New Nurse on Med Surg Floor

TheCommuter, BSN, RN · Aug 1, 2015

Welcome! Your thread has been moved to the Medical/Surgical Nursing forum with the goal of amassing more responses. Good luck with your future endeavors.

gatoraims RN · Aug 1, 2015

Not that it helps but you are not alone. I think even seasoned nurses have moments where they feel like they are always behind. I am coming up on a year of med/surg experience, it does start clicking.

I still have days when I am swamped like the past two nights I had two discharges back to back, I work nights so this is unusual. I just felt stressed and behind. Nurses are a team even on your own you are still part of a team, utilize nurses you can count on.

Are you going to nights or days? Nights I felt overall I can connect more with my patients that on days. I don't like nights because it messes up sleep but I like it much better overal than days.

Everline · Aug 1, 2015

I don't have nightmares, but otherwise I could have written your post. I feel the same way about almost everything you wrote. I'm a new nurse on a very busy med surg floor and I'm just about 3 months in. I feel stressed each and every shift I work. Some days are worse (or better) than others, but they are all pretty bad. I can see ways in which I have improved drastically, but it never seems like it's enough. I worry about making a mistake or forgetting things. It's very hard for me to keep up and I'm always charting at the last minute, even if I get off to a good start on it in the morning. If I take a break, for lunch, bathroom...whatever...I pay for it dearly. In order to keep from drowning, I have to be on it the whole day, every minute. It's very tough. I hardly have any time to connect with patients, which was something I wanted to be able to do as a nurse.

I wish I had some great bit of advice for you. I just keep pushing myself to go in each shift and get through it. Please don't feel that you are alone in your feelings. I've read quite a few posts here over time talking about how stressful it can be for new nurses. So I don't think it's that unusual to have those feelings, even if no one talks about it in person. I can understand wanting to vent. It does help sometimes. I live for my days off and try to find as much enjoyment and relaxation as I can when I'm not at work. Take care of and be gentle with yourself.

graysunday · Aug 2, 2015

Hello,

Here are the things that help me. Make sure you are delegating tasks that your aides can help you with. In the beginning you might want to do everything yourself, but you just can't. Also, make sure you multitask a lot. Making lists of tasks needed to be done helps with the multitasking so that you aren't constantly running in and out of rooms. Eventually it'll click. Give yourself a year and set goals for yourself. While you have a preceptor, use the opportunity to figure out what works for you. If you aren't making calls to docs, placing orders and checking orders, you are never going to get the big picture. Don't be afraid to tell your preceptor how you feel. Maybe she can take on the little tasks so that you can spend more time with charting throughout the day and spend more time managing your patients care.

nurseactivist · Aug 3, 2015

Is it possible that you are not adjusting well to noc shift? The fact that you have nightmares and felt organized in school, makes me wonder if nights are not a good fit for you? Also, are you doing twelve hour shifts. Some nurses love them others know that they are unable to maintain the same level of care after three twelve hour shifts?

nurseofdragons · Aug 5, 2015

Not that it helps but you are not alone. I think even seasoned nurses have moments where they feel like they are always behind. I am coming up on a year of med/surg experience, it does start clicking.
I still have days when I am swamped like the past two nights I had two discharges back to back, I work nights so this is unusual. I just felt stressed and behind. Nurses are a team even on your own you are still part of a team, utilize nurses you can count on.
Are you going to nights or days? Nights I felt overall I can connect more with my patients that on days. I don't like nights because it messes up sleep but I like it much better overal than days.

I agree about days. I am on orientation so my hours are 11-11, 7-7 or 11-7 and I always find my 11-7 days go smoother and I get more time with my patients as the day goes on. When I am off orientation I will be 3-11. I am thinking I will have a lot of discharges and admissions around 3-5 but then I hope it will calm down. The past 2 days of work this week went pretty well and I felt really organized so that gave me a little confidence boost.

nurseofdragons · Aug 5, 2015

Thank you so much for your response. Sometimes I think I just need to hear from other new nurses to reinforce the thought that it will just take time. I felt really good week, everything went well and I was more organized. I made myself a new brain sheet that included a to do list section and that really seemed to help because my mind just gets so cluttered it I don't write it down in a list form for myself. I have tomorrow so I really excited to just enjoy my house haha. Thank you again. Good luck to you!

nurseofdragons · Aug 5, 2015

My shift when I get off orientation will be 3p-11p. I like 12 hours for the fact that once they are over with I have more days off to unwind and reflect what I have learned. I just made myself a new and improved brain sheet for myself to organize my patients information. I added a to do list section for each patient so I can write things down and erase them as I have done them (it seemed to help me this past week...or it could have been because I had a much easier section of patients than I did last week.) These past two days gave me a little boost though because I had all my charting done super early and knew my labs and had all my SBARS updated for the next nurse coming on. So hopefully next week goes well because I will be 5 days in a row. Nights I don't mind, I honestly think it is slower as the days goes on. I think my issue is just all that needs to be done..check the charts, be aware of you telemetry, print my tele strips, check my charts, checking and rechecking for orders, new labs, results, making sure my patients are okay while doing all the tasks haha. Sometimes I feel like I am still always forgetting something. I am still learning to prioritize and delegate so I get overwhelmed with all there is to do. Thank you so much for your response! :) I really appreciate it.

nurseofdragons · Aug 5, 2015

Thank you so much for your feedback. I made myself a new brain sheet with a section for a to do list for each patient and I think that really helped. I also made it a point to try and think ahead so grab my tubing if I know I am going to hang more fluids or ABX. This past week I was really organized and I was done charting early and felt really great about it. (it could have been because it was an easier section though, who knows haha). Today I definitely noticed a change though I felt like everything with my patients was clicking today I started noticed pieces of the whole picture that I don't think I would have connected before. That really made me feel like "okay I am improving, so I am going in the right direction." Everyone always says it takes a year or more and you still have moments where you feel lost so I keep trying to tell myself that. I just always did this to help patients so I never want to feel like I am not there for them and giving them the best care. I really care about my patients and I want them to know that so I think that will motivate to keep striving to get better. I am feeling much more positive after these past two 12 hour shifts if you can't tell haha. I am going to continue to make more goals for each shift to improve on. Thank you so much for your opinion I appreciate your words.

newRNinthecity · Aug 18, 2015

I'm a new nurse 7 months in on a med surge floor. I actually wrote a few panicking posts like this around 3 months in also. I felt like med surg was not for me (still maybe true) and I was a horrible nurse and things would never get better. It does start to get better...I'm honestly still waiting on more time for things to continue to get better...but every shift gets a little better. I still have days where I am running up and down the hall, feeling swamped, trying to think straight. But then there are other days where I will realize, "Wow I just gave a blood transfusion, had a patient pushing 200s systolic BP, a patient with crazy blood sugars, an admission, etc...and I kept my cool, asked for help when needed, and took care of it!" No day will be perfect, and all nurses have stressful days no matter what. There have still been some recent days where I left work wanting to cry due to the sheer stress I felt. I still ask questions all the time, and there are always resources available for things you don't know. Little by little, I find myself worrying less about work the night before a shift, feeling more confident, and even enjoying the work I do on some days. I definitely don't feel totally confident, but it has improved. I still have trouble seeing the "big picture", but that also gets better every day. When I first started it felt like a patient had this list of diagnoses, and all these orders that were like puzzle pieces that did not fit together. I wish I could read the whole chart, but obviously we don't have time for that. I have found that reading the most recent physician progress note and the admission note (if time allows) is helpful to determine what exactly we are focused on doing for the patient. I write down all my little thoughts (recheck a BP, make sure a patient got a dinner tray, etc) or else I will forget them. I usually put an empty check box next to things I need to do, so that I can check them off when complete. I am very type A, so it drives me crazy that all my boxes are never checked off and I keep adding more things to the never-ending to-do list. Once I accepted that the list never ends, and a lot of things are out of my control, I also felt less stressed. I often have to remind myself to take a deep breath. One of my co-workers said it takes well over a year to feel confident and like you know what you are doing. Keep your head up, you can do it! I keep reminding myself that with a year or two of med sure experience, so many doors open up to other nursing careers. Finding something to work towards has helped me as well! Good luck!

sunshyne17 · Aug 19, 2015

'Allo!

It should get better and one of the previous posters were right - even seasoned nurses have rough days. It depends on admissions, discharges, changes in a patient status, etc. I like to have a sheet/brain sheet where I can jot things down. But don't become heavily reliant on writing everything because you will be there for hours after your shift transcribing into the computer. My tips:

- Chart as you go: Not many people on my floor seem to like this but I do. I feel like I accomplish more and in the event someone does go south, you have something "done" already. And you will realize your charting is much more accurate.

- Be upfront: be honest with your pt.'s Let them know you have an emergent issue and you will be with them. Or you are waiting to hear from the doctor. Etc.

- Remember you are ONE person: you can only be in one place at a time. Pick the most urgent issue and tackle that first. Hypoglycemia before pain. Change in LOC before epistaxis, etc.

- Be polite but firm: with staff and patients. Delegate and follow up with techs/aides. Let that pt. know it is NOT ok to use profanity. Let that previous nurse know it is NOT ok to leave behind overdue meds or dressing changes because "they got busy" (the floats at my hospital are notorious for this).

- Smile!: perhaps the most important one yet. YES work is busy and YES that one patient is a grouch. Grin and bear it. Everyone wants a nice nurse! :)