I have been posting on the first year nursing forum, but wanted some tips here to make the transition smoother. I am book smart and hands on stuff takes me a little more time to get than the book stuff, but once I get it. I get it. I just haven't "got it" all yet on the floor. The last week went much better, but I can see I am seriously under a microscope right now. I really want to do well. I am motivated to listen to what others have to say and I have a good attitude.
With that can you gals and guys give me your best do's and don'ts, both professional and personal preferences? Especially the crusty old nurses because I want to know what you folks are expecting from me? What is the best way to ask questions without being annoying? Best ways to be more independent without being unsafe? I hate being new. It's hard. Personal strengths of mine are persistence and I'm not a quitter. I just keep telling myself that every.single.day. Thanks for anyone that takes the time for tips and suggestions. I genuinely appreciate it.
Oh and any tips for dealing with nurse educators too.
Head to toe always, no skipping, even if it seems like it is rather "dumb"
The most "normal looking people" can think it is 1982, and they are 22.
Scan PMH and meds. Make any notes about weird med times, otherwise, your meds are more than likely due at the AM and PM times of the facility. Go do your FBS and insulin stuff before meals. Also, some thyroid meds are given before meals. The information of PMH establishes a baseline.
So, Head: Are they alert, are they oriented? Who, What, Where, Why, How? (who are they, what brought them here--chief complaint), where are they, why, pain, assess--better worse same, and how are you going to increase function.
eyes, PERL?, nose--"stuffy" draining can they breathe? Do they snore, can they sleep? mouth--teeth intact? Can they swallow, do they have a sore throat, do they have bulging carotids? Shoulders, are they even, do they hurt? Can they grip your hands? Do their hands shake, do they drift?
Chest--pain, breast lumps, any unusual changes from baseline?
Lungs--How do they sound, are they coughing, do they have breathing difficulty?
Abdomen--all 4 quads. Are they moving their bowels? How often? Easily? Pain?
Do they urinate regularly, too much, too little? Do they have pain with urination? lady partsl/penile discharge? Are they sexually active? Any concerns with STD's? Regular periods?
Can they stand/walk--with or without assistive devices? Do their legs, knees, feet hurt? Is their skin intact on their feet? Heels non-boggy or red?
Skin risk--any pressure points? Fall risk--how independent are they at home, and how is their current status going to affect function/walking/standing, moving in bed.
Then the other questions--have they been feeling "down" in the last month? Suicidal? Do they partake in drugs and/or alcohol? Do they feel safe at home?
And then plan for the day. Goals for the day. Bring any concerns to your resources. And know what all of your resources are, how to find them and how to use them.
As the shift goes on, and there's orders labs other tests and MD rounding, you may have to rethink the plan for the day, the goal, and that is ok. Let the patient be as active as they can be in that process.
Head to toe always, no skipping, even if it seems like it is rather "dumb"
The most "normal looking people" can think it is 1982, and they are 22.
Scan PMH and meds. Make any notes about weird med times, otherwise, your meds are more than likely due at the AM and PM times of the facility. Go do your FBS and insulin stuff before meals. Also, some thyroid meds are given before meals. The information of PMH establishes a baseline.
So, Head: Are they alert, are they oriented? Who, What, Where, Why, How? (who are they, what brought them here--chief complaint), where are they, why, pain, assess--better worse same, and how are you going to increase function.
eyes, PERL?, nose--"stuffy" draining can they breathe? Do they snore, can they sleep? mouth--teeth intact? Can they swallow, do they have a sore throat, do they have bulging carotids? Shoulders, are they even, do they hurt? Can they grip your hands? Do their hands shake, do they drift?
Chest--pain, breast lumps, any unusual changes from baseline?
Lungs--How do they sound, are they coughing, do they have breathing difficulty?
Abdomen--all 4 quads. Are they moving their bowels? How often? Easily? Pain?
Do they urinate regularly, too much, too little? Do they have pain with urination? lady partsl/penile discharge? Are they sexually active? Any concerns with STD's? Regular periods?
Can they stand/walk--with or without assistive devices? Do their legs, knees, feet hurt? Is their skin intact on their feet? Heels non-boggy or red?
Skin risk--any pressure points? Fall risk--how independent are they at home, and how is their current status going to affect function/walking/standing, moving in bed.
Then the other questions--have they been feeling "down" in the last month? Suicidal? Do they partake in drugs and/or alcohol? Do they feel safe at home?
And then plan for the day. Goals for the day. Bring any concerns to your resources. And know what all of your resources are, how to find them and how to use them.
As the shift goes on, and there's orders labs other tests and MD rounding, you may have to rethink the plan for the day, the goal, and that is ok. Let the patient be as active as they can be in that process.
Best wishes, and it WILL come together for you!
That was awesome! I will add that I am on a specialty floor (OB) which is why I didn't do a full head to toe. I had seen other nurses skip stuff (not here but other facilities) and that's why I thought I would be looking silly asking some of these things. I am going to print this out. I do know how to do a full head to toe, but I've seen a lot of nurses that don't do it too. I also find I am still at the checklist phase of nursing where I just still need it to keep me organized. Thank you so much for your input. It was helpful and I appreciate it.
Specializes in ED, Cardiac-step down, tele, med surg.
when you call the physician, have all the pertinent information at your fingertips, like a full set of vitals just incase they ask, plus a med list. Also have in mind of what you want the physician to do with the information your telling them. Remember the SBAR.
See this thread....https://allnurses.com/general-nursing-discussion/help-i-have-988742.html
LOL
Don't do that.
LOL for the love of god please don't be one of those. Humility, a passion for learning, a respect for the unit culture (or really anywhere there was a group of people working before you started), and a continuously open mind are essential. Never judge the people you start working with -- you do not know their circumstances before you started and you do not have all the information. Wait a while. Then, if it still seems like the place is messed up, leave. You can't fix it. This applies to any job, anywhere.
Congrats on your new job! Admittedly, I don't do a full head to toe assessment first thing on everyone (I work on a surgical floor too- ortho/trauma). I do a quick check on my most stable patients first (safety, ABCs). Then I'll do a full head-to-toe on my least stable/most complex patients. I usually end up catching a few things and am able to articulate these to the MDs, who are generally on the floor around this time, so that we can develop a plan of care together. On my more stable patients, I will do pertinent focused assessments only. Later, after meds/washes/etc are done, I will finish my head-to-toe assessments.
Take the time to be thorough when you are starting out! With practice, you will become faster. It will help you to improve your critical thinking and to put the pieces of your patient puzzle together if you go a bit slower. And try to be systematic about your ABCs/head-to-toe assessment. Otherwise, especially when you are working with higher acuity patients, you may miss important details.
There's lots of articles out there with tips on how to perform head-to-toe assessments. Here's a link that seems to put everything together nicely.
And don't worry about asking questions! It's worrisome to work with a new nurse who doesn't ask questions. You are learning and aren't expected to know everything. Nursing is not easy work and if anyone gives you a hard time while you are learning, try not to take it personally! It is usually more about them than you. So long as you practice safely, own up to your mistakes, learn from your mistakes (you will make mistakes- it happens to everyone so don't beat yourself up!), help out your colleagues whenever possible, and seek out learning opportunities you will do well. Have fun on your new unit!
The best way to ask questions is to not worry about being annoying Seriously though, if you don't know, ask. Much better to temporarily annoy someone (who shouldn't be getting annoyed, anyway) than to permanently hurt someone else.
I always ask questions to my senior RNs, but sometimes I felt like I'm asking so many that I'm annoying them. Reading this thread made me feel less anxious about approaching my seniors/preceptors. Thanks a lot!
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Here's a good way to ask a question: Think of the most likely answer yourself, then run it by someone. "I'm seeing such-and-such and this is what I want to do about it. Is there anything I'm missing?" This shows that you're developing your judgement but still cautious enough to ask when you're not sure. This makes it way easier for someone to guide you without feeling like they're spoonfeeding you.
Another thing is to make good use of your worksheet. If the unit has preprinted ones that work for you, great. If you just can't train your eyeballs to find the info you need, then develop your own worksheet and make copies. Keep all pertinent info on it that you need at your fingertips, plus a timed to-do list. Don't rely on your cranial brain to keep yourself organized; your paper brain will be much more reliable.
Keep thinking of the next 3 things you have to get done now. This will help you with time management. If you have a chatty patient, develop the art of nodding and smiling as you back out of the room.
because I want to know what you folks are expecting from me? What is the best way to ask questions without being annoying? Best ways to be more independent without being unsafe? I hate being new. It's hard. Personal strengths of mine are persistence and I'm not a quitter. I just keep telling myself that every.single.day. Thanks for anyone that takes the time for tips and suggestions. I genuinely appreciate it.
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jadelpn, LPN, EMT-B
9 Articles; 4,800 Posts
Head to toe always, no skipping, even if it seems like it is rather "dumb"
The most "normal looking people" can think it is 1982, and they are 22.
Scan PMH and meds. Make any notes about weird med times, otherwise, your meds are more than likely due at the AM and PM times of the facility. Go do your FBS and insulin stuff before meals. Also, some thyroid meds are given before meals. The information of PMH establishes a baseline.
So, Head: Are they alert, are they oriented? Who, What, Where, Why, How? (who are they, what brought them here--chief complaint), where are they, why, pain, assess--better worse same, and how are you going to increase function.
eyes, PERL?, nose--"stuffy" draining can they breathe? Do they snore, can they sleep? mouth--teeth intact? Can they swallow, do they have a sore throat, do they have bulging carotids? Shoulders, are they even, do they hurt? Can they grip your hands? Do their hands shake, do they drift?
Chest--pain, breast lumps, any unusual changes from baseline?
Lungs--How do they sound, are they coughing, do they have breathing difficulty?
Abdomen--all 4 quads. Are they moving their bowels? How often? Easily? Pain?
Do they urinate regularly, too much, too little? Do they have pain with urination? lady partsl/penile discharge? Are they sexually active? Any concerns with STD's? Regular periods?
Can they stand/walk--with or without assistive devices? Do their legs, knees, feet hurt? Is their skin intact on their feet? Heels non-boggy or red?
Skin risk--any pressure points? Fall risk--how independent are they at home, and how is their current status going to affect function/walking/standing, moving in bed.
Then the other questions--have they been feeling "down" in the last month? Suicidal? Do they partake in drugs and/or alcohol? Do they feel safe at home?
And then plan for the day. Goals for the day. Bring any concerns to your resources. And know what all of your resources are, how to find them and how to use them.
As the shift goes on, and there's orders labs other tests and MD rounding, you may have to rethink the plan for the day, the goal, and that is ok. Let the patient be as active as they can be in that process.
Best wishes, and it WILL come together for you!