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!