience, even totally unrelated to nursing, tends to make you tough and chewy, and not really taste so good.

Anxiety is normal and inevitable, and not even necessarily bad. A healthy dose of anxiety can make you careful, and you need to be careful. Cocky new nurses kill people. Of course, crippling anxiety is not so helpful. Panic rarely improves a situation. And a lot of patients do better if you can manage to put up at least a moderately confident front. Still, it often doesn't hurt to admit you don't know something, as long as you seem confident you can find out. I read about a study, once, that patients evaluate the skills higher in a less skillful but personable nurse than a more experienced but less friendly one. My experience seems to support that. Most patients have a sense of whether you care about them. If they think you do, and your a little slow, they're apt to be a lot more patient than if they think you don't care.

A lot of time management is just like centex's ABC's. Are all of your patients breathing? That's a good start. How is their heart rate and BP? Good? Okay, then. How do you keep them that way? (Of those, the one that will probably give you the most trouble is BP. I estimate half my pages to docs are over BP issues. And more than half of the rest are over pain. Depending on you population, most patients airway and breathing tend to take care of themselves, but you still have to be aware of them, since it's really bad when they don't.)

When I was new, I sometimes would get ready to start an IV or change a dressing and find I'd forgotten half of my supplies. But my feet are smarter than my brain, and I soon got tired of going back after stuff. A lot of nursing is like that. Do it enough times, and you get good at it.

What I told the OP about work ethic is big. If you graduated from an accredited program and passed NCLEX (even if it took more than one try) you know what you need to know to be a nurse. That part is proven. So, most of the time, the difference between success and failure is how hard you try. If you really, really, really want to be a nurse, you'll be a good one--eventually.

Of course, that's assuming you don't find yourself in a toxic unit. Try to look for a place where most people seem at least moderately happy. All nurses gripe about their jobs, but try to avoid places where they really mean it. And give serious thought to doing your first year or so on nights. Less distractions. Also, it seems like zombies tend to stick together. There's an element of commaraderie among nurses with toothpicks under their eyelids that those poor, unfortunate dayshift people don't often have time to develop.

Oh, geez, maleRN2010. I just remembered you said you were starting at 7a. It'll be okay. Probably. Maybe. Oh, hell, dude--it's been good knowing you. (Just kidding--it'll be fine.)

maleRN2010 · Nov 8, 2009

Thanks so much. Any changes in life are difficult for me, but I put myself out there for the wonderful experience of living a fuller, richer life. Your messages are incredibly kind!

beerfish61 · Nov 10, 2009

Thanks for your post, I am starting my first RN job (2nd career) at the end of the month and will try to keep your advice in mind, especially the being happy and staying sane parts. You mention making your own Kardex/MAR notes. Do you know if/where there are examples of nurses' worksheets, so I can see what might best fit my organizational style?